JMIR Publications

ABSTRACT

Background:

Complications due to dysphagia are increasingly prevalent among the elderly; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is currently unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation.

Objective:

Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training game app, a feasibility trial aimed to identify physiological and psychological factors that affect user experience and thus flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. It is hoped that by providing a useful tool for medical rehabilitation, the elderly could retain tongue muscle flexibility.

Methods:

After consulting professional nurses, we developed a mobile game app for middle-aged and elderly people to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and elderly test subjects during three game training tasks, each requiring different reaction speeds. Their physiological signals and the psychological signals as well as the results of the FSS-2 questionnaire were employed for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method.

Results:

K-means clustering revealed that subjects could be categorized into two groups: operation and immersion. In the determination of changes in their physiological and psychological signals for each given task, Pearson correlation indicated that these changes were mostly related to flow direction. Therefore, evaluating the movements of specialized muscles determined that a flow experience could be produced, demonstrating that our tongue muscle training game app could serve as an alternative rehabilitating method for the elderly.

Conclusions:

Results from our research supports further development and evaluation of a game app for assisting the elderly in tongue muscle training. The game can measure the amount of flow experienced by measuring both physiological and psychological signals, which can improve the accuracy and feasibility of training. The next step is to conduct a randomized pilot trial. Our goal is to improve the functions of the app, provide alternative options for tongue muscle rehabilitation, and motivate the elderly to participate in long-term training. In the future, we aim to increase the long-term efficacy of our app and diversify training modes, and a multi-person interactive mode can be added to provide extra challenges.