JMIR Publications

ABSTRACT

Background:

Custom serious games developed for rehabilitation allow for control of feedback, setting of game speed and difficulty. Alternatively, non-custom games provide attractive graphics, sounds and game mechanics. The differences between the systems may affect users exercise intensity, quality of movement and experience during gameplay; which has implications for system and game selection for rehabilitation.

Objective:

This study compared movement performance and user experience of persons after stroke while playing custom and non-custom virtual reality balance games that were both game- and self-paced.

Methods:

27 persons in chronic phase post-stroke participated. They were familiarized with 12 games; half were played using the custom system (Equio, Kinestica) and half with the non-custom system (Nintendo Wii Balance Board, Wii Fit games). Over 2 intervention sessions with randomized blocks of self- and game-paced games and the order of the custom and non-custom systems, participants played games requiring comparable movement of the center of pressure between the systems. Movement performance (weight-shift repetitions and movement amplitude) was extracted from video recordings using Kinovea software. In addition, user enjoyment (Modified Physical Activity Enjoyment Scale), flow (Flow State Scale for Occupational Tasks) and likeability were assessed twice in each study block. For comparisons between the systems paired t-tests or Wilcoxon's tests were used.

Results:

Repetitions and movement amplitude were significantly greater for all non-custom game-paced games and half of the non-custom self-paced games. Perception of exertion was greater for non-custom games. In contrast, users’ flow state (with subdomains of sense of control and emotional experience) and user preference were significantly greater for custom game-paced games. There was no significant difference between custom and non- custom games for enjoyment.

Conclusions:

Serious game-play was influenced by customization and game pacing, both of which should be considered when selecting serious games for balance training. Clinical Trial: ClinicalTrials.gov (NCT06463730).