TheraCade VR

Virtual Reality (VR) gamified at-home rehabilitation exercise designed for adolescents.

- A collaboration with BC Children Hospital Digital Lab.

Project Overview

The project is a collaboration between BC Children’s Hospital Digital Lab (“the client”) and SevenEleven, a multidisciplinary team of students from the Centre for Digital Media (CDM).  The project aims to develop a VR gamified at-home rehabilitation exercise designed for adolescents aged 12-18. The solution includes two to three mini-games centered on the rehabilitation exercises of tracing therapist-created trajectories to achieve the goal of gradually regaining upper limb gross motor skills.

Why TheraCade?

Injuries to the upper body in adolescents can result in the loss of mobility, balance, muscle control, and strength. For those undergoing physical rehabilitation, maintaining motivation and engagement during often monotonous therapy sessions becomes a significant challenge. The high costs and inconvenience associated with traditional rehab exercises, such as scheduling therapists and traveling to clinics, further exacerbate the difficulties faced by these young individuals. The inadequacy of conventional rehab methods not only discourages participation but also hampers recovery and affects the overall well-being of patients.

One promising avenue is the exploration of Virtual Reality(VR) games that can be safely integrated into a home-based rehabilitation platform  to increase engagement and accessibility for young individuals. Currently, there are no existing VR products designed to meet this specific clinical need.

The team aims to develop a VR gamified at-home rehabilitation solution designed for adolescents aged 12-18. The objective is to offer a tailored experience that targets patients' upper body gross motor skills through a series of gamified limb motion trajectories set by a therapist in order to promote a more comprehensive and successful recovery journey.  The solution also serves as a diagnostic tool to collect data on movement to help therapists track rehabilitation progress and continue to tailor the experience for each patient.

1. Research

 To better understand the application of VR in rehabilitation context, the team conducted research on six  different aspects, users (both patients and therapists), rehabilitation, gamification, technical,  art style and research on existing rehabilitation solutions. This section provides a summary of the objective, research findings and insights of each aspect.

User Research

Objective

• Understand the needs, preferences, and challenges of the patients and therapists

• Tailor product functionality to target audience

• Inform design choices for maximum usability

Research findings

• Teenage patients sometimes resist therapy due to boredom.

• Accessibility to therapy is a concern.

• Personalized treatment plans are valued.

• Therapists seek innovative engagement tools.

Insight to the project

Insights from patient and therapist personas highlight the need for more engaging therapy sessions and personalized treatment plans. Therapists' time management challenges underscore the importance of efficient workflows, while their advocacy for innovative tools emphasizes the potential benefits of technology integration in rehabilitation. These insights drive the project's focus on user-centricity, emphasizing engagement, personalization, and efficiency in physiotherapy care.

Rehabilitation Research

The project brief stated the solution should be specifically designed to parallel real-world physical rehabilitation exercises. The objectives of rehabilitation research: 

• Explore different types of rehabilitation movements

• How the experience of rehabilitation exercise in VR  is designed such that the team can apply the insights in development of our own rehabilitation exercise

Research findings

There are five major findings:

• Customized Movement Exercises

Designing movement exercises that specifically target the affected upper limb is crucial. VR allows for personalized exercises that can be adjusted based on the individual's needs and capabilities. 

• Interactive and Feedback Mechanisms

VR provides the opportunity for real-time interaction and feedback. Designing movements that trigger immediate responses within the virtual environment can enhance engagement. For example, successful completion of a movement could lead to positive visual or auditory feedback.

• Game-Driven Exercises

Incorporating game-like elements into movement exercises can make the rehabilitation process more enjoyable. The design should encourage users to perform movements in response to in-game challenges or scenarios, aligning with the gamified aspect mentioned in the abstract.

• Range of Motion Exercises

Given the mention of improvements in active joint range of motion, VR exercises should be designed to target specific joint movements. This might involve reaching, grabbing, rotating, or other motions that contribute to enhancing the range of motion.

• Progressive Difficulty Levels

Designing a system that adapts to the user's progress is important. Gradually increasing the difficulty of movements as users improve ensures that the rehabilitation remains challenging and beneficial over time.

• Safety Considerations

Ensuring that movements are designed with safety in mind is paramount. Users should be guided to perform exercises within their physical capabilities, and there should be mechanisms to prevent any potential discomfort or injury.

Insight to the project

The team has reached a decision to concentrate on addressing gross motor skills related to upper body movement. This strategic choice is influenced by considerations and recommendations from the client. The team also has an awareness of the range limitation which is specific to the context of rehabilitation. The patients should be able to  start from small and reachable areas and progress to bigger and further away areas.

Technical Research

Objective

• Get familiar with working in VR

• Explore the possibilities and limitations of developing games  in VR  with respect to the rehabilitation context

Research findings

• Current development only made it possible to track head and hand movements.

• The project will leverage the capacity of the build-in Spline Tool in Unity.

• Since the development is still at the early stage, the amount of reference is scarce and there are potential issues with frame rates and performance not optimized.

• Possibilities for data collection in VR

• Time taken

• Initial trajectory (pre-defined by therapist)

• User trajectory (when attempting to trace pre-defined trajectory)

• Matched area ratio (percentage of initial trajectory covered by user)

• Data transfer - writing data to Json and uploading to Google Drive API

• Using Drive API as a stand-in for an online database

• Makes it possible to separate therapist and patient experience

• Link to greybox  prototypes: https://drive.google.com/drive/folders/1ACTW4_MU7lG9faMEZV2WqVsfvzvNMz2s 

Insight to the project

Using the built-in spline tool in Unity, it’s possible for the therapist to draw an intended trajectory that the patient has to follow (this removes for the need for the team to predesign trajectories for patients), and separately the patient can then trace this trajectory in a game where data can be collected. With the implementation of Json and Google Drive API it’s possible to have completely remote rehabilitation.

Gamification Research

Objective

• Explore elements that can gamify the therapeutic experience and provide extrinsic motivation to the patients in engaging the therapeutic experience

Research findings

There are different elements that can contribute to gamification:

General elements

• The game can be built revolving around storylines  or guided narratives. An enticing story can keep players  engaged. 

• Breaking down challenges into small manageable tasks provide a sense of satisfaction and progression, which provide a sense of agency.

• Scoring and points quantify the player’s progress and a reward system can provide players with recognition and confidence to advance to next levels or unlock new features.

• Personalization adds a touch of sense of belonging to the game.

Social elements

• Games in multiplayer mode encourages interaction between players and injects competitiveness which increases levels of excitement

• Result of gameplay displayed in leaderboard ranking can encourage healthy competitions

• The accomplishments should be displayed clearly to reassure players of their progressions.

Insight to the project

After discussing with the client and understanding the project requirement, it is decided that factors that may potentially contribute to overexertion (e.g. time pressure and competitive elements) should all be avoided in the design of the gameplay. The team will incorporate a reward system to motivate patients in gradually performing better in the rehabilitation exercise.

Art Research

Objective

• Discover the art styles that are appealing to the target audience

• Explore the types of gameplay that are appealing to the target audience

Research findings

• According to research, the top five types of video games liked by teens were action/ adventure (83.3%), sports (70.8%), racing (68.8%), fighting (56.3%), and puzzle/strategy (50.0%). Those receiving the lowest ratings were casual (33.3%), educational (27.1%), and sandbox (14.6%). (Thompson et al., 2016)

• A wide variety of game features were viewed as ‘‘very important’’ by teens overall, with 50% or more reporting that gameplay (77.1%), controllable avatar or game character (60.4%), customizable characters (56.3%), story (56.3%), graphics (52.1%), and genre (50.0%) were ‘‘very important.’’

• Concerning the interests at the stage (13-17) of development, they think similarly to adults, except their interests and tastes are different. teens don’t like waiting for content to load, are reluctant to explore and click unknown items, prefer limited use of animation and sound effects, accept some scrolling, and prefer some interactive features (Bailey, 2017).

Insight to the project

Owing to the rehabilitation nature of the project, the design of the gameplay will be different from games that are designed for entertainment purposes. Novelty will be injected through an ingenious combination of gameplay, audio sounds and  environmental assets.

Market Research

Objective

• Identify areas for improvement in existing market offerings

• Determine gaps and unmet needs in the market for our target audience

• Gain insights into effective design elements and user engagement tactics

Research findings

• Existing products offer a wide range of game genres, indicating varied approaches to gamifying rehabilitation.

• Most of the products target a broad audience, with only one specifically designed for kids and teenagers, presenting an opportunity to cater to a niche demographic.

• Analysis reveals diverse upper body movements required in games, highlighting the importance of incorporating a variety of motions for comprehensive rehabilitation.

• Existing products employ multiple parameters to evaluate player performance, emphasizing the importance of measuring progress across various dimensions for effective rehabilitation.

Insight to the project

The research indicates diverse game genres and target demographics, highlighting a gap in offerings for kids and teenagers. Varied upper body movements are crucial for effective rehabilitation, while evaluation metrics vary across existing products. Assessing features against our goals revealed opportunities for differentiation. These insights will steer our product development towards creating a compelling rehabilitation gaming solution.

Comparative & Competitive Analysis

Key Findings:

• Existing products offer a wide range of game genres, indicating varied approaches to gamifying rehabilitation.

• Most of the products target a broad audience, with only one specifically designed for kids and teenagers, presenting an opportunity to cater to a niche demographic.

• Analysis reveals diverse upper body movements required in games, highlighting the importance of incorporating a variety of motions for comprehensive rehabilitation.

• Existing products employ multiple parameters to evaluate player performance, emphasizing the importance of measuring progress across various dimensions for effective rehabilitation.

Personas

2. Game Concept

The team were able to develop 2 mini-games: Forest Concert and Wish Granter Inc. Both are first-person VR games specifically crafted for upper limb rehabilitation at home.

Enchant forest creatures with your baton and create a woodland masterpiece.

In Forest Concert, players find themselves immersed in the role of a conductor within the setting of a forest camping ground. As they take charge of the forest orchestra, they need to trace the designated conducting pattern in the air, and the movement precision influences the quality of the performance. The animal audience isn’t mere spectators - they actively respond to the show. They may cheer for exceptional displays or boo lackluster ones. With a variety of music genres to explore and an audience eager for entertainment, players are invited to embark on this enchanting VR journey, where their conducting skills shape the harmony in the forest.

Wish Granter Inc.

As for Wish Granter Inc., players step into the mystical role of a wish granter, stationed in their office. Various animals visit, each with unique desires, ranging from the absurd to the extraordinary. From an elephant yearning to strut in high heels to a chicken dreaming of MMA glory, the wishes are as diverse as the animals themselves. To fulfill these wishes, players must cast spells by tracing the therapist-defined trajectories in the air. However, the precision of their movements directly affects the outcome. A well executed spell realizes the wish perfectly, while some deviation can lead to unexpected and often hilarious consequences. As players strive to meet the wishes with precision and grace, they'll find themselves navigating through a whimsical world where every spell cast brings them closer to mastering their rehabilitation journey.

In-Game Scenes

3. Design System

4. User Interface

Two prototypes were considered when designing the user interfaces: one is the in-game VR interface developed in Unity Engine for patient interaction, and the other is a more functional, less stylized back-end UI for therapist setup.

Design WIP