Using Serious Games to Motivate Children with Cystic Fibrosis to Engage with Mucus Clearance Physiotherapy

Abstract

Abstract-Positive expiratory pressure (PEP) therapy is an effective method for removing mucus build-up in the lungs of sufferers of chronic lung diseases such as cystic fibrosis (CF). However, the compliance by young children and adolescents to undertake such physiotherapy can lead to confrontation and stressful situations within families, and can impact on the health of the individual. We have developed game software which is controlled through breathing into a PEP mask or mouthpiece using an air pressure sensor to interface with the PC. By combining games with mucus clearing devices, it could provide a powerful means of encouraging children, teenagers and adults to engage more frequently, and effectively, with vital mucus clearance physiotherapy. This paper presents promising initial results and describes further usability testing plans.

Developing Digital Games to Address Airway Clearance Therapy in Children With Cystic Fibrosis: Participatory Design Process

“…The clinicians were looking for a novel way to make respiratory therapy more engaging for their young patients. An initial environment scan and literature review targeting CF games showed us only a few games ( AstroPEP , CFpal , Creep Frounter , Flower for all , KIbreath , LudiCross , and MyCarnival [12,20]), which were all very basic games and were not available to the public. Discussions enabled the students to understand the PEP exercise to build the game (Figure 1).…”

“…Transforming the respiratory therapy into a digital game has shown promising results in increasing adherence [12,13]. Digital games are artificial systems in which players interact, which comprise conflict, rules, and quantifiable outcomes [14].…”

SpiroPlay, a Suite of Breathing Games for Spirometry by Kids & Experts

“…One, in sharing the origin, our adaptations, and execution of our approach involving children and experts, we show the possibility and attainability of this approach even in a 1 Following Stålberg et al we believe that an adult adopting a child perspective cannot interpret the child's perspective accurately, not even when engaging with the same situations [53]. Although we use the term co-design, the involvement with only four afternoon sessions and a pilot is less than typically done in this field, we do (mis)use the term co-design, as we aim for giving children a real voice in the design process [12].Note, that keeping close to children's input resulted in not always the most (adult's) logical mappings of breathing to in-game actions, whereas Nacke et al [35] point out the importance of this mapping in breathing or other biofeedback games, reiterated by [41,67], and Tennent et al [54] mention frustration of players when the game does not follow a particular affordance for mapping. 2 See [41] for a non-tailored version of a 'suite of games' incorporating breathing as an input for people with Cystic Fibrosis (CF), and [2] for an extensive set of breathing games for CF designed with therapists and many developers.…”

“…There are also commercial systems for respiratory muscle training for children with lung-related diseases [61,68]. Furthermore, various studies on breathing games target Positive Expiratory Pressure (PEP) physiotherapy for people with Cystic Fibrosis (CF) [41,67], relaxation exercises [1,43,51] 3 including an attempt of calming children during drawing blood [52], and investigating entertainment-purposes [24,35,54].…”

“…Firstly, one attempt for a spirometry test takes a few seconds, where as PEP games takes longer (e.g. 5 min [2], 8 min [41], or even 20 min [67], 1-4 times a day [41,67]). Secondly, spirometry tests include only one cycle of breathing, whereas rhythm, complex patterns, or frequency of breathing can play an interesting role in other types of breathing games [24,41,43,51,54,67].…”