=Paper=
{{Paper
|id=None
|storemode=property
|title=Serious Interface Design for Dental Health: WiiMote-based Interaction for School Children
|pdfUrl=https://ceur-ws.org/Vol-634/Entertainment-Interfaces-Proceedings02.pdf
|volume=Vol-634
}}
==Serious Interface Design for Dental Health: WiiMote-based Interaction for School Children==
https://ceur-ws.org/Vol-634/Entertainment-Interfaces-Proceedings02.pdf
Serious Interface Design for Dental Health:
WiiMote-based Tangible Interaction for School Children
Kathrin Gerling, Matthias Klauser and Maic Masuch
Entertainment Computing Group
University of Duisburg-Essen
Forsthausweg 2
47057 Duisburg, Germany
{kathrin.gerling, matthias.klauser, maic.masuch}@uni-due.de
ABSTRACT Moreover, possible positive effects of tangible interfaces
This paper describes a camera-based approach towards for education are discussed, e.g. the improvement of
creating a tangible interface for serious games. We learning processes due to the closer link between cognition
introduce our game for dental health targeted at school and perception as well as the improvement of collaborative
children which implements the Nintendo WiiMote as work between children sharing the same computer [13].
infrared camera. Paired with a gesture-recognition system, Besides, studies have shown that the availability of tangible
this combination allows us to apply real-world items as interfaces for children may reduce the need for instruction
[23].
input devices. Thereby, the game tries to address different
aspects of dental hygiene along with the improvement of In this paper, we describe our tangible approach towards
children’s motor skills. In our focus group test, we found interface design for a game for dental health which features
that tangible interfaces offer great potential for educational a user interface based on real-world items and thereby tries
purposes and can be used to engage kids in a playful to convey psychomotor skills along with factual knowledge
learning process by addressing their childlike curiosity and on dental hygiene.
fostering implicit learning. RELATED WORK
The issue of dental hygiene of children and teenagers has
Keywords
rarely been addressed by serious games.
Serious Games, Tangible User Interfaces, Design for
Children A ubiquitous approach towards teaching tooth brushing to
school children has been suggested by Chang et al. [3].
INTRODUCTION Their system tracks children’s brushing behavior while
Research has shown that insufficient dental hygiene of cleaning their teeth and presents brushing results on an
children and teenagers has a negative impact on the LCD display. Additionally, they conducted an
development of their second dentition: Children whose accompanying study which showed an improvement of
primary teeth have been affected by cavity are at a brushing strategies and a significantly longer overall
significantly higher risk of developing caries during brushing time. Nevertheless, the application only includes
adolescence and adult life [12]. Therefore, it is important to few game elements and focuses on sensorimotor skills
inform children and teenagers about different means of instead of game play, which might affect player’s
dental hygiene at a very early stage. Because it is difficult motivation in the long run.
to reach school children and teenagers through educational
videos, flyers or other information sessions, new ways of Dental Attack [4] is a serious game featuring 3D graphics
communication have to be found. We believe that a serious in which the player has to protect a large tooth from cavity
game has the potential of reaching our target audience due by administering correct cleaning behaviour. It aims at
the positive impact of playful applications on children’s improving the player’s knowledge and motivation
motivation [15]. In addition to that, tangible user interfaces regarding dental hygiene, but possible positive effects of
enhance immersive effects of digital games, and thus have the game have not been validated in the context of an
the potential to deeply engage users in game play [6]. evaluation.
Additionally, a wide range of flash games featuring the
topic of dental hygiene is available on the internet.
Furthermore, tangible interfaces for children have
frequently been discussed and a variety of playful
applications has been designed.
TICLE was designed by Scarlatos et al. and is an early
approach to game design based on tangible interfaces for
children. It is a tabletop tangram game which supervises
player’s movements and offers help when necessary [19].
Karime et al. [9] created a Magic Stick which enables very contamination and plaque to dental decay, the player may
young children to use digital entertainment systems. The unlock bonus items such as fluoride gel or chewing gum by
tangible stick combines RFID and Bluetooth technology entering quick mini game challenges or decide to switch to
and can be used to read information about pictures from cleaning-mode in order to administer cleaning treatment.
tagged image books which are then displayed in a virtual After switching to cleaning-mode, the player is asked to
scene. choose from a set of three cleaning instruments displayed at
Ryokai et al. [17] developed the concept of I/O Brush, a the top of the screen (cf. Figure 2). He may decide to use a
camera-based drawing tool which allows children to read tooth brush, mouthwash or dental floss to remove traces of
color and texture information from their environment and comestibles and plaque. Depending on the player’s choice,
apply it to virtual images. an adequate input device allowing the conduction of
Furthermore, Ho et al. [8] approached serious game design different cleaning gestures has to be selected (cf. Enhanced
from the perspective of tangible user interfaces and created Tangible Interaction).
a health game aimed at children attending primary school During game play, the user is given the possibility of
which implements the Nintendo WiiMote. returning to each of the game modes as necessary. At the
end of each level, scores are calculated based on the
GAME CONCEPT
average status of the group of teeth and the overall quality
The game concept presented within this paper is based on
of cleaning behavior administered by the player. Thereby,
the idea of fusing game mechanics and learning units in
the player receives additional feedback regarding his in-
order to create an immersive user experience. It features a
game performance.
combination of two complementary game modes which
incorporate different didactic goals. Furthermore, the
concept aims at the implementation of intuitional
interaction paradigms designed to engage the player in
game play and to facilitate learning processes. A detailed
description of the game concept and its didactic foundation
was published in [7].
Game Design
Our game design suggests the combination of two game
modes, nutrition-mode and cleaning-mode, to implement
in-game challenges which address different learning
objectives.
Figure 2: Brushing input in cleaning-mode.
Didactic Goals
As a result of the combination of nutrition-mode and
cleaning-mode, the game addresses three basic didactic
goals, which can be mapped to Bloom’s Taxonomy of
Learning Domains [1]:
• motivation (Affective Domain)
• factual knowledge (Cognitive Domain)
• sensorimotor skills (Psychomotor Domain)
The game tries to raise children’s motivation by putting
Figure 1: Overview of nutrition-mode. them in charge of a group of teeth while equipping them
with different tools. During game play, children are
In nutrition-mode, the player has to take care of a group of continuously asked to make choices and consider
teeth advancing through the game in a style similar to 2D consequences of their actions while being provided with
side-scrolling games (cf. Figure 1). Each level consists of a immediate feedback. Thereby, the game aims at the
set of comestibles which the teeth have to chew. improvement of their self-efficacy while challenging their
Additionally, a time limit which represents an average factual knowledge regarding dental hygiene. Furthermore,
playing value is implemented to support the calculation of a our game concept addresses motivational aspects by the
comprehensible high score at the end of the level. While presentation of teeth as vulnerable creatures which depend
the group encounters challenges represented by a variety of on the player’s care and protection.
comestibles causing negative effects ranging from
Additionally, the transfer of factual knowledge is fostered children. Therefore, an enhanced tangible interaction
by the visualisation of dental decay caused by the applying real-world items as input devices was
consumption of comestibles during nutrition-mode. implemented.
Depending on the type of comestible which was
Enhanced Tangible Interaction
encountered by the group of teeth supervised by the player,
In contrast to our suggestion for a basic interaction scheme,
plaque or contamination is caused. Furthermore, the speed
the enhanced design embeds real world items into the
of decay is affected by the core ingredients of each
game. It introduces infrared input recognition which is
comestible, such as sugar (e.g. chocolate) or acid (e.g.
based on the idea of implementing a gesture-based interface
cola). Besides, the game accentuates dependencies between
which allows young children to actively participate in game
eating habits and their impact on specific requirements of
play and engages older kids due to its innovative nature.
adequate means of cleaning through different game
mechanics. In this context, we decided to use Nintendo’s WiiMote as
primary input device because it is one of the most popular
The development of sensorimotor skills is addressed by the
controllers for digital games. Furthermore, it provides us
implementation of cleaning-mode, which requires gesture-
with a variety of information on user input through its
based interaction and includes the application of real-world
button interface, translatory sensors and the additional
items as input devices (cf. Enhanced Tangible Interaction).
infrared interface. Additionally, the availability of a wide
INTERACTION DESIGN range of third party software such as the WiimoteLib [22]
Interaction design for children and teenagers is a facilitates the implementation of the device.
challenging task due to the particularly wide range of The game requires a total of two WiiMotes: One Mote is
cognitive and sensorimotor skills of the target audience. used as regular pointing device, another mote is located in
This requires an inclusive design approach which takes front of the player and serves as infrared camera. In the
different stages of children’s development into account [2]. following section, both input paradigms will be described.
Our game tries to address this issue by offering two
interaction concepts which require different levels of
sensorimotor precision and both try to reduce children’s
cognitive load by implementing facile input paradigms. The
basic approach towards interaction design includes mouse
and keyboard input, whereas the enhanced interaction
concept is based on the implementation of tangible
controllers, i.e. the Nintendo WiiMote and real-world
items.
Additionally, we believe that our tangible approach to
interface design may address a broader audience and
activate children’s curiosity, which would be ideal
regarding our target audience of both younger children and
teenagers.
Basic Interaction Design
The game features a conventional user interface based on Figure 3: Overview of the complete setup required for
the combination of mouse and keyboard input. The player item-based input.
is offered the possibility of interacting through point-and-
click operations as well as keyboard input: During WiiMote Input
nutrition-mode, the group of teeth is moved using arrow The primary WiiMote controller is implemented as
keys. After switching to cleaning-mode by using the mouse pointing device. This setup requires a wireless infrared
to click on a particular tooth, further mouse input is sensor bar similar to the bar delivered with the Nintendo
required to perform different cleaning actions. In order to Wii, which is positioned in front of the player in order to
evaluate the quality of the player’s attempts to use different track input via the infrared interface. Furthermore, button
cleaning instruments, we implemented a gesture input is registered to trigger in-game events.
recognition system which is also used within the enhanced During nutrition-mode, this remote is used to control the
tangible interaction and is described in the following group of teeth representing the player, to participate in
section. mini-games in order to unlock bonus items and to switch to
The advantage of this basic approach is the wide cleaning-mode when necessary. In cleaning-mode, the
availability of mouse and keyboard as input devices. pointing mote may be used to select an appropriate
Additionally, many children and teenagers have previous cleaning device. Once a device has been selected, the
experience with similar interaction paradigms, which is player needs to exchange the pointing remote with the
likely to provide an easy entry to game play. However, corresponding reflector-based input device.
input in cleaning-mode requires accurate mouse
movements which might not be suitable for younger
Camera-based Input infrared light towards the player in combination with the
Instead of using the WiiMote as pointing device in camera WiiMote allows us to track user input without
combination with a stationary sensor bar, it is also possible attaching any electronics to the input devices of our choice.
to implement the remote as fixed infrared camera and move Because we wanted to be able to track more than one input
a source of infrared light instead. Thereby, it is possible to event at a time at a later point of development, we decided
track different input gestures conducted by the user if he or to adapt a multi-touch finger tracking system originally
she is equipped with adequate input devices. This allows us designed by Chung Lee [11] which supports up to four
to implement a tangible user interface which is based on the touches and requires an LED array throwing infrared light
idea of utilizing real world items as input devices. at the player. It is written in C# and can easily be combined
with the latest version of Microsoft’s XNA Game Studio
System [14] and the WiimoteLib [22].
User
To improve tracking results, Chung Lee suggests that
Game
players attach reflective tape to their finger tips which
WiiMote Input
Detection increases the amount of infrared light being thrown back at
Input Input the camera remote. Instead of adding reflective tape to the
Evaluation
Input Items
Gesture
player’s fingers, we decided to attach it to a tooth brush, a
User cup and an imitation of dental floss. In order to achieve an
Recognition
Brush Feedback
System acceptable transmission result, we used Scotchlite Solas
GradeTM, which is a type of reflective tape that is
Cup
commonly used in shipping. Besides a high flexibility, the
Display / tape concentrates light rather than having a dispersive
Floss Audio
effect which increases the amount of light being returned to
the camera remote.
Figure 4: Overview of the interaction between user and Interface and User
system.. Recognition System
IR light Tools with
Technically, there are two different approaches based on LED Array reflective tape
the idea of casting infrared light on a stationary infrared (Tooth brush, cup
or dental floss)
camera which we considered for our setup. Both require the
reflection
implementation of additional LEDs similar to those used Camera WiiMote
for the original sensor bar. The LEDs utilized for the array
should ideally have a peak wavelength of 950nm, otherwise
tracking results are not stable enough and are easily Gesture
recognition Game
influenced by other sources of infrared light, e.g. sunlight.
At first, we tried to invert the regular pointing system by
Figure 5: Interface setup and information processing.
attaching LEDs directly to the objects which would then be
used as input devices. This requires a power supply which
either needs to be attached to the object or has to be
In order to receive a strong infrared signal, we used an LED
connected by wire. Unfortunately, this may be a
array consisting of 40 LEDs with a wavelength of 940nm
disadvantage when designing for children since the
(+/- 50nm). We installed the LED array on a wooden rack
prototypical input devices we developed were very fragile
with a little hinge which allows for the adjustment of the
and could easily be damaged when dropped or carelessly
LED array in a very flexible manner. This is particularly
handed over to another person. Because we were intending
important because the angle of the array needs to be
to use the interface for teenagers and younger children, it
adjusted according to each player’s body size to grant an
was also problematic that most LEDs which are currently
optimal tracking result. On top of the rack, a clamp was
available have an operating temperature up to 75°C and
installed which allows us to mount the camera WiiMote
therefore cannot be used in interface design for kids
accordingly (cf. Figure 3).
without the risk of injury. However, this method returns
good transmission results and offers the possibility of The advantage of this method is the fact that the input
tracking single input devices as LEDs may be used as devices are lightweight and fully functional without any
markers which are recognized by the system during game additional electronics or other attachments which might
play. Thereby, it is possible to determine whether the disturb the user (e.g. wires connecting the device to the
player is using the correct input device. system). If necessary, all input devices can be replaced at
low cost, because average retail items can be used which
Alternatively, it is possible to implement a system which only need to be enhanced with reflective tape.
does not require the attachment of LEDs to the hardware Figure 5 shows how input information is processed by the
user interface: The installation of an LED array casting system described in the previous section. First, the LED
array casts infrared light towards the objects utilized by the
player. Second, light is reflected by the input device and
thus recorded by the camera WiiMote. Then, 2D
coordinates representing the relative position of the input
device to the camera are obtained and translated into mouse
coordinates. Therefore, it is possible to apply regular mouse
gesture recognition algorithms during the next step of
information processing. Afterwards, information regarding
the quality of player input is passed on to the game and
corresponding feedback is displayed to the player. Figure 7: Gesture recognition for tooth brush input.
For each instrument in cleaning mode, a corresponding If the tooth brush is used correctly, a circular movement is
object was chosen and laminated with reflective tape. Thus, registered by the system. As this is a continuous process,
the game features a tooth brush, a cup as well as an the cleaning period is split into cycles. Once one cycle
imitation of dental floss made of cord and wooden pearls within the brushing process is finished, the recognition
(cf. Figure 6). system evaluates the accuracy of the player’s cleaning
The following section describes the set of characteristic movement by comparing player input to an ideal circular
input gestures which is required to play the game. movement. Figure 6 shows the recognition process: If user
input is registered which may be similar to circle A (good)
To use the cup filled with mouth wash, the player has to lift or circle C (bad), it is compared to the ideal circle B. Based
it up to his face and pretend to drink out of it. Thereby, the on four distinctive points of the player’s input gesture, the
camera records a vertical movement which can easily be area of the circle is approximated and compared to the ideal
identified by the gesture recognition system. Dental floss is circle which is based on a set of four predefined values. It
used by picking up the cord with both hands and slowly was necessary to reduce the amount of values drastically to
lifting both ends in an alternating rhythm. Since the reach an acceptable level of system performance and to be
tracking system supports multiple input sources, two able to deliver immediate visual feedback to the user. In
vertically moving objects are detected and submitted to the order to determine whether the input cycle has been
game as player input. finished, each circle is split into four areas (cf. Figure 7).
The transition between two areas can be detected by a
corresponding change of the X and Y values of mouse
coordinates. Depending on the alteration of these
coordinates, the system defines an initial starting point at
which the cycle started and is later expected to end.
Thereby, the system is able to distinguish between circular
strokes and mere vertical or horizontal scrubbing. Finally,
the user is provided with visual feedback regarding the
individual cleaning performance.
In contrast to regular mouse and keyboard input, the
enhanced interaction design offers a more complex, yet
intuitional tangible interface which we expect to have a
positive impact on player’s motivation and engagement. In
the following chapter, we describe the results of a first
focus group test during which both interaction paradigms
were compared.
Figure 6: Tools with reflective tape.
If the player uses the cup or dental floss, the game only FOCUS GROUP TESTING
checks whether the corresponding gesture has been In order to evaluate the two interaction concepts presented
completed. However, if the tooth brush is used, the quality within the previous chapter, a stable and fully playable
of the gesture has to be evaluated. Therefore, a more prototype which offers both mouse and keyboard input as
complex interpretation process is required which is able to well as WiiMote and item-based interaction was created.
determine the precision of each player’s cleaning behavior. The focus-group test was conducted with nine school
Thus, we implemented a simple algorithm which allows us children with a mean age of 10 (range 9 to 11). The group
to judge whether player input was good, average or bad. consisted of three girls and six boys, all of the children
were from socially disadvantaged families and therefore at
a generally higher risk of suffering from the consequences
of insufficient dental hygiene. Therefore, the focus group
represented one of the core audiences of our design
concept. Besides, all participants had previous experience
using the computer and playing games.
Setting and Method In general, the focus-group test showed that new
At the beginning of the test, the children were divided into technologies offer great opportunities for educational
two groups. Group A consisted of five children and was games because they have the potential to engage children in
later on presented with the enhanced tangible interaction a playful learning process. Teaching staff positively
using both WiiMote and real-world items. Group B highlighted the fact that their students actively discussed in-
consisted of four children who were asked to play the game game actions as well as aspects of dental hygiene, which in
using keyboard and mouse. Each group was granted one their opinion offers a good opportunity of picking up the
hour of playing time followed by a fifteen-minute topic of dental hygiene in a more formal context. Thus, the
structured group interview. Before the start of the playing game could probably be used in a classroom context to
session, the interaction methods as well as keyboard and introduce the topic of dental hygiene. Furthermore, the
button mappings were explained. During game play, implementation of tangible interfaces in combination with
children were observed and asked questions about their in- gaming applications may foster implicit learning processes,
game actions according to the Active Intervention method because the player’s desire to master the game requires
suggested for the evaluation of interactive products with mastery of the input devices, too.
children subjects [21], which is closely related to think- DISCUSSION
aloud techniques [2, 5]. The test was conducted within the
The focus group test showed that the tangible approach
group’s school environment and accompanied by teaching
towards interaction design for serious games has the
staff.
potential of engaging children in game play and learning
Results and Interpretation
processes. Nevertheless, this first approach only included
Children’s comments during the playing session showed few subjects and should be understood as an indication of
that group B generally had no difficulties approaching the future research focuses rather than an extensive evaluation
game, because all children had previous experience using allowing definite conclusions regarding usability, interface
the combination of mouse and keyboard as input devices design and learning success.
for digital games. On the contrary, participants of group A
needed assistance when switching from WiiMote to item- One of the biggest advantages of the reflector-based
based interaction. Difficulties were primarily caused by the approach to interface design presented within this paper is
fact that the specific version of the LED array required the fact that all tangible input devices required during
careful player alignment and did not take children’s cleaning-mode are lightweight and robust as they do not
restlessness into account. In that context, using a regular utilize fragile technology. Additionally, they can easily be
tooth brush and cup was advantageous because these items replaced at low cost since the current implementation is
turned out to be very robust and are barely affected by based on conventional cleaning instruments enhanced with
careless treatment. Additionally, comments showed that reflective tape, which is ideal for the design of tangible
children within group A were enthusiastic about the use of interfaces for children.
real-world items as input devices and were highly However, the current implementation does not allow the
motivated to enter cleaning-mode to take proper care of game to determine whether the player utilized the correct
their virtual teeth. In this regard, we observed that children cleaning instrument. This may be problematic if the game
within group A generally showed a higher willingness to is played without supervision. Besides, we learned about a
cooperate with their peers than participants within group B. number of usability issues regarding the setup process of
the game during the focus group test, for instance
We believe that the increase in participants’ establishing a Bluetooth connection between the WiiMote
communication can be accredited to the availability of and a PC is rather difficult due to connectivity issues and
several input devices which encourages collaborative game requires a level of technical expertise which should not be
play rather than indicating a 1:1 relationship between one assumed. Furthermore, the current setup of the WiiMote
user and the system through a regular mouse and keyboard and LED array is very prototypical (cf. Figure 3) and is not
setup. suitable for unsupervised use by children and teenagers yet.
The observations which were made during both playing
sessions were generally supported by children’s statements FUTURE WORK
and comments in the context of the follow-up interview. Future work will include the replacement of the camera
All of the subjects within group A claimed that they WiiMote by a regular infrared camera to address
preferred cleaning-mode over nutrition-mode because it connectivity issues and to facilitate the setup process which
allowed for the use of real-world items as input devices, is required to play the game. This is especially important as
which they commented on as “fun”, “magic” and a comprehensive clinical study requires an increased level
“exciting”. Participants of group B reported that they of usability regarding the technical installation as the
enjoyed playing the game but did not make any distinction system needs to be set up by both teaching and medical
between both modes. When questioned about the user staff. Additionally, we are planning on introducing a new
interface in particular, they explained that they found the rack to carry the camera WiiMote and the LED array which
interface to be usable, but their comments did not show the is suitable for repeated use in the context of a clinical study.
same curiosity and enthusiasm as those of participants Besides, it is planned to add a basic logging system to the
within group A. game which tracks the most important in-game actions
performed by the player, such as the use of cleaning Conference on Design & Children (IDC ’07):
instruments or the frequency of cleaning sequences during Methodology, 9-16.
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Additionally, our hypothesis regarding the activation of Design using the Nintendo WiiMote: Motivating
implicit learning processes through tangible user interfaces School Children to Improve Dental Hygiene. In:
for serious games needs to be tested within an evaluation of Proceedings of ITECH 2009, Nottingham.
learning success. This includes the revision of additional
hypotheses concerning the transfer of factual knowledge as 8. Ho, J.H., Zhou, S.Z.Y., Wei, D. & Low, A. (2009).
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ACKNOWLEDGMENTS
We would like to thank our project partners Prof. Dr. Elmar 11. Lee, J. (2008). WiiMote Project.
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