=Paper=
{{Paper
|id=Vol-1547/paper1
|storemode=property
|title=Active-U: Playing to Stimulate your Brain
|pdfUrl=https://ceur-ws.org/Vol-1547/paper1.pdf
|volume=Vol-1547
|authors=Maite Garolera,Nuria Berga,Maria Quintana,Gloria Chico,Noemí Cerulla,Melodía López,Yaiza Donaire,Jordi Rimbau
}}
==Active-U: Playing to Stimulate your Brain==
https://ceur-ws.org/Vol-1547/paper1.pdf
ACTIVE-U: PLAYING TO STIMULATE YOUR BRAIN
Garolera, Maite1,
Berga, Nuria2, Quintana, Maria3, Chico, Gloria2,3, Cerulla, Noemí3, López,
Melodía3, Donaire, Yaiza3, Rimbau, Jordi3
1: Neuropsychology Unit of Hospital de Terrassa-Consorci Sanitari de Terrassa
Brain, Cognition and Behavior: Clinical Research group
Carretera Torrebonica s/n. 08227 Terrassa, Barcelona (Spain)
e-mail: mgarolera@cst.cat, web: http://neuropsicologiacst.cat/
2: Hospital Sant Llàtzer - Consorci Sanitari de Terrassa
Plaça Dr. Robert nº1. 08221 Terrassa, Barcelona (spain)
e-mail: nberga@cst.cat
3: Brain, Cognition and Behavior: Clinical Research group
Carretera Torrebonica s/n. 08227 Terrassa, Barcelona (Spain)
e-mail: mquintana@cst.cat, gchico@cst.cat, ncerulla@cst.cat, melodia.lofe@gmail.com,
yaizadomu@hotmail.com, jrimbau@cst.cat
web: http://neuropsicologiacst.cat/
Abstract. The purpose of Active-U is to adapt a playful game (Unlocked) to a
therapeutic game (Active-U) to stimulate cognitive functions. Active-U emerges as a
therapeutic play with a great potential for stimulating cognitive functions, which will
get motivate the target population and thus reduce the withdrawal of cognitive
remediation. Use the motivational elements of the game with the following elements:
fiction, narrative, rules, goals and reward. We use also the principles of cognitive
stimulation based on brain plasticity to adapt a commercialized game (Unlocked) to a
therapeutic game (Active-U). We design exercises to stimulate attention, working
memory and speed of processing information. We assess the Unlocked’s usability and
Active-U usability in patients with Mild Cognitive Impairment. Our results show similar
usability in Unlocked and Active-U. Subjects value require more cognitive resources to
play Active-u than Unlocked. Active-U is shown as a promising therapeutic play, well
appreciated by users. The adaptation of playful games to learn from other therapeutic
purposes to stimulate cognitive functions can be considered a useful method to achieve
therapeutic goals and to optimize technology resources to expand their areas of
application.
Keywords: Serious Game, Cognitive Stimulation, Gamification, Mild Cognitive
Impairment, Health
1. INTRODUCTION
Mild Cognitive Impairment (MCI) is characterized by a cognitive decline greater than
expected for an individual age and education level, but does not significantly interfere
with everyday function (Petersen et al., 1999; Petersen and Negash, 2008). MCI has a
prevalence of 16% of the total population aged 65 and older, it increases with age, from
15% under age 75 and 30% over85 years. Importantly, amnestic is a well recognized
risk factor for Alzheimer disease (AD): according to the different studies, between 8.3%
and 15% in the following year, up to 80% in the five subsequent years will be demented
(Amieva et al., 2004; Petersen, 2004).
The Spanish Society of Geriatrics and Gerontology does not recommend prescribing
acetylcholinesterase inhibitors (IACE) to delay the progression of MCI to dementia.
Meanwhile, it is recommended nonpharmacological therapies (NPT) as a treatment.
Among NPT are cognitive rehabilitation or cognitive stimulation, which aims to
encourage and maintain the various cognitive functions so that will slow or stop the
deterioration process. Currently, Serious Games (SG) is considered a non-
pharmacological promising tool to evaluate, train and stimulate cognitive functions
(Robert et al., 2014).
On the other hand, the increasing number of users using new technologies has led to the
creation of products with therapeutic goal, using the advantages of the game, called
“Serious Games” (SG). These games can work physical, cognitive, social and emotional
aspects. SG represents a motivating, sustainable and relatively economic method for
improving or slow the onset of deficits in the social, emotional, and sensorimotor (Mc
Callum et al., 2012). In addition, the SG should allow any player to play the game; from
casual gamers to the usual, they would have to learn the game and to enjoy it.
According to Chen (2006), the playing experience is described as a state of total
immersion where the challenges fit perfectly with the skills of the players. If the
challenge is too great, easily the player can feel anxiety or frustration; if it's too easy,
the player may consider it boring. To get these features, the game must submit four
elements: clear goals, constant feedback, ability to focus on the task and ability to
complete the task.
Unlocked! is the first mobile game developed for iPhone by Periferia Creative. There
are four concepts: fast game, funny, engaging and challenging. Unlocked! offers 40
levels full of challenges of skill against the clock. Using an elegant design and simple
gestures on the screen of the smartphone (slide, turn, hit and separate) the player will
unlock one after the other, filled doors security systems, always with a set time limit
avoid being discovered. The game puts players in the role of thief whose mission is to
recover a number of valuable objects in different emblematic buildings. Besides these
objects can stay with the rest of the booty, consisting of gems in less or more depending
on the time it takes to pass the level. To achieve the level should open doors interacting
properly with all elements within the defined time. So far, the game is available only for
the IOS operating system, although in the future it is planned to extend it to Android.
2. OBJECTIVES
Active-U is intended to adapt "Unlocked," a game designed and commercialized by
Periferia Creative keeping their playful aspect, modifying the content of their challenges
in order incorporating the therapeutic component.
Considering the technical features of Unlocked, which dominates motor skills, and
given the demand generated fewer elements to orient newly decides version therapeutic
ActiveU towards empowerment cognitive functions such as attention, working memory
and speed of information processing.
General objectives
a) To adapt a playful game (Unlocked) to a therapeutic game (Active-U) designed to
stimulate cognitive functions (attention, working memory and speed of processing
information)
b) To assess the usability of Active-U and to compare it with usability of Unlocked
3. METHOD
3.1. SUBJECTS
The sample consisted of a total of 17 subjects recruited from day hospital for cognitive
impairment (Hospital de dia Sant LLatzer-Consorci Sanitari de Terrassa). For the
selection of subjects the following inclusion criteria were followed. 1) Informed consent
approved by the Ethics and Clinical Trails Committee, signed by the subject. 2) Age 50
to 90 years. 3) Diagnosed Mild Cognitive Impairment. 4) MMSE value greater than or
equal to 24. 5) Rating scale or global dementia 0.5. 6) Enough capacity to read and
write. 7) State medical and pharmacological stable for three consecutive months
immediately before the start of the study. 8) Absence of abnormalities or clinically
significant medical history. And the following exclusion criteria: 1) Neurological
disorders, psychiatric. 2) medical or intellectual deficiency (Vocabulary, under 85). 3) 4
or less years of education. 4) Decrease or severe visual acuity. 5) Moderate or severe
depression according score > 11 (moderate depression) or 19 (severe depression) in the
Geriatric Depression Scale (GDS-Yessavage). 6) Presence or tremor. 7) History or
presence of alcohol or other drug abuse in the 24 months prior to the study. 8) Negative
front or the use of new technologies. 9) existence of any situation that could make the
subject, in the opinion of the principal investigator for the study inadequate.
3.2. MATERIAL AND PROCEDURE
Instruments:
The System Usability Scale (SUS) is a tool for measuring the usability. It consists of a
10-item questionnaire with five response options for respondents; from Strongly agree
to Strongly disagree. The participant’s scores for each question are converted to a new
number, added together and then multiplied by 2.5 to convert the original scores of 0-40
to 0-100. Though the scores are 0-100. Based on research, a SUS score above a 68
would be considered above average and anything below 68 is below average.
Procedure:
The study is performed on the following phases
Phase 0. Usability Unlocked!
Figure 1. Structure of the game (Geographical area - Building - Level). Source: Periferia
Creative
In conducting the usability test, we used System Usability Scale (SUS). We
administered the game at 6 patients during three times. At the end of the process we
administered de SUS to check the usability.
Phase 1.Adaptation Unlocked! to Active-U
For the process of adapting the Unlocked to the creation of Active-U three aspects are
considered: model of cognitive training of attention of Sohlberg i Mateer, the results of
usability testing of phase 0 and the technical requirements.
When structuring the different challenges of the levels, that has to consider
administering simple tasks that minimize the frustration first and go progressively
increasing difficulty until about half and propose new tasks relatively simple to the end.
Phase 2. Usability Active-U
As in phase 0, it proceeds to perform a usability test on Active-U (playful game adapted
to therapeutic game). The same usability scale in the phase 0 is used to permit
comparison.
Statistical analysis
To compare usability results (outcome measures) we will use for the total score a two-
tailed t test for independent sample. To compare specific questions from the usability
between to groups (Unlocked usability versus Active-U Usability) we used a two-sided
chi-square test. Alpha level for statistical significance was set at 0.5. Analyses were
performed by using PASW statistics for Windows, version 18.0
4. RESULTS
Figure 1. Example of Active-U exercices
Mean Minimum Maximum SD
Usability
81,67 65 88 8,612
Unlocked!
Usability
76,36 65 88 7,447
Active-U
Table 1. System Usability Scale
Valor gl Sig.
Question 1 1,346 3 0,718
Question 2 0,298 1 0,585
Question 3 0,069 1 0,793
Question 4 0,944 2 0,624
Pregunta 7 3,766 3 0,288
Pregunta 8 0,58 1 0,446
Pregunta 9 0,701 1 0,402
Pregunta 10 6,491 2 0,039
Table 2. Comparison SUS’s questions Unlocked and Active-U
Seventeen subjects were recruited from day hospital for cognitive impairment (Hospital
de dia Sant LLatzer-Consorci Sanitari de Terrassa) all of them accepted to participate
and signed the informed consent.
Outcomes
Table 1 shows stimuli adaptation to cognitive stimuli. Table 2 shows usability total
score of the two groups (Unlocked and Active-U). No significant differences were
observed for the usability total score between Unlocked and Active-U. Furthermore
only a significant effect on question 10 (“I needed to learn a lot of things before I could
get going with this system”) was found (p=0.039) favoring Unlocked.
5. CONCLUSIONS
The aim of this study was to adapt a playful game to a therapeutic game to stimulate
cognitive functions, taking into account the results of Unlocked’s usability and making
the fewest possible technological changes. Results indicated similar level of usability,
except feel of needing more knowledge to use Active-U, and the instructions were easy
to understand in Active-U.
The adaptation of playful games to learn from other therapeutic purposes to stimulate
cognitive functions can be considered a useful method to achieve therapeutic goals and
to optimize technology resources to expand their areas of application.
6. REFERENCES
Amieva, H., Letenneur, L., et al. Annual rate and predictors of conversion to dementia
in subjects presenting mild cognitive impairment criteria defined according to a
population-based study.Dement Geriatr Cogn Disord. 2004;18(1): 87-93.
Mc Callum, S. (2012). Gamification and serious games for persoanlized health in
pHealth 2012, eds B.Blobel, P.Pharow, and F.Sousa (Amserdam:IOS PREss BV), 85-96
Petersen RC, & Negash S. Mild cognitive impairment: an overview. CNS Spectr.2008;
13(1): 45-53.
Petersen RC, Smith GE, et al. Mild cognitive impairment: clinical characterization and
outcome. Arch Neurol.1999;56(3): 303-8.
Petersen, R.C. (2004). Mild Cognitive Impairment as a diagnostic entity. Journal Intern
Med, 256, 183-194.
Robert P. H., König A., Amieva H., Andrieu S., Bremond F., Bullock R. (2014).
Recommendations for the use of Serious Games in people with Alzheimer's Disease,
related disorders and frailty. Front. Aging Neurosci. 6, 54. 10.3389/fnagi.2014.0005