research movement presentation condensed

8/6/2019 Research Movement Presentation Condensed

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VR Simu la t ion in t he Deve lopment o f MovementCentred Therap ies for Young People wi t h

Complex Trauma Symptomato logy

- Progress to Da te

VR S imu la t ion in t he Deve lopment o f MovementCentred Therap ies for Young People wi t h

Complex Trauma Symptomato logy

- Progress to Da te

Supervisors:

Dr. Mark L inde n (Schoo l o f Nurs ing and Midwi fer y)Dr. Cathy Cra ig (School o f Psychology)

Superv isors:

Dr. Mark L inde n (Schoo l o f Nurs ing and Midwi fer y)Dr. Cathy Cra ig (School o f Psychology)

Alan Cumm insAlan Cumm ins

ContentsContents

Overview of Complex Trauma

Why Use Movement?

Objectives of Research

Study 1 Play-test Findings

Study 2 Custom Games Findings

Planning Study 3

Questions

Complex TraumaComplex Trauma

Complex Trauma is defined asthe experience ofchronicadverse traumatic events, whether real or

subjectively felt, and the associated detrimental affects onchildrenspsychological and physiological development

Seven observed domains of impairment in children:attachment, biology, affect regulation, dissociation,behavioral control, cognition and self-concept.(Pelcovitz, van der Kolk et al. 1997)

Three stage intervention schemes Stabilization

Processing of traumatic memories

Reconnection(Luxenberg, Spinazzola et al. 2001; Herman 1992)

MovementMovement

Movement For Treatment of Complex Trauma Symptoms

Bodily experience as entry to emotion andcognition

Physical sense of control, Sense of mastery

Increasing sense of self, Empowerment

Self-regulation

Motivation andengagement

Means to increasing observation, curiosity andmindfulness

As a groundingprocess

Emphasis on a complete mind-body approach rather than

purely using talk-based therapies.

Object ivesObject ives

Objectives

Determine the capabilities of current technology in terms of MOCAPand movement-based games from user experience and technical

capabilities.

Develop a movement-based intervention.

Pilot intervention on CT symptomatic and non-CT groups.

Measure and analyse levels pre and post intervention:

Balance

Self-regulation.

Executive function.

Mastery

Rati onale Study 1Rati onale Study 1

Benefits of game playing (Prensky 2005)

Enjoyment and pleasure, motivation

Sense of structure, flow as games are adaptive

Learning as games have outcomes and provide feedback

Ego gratification

Excitement, creativity, emotion

Good game design comes out of Designer, Context, Pa rticipants, Meaningfulplay (Preece, Rogers et al. 2007)

Flow in games (Csi kszentmihalyi, 1975, Sweetser & Wyeth, 2005)

Key to Success of games is at outset t hey must bewell-designed (Goh, 2008)

Games are effective whe n designed and used appropriately(Katz & Wertz, 1997)


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In te rven t ion Des ign Study 1In te rven t ion Des ign Study 1

Usability and Design of Movement Games

Participants: n =12, adults (mean age 29 (6)) from QUB

Purpose:Evaluation of technology, baseline

Method: Play-test of

30 mintues

Playing several levels of each game

Semi-structured interview

Thematic analysis and coding

Study 1: Play-TestStudy 1: Play-Test

WiiFit Plus Kung Fu Rhythm: Asks the user to foll ow along in a kung fu classMovement:Temporal control match with th e class instructions.Sensor: Uses of a com bination of the Wii Balance Board and Wiimote.

WiiFit Plus Perfect 10: Requires the user to complete a level by hitting markers to

add up to a specified score.Movement:Shifting of weight to mo ve hips in al l directions.

Sensor: It makes use of the Wii Bal ance Board.

Know Your Shape: Requires the u ser to foll ow an instructor doing exercises.

Movement:Jumping and jogging on th e spot.Sensor: Use of a USB cam era to p resent the participant alongside the trainer.

Dance Dance Revolution: Requires the user to step in time to a music track.

Movement:Stepping forward, backward, left and right.Sensor: It makes use of a dance-pad pe ripheral.

WiiFit Plus Yoga:Users follow a yoga trainer practicing basic yoga moves.Movement:They require standing with weight balanced.Sensor: It makes use of the Wii Bal ance Board.

Study 1: Some QuotesStudy 1: Some Quotes

A good progression of difficulty..Something that isnt too daunting to

begin w ith but still challenging

Am I supposed to be startingnow?.. Wheres the targetlike?.. Am I supposed to be

pressing something?

..the brea thing one I foun d it confusing remember thecircle goi ng in and out.. As well as looking at postureas wel l as tracki ng balance.. Having three things todo in a ta sk that was completely novel was toodisconcerting

Tutorials

Challenge

Visual Display

With kung fu thi ngs theres the sound in the middlewit h hands go t ogether and everything happens andthe screen chang es and theres a sound andeverything jumps and i ts more fun an d lessrepetitive

Audio

showed you ho w your centre ofbala nce was shifting and things..

Clear.. That wa s very helpful

Measurement

..prefer solid board asknow whe re you are,

more in control

Control

Study 1 Find ings to Guid ing Pr inc ip lesStudy 1 Find ings to Guid ing Pr inc ip les

Aspects of Tutorials Clear

Well paced

Controllable

Challenge in Games Adaptable level of difficulty

Well paced

Clear goals

Visual fee dback Simple

Focused on goals

Positive reassurance

Audio feedback Non-patronising, Positive in tone

Sound coincide w ith action

Measurement Functionally accurate

Indicate w hat is being measured

Control mechanisms Controller takes out of situation

Need to orient player to controller

Progress in games Meaningful scores

Balance of competition

Learning by scores tied to performance

Aspects of Fun Continuous, Challenging, Pacing

Structured games

Game context as fun, exercise, therapy orcombination

In ter vent ion Design Study 2Inter vent ion Design Study 2

Usability Movement Games Participants: n =13 adults from QUB

mean age 20.26 (3.19)

89 contacted to 18 accepting to 15 starting to 13 fully completing

Purpose: Initial Testing and refinement of intervention

Method: Sessions lasting approximately 40 mins One PRE testing session

Measure Executive Function

Trail making - A4 touch screen, Wisconsin Card Sort Pebl Softw are

Balance (Static , Dynamic and Sway using Custom balance measures Dr. WillYoung, Dr. Cathy Craig)

Five PLAY sessions (Bubble Pop and Balloon Pop)

One POST testing session

Measure

Tests as in PRE session

VRUSE Usability Questionnaire

Study 2 Imp lementa t ion & Mate r ia lsStudy 2 Imp lementa t ion & Mate r ia ls

Custom game software developed using Virtools (3DVIA Inc.)

Programming of Game logic and presentation graphics

Connection to Nintendo Wii Balance Board

Ability to specify direction, speed, size, life-time of bubbles, sharks andquestions.

Ability to draw any type of puzzle for use in balloon pop.

Including mazes, questions, keys, bonuses and penalties

Portable making use of laptop, Nintendo Wii Balance Board and projector.


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Demonstr at ion of Balance TestsDem onst rat ion of Balanc e Test s Dem onst rat ion of Bubble PopDemonst rat ion of Bubble Pop

Demonstrat ion of Bal loon PopDem onst rat ion of Bal loon Pop Gam e Trac e Bal loon PopGame Trace Bal l oon Pop

During games the following are stored:

Gamescore Time to Complete Centre of Pressure

Progress

Smart Shrimp

Balloon Pop

Game Sess ions and User Stat is t icsGame Sess ions and User Stat is t ics

Number of Participants n =15 Number completed = 13

4 males, 11 females from QUB 1st Year Psychology

Participants are no vice computer game players spending less than 2 hours a w eek playing games

Mean age = 20.26 (3.19)

Total Sessions = 74

Bubble Pop (Bubble Pop, Avoid the Shark, Smart Shrimp) Total Combined Play Time = 15 hrs 19mins 34s for a total level attempts = 827

Play Ti me Per Session: Max = 15mins 37s, Min = 10min 27s, Avg = 14 mins18s

Balloon Pop Total Combined Play Time = 16hrs 20 mins48s for a total level attempts = 1596

Play Time Per Session (excluding breaks) Max = 17 min 46s, Min = 8 mins44s, avg = 13 mins 15s

Average Success Rate Per Play S ession = 75 %

Level Obtained : Max = 41, Min = 24, Avg= 35 (4.87)

Levels Attempted Per Session: Max = 39, Min = 12, Avg = 22.5 (5.2)

Execut ive Funct ion - Trai l Mak ingExecut ive Funct ion - Trai l Mak ing

General measure of Frontal Lobe Deficits

Measures sequence ability, ability to shift rule set, processing speed via time tocomplete

Non-parametric Wilcoxon

% Change Trail A % Change Trail B % Change

Combined

Sig (2-tailed)

Trail A

Sig (2-tailed)

Trail B

Sig (2-trail)

Combined Score

-10.51 -17.32 -26.86 0.064 0.009 0.007

Trail A Trail B


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Execu t ive Func t i on - Wiscons in Card Sor tExecu t ive Func t i on - Wiscons in Card Sor t

General Measure of Frontal Lobe Deficits Measures planning, organized searching, shifting cognitive

sets, directing behaviour toward achieving a goa l, and

modul ating impulsive responding

Measured by m atching card to group based on shiftingrules according to colour, shape and number


Measure Component % ChangePre to Post

Sig (2-tailed)Pre toPost

Number Categories Completed -4.74 0.524

Percentage Total Error 19.58 0.6

Percentage Correct Trials -1.68 0.6

Number Preservative Errors -7.74 0.5

Number Trials 0.74 0.7

Failure to Maintain NA 0.023

Learning to Learn 45.86 0.249

Conceptual Level Response -16.97 0.101

Balance TestsBalance Tests

Sample Participant Trace Pre and Post Game Sessions

0

0.1

0.2

0.3

0.4

0.5

0.6

-0.2 -0.1 0 0.1 0.2

0

0.1

0.2

0.3

0.4

0.5

0.6

-0.2 -0.1 0 0.1 0.2

ANTERIOR Static Test Centre of Pressure Trace

Balance Tes ts - Sta t icBa lance Tes ts - Sta t ic

Comparison of Balance (Static) Pre and Post Game Sessions Percentage Change


Balance Component Excursion Area Excursion Lateral Excursion Medial

Pre Post Sig (2tailed) Pre Post Sig (2tailed) Pre Post Sig (2tailed)

Left 0.016 0.011 0.182 0.087 0.068 0.028 0.178 0.164 0.638

Right 0.018 0.012 0.087 0.098 0.072 0.101 0.189 0.172 0.552

Centre 0.034 0.008 0.050 0.108 0.055 0.272 0.252 0.142 0.041

Posterior 0.1 0.008 0.382 0.059 0.052 0.196 0.164 0.157 0.382

Anterior 0.024 0.009 0.003 0.092 0.064 0.023 0.217 0.145 0.028

Balance

Component

% Change

Excursion Area

% Change

Excursion Lateral

% Change

Excursion Medial

Left -9.2 -17.1 0.9

Right -14.7 -17.3 -1.4

Centre -15.3 -8.7 -22.2

Posterior -0.2 -4.1 -2.3

Anterior -35.2 -18.2 -22.4

Balance Tests Dynamic , Sw ayBalance Tests Dynamic , Sw ay

Comparison of Balance (Dynamic) Pre and Post Game Sessions Non-parametric Wilcoxon

Comparison of Balance (Sway) Pre and Post Game Sessions Non-parametric Wilcoxon

BalanceComponent

Pre Av g Score Post Av g Score % Change Score Sig (2-tailed)

Dynamic 21.6 30.6 113.19 0.001

BalanceComponent

Fast Pre / Post Sig(2-tailed)

Slow Pre / Post Sig(2-tailed)

Med Pre / Post Sig(2-tailed)

SlowSlow Pre /Post Sig (2-tailed)

Sway 0.311 0.311 0.6 0.116

Game Play ProgressGame Play Progress

Bubble Pop (Average score improvement)

Balloon Pop (Average score improvement

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1 2 3 4 50

200000

400000

600000

800000

1000000

1200000

1400000

1 2 3 4 5

0

200

400

600

800

1000

1200

1400

1 2 3 4 5145150155160165170175180185190195200

1 2 3 4 5

Smart Shrimp Avoid Shark

Score Time

Usabi l i t y - VRUSEUsabi l i t y - VRUSE

VRUSE questionnaire with 100 questions

Participants were also questioned on favourite games and aspects of engagement,control, feedback, physical demands

Category Average Rating Satisfaction %

Functionality 60.87

User Input 59.78

System Display 59.46

User Guidance 54.06

Consistency 59.23

Flexibility 53.07

Simulation Fidelity 60.41

Error Correction 49.01

Sense of Immersion 49.07

Overall Usabilit y 63.21

Favourite Game Ranking

Balloon Pop 1

Avoid the Shark 2

Smart Shrimp 3

Bubble Pop 4


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Usabi l i t y Par t ic ipant Comm entsUsabi l i t y Par t ic ipant Comm ents

Did enjoy some o f them, but as withgames, felt frustrated if I didn't dowell, which then made me lose

concentration.

The ba lance board was very sensitive to

changes in m ovement which meant that yourbalance was tested very well, the screenresolutio n wasvery clear and I could see where

my character was in the visual environment veryeasily.

The strength is that you are interacting with thegame an d so it is mostenjoyable this way. Theweakness is that it can ge t tiring after a period of ti me

and it can be frustrating.

Really good games all round, I

progressed a lot through outthe sessions.

Lessons LearntLessons Learnt

Balloon Pop Enjoyed and would stay longer to achieve results

Only two drop-outs

Design of games Pacing of levels and ability to skip sticking points

Ending a session on a positive note

Increased breaks to avoid fatigue

Comparison of scores to self to motivate but need flexibility

Motivation to achieve bonuses within games, path of least resistance

Reduction of number of games played

Recruitment is difficult! Retaining is tricky! Need to consider some means of incentive

Experimental Design Fine line between repeated improvement and disruption of enjoyment

In ter vent ion Design Study 3Inter vent ion Design Study 3

Movement Intervention with Complex Trauma Population

Participants: n = 20, 10 teenagers with CT symptomatology, SouthernHealth Trust, Belfast Trust compared with 10 non-CT sample.

Purpose:Pilot movement sessions with clinical pop

Method: Experimental

Movement Game Training Sessions

Record demographic and abuse history

Measure pre and post

Balance

Executive functioning

Mastery

Discussion Point sDiscussion Point s

Initial impression of games

Positives and negatives

Aspect of frustration, concentration with clinical population

Thoughts on demands of games

Structuring play in safe manner

Capturing the effects

Currently capturing executive functioning, balance, usability, mastery

But what recommendations for capturing effect on general behaviour

over and above those captured by IASC, TABS

QuestionsQuestions

Any questions, comments, feedback welcome.

Email: [email protected]

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