Abstract
Stroke is a debilitating condition that impairs one's ability to live independently while also greatly decreasing one's quality of life. For these reasons, stroke rehabilitation is important. Engagement is a crucial part of rehabilitation, increasing a stroke survivor's recovery rate and the positive outcomes of their rehabilitation. For this reason, virtual reality (VR) has been widely used to gamify stroke rehabilitation to support engagement. Given that VR and the serious games that form its basis may not necessarily be engaging in themselves, ensuring that their design is engaging is important. This chapter discusses 39 principles that may be useful for engaging stroke survivors with VR-based rehabilitation post-stroke. This chapter then discusses a subset of the game design principles that are likely to engage stroke survivors with VR designed for upper limb rehabilitation post-stroke.
TopIntroduction
Stroke affects an individual’s ability to live independently, because it impairs their ability to perform basic activities such as eating, dressing, washing and walking (Ploderer et al., 2017). Given the impact a stroke has on someone’s life and independence, rehabilitation is important. Engagement with the rehabilitation process has been recognised as playing a crucial part in stroke rehabilitation, increasing a stroke survivor’s recovery rate and positive outcomes of their rehabilitation (MacDonald et al., 2013). Gamification is considered to be important with the engagement process. According to Patricio et al. (2020):
Gamification is the process of making activities more game-like in non-game contexts to encourage users' motivation and engagement in a particular task.
Patrício et al. (2018) also stated that:
Effective gamification approaches attempt to encourage users' engagement, amusement, and enjoyment toward various activities.
Because of the importance of gamification, this chapter discusses various Serious Games (which form the basis of VR) Design Principles using VR to enable the gamification of stroke rehabilitation for improved engagement. The chapter begins with a background discussion of stroke, rehabilitation, Serious Games, VR and the use of VR for stroke rehabilitation. The chapter then provides a discussion of game design principles that may be applicable in the design of VR for gamified stroke rehabilitation, with the aim of making it more engaging. The chapter concludes by discussing an application of the principles to upper limb rehabilitation post-stroke. This research identified which of the game design principles discussed are likely to engage stroke survivors with VR designed for upper limb rehabilitation post-stroke.
TopBackground
Stroke
The Stroke Foundation of Australia (What is a stroke — Stroke Foundation - Australia, 2021) provides this layperson definition of stroke:
Your brain is fed by blood carrying oxygen and nutrients through blood vessels called arteries. A stroke happens when blood cannot get to your brain because of a blocked or burst artery. As a result, your brain cells die due to a lack of oxygen and nutrients.
Physical impairments potentially caused by a stroke include impaired movement of limbs (Norman, 2014). Having upper limb impairment means that one arm is likely to be paralysed or suffer from limited movement. A paralysed arm curls upwards into a wing with a clenched fist. Having only one good arm makes tasks that require or are much easier to perform with two arms very difficult. This can include simple domestic tasks such as opening a jar or using a telephone.
Stroke Rehabilitation
Intensive rehabilitation after a stroke is crucial to minimise long-term effects, improve rehabilitation results and decrease the responsibility placed on carers and health care systems (Langstaff et al., 2014).
Physical Rehabilitation
Physical rehabilitation includes rehabilitation of both the upper and lower limbs, including motor skills, gait and balance. Conventionally, a course of physiotherapy is used in the physical rehabilitation of stroke survivors. Other methods used for physical rehabilitation include Serious Games (see the section “Stroke Rehabilitation and Serious Games” for an in-depth discussion of this) and VR (see the section “Stroke Rehabilitation and Virtual Reality”).
Rehabilitation and Engagement
Engagement with the rehabilitation process has been recognised as playing a crucial part in stroke rehabilitation, increasing a stroke survivor’s rate of rehabilitation and rehabilitation outcomes (MacDonald et al., 2013). If they are not engaged, they may fail to attempt rehabilitation and lose what movement they have remaining. Therefore, stroke survivor engagement with their rehabilitation is critical. To engage is defined as (Oxford Dictionary of English, 2010): “occupy or attract (someone's interest or attention).”
Key Terms in this Chapter
Non-Serious Game: A game designed purely for entertainment.
Engagement: Having one’s attention or interest attracted or occupied ( Oxford Dictionary of English , 2010 AU70: The in-text citation "Oxford Dictionary of English, 2010" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).
Virtual Reality (VR): “A computer-based, interactive, multisensory simulation environment that occurs in real-time. VR presents users with opportunities to engage in activities within environments that appear, to various extents, similar to real-world objects and events” ( Henderson et al., 2007 ).
Serious Game: Games with greater aims than entertainment, intended for learning and behavioural alteration ( Connolly et al., 2014 ).
Stroke: “The clinical syndrome of rapid onset of focal (or global, as in subarachnoid haemorrhage) cerebral deficit, lasting more than 24 hours or leading to death, with no apparent cause other than a vascular one” ( Warlow et al., 2003 ).
Game Design Principle: A single concept that can inform a segment or the entirety of the specifications of a game.
Rehabilitation: “The action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness” ( Oxford Dictionary of English , 2010 AU71: The in-text citation "Oxford Dictionary of English, 2010" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).