No protocols, so USELESS. Start guessing what might help you. I expect our stroke medical professionals to know EXACTLY what needs to be done for rehab. This is totally worthless.
Impact of game mode in multi-user serious games for upper limb rehabilitation: a within-person randomized trial on engagement and social involvement
Journal of NeuroEngineering and Rehabilitationvolume 16, Article number: 109 (2019)
Abstract
Background
Serious games have been increasingly used for motor rehabilitation. However, it is not well known how different game features can be used to impact specific skills properly. Here, we study how the mode (competitive, co-active, collaborative) in which a multi-user game is presented impacts engagement and social involvement.Methods
We collected data from 20 pairs of community-dwelling older adults (71.5 ± 8.7 years) in a study following a within-persons design. The participants performed a two-player upper limb rehabilitation game with three conditions (Competitive, Co-active, and Collaborative modes). Engagement and social involvement were assessed through the Core Module and Social Presence Module, respectively, from the Game Experience Questionnaire. To infer the impact of personality and cognitive function, users answered the International Personality Item Pool (short version) and the Montreal Cognitive Assessment, respectively.Results
Results show that the Collaborative game mode promotes more social involvement when compared to Competitive and Co-active modes. This result is mostly explained by those participants with higher cognitive skills, and those that are more extrovert. Extrovert participants feel more empathy and are behaviorally more involved when playing the Collaborative mode. Also, the Collaborative mode is shown to be appropriate to promote interaction with participants that previously had a distant relationship, while the Competitive mode seems to be more beneficial to promote empathy between players with a closer relationship.Conclusions
The Collaborative game mode elicited significantly higher social involvement in terms of Empathy, Positive Affect, and Behavioral Involvement. Hence, this game mode seems to be the most adequate choice to be used in multiplayer rehabilitation settings, where social interaction is intended.Background
Serious games have been widely studied concerning their impact on improving physical and social skills with elderly [1], mostly because of their potential to increase motivation levels compared to conventional therapies [2, 3].
Moreover, the therapeutic potential of games for the elderly is well
documented, with results showing a positive impact on their health and
well-being [1]. However, while one of the most critical elements of successful aging is to conserve social relationships [4], research on how to appropriately address social experiences with serious games is still scarce [1].
Also, social interaction through multiplayer games has been underlined
as an essential aspect of motor rehabilitation because it supports
enhanced enjoyment during interaction and an increased sense of
self-efficacy [5]. In fact, stroke survivors with low levels of social support have a greater risk of developing depression [6].
A longitudinal study examined the impact of social support in 5643
participants that had experienced a heart attack or stroke, with results
indicating that the risk of developing depression is very contingent to
the level of social support [6].
Moreover, social support is a modifiable factor that can mitigate the
impact of illness on depression, and higher social support could improve
the outcomes [6]. In another study, Janssen et al., investigated how social activity of stroke patients undergoing rehabilitation changes over time [7].
After analyzing data from a sample of 14 participants, the authors
concluded that the levels of social activity were low even after
improvements in the levels of independence and mood. These data
highlight the need to explore alternative ways of social stimulation
within rehabilitation environments [7].
One way to foster social interaction is through multiplayer modalities, which typically promote more socialization than their single-player counterparts [8]. For rehabilitation purposes, the design and specific characteristics of these games should be carefully analyzed, to identify the features that influence motivation and engagement levels, which in turn could have an impact on recovery. One feature that potentially can have an impact is the playing mode. I.e., inter-player relationships can be of one of the following four kinds of interaction: competitive, co-active, cooperative or collaborative [9, 10]. However, the literature typically addresses competitive, collaborative and cooperative modes only [11]. In addition, most of the studies that addressed game modes focused on competitive vs. cooperative, or competitive vs. collaborative, not establishing a difference between cooperative and collaborative modes [8, 12,13,14,15,16]. The main difference between cooperation and collaboration is that cooperation requires players to work together to complete a task but having different roles, while collaboration implies players to have the same role and still needing to work together to complete the task [9, 17]. Moreover, there is no consistency in nomenclature. Some modes of training identified in previous studies should be named as co-active instead of cooperative, as they imply that players work together to reach the same goal with the same task, but they do not depend on each other to finish it [9, 10]. Considering these different definitions, research on collaborative games is lacking. To our best knowledge, only a minority of studies differentiated the three above mentioned game modes [18], and according to a systematic review on multi-player games, there is no research comparing them [11].
Multiplayer rehabilitation games show good potential for producing greater enjoyment and more intense exercise in comparison to single-player modalities [8]. A study with 12 pairs of unimpaired participants concluded that participants prefer to cooperate than to exercise alone, feeling less pressure in this mode [19]. Another study that linked patients with their spouses in rehabilitation through haptic interaction found that multiplayer modes were more motivating when compared to single-player modes [20]. Nevertheless, the right game mode, when comparing competitive vs. collaborative modes, for a specific person depends on skill and personality, alongside with having an appropriate co-player [8]. A study with 158 healthy adults found that a co-active mode caused higher levels of motivation and effort in comparison with a competitive mode, but motor performance was similar in both [21]. An interesting result of this study was that the level of relationship (friends vs. strangers) also influenced players’ motivation, goal commitment, and performance. Those who played with friends showed greater goal commitment than those who played with strangers [21]. In contrast, several studies indicate that competitive modes motivate players more, resulting in more intense performance, and are associated with more movement repetitions [12, 15, 22, 23].
Here, we aim to understand the impact on engagement and social involvement of different multiplayer settings, specifically aiming to distinguish collaboration and cooperation. For this purpose, we deployed a game in three different modes (Competitive, Co-active and Collaborative) and tested these in a sample of healthy older adults (> 55 years). We decided for a sample of older adults without motor deficits to avoid potential confounds brought by stroke, which is known to impact cognitive, motor, emotional or social domains. We believe that a sample where these domains remain relatively intact represents a good baseline to assess the impact of these game modes on engagement and social involvement. Next, with a stroke population it will be possible to better understand how these results are modulated by the deficits brought by stroke. Our first hypothesis is that engagement will be significantly higher in the Competitive mode when compared to Co-active and Collaborative modes. Our second hypothesis is that social involvement will be significantly higher in the Collaborative game mode compared to Competitive and Co-active modes. Additionally, we want to understand how the results are modulated by the cognitive profile, personality, and previous relationship between co-players.
One way to foster social interaction is through multiplayer modalities, which typically promote more socialization than their single-player counterparts [8]. For rehabilitation purposes, the design and specific characteristics of these games should be carefully analyzed, to identify the features that influence motivation and engagement levels, which in turn could have an impact on recovery. One feature that potentially can have an impact is the playing mode. I.e., inter-player relationships can be of one of the following four kinds of interaction: competitive, co-active, cooperative or collaborative [9, 10]. However, the literature typically addresses competitive, collaborative and cooperative modes only [11]. In addition, most of the studies that addressed game modes focused on competitive vs. cooperative, or competitive vs. collaborative, not establishing a difference between cooperative and collaborative modes [8, 12,13,14,15,16]. The main difference between cooperation and collaboration is that cooperation requires players to work together to complete a task but having different roles, while collaboration implies players to have the same role and still needing to work together to complete the task [9, 17]. Moreover, there is no consistency in nomenclature. Some modes of training identified in previous studies should be named as co-active instead of cooperative, as they imply that players work together to reach the same goal with the same task, but they do not depend on each other to finish it [9, 10]. Considering these different definitions, research on collaborative games is lacking. To our best knowledge, only a minority of studies differentiated the three above mentioned game modes [18], and according to a systematic review on multi-player games, there is no research comparing them [11].
Multiplayer rehabilitation games show good potential for producing greater enjoyment and more intense exercise in comparison to single-player modalities [8]. A study with 12 pairs of unimpaired participants concluded that participants prefer to cooperate than to exercise alone, feeling less pressure in this mode [19]. Another study that linked patients with their spouses in rehabilitation through haptic interaction found that multiplayer modes were more motivating when compared to single-player modes [20]. Nevertheless, the right game mode, when comparing competitive vs. collaborative modes, for a specific person depends on skill and personality, alongside with having an appropriate co-player [8]. A study with 158 healthy adults found that a co-active mode caused higher levels of motivation and effort in comparison with a competitive mode, but motor performance was similar in both [21]. An interesting result of this study was that the level of relationship (friends vs. strangers) also influenced players’ motivation, goal commitment, and performance. Those who played with friends showed greater goal commitment than those who played with strangers [21]. In contrast, several studies indicate that competitive modes motivate players more, resulting in more intense performance, and are associated with more movement repetitions [12, 15, 22, 23].
Here, we aim to understand the impact on engagement and social involvement of different multiplayer settings, specifically aiming to distinguish collaboration and cooperation. For this purpose, we deployed a game in three different modes (Competitive, Co-active and Collaborative) and tested these in a sample of healthy older adults (> 55 years). We decided for a sample of older adults without motor deficits to avoid potential confounds brought by stroke, which is known to impact cognitive, motor, emotional or social domains. We believe that a sample where these domains remain relatively intact represents a good baseline to assess the impact of these game modes on engagement and social involvement. Next, with a stroke population it will be possible to better understand how these results are modulated by the deficits brought by stroke. Our first hypothesis is that engagement will be significantly higher in the Competitive mode when compared to Co-active and Collaborative modes. Our second hypothesis is that social involvement will be significantly higher in the Collaborative game mode compared to Competitive and Co-active modes. Additionally, we want to understand how the results are modulated by the cognitive profile, personality, and previous relationship between co-players.
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