Knobel Samuel Elia Johannes, Kaufmann Brigitte Charlotte, Gerber Stephan Moreno, Urwyler Prabitha, Cazzoli Dario, Müri René M, Nef Tobias, Nyffeler Thomas
Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.
Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, Bern, Switzerland.
JMIR Serious Games. 2021 Jul 2;9(3):e29182. doi: 10.2196/29182.
Serious games are gaining increasing importance in neurorehabilitation since they increase motivation and adherence to therapy, thereby potentially improving its outcome. The benefits of serious games, such as the possibility to implement adaptive feedback and the calculation of comparable performance measures, can be even further improved by using immersive virtual reality (iVR), allowing a more intuitive interaction with training devices and higher ecological validity.
This study aimed to develop a visual search task embedded in a serious game setting for iVR, including self-adapting difficulty scaling, thus being able to adjust to the needs and ability levels of different groups of individuals.
In a two-step process, a serious game in iVR (bird search task) was developed and tested in healthy young (n=21) and elderly (n=23) participants and in a group of patients with impaired visual exploration behavior (ie, patients with hemispatial neglect after right-hemispheric stroke; n=11). Usability, side effects, game experience, immersion, and presence of the iVR serious game were assessed by validated questionnaires. Moreover, in the group of stroke patients, the performance in the iVR serious game was also considered with respect to hemispatial neglect severity, as assessed by established objective hemispatial neglect measures.
In all 3 groups, reported usability of the iVR serious game was above 4.5 (on a Likert scale with scores ranging from 1 to 5) and reported side effects were infrequent and of low intensity (below 1.5 on a Likert scale with scores ranging from 1 to 4). All 3 groups equally judged the iVR serious game as highly motivating and entertaining. Performance in the game (in terms of mean search time) showed a lateralized increase in search time in patients with hemispatial neglect that varied strongly as a function of objective hemispatial neglect severity.
The developed iVR serious game, "bird search task," was a motivating, entertaining, and immersive task, which can, due to its adaptive difficulty scaling, adjust and be played by different populations with different levels of skills, including individuals with cognitive impairments. As a complementary finding, it seems that performance in the game is able to capture typical patterns of impaired visual exploration behavior in hemispatial neglect, as there is a high correlation between performance and neglect severity as assessed with a cancellation task.
严肃游戏在神经康复中越来越重要，因为它们能提高患者对治疗的积极性和依从性，从而有可能改善治疗效果。通过使用沉浸式虚拟现实（iVR），严肃游戏的优势，如实现自适应反馈和计算可比性能指标的可能性，可以得到进一步提升，从而实现与训练设备更直观的交互，并提高生态效度。
本研究旨在开发一种嵌入iVR严肃游戏环境的视觉搜索任务，包括自适应难度缩放，从而能够适应不同个体群体的需求和能力水平。
通过两个步骤，开发了一款iVR严肃游戏（鸟类搜索任务），并在健康的年轻参与者（n = 21）、老年参与者（n = 23）以及一组视觉探索行为受损的患者（即右半球中风后患有半侧空间忽视的患者；n = 11）中进行了测试。通过经过验证的问卷评估iVR严肃游戏的可用性、副作用、游戏体验、沉浸感和临场感。此外，在中风患者组中，还根据既定的客观半侧空间忽视测量方法，考虑了iVR严肃游戏中的表现与半侧空间忽视严重程度的关系。
在所有3组中，报告的iVR严肃游戏可用性高于4.5（在1至5分的李克特量表上），报告的副作用很少且强度较低（在1至4分的李克特量表上低于1.5）。所有3组都同样认为iVR严肃游戏极具激励性和趣味性。游戏中的表现（以平均搜索时间衡量）显示，半侧空间忽视患者的搜索时间在一侧出现增加，且随客观半侧空间忽视严重程度的变化而有很大差异。
所开发的iVR严肃游戏“鸟类搜索任务”是一项具有激励性、趣味性和沉浸感的任务，由于其自适应难度缩放，它能够适应不同技能水平的不同人群，包括认知障碍患者。作为一个补充发现，游戏中的表现似乎能够捕捉半侧空间忽视中视觉探索行为受损的典型模式，因为表现与用划消任务评估的忽视严重程度之间存在高度相关性。
