Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity

Abstract

Background: People with chronic arm impairment should exercise intensely to regain their abilities, but frequently lack motivation, leading to poor rehabilitation outcome. One promising way to increase motivation is through interpersonal rehabilitation games, which allow patients to compete or cooperate together with other people. However, such games have mainly been evaluated with unimpaired subjects, and little is known about how they affect motivation and exercise intensity in people with chronic arm impairment.

Methods: We designed four different arm rehabilitation games that are played by a person with arm impairment and their unimpaired friend, relative or occupational therapist. One is a competitive game (both people compete against each other), two are cooperative games (both people work together against the computer) and one is a single-player game (played only by the impaired person against the computer). The games were played by 29 participants with chronic arm impairment, of which 19 were accompanied by their friend or relative and 10 were accompanied by their occupational therapist. Each participant played all four games within a single session. Participants' subjective experience was quantified using the Intrinsic Motivation Inventory questionnaire after each game, as well as a final questionnaire about game preferences. Their exercise intensity was quantified using wearable inertial sensors that measured hand velocity in each game.

Results: Of the 29 impaired participants, 12 chose the competitive game as their favorite, 12 chose a cooperative game, and 5 preferred to exercise alone. Participants who chose the competitive game as their favorite showed increased motivation and exercise intensity in that game compared to other games. Participants who chose a cooperative game as their favorite also showed increased motivation in cooperative games, but not increased exercise intensity.

Conclusions: Since both motivation and intensity are positively correlated with rehabilitation outcome, competitive games have high potential to lead to functional improvement and increased quality of life for patients compared to conventional rehabilitation exercises. Cooperative games do not increase exercise intensity, but could still increase motivation of patients who do not enjoy competition. However, such games need to be tested in longer, multisession studies to determine whether the observed increases in motivation and exercise intensity persist over a longer period of time and whether they positively affect rehabilitation outcome.

Trial registration: The study is not a clinical trial. While human subjects are involved, they participate in a single-session evaluation of a rehabilitation game rather than a full rehabilitation intervention, and no health outcomes are examined.

Keywords: Exercise intensity; Interpersonal rehabilitation games; Motivation; Multiplayer games; Rehabilitation; Social interaction; Virtual reality.

Fig. 1

The BiMeo used unimanually without support (top left), unimanually on a table (top right), bimanually without support (bottom left), and bimanually on a table (bottom right)

Fig. 2

The rehabilitation games. From left to right: single-player / competitive game (which look the same), cooperative game with split field, cooperative game with shared field

Fig. 3

Experimental setup. An impaired participant (left) wears the BiMeo device and exercises together with an unimpaired participant (in this case, their spouse), who uses a joystick. The games are displayed on the laptop in front of them

Fig. 4

An impaired participant’s hand velocity in the single-player game. The first 50 s are a high-intensity exercise interval while the second 50 s are a low-intensity interval

Fig. 5

Results of the overall experience questionnaire for all impaired participants. Presented as numbers of participants that chose a particular game in response to the questions “What was your favorite game?”, “Which game did you put the most effort into?”, “What game did you feel the most competent at?”, and “Which game was the most stressful?”

Fig. 6

Self-reported interest/enjoyment in different games for all impaired participants (N = 29), for participants whose favorite game was the competitive one (N = 12), and for participants whose favorite game was one of the two cooperative ones (N = 12). Presented as means and 95% confidence intervals

Fig. 7

Self-reported effort/importance in different games for all impaired participants (N = 29), for participants whose favorite game was the competitive one (N = 12), and for participants whose favorite game was one of the two cooperative ones (N = 12). Presented as means and 95% confidence intervals

Fig. 8

Root-mean-square values of hand velocity in different games for all impaired participants (N = 28), for participants whose favorite game was the competitive one (N = 12), and for participants whose favorite game was one of the two cooperative ones (N = 12). Presented as means and 95% confidence intervals