title: Increasing motivation in robot-aided arm rehabilitation with competitive and cooperative gameplay.
abstract: BACKGROUND
  Several strategies have been proposed to improve patient motivation and exercise intensity during robot-aided stroke rehabilitation. One relatively unexplored possibility is two-player gameplay, allowing subjects to compete or cooperate with each other to achieve a common goal. In order to explore the potential of such games, we designed a two-player game played using two ARMin arm rehabilitation robots.
  
  
  METHODS
  The game was an air-hockey task displayed on a computer monitor and controlled using shoulder movements in the ARMin robot. Three game modes were tested: single-player (competing against computer), competitive (competing against human), and cooperative (cooperating with human against computer). All modes were played by 30 unimpaired subjects and 8 impaired chronic stroke subjects. The subjects filled out the Intrinsic Motivation Inventory questionnaire after each game mode, as well as a final questionnaire about game preferences and their personality.
  
  
  RESULTS
  Nearly all unimpaired subjects preferred playing the two-player game modes to the single-player one, as they enjoyed talking and interacting with another person. However, there were two distinct player groups: one liked the competitive mode but not the cooperative mode while the other liked the cooperative but not the competitive mode. Unimpaired subjects who liked the competitive mode also put significantly more effort into it than into the other modes. Results from impaired subjects were similar, with even impaired subjects over 60 years old enjoying competitive gameplay. The subjects' personalities roughly predicted which mode they would prefer, which was especially evident in a poorly-matched impaired pair that preferred the single-player mode.
  
  
  CONCLUSIONS
  Results indicate great potential for two-player rehabilitation games, in the form of greater enjoyment as well as potentially more intensive exercise compared to single-player games. However, the right game type needs to be chosen for each subject depending on skill and personality, along with selecting an appropriate co-player. Further studies with patients that are currently enrolled in rehabilitation programs are recommended, and the subjective measures used in our study should be augmented with objective measures such as electromyography.
authors.affiliation: Sensory-Motor Systems Lab, ETH Zurich, Zurich, Switzerland. domen.novak@hest.ethz.ch.
authors.forename: Domen
authors.initials: D
authors.lastname: Novak
authors.forename: Aniket
authors.initials: A
authors.lastname: Nagle
authors.forename: Urs
authors.initials: U
authors.lastname: Keller
authors.forename: Robert
authors.initials: R
authors.lastname: Riener
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm; D005081:Exercise Therapy / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012371:Robotics / Q000379:methods*; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation; D018910:Video Games / Q000523:psychology*
references.citation: J Neuroeng Rehabil. 2010 Sep 22;7:48
references.pmid: 20860808
references.citation: Soc Sci Med. 2000 Feb;50(4):495-506
references.pmid: 10641802
references.citation: N Engl J Med. 2010 May 13;362(19):1772-83
references.pmid: 20400552
references.citation: Arch Phys Med Rehabil. 2013 Sep;94(9):1737-46
references.pmid: 23500181
references.citation: J Rehabil Res Dev. 2006 Aug-Sep;43(5):695-710
references.pmid: 17123209
references.citation: Lancet Neurol. 2014 Feb;13(2):159-66
references.pmid: 24382580
references.citation: Br J Psychol. 2013 Aug;104(3):320-38
references.pmid: 23848384
references.citation: J Rehabil Med. 2011 May;43(6):493-9
references.pmid: 21491072
references.citation: Cochrane Database Syst Rev. 2011 Sep 07;(9):CD008349
references.pmid: 21901720
references.citation: Neuropsychol Rehabil. 2011 Dec;21(6):808-24
references.pmid: 21916659
references.citation: Annu Int Conf IEEE Eng Med Biol Soc. 2011;2011:1395-8
references.pmid: 22254578
references.citation: Psychol Rep. 2002 Feb;90(1):31-4
references.pmid: 11899003
references.citation: Disabil Rehabil. 2006 Jul 15-30;28(13-14):823-30
references.pmid: 16777769
references.citation: Arch Phys Med Rehabil. 1998 May;79(5):475-87
references.pmid: 9596385
references.citation: Stroke. 2009 Jan;40(1):169-74
references.pmid: 18988916
references.citation: Med Biol Eng Comput. 2011 Oct;49(10):1213-23
references.pmid: 21796422
references.citation: J Neuroeng Rehabil. 2013 Sep 28;10:102
references.pmid: 24073670
references.citation: Cyberpsychol Behav Soc Netw. 2010 Jun;13(3):251-6
references.pmid: 20557243
references.citation: J Diabetes Sci Technol. 2012 Jul 01;6(4):812-9
references.pmid: 22920807
references.citation: Scand J Rehabil Med. 1975;7(1):13-31
references.pmid: 1135616
references.citation: Am J Occup Ther. 1985 Jun;39(6):386-91
references.pmid: 3160243
references.citation: J Neuroeng Rehabil. 2007 Feb 19;4:3
references.pmid: 17309790