Chapter 8

New Game +

“Once you learnt, you felt like you had conquered it.”

(‘Alex,’ personal communication, 17th June 2016)

This final chapter concludes our research. The knowledge that has been acquired thus far indicates certain aspects of the system that should be explored further. This chapter discusses how these aspects might be progressed and provides speculation as to how future research might be applied.

8.1 Future Work

Many elements of the system are dependent on more user testing to prove their effectiveness. Examples such as the game’s ability to foster competitive play cannot be proven without repeated testing on numerous people. The following section focuses less on what needs to be proven and more on what can be explored.

In the current model of 12-12, increasing the amount of repetitions simply makes playing a domino more difficult to achieve. A player who uses the game for an extended period may find having to work harder for the same result frustrating. Changing the visual effects of this interaction to represent the amount of effort required of the player could rectify this. For example; playing a domino from twelve repetitions returns significantly more visual and aural celebration than playing one for four repetitions.

The adaptability of 12-12 can be improved by the introduction of a clinical interface that allows for the adjustment of exercises based on what the clinician believes is the most appropriate for their clients to be performing. Ideally this would be accessed remotely. Such an interface would require detailed player analytics that allow clinicians to see their patient’s exercise data over an extended period of time, as well as whether they are improving or degrading in their capabilities. Rendering these analytics visible to the player could provide extrinsic motivation for measuring self-improvement.

The addition of player analytics requires custom user profiles. Expansions could be made through the current in-game options menu, on which players are free to choose their username, avatar, the colour of the game board etc. Enabling the player to personalize their experience promotes investment in the system. With persistent player data, adding a ‘badge’ system that tracks progress on a daily/monthly scale would be possible. Such a feature rewards players for regular interaction or achieving large gradual goals. It could even be possible for badges to be generated by clinicians to tailor them to their patients’ goals, creating an internal reward structure for the achievement of extrinsic goals.

Player profiles could expand on connectivity through an online version of 12-12, allowing players to compete from the comfort of their individual homes. The inclusion of network functionality would require a very simple interface. Older adults are the least frequent users of the internet (Ijsselsteijn et al., 2007, p. 18), therefore simplicity is necessary to reduce the chance of intimidating or confusing players. Local multiplayer (offline, sharing a single device) was implemented but remains to be tested. The socially connective potential of games has been acknowledged by many sources to be a strength and worthy of pursuit in serious games research (Blythe et al., 2005, p. 687, Costikyan, 2006, p. 208, Ijsselsteijn et al., 2007, p. 17, Jack et al., 2010, p. 227, Mahmud et al., 2008, p. 405, Miller, 2004, p. 219). This is particularly relevant for games that target older adults (Binstock & George, 2001, p. 299, Gerling et al., 2011, Nap et al., 2009, p. 249).

There are many other aspects of serious game design and human-computer interactions that warrant further research. Traits such as flexible UI elements have been acknowledged to have potential for improving accessibility to technology for older adults (Gerling et al., 2010, p. 67, Gregor et al., 2002, p. 154, McLean et al., 2010, p. 516). Alternatively, the use of spoken instructions and supporting video to teach gameplay may yield interesting results.

These are but a few ways the system could be improved. They form the next steps that would be pursued with the continued development of 12-12.

8.2 Conclusion

In this thesis we have explored how digital games can facilitate engagement with lower-limb rehabilitation for older adults recovering from stroke. Many consider physiotherapy to be strenuous and monotonous, resulting in reduced motivation to maintain rehabilitation and ultimately less effective recovery. Serious games research, although relatively new, has shown promise for digital games to encourage players to persist in their recovery. The development of 12-12 has contributed to this field of research, exploring how elements of game design can engage players from an older demographic.

The development of 12-12 was informed by three criteria that were derived from background research on engagement within digital gaming. These criteria were adaptability, connectivity and meaningful interactions. We proposed that embedding these criteria in the game would engage players, promoting continued use of the game system and thereby supporting healthy recovery.

The original weighting of the criteria shifted to favor adaptability over the other two, based on responses from user testing. Meaningful interactions was lessened by novelty. Connectivity was unable to be tested effectively, thus remained unaltered. The importance of usability in addition to these criteria became very apparent. Older adults proved a complex demographic, with immense levels of diversity in physical and cognitive capabilities. Increasing accessibility to the system was paramount and adaptability was the most appropriate means of achieving this.

Many elements of the design of 12-12 were informed by background research. Despite the field of serious games being relatively new, the resulting design decisions yielded positive responses from user testers. The limited sample size and time restrictions of this research render these results far from conclusive.

More persistent studies of the effects of systems like 12-12 need to be conducted to prove the positive effects of digital gaming systems in a rehabilitative context. The subjectivity involved with defining engaging gaming experiences may limit what quantitative data can accomplish, however such perspectives may help the field of research mature.

Although the methods chosen for this research were largely subjective, the combination of perspectives from clinicians, user testers and researchers helped reduce bias and validate design outputs. Testing with an expanded user-base and conducting official clinical trials will further minimize this bias, and is a natural progression for the research to take.

There is a lot of potential for digital game systems to make a difference in the lives of people after stroke. This research has explored how these systems might make the rehabilitation process more engaging, thereby improving recovery and helping survivors of stroke lead more independent lives. The positivity with which the system was received suggests that serious games can be an enjoyable and effective alternative to standard rehabilitation and we urge the pursuit of further research in this area.