d6.3 ll implications 130531 finalfp7-ict-2011-7 contract #287361 istoppfalls deliverable the siegen...

ISTOPPFALLS FP7-ICT-2011-7 Contract #287361

iStoppFalls Deliverable <6.3>

The Siegen & Sydney Living Lab Studies

Implications for Re-Design

Editor: Anne Weibert (USI), Ashley Woodbury (NeuRA)

Deliverable nature: <Report (R)>

Dissemination level: (Confidentiality)

<Public (PU)>

Contractual delivery date: M22

Actual delivery date: M20

Suggested readers: All project members

Version: 2.0

Total number of pages: 36

Keywords: Living Lab, Falls, Older adults, Technology, Implications for Design

Abstract

This Deliverable reports results and implications from the Siegen and Sydney Living Lab Studies. The primary focus is the design implications for the re-design of the components of the iStoppFalls system. Those implications have been derived from a series of usability tests and observations, semi-structured interviews, workshop and focus group, as well as from questionnaires.

ISTOPPFALLS Deliverable D<6.3>

of (36) © ISTOPPFALLS consortium 2011 – 2014

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[Full project title] ISTOPPFALLS– ICT-based System to Predict &Prevent Falls

[Short project title] ISTOPPFALLS

[Number and title of work-package] WP6 - End-User Developments

[Document title] The iStoppFalls Living Lab Study - Implications for Design

[Editor: Name, company] Anne Weibert (USI), Ashley Woodbury (NeuRA)

[Work-package leader: Name, company] Anne Weibert (USI)

Copyright notice

2011-2014 Participants in project ISTOPPFALLS

Deliverable D<6.3> ISTOPPFALLS

© ISTOPPFALLS consortium 2011 - 2014 of (36)

Executive summary

This report presents the implications for the improvement of the design of the iStoppFalls system that have been derived from the different living lab study results from Siegen and Sydney. In the process of these studies, the system was installed and tested by means of quantitative as well as qualitative empirical methods in participant households over the course of four months (Siegen, n=10) and 1 month (Sydney, n=4).

The four topical areas that emerged from these results form the basis for the implications for design presented in this report. These are

the utilization of the technology;

orientation;

language/ word choice; and

the user experience.

Furthermore, implications for design also circle around these topics. In this report, they are presented by each system component.

With regard to the exergame, seven areas for improvement have been identified: utilization and function, the introductory explanation, balance/ strength training of the game, the avatar appearance, the audio experience, fall risk assessment, and entering and exiting the game.

Regarding the iTV, implications for design included: navigation around the system, the labelling of system functions, and the entering and exiting of the iTV system.

Design implications for the SMM relate to the technical management, the appearance and the visualization of results.

With regard to the Social Media Platform the design implications include: general communication via message, profile use and the enhancing of friendships.

Design implications for the Gesture- and Voice Control focus around the recognition and sensitivity of the control functionality, and the utilization of the control device.

Regarding the Tablet the implications for design relate to the correct adjustment of screen resolution, and the utilization of the device.

For the Interactive Tutorial that was developed additionally and tested with mock-up screens in a first evaluation phase of the iStoppFalls living lab, the design implications relate to: navigation, the mascot that is guiding participants through the tutorial, language and word choice.

Results and Implications from the Siegen and Sydney Living Labs are presented in different sections of this document.



List of authors

Company Author

USI Anne Weibert

USI Thomas von Rekowski

USI Rainer Wieching

USI Volker Wulf

USI Sima Schöning

USI Katja Gutjahr

USI Laura Festl

USI Hannes Kurze

USI Daryoush Vaziri

NeuRA Ashley Woodbury

NeuRA Kim Delbaere

DSHS Hannah Marston



Table of Contents Executive summary ........................................................................................................................................... 3 List of authors .................................................................................................................................................... 4 Table of Contents .............................................................................................................................................. 5 1 Introduction ................................................................................................................................................ 6 2 Methods and Data Analysis ........................................................................................................................ 7

2.1 Siegen Living Lab ............................................................................................................................... 7 2.1.1 Methods ....................................................................................................................................... 7 2.1.2 Data Analysis ............................................................................................................................... 7

2.2 Sydney Living Lab .............................................................................................................................. 7 2.2.1 Participants .................................................................................................................................. 7 2.2.2 Baseline assessments ................................................................................................................... 8 2.2.3 Intervention .................................................................................................................................. 8 2.2.4 Outcomes ..................................................................................................................................... 8

3 Summary of results from the Siegen & Sydney living labs ....................................................................... 9 3.1 Siegen Living Lab (D2.4) ................................................................................................................... 9 3.2 Sydney Living Lab .............................................................................................................................. 9

3.2.1 Recruitment .................................................................................................................................. 9 3.2.2 Participants .................................................................................................................................. 9 3.2.3 Qualitative evaluation of the iStoppFalls program – questionnaires ..........................................10 3.2.4 Qualitative evaluation of the iStoppFalls program – interview ..................................................12

4 Implications for Re-Design from the Siegen Living Lab ..........................................................................14 4.1 Exergame ...........................................................................................................................................14 4.2 iTV .....................................................................................................................................................15

4.2.1 Design implications resulting from usability tests ......................................................................15 4.2.2 Design implications resulting from the questionnaires ...............................................................17 4.2.3 Design implications resulting from the workshop ......................................................................18 4.2.4 Design implications resulting from interviews ...........................................................................18

4.3 SMM ..................................................................................................................................................19 4.4 Social Media Platform .......................................................................................................................19 4.5 Gesture- and Voice-Control ...............................................................................................................20

4.5.1 Gesture control ............................................................................................................................20 4.5.2 Voice control ..............................................................................................................................20

4.6 Tablet .................................................................................................................................................21 4.7 Interactive Tutorial .............................................................................................................................21

5 Implications for Re-Design from the Sydney Living Lab .........................................................................23 5.1 Exergame ...........................................................................................................................................23

5.1.1 Prediction assessments: ..............................................................................................................23 5.1.2 Balance games: ...........................................................................................................................24 5.1.3 Strength exercises: ......................................................................................................................24 5.1.4 Acceptability of using Exergame in older adults ........................................................................24

5.2 SMM ..................................................................................................................................................24 5.2.1 Acceptability of wearing a mobility monitor in older adults ......................................................25

5.3 iTV .....................................................................................................................................................25 5.3.1 SMP ............................................................................................................................................25 5.3.2 Education ....................................................................................................................................25 5.3.3 Acceptability of an in-home telehealth system in older adults ...................................................25

5.4 Technology issues and installation problems: ....................................................................................26 5.4.1 Kinect camera detection..............................................................................................................26 5.4.2 Voice recognition ........................................................................................................................26 5.4.3 Remote control ............................................................................................................................26 5.4.4 Installation ..................................................................................................................................26

5.5 Limitations and implications for future research ...............................................................................26 6 Conclusion .................................................................................................................................................28 Annex A Detailed data from the Sydney Living Lab .................................................................................29



1 Introduction

This report includes result and implications from both living lab sites of the iStoppFalls project, Siegen and Sydney. Results from the Cologne Pilot are reported in deliverable D2.3.1.

The living lab studies were conducted to assess an in-depth understanding of the initial development of the iStoppFalls system. This was achieved by installation and testing of the system by means of quantitative as well as qualitative empirical methods in participant households. This was done in subsequent phases over the course of four months in Siegen and for one month in Sydney.

Twelve participants took part in the study in Siegen. The participants included; four males, and eight females. Two of the female participants dropped out in the early stage (month 1) of the living lab, because they were frustrated with the system not working. The average age of the remaining ten participants was 72.8 years, with the youngest participant being 60 and the oldest being 85 years old.

Five 'Tech-savvy' older adults were recruited from an exercise clinic in Sydney. Baseline data was collected via questionnaires and a physical and cognitive assessment after informed consent was gained.

The results focused on (1) the use of the technology and familiarization with the new digital devices, (2) navigation and structure, (3) language and choice of words used in the system, and (4) the user experience of the iStoppFalls system.

The objective of this approach is to increase accuracy and reliability of the system. As all results from the Siegen living lab have been laid out per system component in great detail in Deliverable D2.4 and the usability of iStoppFalls AAEP has also been assessed and reported in Deliverable D 2.1.8. This report solely focuses on the design implications that have derived from living lab results.

The design implications are presented by system component

Exergame;

iTV;

SMM;

Social Media Platform;

Gesture- and Voice Control;

Tablet; and

Interactive Tutorial.

They have been assessed by means of a combination of methods. For the analysis of data, usability problems and incidences were prioritised according to their frequency, as well as the significance of the respective function or feature of the iStoppFalls system. Results from usability tests, interviews, focus group, workshop and questionnaires were combined to add strength to the design implications that have been derived from each of the methods.



2 Methods and Data Analysis

2.1 Siegen Living Lab

2.1.1 Methods

The Siegen living lab was undertaken in three phases. Phase one was the familiarization of the system. It covers the installation of the system in the participant’s households; participants get to know the other participants and the research team, and the course of the up-coming living lab activities in addition to the technology involved is explained in detail.

In the second phase of the Siegen living lab, all participants are familiarized with the system including how to use it. Several methods are applied to record their experiences: (1) participant’s experiences are collected via diaries (where each participant has a copy of his/her own to record their experiences, problems encountered and facets which they dis/liked), (2) A number of system utilizations are being observed by researchers, these include: a usability-walkthrough, where pre-defined realistic tasks are given and user completion is evaluated by means of a rating scale (from 1-4). Simultaneously the participants are required to “think aloud” during this process, voicing their thoughts about the task, and finally (3) several questionnaires focusing on usability, accessibility, user experience and environment were distributed to all participants to be completed.

In the third and final phase of the Siegen living lab, several semi-structured, qualitative interviews were conducted, enabling participants to express and detail their experiences with the iTV, exergame and SMM. During the interviews, the participants had the opportunity to discuss any problems which occurred and changes that they would make. Furthermore, participant experiences are collected via workshops, usability tests and an additional set of questionnaires are completed, in conjunction with diaries collected from all participants and then analyzed.

A detailed description of the Siegen living lab approach and all methods used can be found in D2.4.

2.1.2 Data Analysis

For the analysis of the data, usability problems and incidences were prioritised according to their frequency, as well as the significance of the respective function or feature of the iStoppFalls system. Results from usability tests, interviews, focus group, workshop and questionnaires were also combined to further strengthen the weight of the implications for design that have been derived from each of the methods.

2.2 Sydney Living Lab To determine the feasibility of the iStoppFalls Exergame and the Philips Senior Mobility Monitor (SMM), five 'Tech-savvy' older adults were recruited from an exercise clinic in Sydney.

2.2.1 Participants

Participants were recruited through advertisements and flyers at an exercise clinic in Sydney. Participants were eligible for the trial if they were at a relatively high risk of falls defined as (a) aged 65–79 years with a history of one or more falls in the last 12 months or b) aged 80 years and over. Other inclusion criteria comprised: indicating that they are 'confident' of complying with the study recommendations. People were excluded if they: resided in a high-care residential facility, had a cognitive impairment (an ACE-III score of less than 87), a severe visual impairment, insufficient English language skills to understand the assessment and/or intervention procedures, or had a medical condition at enrolment that prevented participation in an exercise program. All participants were required to give informed consent prior to baseline assessments.



2.2.2 Baseline assessments

Initially the study aims were explained, and then the participants were asked if they felt ‘confident’ to undertake a regular exercise program (3 sessions per week [30-60 minutes/session]). Only participants who answered 'very or quite confident’, as opposed to 'not confident' or 'very unconfident', underwent consent, assessments and allocation to the intervention. The rational of targeting this intervention to those who perceived themselves as ‘confident’, is to increase adherence to the exercise program. Demographic details and potential confounders were recorded, including age, gender, living alone status, technology use, falls history, and medical history. A general disability score across six domains (i.e., understanding and communicating, mobility, self-care, interpersonal interactions, household and work activities, and participation in society) was obtained using the 12-item World Health Organization Disability Assessment Schedule (WHODAS II), Quality of life was assessed using the 20-item AQOL II. The average weekly physical activity over the past 3 months was assessed with the Incidental and Planned Exercise Questionnaire. Symptoms of depression were assessed using the 15-item Geriatric Depression Scale. The 30-item Iconographical Falls Efficacy Scale (Icon-FES) was used to measure concerns regarding falls during everyday activities. Physiological fall risk was estimated with the short-form Physiological Profile Assessment (PPA). Functional mobility was assessed with the timed up and go test and the sit-to-stand test. The cognitive assessment the ACE-III and Trail making Test (Trails A and B). Following the initial assessment, participants received a home visit from a trained research assistant to establish an appropriate location within the home for training. During the first home visit, participants received a lesson in system use and any possible physical or technical impediments to system use were addressed.

2.2.3 Intervention

The Exergame consists of exercises primarily targeting balance and strength suited to the functional level and interests of older adults. The participants were advised to perform the exercises 3-4 times a week for approximately 20 min. The Exergame contains two parts, i.e. strengthening exercises and balance exercises. The strength exercises are taken from the Otago exercise program and include exercise for front knee extensors, back knee flexors and side hip muscles. The balance exercises are delivered through a game called the ‘Bumblebee’ game and incorporates stepping balance and leaning balance. Participants are asked to perform the physical assessment once a week to track their progress and improvement in physical outcome measures. The assessment involves near tandem standing for 10-30 seconds, standing up 5 times from a chair as fast as possible, and a reaction time test. Senior Mobility Monitor (SMM) The SMM is an inertial sensor system which is worn as a necklace without restrictions. The SMM can assess the level of activity continuously, taking an average activity level over each minute Participants are asked to wear the SMM as often as possible and were required to charge the device overnight.

2.2.4 Outcomes

Participants were required to complete a falls and adverse events calendar, an adherence calendar on a weekly basis. Participants received calls on a weekly basis and could also access a support line. During the reassessment participants filled in a usability questionnaire relating to their experience with the exergame (see Annex 1). This questionnaire was developed on the basis of survey data from three published questionnaires: The Physical Activity Enjoyment scale (PACES), the Flow State Scale and the System Usability Scale (SUS). First, the participants could rate the overall iStoppFalls program from ‘worst imaginable’ (1) until ‘best imaginable’ (7). To calculate with the results, this scale was rescaled to a percentage. The participants were also asked to indicate if they would like to integrate the IStoppFalls program to their everyday life. They could answer this question with ‘disagree’ (1) until ‘agree’ (4). Again, this score was rescaled to a percentage. To assess the experience of the participants with the Exergame and SMM, the questionnaire was divided into three sections; enjoyment, usability and immersion. Results were rescored to a percentage and an average percentage calculated. A detailed report on the AAEP and exercise specific outcomesare described in deliverable D2.1.8.



3 Summary of results from the Siegen & Sydney living labs

3.1 Siegen Living Lab (D2.4)

Overall, the results that have been identified from the Siegen Living Lab form four extended areas of interest.

Primarily, what was identified was the use of the technology and familiarization by the participants. For many of the participants they had not previously used the devices which also contributed to their use and familiarization process.

Secondly, the results relate to the navigation of the system. For example, the structure of the system was not always clear and self-explanatory. Consequently, participants lacked an overview of exactly where they were in the system and how they should navigate to another section.

Additionally, the language and choice of words was reported. For example, the labelling of items and features in the system is crucial for ease of use within the iStoppFalls system.

Finally, the user experience of the iStoppFalls system was an issue. This aspect showed even though there were extensive technical problems in the first phase of the living lab. User’s experiences with the system could still be collected.

All results have been presented in greater detail through each system component in Deliverable D2.4. This information forms the basis for the implications for design from the Siegen Living Lab given in the proceeding chapter.

3.2 Sydney Living Lab

For a more detailed overview, please refer to Annex A.

3.2.1 Recruitment

A total of nine people expressed an interest in being further screened for the study after they saw the advertisement. Individuals were excluded for the pilot study for the following reasons: (1) no LCD TV or wireless internet (n=1); (2) no wireless internet (n=1); (3) did not respond to any phone calls (n=1); (4) had a fall and was to shaken up to participate (n=1). All the drop outs were interested to participate in the future Randomized Clinical Trial though. All in all, this resulted in a total sample size of 5 participants.

3.2.2 Participants

Five people agreed to participate in the study (4 females, 1 male). The average age of the participants was 73.2 years (SD 8.2). Of these, one dropped out after baseline assessment due to generalized pain. The sample characteristics for the 5 participants are described in Table 1. No serious adverse events occurred during the intervention. There was one fall reported, this did not occurred while using the exergame and the participant was able to continue participating in the study. Table 1: Sample Characteristics (n = 5) P1 P2 P3 P4 P5 Age 66 79 64 83 74 Gender Female Female Male Female Female College educated or higher

No No Yes Yes Yes

Married/partnered No Yes Yes No No Live alone Yes No No Yes Yes Retired, not working Yes Yes Yes Yes Yes Body Mass Index 27.3 31.7 23.3 22.4 29.1 Health Status (self-rated) Moderate Good Excellent Moderate Moderate



Balance (self-rated) fair fair Excellent poor fair >2 chronic conditions No No No No No Fall in past 12 months 2x 1x 0 2x 0 Help for ADL No No No No No Experience with video games

No No No No No

Exercise(times per week) 2x 1x 7x 3-6x 2x Confident using new technologies

yes yes yes yes Yes

EQ-5D scale 85 80 100 80 50 ACE 92/100 86/100* 93/100 93/100 87/100 Trails A 37.35 sec 38.50 sec 42.38 sec 57.09 sec 52.38 sec Trails B 2 min 43.59

sec 2 min 38.40 sec

1 min 0.33 sec

1 min 52.81 sec

2 min 16.40 sec

Fall risk score ** 0.13 -0.99 -1.1 0.9 -0.43 *Not excluded due to non-English speaking background. **Fall risk score: displayed as a Z-Score:, See Figure 1 for an overview of the fall risk score of the five participants.

Fig. 1 Fall risk score of the five participants.

3.2.3 Qualitative evaluation of the iStoppFalls program – questionnaires

The overall iStoppFalls system was rated as ‘good’ (5 out of 7) by three out of four participants. One participant rated it as ‘awful’ (2 out of 7). The percentages therefore are: P171.4%, P271.4%, P371.4%, P428.6%. Thus, the overall score of the iStoppFalls program was 60.7 %( SD=18, 9%) Two out of four participants ‘slightly agree’ (3 out 4) that they could see themselves integrating the use of the iStoppFalls program in their everyday life, one agreed (4 out 4) and one disagreed (1 out of 4). The percentages thus are: P175%, P2100%, P375%, P425%. Therefore, the score for the integration of the program in their everyday life was 68.75%(SD= 31.46) (see fig. 2 and 5)



The overall score for enjoyment of the Exergame was 60 %( SD=29.3). Immersion is scored as 54 %( SD=29.3) overall and usability as 64.75% (SD=2.2) overall. (see Fig. 3)

Only the usability of the SMM was measured on the questionnaire. The overall score was 80.8 %( SD=7.4). (see Fig. 4)



3.2.4 Qualitative evaluation of the iStoppFalls program – interview

All four participants indicated that the sensor did not always detect the movements the participants were performing. Because of this, the participants sometimes performed the exercise more often than was intended. The participants were asked to abort the game if this occurred. Three out of the four participants experienced difficulties using the remote. The remote has many buttons while only the ‘’up/down/left/right’’ and ‘’OK’’ buttons were used. P2 suggested integrating the remote into the SMM. All four participants found the instructions where too long. The option to skip instructions often failed meaning participants had to listen to instructions before being able to start the game every time. P1 said: ‘’The instructions take too long, a picture would be enough’’. Two out of four participants reported that they did not find the exercises challenging enough. All of the participants experienced technical difficulties. Common problems include: failure of the Kinect voice recognition function, poor object and movement detection of the game resulting in a distorted avatar, and internet connection problems. Three of the four participants said that they would like to see more games incorporated into the iStoppFalls system. They suggested a tennis game or skiing game. Also, P1 said: ‘’I would like to see more bees in the BumbleBee game, this is quite good for us older people’’. P4 participant found it hard to see which option in the menu was highlighted. She said: ‘’How can older people with cataracts see this?’’ Three of the four participants enjoyed playing the BumbleBee game. P2 said: ‘’This game is fun and the exercise is good for me’’. Finally, two out of four participants thought that the iStoppFalls exergame was appealing.



4 Implications for Re-Design from the Siegen Living Lab

4.1 Exergame

With regard to the exergame, seven areas were identified focusing on improvements relating to the design facet, which was extracted through usability tests, interviews and questionnaires. This information is explained below.

Handling and Control:

- Older adults may have different health constraints, e.g. impaired hearing or visual abilities, following a stroke. With this in mind, there should be a choice of input devices offered enabling the users to interact successfully with the system, i.e. via standard controller, a tablet or voice and gesture control.

Introductory Explanation:

- There should be a skip button implemented enabling the user to choose to turn off the introductory explanation at the beginning of the game. It was perceived by the participants to be frustrating and annoying. Additionally, there could be the pop-up of the introductory explanation if the system has not being used for several weeks. Finally, the introduction should be displayed in the menu section at all times and where this element can be located.

- The content of the introductory section should be carefully reworded and checked, to eliminate incorrect images and language errors. For example; when an explanatory image indicates that an exercise needs to be executed sideways to the TV, what it actually means is the exercises needs to be conducted in front of the TV.

- The characters – especially the male one – in the introduction section were not perceived by the participants to be sympathetic. It was requested that they should appear friendlier, as this would support and increase motivation. With this in mind changing the characters should be considered.

Balance Game:

- The level of difficulty should be increased sufficiently at intervals to keep all participants engaged throughout the game.

- To maintain the experience of enjoyment, new challenges should be implemented. An example of this could be obstacles which need to be avoided by the user. Furthermore, increasing the speed throughout the game will add an additional challenge and it is suggested this could enhance user motivation.

- The games implemented should appeal to both genders of users. Both sexes reported different ideas. For example; the male participants wished for more sporting activities, such as golfing, tennis or skiing. Additionally, hiking was reported the female participants as a game concept which they would enjoy playing. Furthermore more, walking through a maze or labyrinth and the exploration of different cities. Dancing was also reported, however, it is to be considered this may not be possible unless it was a stepping concept similar to that of the DDR game.

- Incorporating a multi-player option was suggested and may motivate the users to play enabling the notion of social gaming.

Strength Training:

- Implementing feedback into the system which would provide users whether they are actually executing the exercises correctly. The idea of a “trainer” could be included, who would lead the user through the exercises, and provide tips and advice. Furthermore, the participants reported the implementation of a trainer to advise on correct breathing would be beneficial.

- Personalizing the training should be considered to correlate with the user’s health condition. The participants would like the option to exclude exercises they were not able to complete due



to their health impairments. Further amendments included the increase of difficulty and the number of cycles should also be customized by the respective participant. This would diminish the risk of either over- or under-challenging users.

Avatar:

- The appearance of the avatar in the game should be reworked. In the questionnaires, participants rated the avatar to be not sympathetic, artificial, and no figure one would want to identify with. This feedback was confirmed in the interviews where participants demanded the avatar to be more friendly and moving more realistically.

Fall Risk Assessment:

- The revision of the fall risk assessment questionnaire should be considered. This is suggested because the navigation throughout the questions was difficult for the users to understand. Additionally, the answers provided for the users to select were not necessarily easy to understand or are lacking in connection. For example, the assessment does allow the user to choose several answers or a non-applicable option. The design of the questionnaire should also be reworked as it was perceived to be irritating. However, it is to be taken into consideration the design of the fall risk assessment was developed from standardized assessments which had previously being completed by a clinician and patient through a paper and pen assessment. Due to the requirements of the iStoppFalls project, the re-development of the assessment is not necessarily feasible.

Turning the Game On and Off:

- The game should automatically start when the user enters the environment. This could be executed via an .exe file format, similarly to what one would see when playing a AAA commercial game developed by EA games.

- Once the user has completed the training element of the system, it should lead the user back to the main menu section not automatically turn off. Additionally, a “turn off”-option should be included in the iTV application.

Audio:

- The implementation of audio into the exergame would enhance the user experience. For example; in the “Bumblebee park” balance game, the volume of the bee sound should be lower, as it was perceived to be annoying and also conflicting the voice control.

- Additional sound should be implemented into the strength training. It is suggested providing the users with a choice of sounds. The participants suggested slower, relaxing styles, as well as more lively beats and marches. There should be an option to include a beat, so that users can conduct the training following the correct rhythm.

4.2 iTV

Implications for design with regard to the iTV have been derived from usability tests, questionnaires, interviews and a workshop. These are presented in the following sections. As we see implications double resulting from different measurements, this can be taken as a strengthening of the importance of the respective implication.

4.2.1 Design implications resulting from usability tests

There were nine areas for the improvement to the design of the iTV section which were identified from the usability tests.

Lack of support mechanisms which hindered the fostering of intuitive orientation:

- An improvement of navigation across the lower levels, to provide the four sections on the main menu and the current choice.



- There should be an improvement of descriptions relating to the menu contents. For example; what facets can be found behind the different menu points (e.g. for “activity profile”: “Here you find the movement data that the SMM has recorded for you”). Another option might be the extension of the given functionality names, e.g. “start training/assess fall risk”. This might be i.e. in form of a pop-up text box.

- Improved labelling of the start menu – e.g. via headline “iStoppFalls main menu”.

- Every level should have a direct link back to the main menu. This link should be clearly labelled, e.g. “to the main menu”.

- There should be a direct link to the assessment of fall risk in “Learning”-“My fall risk”.

- At the initial start of the system, there should be a full description of all features and functionalities. This information should be easily accessible by the participant when they want to, for example via a tutorial.

The iTV system is not perceived as part of the iStoppFalls system:

- At the initial login of the system, all components should be explained. This explanation should be accessible at all times, e.g. as part of a tutorial.

- Improved labelling of the start menu – e.g. via headline “iStoppFalls main menu”.

The naming of the functionalities are not suitable for the targeted user group:

- The term “gesture control” should be replaced, and should coincide with an illustration of the meaning.

- Simplifying the terms within the “settings” section, or provide more specific explanations of the functionalities, or subdivision of this section in “user settings” and “administrator settings”.

- The term “activity profile” may need to be re-labelled or provide a more detailed description of this feature.

Exiting the system is complicated:

- At the moment the label “sign off”, is not comprehensive, and it is suggested changing it to “change user” would be more comprehensible.

- Implementing both the “Quit” and “change user” options should be displayed.

- The “Quit” and “change user” buttons should not be placed under “settings” but instead be directly visible on all levels.

- The ability to switch to the TV program should be included in the system.

- The “Quit” function should be clearly marked on the control/input device.

Starting the system is complicated:

- There should be just one input/control device, it is suggested this will provide ease of use for the user when changing between different functions.

- The “Start” function should be clearly marked on the control/input device.

Navigation in question-answer sections is difficult:

- Direct move to the new answer option with every new question.

- Improved labelling of the current question.

- There needs to be an explanation of the “Quit” button, which needs to be clicked, when all of the questions have been answered.

- A notification to the participant should appear, when no answer(s) has been selected.

Intuitive opening of messages is not supported:



- When a new message has been received a notification of how the message can be opened and read, when a new message has arrived. Explanation, how it can be opened and read.

Educational material section:

- In this section the educational information is not easily readable and therefore it is suggested the font size needs to be made larger or provide the participant with the option of changing the font size themselves.

- It is suggested the layout of the information is not suitable and to improve on this, a reduction of the text and adding more images may be more appropriate.

Navigation in the “health guide” is difficult:

- The arrows should only be displayed, when scrolling is an option. For example, there should be just one arrow, when scrolling can be done in one direction only.

- Consider adding a “Forward” option in the ‘tips’ section.

- The “Close” button should be placed more prominently.

4.2.2 Design implications resulting from the questionnaires

There were seven areas identified for improvement to the iTV design.

Fault tolerance:

- It is suggested an appropriate input device for the prospective participants, such as a remote control with large buttons and labels would be more suitable.

- Implementing a colour scheme on the buttons or a prominent frame around the selected button would make the selection of the chosen function easier to understand.

Easy appropriation:

- There should be only one input device not several.

- When a user wants to start-up the system, there should be a precise start button label on the input device.

Controllability:

- There should be a direct link to the start menu from every level of the system.

- It is suggested displaying all four menu sections on every sub-page of the system to facilitate ease of use.

Personalization:

- It is suggested adjustment of font size could be implemented.

Minimize unnecessary actions:

- It is suggested the layout could be improved by reducing the amount of text per page and by adding (more) images.

- Appropriate input device for the targeted user group (older adults), such as a remote control with large buttons and labels.

Consistency:

- Substitution of grey accentuation of marked buttons as well as grey letters on the buttons in contrast by rich colours.

Self-Explanatory handling:

- Improved orientation on the lower levels, for example by means of a navigation path or the display of the four sections of the main menu and the current choice.



4.2.3 Design implications resulting from the workshop

Design implications derived from the workshop focused primarily on the reminder function are listed as follows:

It should be an individual character, being funny and animated.

The degree of concern about the lack of training could be displayed via a traffic light concept (character appears red, yellow or green).

Transfer of reminders should be configured individually (SMS, E-Mail or automated by a voice message on the telephone landline).

Display of the reminder with the next start of the system, when it has not yet been followed.

There should be the option to turn off the reminder function.

There should be an option to delay the reminder.

There should be a direct link to the training section.

4.2.4 Design implications resulting from interviews

There were eight features which were identified for improvement these are as follows:

Use of the iTV section:

- Different input device; just one input device.

- Improvement of the “Start” procedure by clear labelling of “start” functionality on the input device.

Appearance of the menu:

- Enhanced frame around the button(s) when highlighted by the participant.

- Enhanced colour accentuation of marked buttons.

Navigation between the sections:

- Implement a “Back” button to access the quiz and the fall risk questions, instead of the “Back” button on the bottom part of the page.

- Implement a direct link back to the start page, symbolized by a house or the iStoppFalls logo.

- The four main sections of the menu should be visible at all times, in the training, on the sub-pages, and after finishing the exercises.

Exiting the system:

- Clear labelling of the “Exit” function in the iTV which changes to the TV program.

- There should be an option to separate the system from power.

Individualization:

- Provide an option to change font size according to one’s needs.

Gesture control:

- It is suggested a waiting time of 2-3 seconds.

- It is suggested a hand symbol instead of a mouse arrow, similar to that found on some websites would appear when the user is hovering over a button. Otherwise the arrow should be visible.

- Information on the quality of recognition should be displayed on the screen (for example green hand = good recognition; red hand = bad recognition).

Voice control:



- The terms/explanations should be written on the buttons. The main word as well as the entire phrase should be recognized.

- It should be displayed on the screen that voice control is active.

- There should be a display of what can be said.

Reminder function:

- Transfer of reminders should be configured individually (SMS, E-Mail or automated by a voice message on the telephone landline).

More implications, regarding the real-time correction of movements have been reported in detail in Deliverable 2.1.8.

4.3 SMM

Two areas were identified during the living lab phase for improvement to the SMM these are:

Technical Management:

- The device is perceived as being too big and obtrusive;

- The possibility to minimize the movements of the device while wearing it should be added;

- The button should be explained more clearly, especially with regard to its significance for the start of the synchronization process.

Appearance:

- The LED should be placed less prominently and not be too distracting, and the purpose for it should be explained more clearly;

- The surface material might possibly be changed as it was perceived to be “not of good quality”.

Wearing Comfort:

- Alternative wearing modes could be considered, as the necklace mode was reported to be comfortable by the females, but was disliked by the male participants in the study. Male participants did not provide any alternatives to wearing the device.

Result Visualization:

- It should be ensured that results are readily available, as malfunctioning and missing results were reported to be frustrating and demotivating.

4.4 Social Media Platform

Four main areas were identified to the improvement of the design these are as follows:

Message function:

- A key area for improvement of the social media platform is concerned with the input device. For example; writing a message. It was noted holding the keyboard to write a message was not very comfortable and it was complicated (this was identified during the living lab).

- Participants reported the visual representation of this section was impersonal resulting in the users preferring not to write messages.

Communication:

- Participants requested an option to communicate via voice, similar to a feature like skype.

Enhancing friendships:

- It is suggested to change the term “friendship” as it is taken rather seriously among the targeted users. Alternative wording has not been proposed by the participants.



- Improvement in the search function is requested for example, enabling searches to be executed by user via their place of residence.

Profile use:

- An explanation is required relating how to make changes to one’s own profile. One participant discovered on his own that it was possible to make changes to the information given there however the participant was unsure how to execute this.

- The participants suggested the following information be made available on their profile: place of residence; age; profession; game results; online status.

Use of the “like” button:

- Greater visibility of the “like” button should be implemented, the participants perceived the icon to be too small. They also interpreted the colour (light grey) as an indicator that the button was inactive and could not be pressed.

4.5 Gesture- and Voice-Control

4.5.1 Gesture control

Several design implications could be identified from the participant feedback undertaken from the usability test these are listed below:

“Back” Navigation:

- There should be a clear, visible signal when buttons have been successfully triggered – even if the action still takes time to complete.

Handling of the Health Guide:

- Using the Health Guide (educational material) the button sizes and sensitivity need to be controlled carefully, to minimize the risk of the buttons being pressed by accident. It is possible this cause is due to the size and/ or the sensitivity of the gesture control.

Hand Symbol on the bottom part of the screen:

- The hand symbol at the bottom of the screen was not suitably coloured or self-explanatory to ease participant understanding. It is suggested, this can be improved by adding text information, stating “gesture control active”. Additionally, the symbol could be made to stand out more, if it was more colourful.

Recognisability of gesture functionality:

- Recognition of the gesture function needs to be made more visually clear. For example it should be clear, which buttons are controlled via each gesture. A logo may be appropriate placed on the buttons to signify that they are controlled by a gesture.

Low sensitivity:

- The sensitivity of the gesture control needs to be rectified, thus to eliminate accidental selection. This section should be able to be executed easily by the user.

Arrow cursor:

- The arrow cursor should behave similar to that found via a mouse and computer. It should not jump around and be more stable.

4.5.2 Voice control

Three points were identified by participants from the usability tests these are as follows:

Recognisability of voice functionality:



- Recognition of the voice functionality needs to clearer. This could be via a signal displaying that voice control is active, e.g. with a pre-defined symbol or text.

- Also, there should be a clear and coherent visualization, which buttons are active for voice control and how these can be triggered (e.g. by means of quotation marks). Buttons may be furnished with a logo signalling that they are controllable via voice control. This visualization is needed also, if buttons are not furnished with words.

Low sensitivity:

- Participants said it would be good if there was a visual feedback inherent to the voice control. This could be similar to the exergame, where buttons change their colour to yellow when activated but before the actual activity is completed. Also, the tolerance for speech recognition needs to be adjusted, allowing for a slightly less distinct pronunciation.

Control of Question-Answer-Screens:

- The participants demanded a clear, more apparent visualization of what needs to be said to trigger a button via voice control.

4.6 Tablet

Implications for design with regard to the tablet have been retrieved from five usability tests. They are covering the following use aspects:

Not adjusted display:

- Adjustment of logo, button and check-box sizes to fit for the tablet.

- Adjustment of font sizes to meet the needs of users with impaired vision.

Handling:

- Explanation is needed, how the keyboard can be summed up, e.g. to write a message. This could be provided in the tutorial.

- Explanation on the general handling of a tablet and its specificities is needed, as participants compared it to their knowledge from the PC (e.g. asking how they would be able to “go back” fixing a typo, when there was no [cursor] arrow). This could be provided in the tutorial.

Technology:

- Explanation on the handling of the tablet and the input specificities is needed, to avoid e.g. that users accidentally make an input without realizing that they had even touched a button.

4.7 Interactive Tutorial

Several implications were identified relating to the interactive tutorial these were obtained from the first evaluation of mock-up screens.

General navigation was coherent;

It may be helpful to implement clickable navigation;

The tutorial should be controllable via voice control;

Font size should be slightly larger in order to be easily legible;

The mascot that is guiding users throughout the tutorial received positive feedback and implementation should be considered;

It is suggested the boxes on the TV that can be selected in the interactive parts section of the tutorial might be confusing, because they act differently than in the main menu;

There are non-grey areas of the main menu section which are not clickable but explanation of the main menu are not clickable but might be perceived as such;



In general, participants agreed that there should be a paper manual in addition to the interactive tutorial. This was justified with regular manual use habits; also, participants reasoned that this would be the only usable help in case the system froze or was not accessible at all.

It turned out that appropriate wording is an aspect that requires special attention. Participants also identified some critical, unclear terms that should be explained or changed:

Relating to the Microsoft Kinect the terms and words which were identified were: camera, recorder, gesture recognition tool;

Relating to the tutorial the word help was identified, but no suggestion for an alternative was given;

Relating to the touchpad – the English term should be replaced by some German word illustrating the meaning, as the term was not commonly understood by the older adults;

Relating to the Settings – it should be clearly marked that it is appropriate if “regular users” entered this section.

Altogether, it appeared to be important for this audience that wording in the tutorial explanations was related to their living environment and that no terms were used which have a second, technology-related connotation that may be possibly unknown to people not familiar or insecure with technology use.



5 Implications for Re-Design from the Sydney Living Lab

5.1 Exergame

This study suggests that a home-based intervention is feasible in older adults. Overall, the participants rated the iStoppFalls positively and they would like to integrate the program in their everyday life. The participants gave a positive overall score for enjoyment, immersion and usability of the Exergame. The usability for the Senior Mobility Monitor was even higher than for the Exergame. As noted in D2.8.1, there are several issues that need attention, listed below.

5.1.1 Prediction assessments:

All participants (n = 4) liked the idea of assessing their fall risk using the iStoppFalls system. However, due to technical problems, poor functioning of the assessments and lack of feedback, no participant completed the assessments during the 4-week pilot trial.

STS: The system needs to start timing from the first movement of the shoulders, and stop timing when the user has completed 5 full repetitions and is seated. The avatar needs to move more smoothly during the assessment so the user is not distracted by a distorted avatar. Semi-tandem stand: This assessment needs to be redesigned. Currently it does not assess balance, it is more of a training exercise. The test should assess whether or not the user is able to stand with their feet in a near tandem position for a period of 30 seconds with their eyes open. The test needs to be performed without the use of aids or support and without taking a step. The timer should start when the user is in the correct near tandem position without support, and stop timing and end the test when the near tandem foot position is lost, a step has been taken or the user requires support. The time recorded should therefore reflect the maximum amount of time the user was able to stand in the correct position without stepping or holding on for support. If the user is unable to stand in a near tandem position without support, a fail should be recorded for the assessment. Reaction time: This test needs to standardise the distance at which the user stands away from the camera (e.g. 3 metres). This ensures repeatability of the test and increases the validity of the assessment which allows measures to be compared not only within each user, but between users at different time points. Without standardisation, this cannot be done. The test also needs to have 15 trials, then averaging the fastest 10 results to provide an accurate estimate of upper limb reaction time. As mentioned previously, the lights on the table need to be the same colour and the contrast enhanced.

Feedback should only be provided at the end of the 3 physical assessments as this distracts the participant during the tests. Following completion of all 3 assessments, a summed fall risk score should be displayed along with the individual assessments scores. Current and previous scores should be shown for comparison and monitoring performance. All videogame prediction assessments need to undergo technical and quality testing to ensure accuracy, reliability and validity of fall risk measures as soon as possible. A valid videogame-based fall risk tool will assist in providing reliable and accurate feedback to participants. This should in turn increase adherence to the program by providing an incentive to use the iStoppFalls system as no other home-based exercise intervention offers this valuable feature.



5.1.2 Balance games:

All participants enjoyed the bumble bee balance game when the system was working. Feedback after each exergame should be provided immediately after each game. Results should be displayed in whole numbers, images, tables or graphs where possible. Within each game there should be an option to review previous performances with a graph tracking each attempt and monitoring improvement. Most issues have been outlined in D2.8.1 however NeuRA have a few feature suggestions to incorporate into the new and existing balance games.

Bumble Bee park game: In addition to the bumble bees, the game could include more animals as it progresses; a swooping bird and a charging bear. Bird: A bird could appear on the side of the screen, waits 2-3 seconds then tries to swoop the avatar.

To avoid the bird, the user must squat down. The users head must clear a certain distance for a ‘miss’ to be recorded. If the user does not squat, points can be deducted.

Bear: A bear could appear in the distance, waits 2-3 seconds then starts running towards the avatar. To avoid the bear the user must step to the side and out of the way.

Skiing game: The current features of the skiing game; gates, coins, snowmen and the cognitive dual tasks, may be too overwhelming for the first introductory level. These features should be spread out over a few levels, the first level being fairly easy so the user is able to experience and understand the concept of the game. In addition to the features mentioned above, the game could add blackened out ditches as an obstacle to avoid, whereby if the avatar passes over the hole they fall into it and the game ends. Knee bending for acceleration is yet to be added. To increase the intensity of the game the computer could vary the width of the gates (larger then progressively becoming narrower as the user’s skills advance), if the avatar hits a snowman the user loses some/all of their collected coins (this will require a running total of collected coins on the screen).

5.1.3 Strength exercises:

Problems encountered with the strength exercises include poor movement tracking and the systems lack of ability to detect and monitor exercise technique. The three exercises that are included in the game are limited and can become dull to play with no variability. To overcome this, 2 new exercises will be incorporated into the game and tailored progression guidelines implemented into the Knowledge Based System (KBS). Most participants (n = 3) felt performing the strength exercises with the videogame provided no added incentive or benefit to performing the exercises alone. The game developers will need to address this issue as the current strength game did not have very high adherence rates.

5.1.4 Acceptability of using Exergame in older adults

This study suggests that exergaming is an acceptable means to deliver a fall prevention exercise intervention, similar to other studies. Future studies are needed to confirm whether the Exergame can improve balance and self-perceived confidence, and ultimately prevent falls in older adults.

5.2 SMM

During the 4-week pilot study, adherence to wearing the SMM was very high with a majority of participants (n = 3) wearing the SMM at all times. The main concerns with the SMM are that is too big and bulky. Participants felt more comfortable if they wore it under their clothes. One participant suggested designing the SMM’s to look more like jewellery by having a metal chain instead of the cord. By making the SMM’s more



appealing and attractive to wear, it may further improve adherence as users are less likely to be embarrassed to wear it.

Participants also reported the need to receive some form of feedback from the SMM, either by uploading the information to their computer or accessing results via the iStoppFalls system. Results from the SMM should be clearly displayed, easy to access, understand and interpret. The possibility of the SMM containing an automatic falls monitor was appealing to all.

5.2.1 Acceptability of wearing a mobility monitor in older adults

Accurate measurement of the amount of daily activity provides a valuable tool for monitoring the state of health of older adults, without relying on subjective recall. Additionally, these systems could be employed to motivate older people to stay active and perform specific balance exercises known to prevent falls.

5.3 iTV

Participants had difficulty seeing which screen element on the iTV menu was selected as the thicker border and darker grey background was difficult to see on some of the darker TVs; especially when the focus accidentally shifted to the black bar at the bottom of the screen. The boarder needs to be thicker and they grey needs to be darker for the tab that is selected to make them easier to see. Navigation through the iTV menu to access certain elements was difficult as there were too many options to select, too many pages to navigate through. The iTV menu needs to be more user-friendly, easier to access and clearer. All participants were frustrated with the constant repetition of the exceedingly verbose instructions and the many load screens. It would be preferable to have fewer but longer load screens instead of screens between every part of every activity.

5.3.1 SMP

Due to technical problems and poor functioning of the system, no participant was able to use the SMP during the 4-week pilot trial. Half of the participants (n = 2) actively engaged in other social media platforms such as Facebook, prior to commencing the pilot study. However, they reported that they would not be interested in using the iStoppFalls SMP as a means to meet other people. The other half of the participants reported a slight interest in using the SMP to meet other users. One participant suggested using the SMP to compare their results with other players, they stated this option would interest and motivate them to participate in the games.

5.3.2 Education

None of the participants accessed the education material through the iTV as they found the screen and text very difficult to read. A printed PDF booklet was made available instead.

5.3.3 Acceptability of an in-home telehealth system in older adults

Several telehealth technologies have been developed by different companies and research groups, all with the aim to develop sound and sustainable (home) healthcare to ensure that people can stay independent for longer. The use of a telehealth system that integrates in-home assessment, delivery of an individualized fall prevention program and continuous monitoring offers scope in the area of falls prevention. In our pilot study we also found that the integration of a telehealth program in older adults is feasible.



5.4 Technology issues and installation problems:

5.4.1 Kinect camera detection

Pose detection was poor. Participants constantly had their legs straight when the avatar’s was not, their avatar’s head craned right back and their shoulders twisted into unnatural positions. The system particularly had problems detecting some participants in a seated position and would constantly show the Kinect detection screen.

System repeatedly detected the legs of the chair the participant was sitting in as the participant’s legs. This resulted in either the participant could not complete the activity or the avatar jumped around like crazy as the activity was performed.

5.4.2 Voice recognition

Voice control was very poor especially for female participants. Repeated attempts were regularly needed for males while most females could not get consistently recognized. Even when the commands were correct it took at least 3 seconds before they were recognised by the system, this delay was very frustrating to users. If this option fails the gesture recognition option should be made available.

5.4.3 Remote control

All participants needed to press the TV button on the STB remote after starting an activity as the TV’s screen turned black and did not display the PC signal until the TV button was pressed.

Some participants accidently brushed the STB remote’s touchpad (directly below the direction keys), while navigating with the direction keys, which moved the focused element on the screen. They did not always understand what they had done and why the focus had moved.

5.4.4 Installation

A Participant had cable modem with only a USB interface, no Ethernet or Wi-Fi. We were unable to connect the system to the Internet in her home. As Internet connectivity is essential for the pairing of the STB and PC we had to instruct the participant to use the ‘standalone’ game.

A Participant’s router changed the IP address of the PC and STB a numerous times, i.e. when the IP lease ran out, it did not always get the same IP address. As pairing is based on specifying a static IP address for the STB and PC it failed and the STB could no longer communicate with the PC.

KBS ID/Key contained I, l and 1 characters which were impossible to distinguish between with the font used on the STB, trial and error was the only way to get this right.

5.5 Limitations and implications for future research

The study was designed as an initial pilot study using a one-group design of 5 participants over a short period of time (4-weeks). A planned randomized control trial in 60 participants (30 controls) will explore feasibility and effectiveness of the iStoppFalls program towards reducing fall risk in older adults over 4 months. The current study has given us some important feedback that should be incorporated in the planned RCT.

First, due to the system requirements of the iStoppFalls system (HDMI television and wireless internet), the current study included people who had access to, and were comfortable using technology. This background technological knowledge seemed important for participants to be able to operate the system. For example, 3 out of 4 participants (considered to be tech-savvy) indicated they found the remote control difficult to use. Therefore, these technological barriers need to be



minimized or, if not possible, the next study may need to recruit older adults who have more experience with technology.

Second, a second home visit was added in this pilot study after 1 week. The initial information

session included both installation and comprehensive instructions on how to use the system. Combining both aspects into the one home-visit seemed to fatigue participants. Therefore, during the RCT, a second home visit should be scheduled a few days after installation to explain the iStoppFalls system in more detail.

Third, it is very important that the games work seamlessly, e.g. movement detection, voice

recognition, etc. as this is a barrier for older people to adhere to their exercise regime. The current study indicated that the body shape of a person might compromise movement detection and that the voice recognition does not work in all people. Therefore, if one of the functions is not working, there should be an alternative option, e.g. navigate through the system using the remote control rather than with voice recognition, in order to prevent frustration among the participants. In conclusion, findings from this study suggest that participants would like to integrate the program in their home. The participant’s feedback can be used to improve and re-design the program where necessary, prior to the randomized control trial (RCT) in late 2013.



6 Conclusion

The iStoppFalls living labs commenced with numerous technical problems. Therefore, the first phase of the study was not only characterized by the participant’s technical learning and related difficulties to using the various system components but can also conclude by a good deal of frustration relating to technical problems hindering the potential smooth operating of the system.

Still, it can be concluded from these first living lab experiences that the system was in overall approved by the target audience. Wherever the system was working properly, participants reported to be in favour of the training and the game.

Summing up the design implications that have been presented in this report, three larger topics have emerged. One of them is the technical use of system components. Secondly, we see the design implications to focus on the language and choice of words implemented: the correct, labelling of items is important to ensure an easy use and engagement of the system. The third aspect relates to the contents, looking at aspects that enhance the gaming experience and/ or support and increase training motivation.

With regard to the exergame, seven areas for improvement have been identified which include: the use and control of the system, the introductory explanation, balance game and strength training exercises, the appearance of the avatar, the audio experience, fall risk assessment, and entering and exiting the game.

Regarding the iTV, implications for design circle around orientation and navigation in the system, the labelling of system functions, and the entering and exiting of the iTV system.

Design implications for the SMM relate to the technical management, the appearance and the visualization of the results to the participants.

With regard to the Social Media Platform the design implications relate to writing of messages and communication features, profile use and the enhancing of friendships.

The design implications for the Gesture- and Voice Control focus on the recognition and the sensitivity of the control functionality, in addition to the technical use of the control device.

Regarding the Tablet the design implications are concerned with the correct adjustment of screen resolution, and the use of the device.

For the Interactive Tutorial that was developed in addition and tested with mock-up screens in a first evaluation with the iStoppFalls living lab participants, the design implications relate to navigation, the mascot, and language and word choice.

As participants were aware of the fact that they were testing the iStoppFalls system at a very early stage of its development, they were contributing new ideas for additional games and were providing their experiences of using the system in detail. Here again, a strong link to the participants respective everyday lives and experiences could be observed, e.g. when themes such as hiking were suggested to form a game concept.

The next step to take for the Siegen living lab study will be to conduct further testing of the iStoppFalls system in an EU Intermediate Study. Here, unresolved questions regarding the accessibility and usability of some of the functionalities will be tested. Among them are gesture- and voice control, which had not been fully accessible during the initial living lab study, and data sharing, which had not been implemented at the time of commencing the living lab. Furthermore, the design aspects from the iTV and Social Media Platform will have improved as a result from the living lab, which will also tested in the Intermediate Study.



Annex A Detailed data from the Sydney Living Lab

GENERAL INFORMATION, MOBILITY AND HEALTH Four community dwelling older adults from Sydney participated in a four week Living Lab and were then interviewed in April 2013. This section presents the information provided by the users during the base line assessment about their personal data, dwelling, current health status and activities performed in their daily life. Table 1 shows the general information of the participants as well as aspects related to mobility and health are. All four participants live independently in the community and do not require assistance for ADLs. One participant suffers from minor medical conditions and is very active, takes part in a cycling team. The other three participants are in good/moderate health and suffer from diverse medical conditions. Participant 2 and 4 experience pain that interferes mildly with their life. They all engage in some type of exercise. All participants expressed a desire to remain physically active and independent for as long as possible.

Participant 1 Participant 2 Participant 3 Participant 4

Age (yrs) 64 79 83 66 Gender Male Female Female Female Health condition (overall health)

Very good Good Good Moderate

Social situation Lives with spouse and children. In spare time takes part in a cycling team and attends the theatre.

Lives with spouse. In spare times goes walking and plays cards.

Lives alone. In spare time goes walking, attends concerts and theatre, eats out with friends and works on trading stocks.

Lives alone. In spare time goes walking, attends lifestyle clinic and goes to the theatre.

ADL No help needed for any ADL

No help needed for any ADL



Objective health condition

Suffers from osteoporosis and high cholesterol.

Suffers from osteoarthritis in multiple joints, high blood pressure, high cholesterol, urinary incontinence, back pain. Has a knee replacement.

Suffers from peripheral vascular disease, high blood pressure, high cholesterol, cataracts in both eyes, osteoarthritis of the neck, back and knee, gout on the feet. Suffers pain in the neck, back, hip and knee/leg.

Suffers from osteoporosis, urinary incontinence, thyroid disorder, Hodgkin’s disease and back pain.

Physical activity (on average per week)

Cycles 6x/week for 2-4 hours.

Goes for 1hr walk once a week and does strength exercises 2x/week for 1-2 hours.

Goes for 30 min to 1hr walk 3-6x/week. Attends a weekly activity class for 45+minutes and does a home activity 1x/week for <30min.

Goes for 30 min to 1hr walk 2x/week. Attends 2x/week activity class for 45+minutes.

Pain (During the past four weeks)

None Mild pain with no interference in ADL.

Moderate pain with no interference in ADL.

Very mild pain with no interference in ADL.

Overall health difficulties

No health difficulties that interfere with his life.

Overall health difficulties interfere mildly with her life.

Overall health difficulties do not interfere with her life.

Overall health difficulties interfere mildly with her life.

Falls (in the past year)

None 1, with no injuries 2, suffered from a broken pelvis.

2, with no injuries

Table 1. General information, mobility and health of the participants



ASPECTS RELATED TO THE USE OF TECHNOLOGY. In this section the aspects related to the use of technology such as computers, game consoles, mobile phones, internet and tablets is presented. Table 2 shows information related to the use of media by the participants. All four participants had a computer that they used at least once a day. Common purposes for the use of the computer among the participants were the use of internet for email, banking, and checking facts. Participant 1 and 3 also used internet to access social media platforms such as Facebook and Twitter. None of the participants had previous knowledge or experience with de use of videogames.


Use of media (type)

Computer, mobile phone.


Computer, mobile phone, iPad.


Frequency of computer use

Computer: more than once a day.

Computer: Once a day. Computer: more than once a day.

Computer: Once a day.

Purpose of computer use

Email, internet banking/ purchasing/ checking facts, social network (Facebook).

Email, word processor, playing games, internet facts and banking.

Email, internet banking/ purchasing/ checking facts, social network (Facebook, twitter), database, accounts.

Email, checking facts on the internet.

Previous knowledge and use of videogames

No No No No

Table 2. Use of technology by participants



ASPECTS RELATED TO THE USE OF TECHNOLOGY. In this section, the results obtained from the assessment of use of the exergame are presented. Table 3 shows information related to the use of the Bumble Bee game and the Strength game. All participants reported some level of enjoyment while playing the games but all participants reported frustration due to the several technical difficulties the program experienced. These include the voice control not working and a distorted image of the avatar. All four participants preferred the Bumble Bee game over the Strength game. Participant 1 and 3 reported they would prefer to do the strength exercises on their own because the strength game is too cumbersome.

A main issue raised by all four participants is the urgent need for a feedback to appear on the screen immediately after playing the games. This would motivate them to continue exercising. None of the participants was able to receive any feedback regarding their performance.

Participants also reported the need to implement more levels of difficulty on the games as a means to keep them motivated and engaged with the program.


Score for enjoyment

3/5

5/5 ¨Fun when it worked¨

Bumble bee:2/5

Bumble bee:3/5

Technical difficulties

Discrepancy between the bumble bee appearing on the screen and the noise. Screen is too busy. Distorted image of avatar. Voice recognition did not work. Pause screen kept appearing.

Voice recognition did not work. Avatar would not respond accurately, got irritated by that.

Voice recognition did not work well. Avatar would not respond accurately, got very frustrated. The noise of the bees confused her. Performance of the game below expectations. Pause screen kept appearing.

Avatar frequently distorted. Voice recognition did not work well.

Challenge of the Bumble Bee game

Challenging enough for the first few times, but needs levels of progression

Challenging enough. Needs levels of increased difficulty.

Challenging enough to start, but needs more levels of increasing difficulty.

Challenge is ok for now but would like to have more levels of increasing difficulty. Suggested adding more obstacles.

Challenge of the strength game

Not challenging at all Not very challenging Not very challenging Challenging enough

Instructions Long, add option to skip them

Too long Too long and repetitive. Too long. Needs an option to skip them.

Results Needs a scoring system that appears on the screen immediately after paying the game, suggested an option to play against the computer.

Need for the results to be presented immediately after playing the game.

Need for the results to be presented immediately after playing the game. Suggested presenting the results in comparison to her own best score and in relation to her age matched population.

Need for the results to be presented immediately after playing the game.

Suggestions for Incorporate the need to Add levels of difficulty. Add a progression to Create different levels.



improvement of the Bumble bee game

perform other movements. Different insects Option to see other peoples scores.

the game.

Suggestions for improvement of the strength game

Include more complex exercises. It is boring as it is.

Include progression and more variety of exercises.

Add feedback Incorporate more variety of exercises of increasing difficulty. It is too boring as it is now.

Incorporate upper body exercises.

Suggestions of themes for other exergames

Cycling Tai Chi - -

Incorporation of dual tasking

Yes Yes Yes No

Preference of exergame over paper based exercise prescription

Bumble Bee: Yes Strength: No

Bumble Bee: Yes Strength: Yes

Bumble Bee: Yes Strength: No

Bumble Bee: Yes Strength: Yes

Table 3. Use of the exergame.



ASSESSMENT OF THE USE OF THE SENIOR MOBILITY MONITOR. In this section, the results obtained from the assessment of use of the mobility monitor are presented. Table 4 shows information related to the use of the senior mobility monitor (SMM).

Three participants used the SMM at all times and one reported only using it sometimes. Main concerns with the SMM are that is too big and bulky so participants felt more comfortable wearing it under the clothes. Participants also reported the need to receive some feedback from the SMM. The idea of having a falls monitor was appealing to all. Participant’s suggestions for improvement of the SMM are presented below.


Design SMM Fine, wears it under clothes.

It is Ok, wear it under clothes.

Too big, cord is too long, light flashes through the clothing.

Too big, did not like to wear it outside because of what other people might think.

Suggestions Make it waterproof, smaller, have an option to upload the data from the computer.

Make it smaller, add a more comfortable strap, make it look like a jewellery.

Make it smaller, adjustable strap Light less obvious Upload data to the computer.

Make it smaller.

How often did you wear the device?

Always Always Always 2 times, did not know she had to wear it at all times.

Table 4. Assessment of the senior mobility monitor



ASSESSMENT OF THE USE OF THE SOCIAL MEDIA PLATFORM (SMP). Table 5 shows information related to the use of the social media platform (SMP). Participant 1 and 3 actively engage in other social media platforms such as Facebook, but reported they would not be interested in using the iStoppFalls SMP as a means to meet other people. Participant 2 and 4 reported an interest in using the SMP to meet other users. Participant 1 reported that comparing his results with other players through the SMP would be interesting and motivating.


Do you use any social media network?

Facebook No Facebook Twitter

No

Did you use the SMP?

No No No No (No access due to technical difficulties)

Would you be interested in using the SMP as a means to get to know other users, or compare your performance with others?

Only to compare performance, that would motivate me.

Yes, would like to get to know other people through the SMP. I wouldn´t like to compare myself with others.

No Yes, would like to get to know other people through the SMP.

Table 5. Assessment of the Social Media Platform



ASSESSMENT OF THE USE OF THE iTV APPLICATION. Table 6 shows information related to the participants views on the iTV. Participant 4 did not have access to the iTV application due to technical problems with the installation of the program. All other three participants reported only having used the exergame. All four participants like the idea of assessing their falls risk through the iTV. Participant one reported the screen being too flooded with options. Regarding the remote control, participants’ suggestions for improvement include the use of a remote control with less buttons.


General comments

Mainly focused on the exercise games. Felt a bit flooded with all the options in the menu. Would like to have a “Game” option and an “Other” option. Would like to see his results plotted in a graph.

Only used the exergames. Likes the idea of assessing her falls risk through the iTV if it worked properly. Would like a reminder to do her falls assessment every 3 months.

Only used the exergames. Likes the idea of assessing her falls risk through the iTV if it worked properly.

Only used the exergame. Had no access to iTV. Likes the idea of assessing her falls risk through the iTV if it was working properly.

Perception of the remote control

Easy to use Easy to use Too many buttons, difficult to understand, buttons too small

Too many buttons,

Table 6. Assessment of the iTV.



RATING OF THE iStoppFalls PROGRAM Table 7 shows the rating of the participants in regards to four different statements. Participants rating of the user-friendliness of the exergame ranged from “poor” to “awfull”. This was mainly due to all the technical difficulties they experienced while playing the games. One participant agreed that he “enjoyed using the exergame as a means to exercise”, while two “disagree” and one “completely disagree”. The overall iStoppFalls system was rated “poor” by three participants and “awful” by one. Again, participants reinforced their frustration with all the technical difficulties they experienced. Lastly, participant’s response to “Overall, do you see yourself integrating the use of the iStoppFalls program in your everyday life AS IT IS NOW?” varied from, “Slightly agree” to “disagree”. Nevertheless, they all reported that they would consider using it “IF” mayor improvements were done.


“Overall, I rate the user-friendliness of the exergame as:”

Score 2/6: Awful Score 3/6: Poor Score 2/6: Awful Score 3/6: Poor

“Overall, I enjoyed using the exergame as a means to exercise”

Score 5/6: Agree Score 2/6: Disagree Score 1/6: Completely disagree

Score 2/6: Disagree

Overall, how do you rate the iStoppFalls system?”

Score 3/6: Poor Score 3/6: Poor Score 2/6: Awful Score 3/6: Poor

“Overall, do you see yourself integrating the use of the iStoppFalls program in your everyday life AS IT IS NOW?”

Score 2/6: Agree Score 4/6: Slightly agree.

Score 2/6: Disagree Score 4/6: Slightly agree.

Overall, do you see yourself integrating the use of the iStoppFalls program in your everyday life IF IT WERE IMPROVED?

Only the Bumble Bee game if it was improved. Not the strength game.

Would have to see it first.

Would have to see it first. Not the strength game.

Yes, but it would need a lot of improvement.

Table 7. Overall rating of the iStoppFalls.

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