JMIR Publications

ABSTRACT

Background:

People with intellectual and developmental disabilities (IDD) face difficulties in being included in activities with their peers due to differences in cognitive abilities and social skills required for group interaction. While existing accessibility policies attempt to accommodate their needs, these adaptations may result in experiences that differ from those of neurotypical peers, limiting true inclusion. Videogames offer a promising medium to support inclusion, physical activity, and social engagement, but current solutions struggle to provide equitable experiences to heterogeneous group of users, especially in a multiplayer real-time context.

Objective:

This work aims to co-design and develop an inclusive collaborative real-time multiplayer exergame, assessing its usability, the impact of accessibility features, and players’ satisfaction and enjoyment.

Methods:

The exergame Elemental was co-designed following the CeHRes Roadmap, involving clinicians, educators, engineers, and individuals with IDDs. Two cooperative minigames were developed: Igloo (focused on collecting reaction time data), and Volcano (focused on enhancing collaboration), each playable with four different input devices (buttons, tablet, hand-tracking, and full-body tracking). Customizable facilitation options were implemented to adapt gameplay to sensory, cognitive and motor needs. Young adults with IDDs participated in a two-phase study testing whether personalized accommodations could eliminate performance disparities: 1) Igloo in homogeneous groups without facilitations, using all devices to identify optimal input methods; 2) Volcano in heterogeneous groups using their best-performing devices with individualized facilitations tailored by educators. Data collected included in-game performance (accuracy, reaction time, collaboration contributions), behavioral observations, and questionnaires on usability and enjoyment from both players and operators. Non-parametric analyses were used to assess relationships between disability severity, performance, and the impact of facilitations.

Results:

11 individuals aged 19-36 with different IDD diagnosis were included in the testing. In the Igloo sessions performance was correlated with their intellectual disability severity (r = –0.87, P < .001), while in the Volcano sessions no correlation was retrieved (P = .45). These results highlight that tailored support (personalized facilitations and best-suited devices) can foster equitable participation even in heterogeneous groups. Behavioral analysis revealed frequent peer collaboration, and both participants and operators reported high usability, satisfaction, and enjoyment.

Conclusions:

This study demonstrates the effectiveness of inclusive co-design and personalized features to transform an activity into an inclusive and collaborative experience that is enjoyable by individuals with different abilities and intellectual impairments. This work proves the importance of shifting the focus from fitting individuals into existing digital spaces, to designing digital spaces able to embrace diversity.