Virtual Rehabilitation Environment Using Principles of Intrinsic Motivation and Game Design

Abstract

This paper presents a novel multimodal virtual rehabilitation environment. Its design and implementation are based on principles related to intrinsic motivation and game design. The system consists of visual, acoustic, and haptic modalities. Elements contributing to intrinsic motivation are carefully joined in the three modalities to increase patients' motivation during the long process of rehabilitation. The message in a bottle (MIB) virtual scenario is designed to allow interplay between motor and cognitive challenges in the exercising patient. The user first needs to perform a motor action to receive a cognitive challenge that is finally solved by a second motor action. Visual feedback provides the most relevant information related to the task. Acoustic feedback consists of environmental sounds, music, and spoken instructions or encouraging statements for the patient. The haptic modality generates tactile information related to the environment and provides various modes of assistance for the patient's arm movements. The MIB scenario was evaluated with 16 stroke patients, who rated it positively using the Intrinsic Motivation Inventory questionnaire. Additionally, the MIB scenario seems to elicit higher motivation than a simpler pick-and-place training task.

A Survey of Multimodal Systems and Techniques for Motor Learning

“…The motivational effects of these virtual systems are also well documented in recent findings [9]. Multimodality is often a primary component of VR environments, as they are intended to mimic and augment the multimodal feedback environment of real-world interactions with therapists and trainers [10].…”

“…Serious games often provide motivating and interactive engagement with motor tasks despite their repetitive nature [10,18]. They have been indicated, for example, by Ma and Bechkoum [19], to yield short term improvements in motor impairment and generally positive health outcomes in the post-stroke rehabilitation process.…”

Dynamic Difficulty Adaptation in Serious Games for Motor Rehabilitation

“…The online difficulty adaptation approach has got the interest of many researchers in rehabilitation games [8] [9] [10] [11]. This approach consists in automatically adapting the game in real-time to maintain patient's motivation on the one hand.…”

“…However, as stroke patients performance can highly vary depending on their daily health conditions, this model should also be evaluated by including stroke patients' performance. In these studies, the adaptation inputs are mainly (i) the player's performance such as his/her final score [10], movement accuracy, range of motion and latency [9], reached zone, wrist weight and grasp pressure [8] as well as (ii) biomechanical measurements such as mean frequency of the position and force of signal [11]. Indeed, most difficulty adaptation techniques in upper-limb rehabilitation games are inspired by motor learning theories.…”

“…However, the patient's motivation and engagement are among the key factors for recovery. In existing rehabilitation games, the patient's fatigue and motivation have been considered only to evaluate the game successfulness, but without including them in the decision on game adaptation [11]. Indeed, most studies attempted to show the utility of the game in increasing the training outcomes (e.g.…”