Su Kuan-Chu, Wu Ko-Chiu, Chou Kuei-Ru, Huang Chia-Hsu
Department of Interaction Design, National Taipei University of Technology, Rm.701-4, Design Building, No.1, Sec.3, Chung-hsiao E. Rd, Taipei, 10608, Taiwan, 886 912-595408, 886 2-87732913.
School of Nursing, Taipei Medical University, Taipei, Taiwan.
JMIR Serious Games. 2025 Jan 9;13:e53045. doi: 10.2196/53045.
Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation.
Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility.
After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9%; 25 females, 78.1%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method.
Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit (χ²36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach α=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants' physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58% (7/12), 50% (6/12), and 25% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50% (6/12), 33% (4/12), and 17% (2/12) of indicators, respectively.
Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge.
吞咽困难引起的并发症在老年人中越来越普遍；然而，传统舌头康复治疗的繁琐和复杂影响了他们康复的意愿。尚不清楚将游戏玩法融入舌头训练应用程序是否是一种可行的康复方法。
舌头训练已被证明对吞咽困难治疗有帮助。在开发了一款舌头训练应用程序后，一项可行性试验旨在确定影响用户和心流体验的生理和心理因素，并探讨训练特定肌肉是否能产生心流体验以实现最佳沉浸感。我们旨在为医学康复提供一个有用的工具，使老年人能够保持舌头肌肉的灵活性。
在咨询专业护士后，我们为中老年成年人开发了一款用于训练舌头肌肉的移动游戏应用程序。这项初步研究使用图像识别系统在3项游戏训练任务中检测32名健康中老年成年人（7名男性，占21.9%；25名女性，占78.1%）的舌头运动，每项任务需要不同的反应速度。他们的生理和心理信号，以及心流状态量表2（FSS2）问卷的结果，用于对相关心流体验进行相关性分析，以建立和评估我们方法的可行性。
通过探索性因素分析，确认了一个双因素（操作和沉浸）结构具有良好的模型拟合度（χ²36 = 448.478；P <.001；Kaiser - Meyer - Olkin = 0.757）和内部一致性信度（Cronbach α = 0.802）。慢、中、快水平均显著影响操作的FSS2得分（P =.001）、美国国家航空航天局任务负荷指数（P <.001）和心流距离（P <.001）。K均值聚类显示参与者可进一步分为3组。通过分析参与者在每个给定任务中的生理和心理信号变化，Pearson相关性表明变化主要与心流距离相关。对于本研究中测量的12项指标，低、中、高操作组分别在58%（7/12）、50%（6/12）和25%（3/12）的指标上表现出显著性。同样，低、中、高沉浸组分别在50%（6/12）、33%（4/12）和17%（2/12）的指标上有变化。
我们的研究支持进一步开发一款游戏应用程序，以帮助老年人进行舌头肌肉训练，并使用生理和心理信号测量心流，以提高训练的准确性和可行性。接下来，我们旨在进行一项随机初步试验，改进应用程序功能，提供替代康复选项，并鼓励长期参与。未来目标包括提高长期疗效、使训练模式多样化以及添加多用户交互选项以增加挑战性。
