"The more we can do for ourselves the better."
('Charlie,' personal communication, 30th May 2016)
This chapter discusses the final version of 12-12 that was used for the secondary user tests. We revisit the criteria for success established in Chapter 4 to evaluate this final version of the game. We acknowledge what the game accomplished and speculate on which aspects need further development.
The following images depict the final version of 12-12 we developed for this research.
The final version of 12-12 allowed a single person to use William Duncan’s device (defaulting player one). This required them to perform strength-training repetitions to begin the game and basic repetitions to play dominoes. Additional players simply had to press a domino to play it.
Interaction with the system was limited by the inaccuracy of the IMU sensors. In the timeframe of this research we were unable to collect consistent enough data from the sensors to accurately read the motions of the player wearing the device. Despite this, the ‘OZ paradigm’ (Kelley, 1984) implemented for user testing replicated the desired interaction with enough similarity to keep the tests valid.
Natural progression for the system would be to improve the use of sensors to accurately read input movements. Additionally, the multiplayer elements of the game need more detailed testing to ensure the connective potential of 12-12. Once these elements have been mastered, the next step would be to perform proper clinical trials and test the game on a broader audience for an extended period of time.
7.2 Evaluation Through Criteria
This section covers our personal evaluation of the game system’s ability to harbour adaptability, connectivity, and meaningful interactions.
Adaptability embodies how well 12-12 adjusts internal parameters to suit the personal needs of each player. Games in 12-12 can be padded out with more waiting time between turns by adding more players. This adjusts the difficulty of the game in a strategic sense, adding to the cognitive load on players, but also grants longer breaks between repetition targets. Increasing the ending score lengthens the game by the amount of rounds the player needs to complete to reach resolution. This is purely an experiential factor and does not influence the player’s rehabilitation any more than increasing the amount of repetitions. Such an increase directly affects the physical difficulty of play and is the easiest way to adapt to player progression.
The adaptable functionality of 12-12 allows for precise control over the physical requirements to play. The weakness of this functionality becomes apparent when the physical capabilities of the player are either very limited or highly capable. Severely limited players may not be able to complete a full game of dominoes, even with a low ending score. Catering to these players requires a reduced version of the game that ceases resemblance to typical dominoes. We hypothesise that such a version of 12-12 would be highly reliant on the novelty of interaction to entertain players. As novelty is a temporary phenomenon, alternative means of holding player attention would need to be explored.
Adaptability became the most significant criteria of the three. The abundance of backing literature, in tandem with clinical recommendation and feedback from users made it clear that adaptability was an absolute necessity for the success of the system. It was the easiest of the criteria to implement; most likely the result of its clear definition and purpose. Comparatively, the broadness of the other criteria made them more difficult to define.
Connectivity represents 12-12’s ability to foster social connections between its users. 12-12 takes advantage of the popularity and social nature of traditional tabletop games. Dominoes is a multiplayer game by default, meaning whether the device-user is playing with human or computer players, they are always interacting with another. The use of scoring between rounds encourages competitive play. The application of the device-user’s exercises in gameplay was deliberately kept separate from strategizing to keep all players on equal footing.
A limitation of the connectivity of 12-12 comes from the lack of network capabilities. Only having one player with a working device in a game discriminates them from other players, as their turns take significantly longer to complete. An ideal setup would involve every non-computer player using a device with their own calibration and exercise scheme. This would increase the wait time between turns, but the pacing of the game would be more consistent and device-users may feel less self-conscious. The lack of persistent player profiles limits the amount of personalisation users can experience through 12-12, therefore limiting their connection (and investment) with the game.
Meaningful interactions encapsulates how interacting with 12-12 benefits the user. This includes how well 12-12 supports the extrinsic motivations of its players, as well as its ability to communicate these elements to the user. As a rehabilitation game, 12-12 automatically hosts the extrinsic motivation of self-improvement. It also provides intrinsic motivation to those who enjoy dominoes as a pastime. The inclusion of playful animations and visual effects rewarded players for interactions that progressed the game, thereby encouraging further interaction. Our user testers enjoyed the novelty these features provided.
Meaningful interactions was too broad a criteria to be applied with the specificity seen with adaptability. The lack of persistent profiles limited the use of goals or progress tracking, making the user experience less personal. This meant 12-12 relied largely on players’ extrinsic motivation to recover from stroke and intrinsic motivation to play dominoes to attract an audience. This was less effective on users like Dannie, who had less experience with dominoes. The abstract nature of dominoes meant the connection between user input and in-game action was arbitrary. While this was advantageous for adapting input exercises, users like Dannie may find the system difficult to understand. Despite meaningful interactions having less of an effect on 12-12 than connectivity or adaptability, the game would benefit from a more focused approach in this regard.
7.2.1 Limitations of the Research
Like many similar papers (Alankus et al., 2010, p. 2121, Chen et al., 2014, p. 8, Flores et al., 2008, p. 383, Holden & Dyar, 2002, p. 70, Nap et al., 2009, p. 260), the findings of this research are also subjective. This is an inherent property of the methods that were chosen. Despite the research being developed with consultation from multiple sources and disciplines, the amount of people involved was comparatively small. The sample size for user testing meant feedback was not reliably representative of the older adult demographic.
Another limitation of this research was the lack of fully functioning sensors. Kelley’s ‘OZ paradigm’ (1984) allowed our user testers to experience the novelty of interacting with the system as if the sensors were functional. However, this means the system is not capable of testing beyond a controlled environment. Significant technical progress needs to be made before the system would be ready for clinical trials.
7.2.2 Final Evaluation
How can digital games facilitate engagement for lower-limb rehabilitation for older adults recovering from stroke?
A person must show active participation and investment in their rehabilitation with energy, enthusiasm and commitment to be “engaged” by it. The criteria used to evaluate 12-12 were established from research regarding engagement. 12-12 met these criteria with varying degrees of success.
Adaptability was the criterion 12-12 fulfilled most completely. Functionality supporting social connectivity was implemented but time constraints limited its testing, rendering the effectiveness inconclusive. Meaningful interactions was the criterion with the least fulfilment. Engagement is not dependent on the success of all three criteria, therefore the limited integration of meaningful interactions did not stop 12-12 from engaging users.
12-12 is capable of facilitating lower-limb rehabilitation through the regular repetition of exercises to play dominoes. The inclusion of a priming phase enables the incorporation of Strength for Task Training (Signal., 2014), however this functionality is dependent on the patient’s access to a device that can host the appropriate weight. The customisation of these elements allows for 12-12 to be accessed by people with a variety of physical capabilities. The accessibility to 12-12 was enhanced by being a digitized dominoes game, utilizing the game’s simplicity and familiarity with an older audience.
12-12 was received with interest and enthusiasm by our user testers, all of whom could see fellow survivors of stroke benefitting from the system. This is not representative of the user-base, however it does indicate a level of acceptance and eagerness with which similar systems may be met. With further iterations and more expansive user testing, 12-12 could become an effective contributor to the physiotherapy process.