Appendices


Appendix A - Background Research

Additional Notes on a Research Session with Dr. Nicola Kayes

Dr. Nicola Kayes, a specialist in the field of neuro-rehabilitation, has conducted studies into understanding the perspective of people suffering from stroke, using that knowledge to help them engage with the recovery process. She has also explored the role of the practitioner in the engagement process and what drives human behaviour in the face of injury and illness.

Kayes acknowledged the role of technology in regards to connectivity. It is certainly possible to engage in fun and entertainment without social connectivity. Anyone can experience film, music, games etc. by themselves and find it enjoyable. But a rehabilitation system that lacks any substantial connection to the user’s personal clinic will not be as effective, as discussed in the literature. The connections between a patient and their goals, progress and motivation, are too important to bypass. Without the greater context of recovery, and the system’s connection to it, it is merely another niche mode of entertainment.

Kayes elaborated on this by explaining that patients who could not make a connection between the technology and their rehabilitation goals became frustrated by it. They had specific expectations on what the technology was supposed to accomplish, and when their expectations were not met, the patients stopped using the technology.

One last note Dr. Kayes made was the influence anxiety, depression and mental fatigue has on patients. It is common for survivors of stroke to be cognitively affected in such a way. This influences their ability to regulate their behaviour, meaning they struggle with developing and maintaining goals, identifying barriers, accepting and processing feedback and self-monitoring. Normally these skills are inherent and unconscious, but a stroke can remove that property, requiring renewed self-regulation from the survivor. The significance of this comes from the connection between self-regulation and self-motivation.

Further discussion with Prof. Taylor and Dr. Signal highlighted that they found the clinical tools they used were not effective at measuring small changes. They stressed the importance of granting patients with a clear sense of progression. It is that sense of progression that keeps people motivated to continue, despite how small the changes are.

 

Additional Notes on a Research Session with Dr. Nada Signal

Dr. Nada Signal is a physiotherapy expert and researcher. She has conducted research into developing physiotherapy practice and has explored the benefits of “strength for task training” (STT). STT involves the “unilateral progressive resistive strength training of a relevant muscle group on the affected side immediately followed by locomotor task-specific training” (2014, p. 50). Dr. Signal’s time with us was spent discussing clinical reasoning for appropriate rehabilitation, and the factors that contribute to such reasoning.

A lot of therapy is task-specific training with little time being dedicated to aerobic and strength training. Task-specific information can be incorporated organically into the media of the intervention, allowing for the clinic time to be applied more effectively.

 

Additional Notes on a Research Session with Dr. Denise Taylor

Dr. Denise Taylor is a physiotherapy specialist and researcher. In our brief meeting she discussed the importance of repetition in rehabilitation. Over the course of a patient’s rehabilitation they are expected to conduct thousands of repetitions of the same movement. It is significant that each repetition is performed properly and that the patient does not lose interest.

Prof. Taylor declared variation of task to be a key element for maintaining patient interest. If the practice structure has elements that are random or varied, then they are more likely to hold the patient’s attention. This is apparent in many games that employ operant conditioning (Skinner, 1963) through random/semi-random reward structures to increase user play time.

 

Observation at NeuroRehab Results Physiotherapy Clinic

Patient completed laps around the clinic. Every second lap he held a basket in his hands. The clinician walked the patient over padded mats, layering more on top to increase the difficulty of the task. The soft footing of the mats required the patient to apply greater control over their movements to retain their balance. The clinician engaged the patient in conversation during the task to distract them.

These simple tasks were designed to replicate everyday interactions the patient would experience. The tasks were reduced to their basic components and despite being physically challenging for the patient, there was little mental stimulation. The conversation provided by the clinician was the only mental distraction. The patient was observed to be focussing primarily on their movements.

The patient walked between a set of parallel bars at elbow height. On reaching the end of the bars, they turned 180 degrees and returned to their starting position. This action was repeated with the clinician providing verbal support and instruction.

We were informed of the significance of physical balance in physiotherapeutic training. Balance is required to participate in more complicated exercises and is paramount for regaining independent mobility. The parallel bars used in the exercise reduce the risk of patients falling and injuring themselves. As patients advanced in their capabilities, the bars were removed from training. This had to occur before the patient learned to become dependent on the bars for support. The only way for the patient to develop is to challenge them.

The doctors at the clinic reiterated the importance of effective lower-limb training early in the rehabilitation process. If a patient is capable of regaining their ability to stand and walk, they regain a significant portion of their independence. Even minimal lower-limb mobility can be useful, unlike upper-limb where tasks tend to demand more manual dexterity from people.

The most common phrase from Dr Taylor and Dr Signal was “it depends.” It depends on the patient. It depends on their circumstances. This increased the importance of having an adaptable system and it is from this meeting that ‘adaptability’ became a definite criterion.

 

An Interview with Samantha Ogilvie

Samantha Ogilvie is the Quality and Training Manager at the Wellington Hospital, as well as a researcher in rehabilitative care and procedures. Her research involves comparing two groups of patients with hemiparesis of the arm; one of which will undertake a period of rehabilitation using computer games and the other conventional therapy of passive exercises. She was able to provide insight to the type of experience a survivor of stroke might have in their day-to-day life.

Ogilvie provided us with a detailed example of a user profile based off a patient she had worked with in real life. From this profile and examples gathered from literature, it was possible to establish a set of user profiles that reflect the types of personalities we might encounter.

Another user profile we were introduced to reinforced the importance of task-specific training. This particular patient was a fond golfer whose balance was affected by a stroke, removing his ability to tee off the green properly. He was still capable of performing his short game and resultantly showed a lot of interest in a digital game that let him play golf from home. Regardless of the mechanics of the game, it was the personal relevance of golf that caught his attention.

Ogilvie stated that lower-limb rehabilitation tends to be more effective than upper limb. Whether or not this is because it is innately easier, more important or receives more time than upper limb is uncertain. Lower-limb functionality has a large impact on an individual’s ability to tend to basic needs of life, e.g. walking, using the lavatory, getting in and out of bed etc. In contrast, upper limb functionality affects higher quality of life, e.g. playing a musical instrument, gardening, tinkering etc.. Lower-limb functionality enables more than just basic mobility; it is tied to one’s sense of individuality and their ability to enjoy life.

When asked about the sorts of games she had observed older adults interacting with, Ogilvie claimed many were capable of handling those with a reasonable cognitive challenge such as chess, cards and tetris. Only those who had been significantly cognitively affected would not be able to play. Instead they played simpler games, such as bowls. She doubted such people would be capable of acquiring the skill-set necessary to learn a digital game, indicating our game may have a cognitive threshold for suitable players. Ogilvie also mentioned that the younger side of the older generation tend to be more accepting of digital media and it makes sense to focus on them. While the oldest patients may not be capable of learning new technology, it is not the most relevant thing to them at their stage in life.


 Appendix B - Expanded Concepts

Expanded Concept Descriptions: First Iterations

Four Seasons: This concept stemmed from the idea of familiarity. It used three standard playing decks, removing the face cards and using four suited counts from ace to ten. The lack of face cards meant the form of cards was not as relevant, and it evolved into a tile game, complete with four new suits: the four seasons.

The game was played by each player taking turns to place tiles on their respective suit. As tiles can only be played on those of lesser value, the amount of playable tiles diminishes with each turn, making the game a race. A scoring system between rounds gave players an overarching goal. The primary experiential goals of Four Seasons were control, strategy and the thrill of competition and luck.

The main mechanics explored through playtesting were making the ace flexible (to be played at value “1” or “11”), ‘5-go-low’ (where playing a five allowed the next tile to be of lesser value) and ‘consecutives’ (where having three tiles of consecutive value forced the rest of the tiles of that suit to be consecutive in order of play). Variation of the size of players’ hands, the size of the deck and the way scoring was calculated were tested. Four Seasons was enjoyable to play and simple enough to learn as it borrowed all its mechanics from existing card games. This concept was the first attempt at striking a balance between confidence through familiarity of gameplay, and excitement through new content.

Interaction with the game system were depicted by basic user interface (UI) elements that represent the player’s real world movements. As card/tile games are generally played around a table with a player’s hands (opposed to feet), there was a large disconnect between the exercises and gameplay that cannot be avoided. Expressive UI elements were the simplest manifestation of the player’s exercises in-game. They could be accompanied by images of the proper exercise form etc. Unfortunately this did not support meaningful interactions as well as it could.

As Four Seasons was a multiplayer game, it promoted local connections with peers who play together, as well as give the clinician a chance to engage with their patients in a non-explicit physiotherapeutic environment. If network elements were introduced, the system could provide connections with players in separate home spaces where each player would require a separate device. A potential barrier was that players were required to understand how to set up and join a networked game.

Lastly, the adaptability of the system would come down to the calibration of the device and the responsiveness of the UI, making it very flexible.

Figure B1 -  Four Seasons  rules

Figure B1 - Four Seasons rules

Figure B2a -  Four Seasons  Gameplay

Figure B2a - Four Seasons Gameplay

Figure B2a -  Four Seasons  Gameplay

Figure B2a - Four Seasons Gameplay

Figure B3 - Four Seasons  alternative rules

Figure B3 -Four Seasons alternative rules

 

Plane Concept: This concept could manifest as either a 2D or 3D game, depending on how much input the player is able to give the system. The player performed regular exercises to keep the plane aloft as they delivered packages to different airports.

The rate of altitude loss and distance between airports varied depending on how frequently and how many repetitions the player needed to complete. In the 3D version of the game it was possible to have basic steering controlled by exercises too. This would depend on the how much variety the player has or needs to train. If the player only had access to one sensor, some movements such as thigh adduction and abduction became less viable. Additionally, the more controls attached to movements, the more accurately the device had to trace and separate them.

The adaptability of the system came from its flexibility of input. As long as the motions were mapped to the same axis for the plane, they remained meaningful. Cosmetic player customisation could also be included to appeal to a wider audience. The game focused heavily on single player and although multiplayer elements could be added, they would not affect the core gameplay.

 

Dominoes Concept: The game would simply be a digital recreation of classic tabletop dominoes. The two variants of dominoes that were examined were Tiddlywinks and The Mexican Train Game. Both rule sets embodied the criteria for success in different ways. Tiddlywinks had forceful play but is in short, snappy rounds; good for people with a shorter attention span. The Mexican Train Game had a less binding play-style and games tended to be a lot longer.

The betting aspect included in Tiddlywinks added competitive flair to gameplay and suited the shorter rounds. Networked players would require tabletalk functionality to enhance the social aspects of the game. The Mexican Train Game tends to cover a large table area and would require a comprehensive navigational tools for a digital version.

The strength of using dominoes came from the familiarity it had with an older audience and the simplicity of play (even card games have four suits to keep track of). The game would promote connectivity through local multiplayer or over a network. Unfortunately the familiarity of dominoes meant playing the game using lower-limb exercises required abstract thinking from players for the interactions to be meaningful. It is likely such interaction could be viewed as a novelty, therefore needed to retain enough of its charm between games to enable repetition. The system could be adaptable through tweaks to basic game rules (e.g. size of hand, size of deck, amount of players etc.) and providing a large array of more advanced options.

 

Mountain Climbing Concept: Players adventure in bright, colourful environments to conquer mountains, temples, caverns etc. This concept held one of the strongest metaphors for the recovery process. The gameplay represented the physical exertion the players will experience in a light-hearted manner.

Gameplay was broken down to several simple phases. The first is planning the route, and requires cognitive effort from the player. Adding hazards provided challenge (e.g. some ledges can only be crossed once). The second phase required players to strafe to reach their desired route. The third phase, and primary gameplay, were the bouts between ledges. Climbing from ledge to ledge required several repetitions of an action that moves the player from handhold to handhold. The ledges functioned as rest points between climbs.

The adaptability of this game manifested in the level design. The more physical and cognitive exertion needed from the player, the longer and more complicated the levels needed to be. There could be small elements of avatar customization to increase player investment, but this was not the focus. The connectivity of such a game was lacking as the gameplay focused on singular interaction. The gameplay, through the representation of player movement and the goals they were overcoming, would make interaction highly meaningful. This could be enhanced with an achievement system where the players retrieve treasures from their expeditions that represent personal goals (e.g. complete one hundred repetitions in a single expedition).

 

Perpetual Motion Concept: This concept revolved around removing forward motion from the player’s control, making gameplay more reactive. It had the advantage of being able to be visually represented in a variety of ways. The exercise focused of this concept was using rotary motion to steer.

The pacing of the game was relatively peaceful to be suitable for a survivor of stroke, therefore gameplay did not focus on racing. Rather, motions were gentle and fluid, such as gliding, and obstacle/collectables had a large warning period so the player could react accordingly. The inclusion of an escape mechanic, such as a jump for obstacles, could be a good way of including diversity in the exercises required, as well as giving a player a way out if they are finding the steering exercises difficult.

The placement of obstacles and the speed of the player’s avatar kept the system adaptable to different levels of skill and mobility. The game could include an endless mode where players can set personal records for endurance. The interaction consisted of held motions and is thereby only suitable for dynamic motion in-game, rather than rigid lane-based movement seen in games such as Temple Run. This dynamic motion gave meaning to the player’s interactions as they were able to see a direct connection between their exercises and the motion depicted in-game. Connectivity was not addressed by this game as it was strictly single-player. Leaderboards for in-game accomplishments were not appropriate due to each player’s device being calibrated to their physical limitations.

 

Painting Concept: This concept was directed at players whose mobility has been severely restricted. The game functions as a colouring book for adults. Players complete detailed vector illustrations by tapping on the area they wish to paint and completing repetitions to fill it with colour. The gameplay did not focus on action but instead provided a more relaxing experience.

Navigating the painting was suited to typical tablet interactions (dragging pan, pinching zoom etc.). Exercise repetitions behaved as a brush stroke, painting within the lines of the image. The pacing was completely under player control, meaning they could start, stop and save whenever they felt like it. Resultantly, this makes adjusting the size of the player’s brush pointless. The game could keep track of various thresholds, alerting the player when they had done enough for the day.

The adaptability of this concept was largely under player control. They chose when to start and stop, and how complex the image they wished to paint was. This ran the risk of people with less motivation leaving exercises incomplete, but if the experience was relaxing enough, the exercises would not be as strenuous on the player. The ideal motion for painting was a simple back-and-forth movement to grant a connection between the player’s movements and that of the on-screen brush strokes. The connectivity of the system came after the painting was complete, where players could email it to friends and family. Otherwise it was a strictly individual experience.

 

Sports Concept: Taking a page out of the Ninendo Wii’s book, these were two visualisations of the same idea. Preference was given to the golf theme due to its popularity among older adults. It also functioned as a motivator for regaining lost mobility to play the game in real life.

Aiming was controlled by rotary motion and the power of the stroke came from either a lift and hold motion or several rapid repetitions. The golf variant recorded past play statistics to establish a player handicap that contextualised and motivated self-improvement. As play continued on a shot-by-shot basis, players could move at a pace that suited them.

The play experience was adaptable by the amount of holes, goals, hoops players attempted to complete and the difficulty of each shot. In golf it was a selection of different par courses; in football it was the distance of the shot and skill of the goalie. The meaning of each exercise was established through clear visual links between the exercise performed and the in-game result. Supporting UI could be used if players wish to see how their actions are being measured. Connectivity could be established through online leaderboards (albeit at the same risk of not being truly representative). Alternatively, the turn-based nature of golf allowed for multiple people, either locally or through a server, to partake in the same course together. Generative courses were set with a par or recommended handicap average so users of similar skill could play together.

 

Sneaking Concept: This concept explored the stronger use of fantasy elements in gameplay while maintaining clear translation of player motions to in-game outcomes. The game’s appeal came through the caricature that is the player’s avatar and their melodramatic attempts to sneak along a noisy and obstacle-ridden passage.

Movement was controlled by two distinctive exercises. The more elongated of the two was used for the basic sneaking step for moving past sleeping persons. The tighter of the two was used for the hunched step for moving through illuminated areas. Switching between the two exercises provided variation to the player’s routine. The exaggerated motions in-game provided a comedic interpretation of the player’s actions.

The adaptability of the game relied on the player’s successful calibration of the system. The exaggerated movements of the player’s avatar removed any expectation they had to achieve similar motion; they simply needed to meet their calibrated bounds. Connectivity was established within the bounds of a clinic session where each player with a device joined the game. The player with the lowest calibrated range of motion led the group and each player had to synchronise their actions with the leader. Players who moved too far out of synch with their colleagues bumped into them, making noise. The purpose of this exercise was to bond members of the clinic together through mutual success and failure.

 

Second Concept Matrix Evaluation Expanded Criteria

Multiplayer: the game’s allowance for multiple people to play together in a single session. This could be over a network but local multiplayer was more valuable.

User profiles: the game’s ability to provide personal profiles that tracked player progress and integrated it into gameplay.

Logical motion mapping: how clearly the player’s real-world actions were related to their in-game results.

Ease of learning: how simple the game was to learn.

Adaptable difficulty: how well the game catered to variable player skill.

Variable input: the game’s ability to respond effectively to a range of input motions.

Variation of task: the range of different motions that were incorporated into a single play session.

Replayability: the quality of experience and novelty the game retained through subsequent playthroughs.

Single player value: the quality of the game’s play experience that did not require interaction from multiple human players.



Preliminary Test Summary

Strengths: Written feedback addressed the effectiveness of the animations in smoothing out the flow of the game, suggesting that the inclusion of more animations and dialogue that clarified the areas in need would be beneficial. The conversational language used in the tutorial made the experience more ‘relatable’ and easier to understand. Maintaining a personable interface would be important with the introduction of the medical aspects, as it was desirable for players to view the game as a means of entertainment, not as a medical tool. Being able to select a player icon was another popular feature that allowed the players to invest a small part of themselves in the experience. Having a wider selection of icons would enhance the effectiveness of this feature, appealing to a broader range of tastes.

Weaknesses: The sparse nature of the main menu felt too empty compared to the tight layout of the gameplay UI. Players also found the prompt text appeared too rapidly and detracted from their sense of freedom within the game. Having the option to extend the time and/or turn off prompting would be useful. It was mentioned that the pre-game aspect of the tutorial was overwhelming as it depicted too much information that was not explicitly related to how to play (such as navigating the ‘Options’ menu). Several players found the pacing too slow when more than two people were playing. It was important to clearly portray how and when a round finished, and to distinguish between the causes.


Additional User Information: “Bernie”

Bernie plays Crib, Euchre and Poker with their friends at the stroke club, meaning they still have the capacity to play complex games. Despite this, Bernie’s confidence with using the tablet limited their ability to interact with it. They did not appear to understand elements of the UI and quickly gave up. Their rejection of the system was likely a mix of reasons. The tutorial was rather word heavy and could have been intimidating. The flat design of the UI was too subtle, with interactive elements needing to be bolder (Bernie was not the only participant who had difficulty identifying buttons). It could have also been the result of Bernie’s limited attention span or willingness to learn something new. Due to their minimal input in the post-test interview, the best we can do is speculate.

The significance of Bernie’s test is that it is an example of our designs failing. It became apparent that the type of system that Bernie would be capable of interacting with differs greatly from what we presented. Adjustments could be made to the interface and core mechanics of the game to suit someone of their abilities, however the system would resemble something quite different at this point. Functionality that achieves this could be implemented, yet setting up the options to reach such a state would require external help. It would be simpler to claim that there is a threshold of cognitive capability that needs to be met for the current system to be usable.


User Test 1: Additional Notes

ALEX

  • Owning a personal computer system is too expensive for many older adults.
  • Tapped ‘play’ before it was available in tutorial.
  • Was not confident enough to hold iPad and play at the same time; needed table nearby.
  • Thought the system would be best suited for people who were recently in hospital from stroke.
  • Needed clarification of how the score worked in-game.
  • Didn’t understand the counting down of reps on priming. Wording could be clearer.
  • Wasn’t sure about “When you’re ready” button.
  • Animation needs to present the back and forth, not just one direction.
  • Tried to press exit button to leave tutorial prompts.
  • “You’re not a dummy. You can still make your brain work.”
  • Thinks have a version available at the club would be competitive. “They love it at club when they have one another on. They love competition.”
  • The system needs to be brought on in stages. “Not bang all together.”
  • “If you’re expected to do it in a hurry I don’t think it would be any good.”
  • Early stages of stroke need to have slower pacing.

BERNIE

  • Tapped simulate to no response when it was visible beneath the tutorial text.
  • Was dragging over buttons which nullified their functionality.
  • Tried pressing greyed out buttons in the tutorial.
  • Instructions for one handed use should be included.
  • Seated version of exercises is definitely necessary.

CHARLIE

  • Highlighting the area of description is necessary in the tutorial.
  • Direction of motion for exercise needs to be clearly established.
  • Prompt to take first step (first rep) necessary to get dominoes moving forward.
  • Blank tiles did not register as a match with other blank tiles.
  • Shifts in turn phases need to be clearer.
  • Toggle-able visual aids on the interface would be beneficial.
  • She could make cognitive connections between similar tasks. E.g. reading the game instructions vs. reading letters in her mail.
  • “We need to be able to work out the technology and be able to do it for yourself.”
  • The game removes the fiddly interaction with placing the dominoes in the right place. Instead, it focuses on training the brain to recognise the numbers.
  • “When there isn’t a number on the tile, my brain doesn’t see that end of the tile at all.” May take a couple of games down the track to learn this. It doesn’t necessarily mean it’s a bad thing.
  • There were points where she wasn’t sure if she had done the right thing but she liked that it made her think. It put her out of her comfort zone. “We need to be pushed to get the brain to do these things.”
  • “The more that we can do for ourselves the better.”
  • Can relate aspects of the game to other real-world actions like using the telephone or the toaster. “The phone’s not so scary after all.”
  • Make it clear that doubles are required to start.

DANNIE

  • Grey buttons caused more trouble for not being clear enough.
  • Prompting from hand to table exercise needs to be a thing.


User Test 2 – Additional Notes

General

ALEX

  • Emphasised how some survivors of stroke may not have access to adequate facilities, meaning home-based rehabilitation is the only viable option they have.
  • Would not have been able to perform the exercises without using the table for support.
  • Someone who is less able needs to start with less exercise, less weight, set by clinician.
  • Believed most important point to introduce the system was early on in the recovery process. “Get them in the earliest stages of the rehab.”

CHARLIE

  • Had TIAs (Transient Ischemic Attack) in 2009, 2010 and 2011.
  • Having a physical version of the instructions (for both game and orthosis), printed on sturdy material, e.g. laminated card, would provide security. Users may not be confident trying to get help from the machine and having the card available as a fall-back would avoid embarrassment.
  • The card would “[remind the user that they] are okay to continue.” “Just knowing that the card is there might remind me of what is going on. I might not even need to read it.”
  • Enjoyed the experience because it is “new, exciting and helpful.” It allowed her to see where she is at (with her own capabilities).

Media Specific

ALEX

  • Once you accomplished something in game, it felt like you’d learnt something.
  • Wording of selection prompt to start exercises needs to be more obvious. Needs more clues for what to do.
  • Indication to put on weight/take weight off need to be clearer - diagram may suffice.
  • Bug: double control no longer triggers.
  • Open face arrows purpose is not being communicated. Was not sure which the open face was.
  • “When you’re ready…” should be reworded to “Press me when you’re ready.”
  • Started doing exercises on Clear Space screen.
  • Enjoyed the novelty of the dominoes moving forward in response to her movements.
  • Interpreted highlighted dominoes as buttons.
  • Acknowledged it would come easier once you got used to it.
  • Need clearer visual representation of separation between table (played dominoes) and the dominoes in hand.
  • Explanation for BLOCKED (Everybody passed) needed.

CHARLIE

  • Looking down while concentrating made her feel dizzy. Had to sit down after tutorial and have a glass of water.
  • Wanted visualisation of the exercises in addition to the written prompt to remind her which exercise to do when.
  • Before priming, break the exercise down into a step by step process: explain how it works with accompanying animation, add suggestions if needed (e.g. you can hold the edge of the table if it helps you keep your balance), let them practice the motion with supportive messages (e.g. “a little higher”) and once they get it right it counts as their first repetition towards 15. There should be the option to remove this functionality once the player feels they have mastered the exercise’s form. A similar process would take place before the main phase as well. For something like sidestepping, mention to lead with the weaker foot (the foot that did the strength training reps.
  • Having a button that loads this demonstrative information would be necessary. “It’s okay. We’ll show you to help you remember.”
  • Addition supportive information should be included: “If you feel tired or dizzy, take your time to sit down and drink some water.”
  • Mixed mediums of communication is necessary. Charlie is more confident with written instruction but other people she knows are more dependent on diagrams or spoken instruction.
  • Expressed excitement to play. Used the game as a test of where her abilities were at.
  • Talked of how the offer to play a game made her feel wanted as a person.
  • Everything comes back to independence.
  • “We are not a forgotten cause. You’re still a person and should be treated like a person.”
  • The option to request help from the game, or exit it entirely, felt like a failsafe if she messed anything up in the game.
  • Acknowledged the beginning of strategy. Thinking about what her opponents held in their hands.
  • Felt words, numbers and movement were the most important things to be exercising.
  • Don’t put time pressure on anything. The player must know that they control the pace.
  • Liked that it encouraged her to read. If they are still processing one piece of information, all other information presented at this point will be missed.
  • The offer to play a game made her feel included - “It all boils down to feeling needed, wanted and independence.”
  • “Just because I’ve had a stroke doesn’t mean I’ve lost the plot.” “We’re not a forgotten cause.”
  • Found the bright aesthetic appealing.
  • “It might be repetition, but every time you’re doing it you’re getting better, getting faster.”
  • “Let people know if they can’t do it, it’s okay” - You can ask for help at any time.

DANNY

  • “It’s stimulating in both ways” - in reference to cognitive and physically.
  • Also needed clearer reminder imagery for which repetitions he was supposed to be doing.
  • Was tired after game - “starting to break out a sweat.” Necessitates having a build up into more difficult exercises. Completed 30 leg raises and 55 sideways steps and believed the maximum he could accomplish would be roughly double.
  • By the end of the game he was acting without the aid of prompts.
  • Got muddled by which exercise to do when.
  • Make sure prompt to remove sole and put sole on is explicit.
  • Found moments of gameplay (starting a round with a double) confusing from lack of experience with dominoes.

Additional Online Resources

Tiddly-Wink Domino Rules, 2016. Retrieved from http://www.domino-games.com/domino-rules/tiddly-wink-rules.html

Stroke Foundation of New Zealand, 2016. Retrieved from http://www.stroke.org.nz/

Stroke Central Region, 2016. Retrieved from http://www.strokecentral.org.nz/

Stroke Recovery Association of BC, 2016. Retrieved from http://strokerecoverybc.ca/

7 Steps to Stroke Recovery [Video file], 2014. Retrieved from https://www.youtube.com/watch?v=GHJL42xFuz8