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- Augmented Human Assistance (AHA)Publication . Bermúdez i Badia, Sergi; Odekerken-Schröder, Gaby; Mahr, Dominik; Čaić, Martina; Lee, Min Hun; Siewiorek, Dan; Smailagic, Assim; Gamboa, Hugo; Belo, David; Carnide, Maria Filomena Araújo da Costa Cruz; Baptista, Maria de Fátima Marcelina; Simão, Hugo; Avelino, João; Sousa, Honorato; Paulino, Teresa; Gonçalves, Afonso; Cardona, John Muñoz; Cameirão, Mónica S.; Bernardino, Alexandre; Gouveia, Élvio RúbioAging and sedentarism are two main challenges for social and health systems in modern societies. To face these challenges a new generation of ICT based solutions is being developed to promote active aging, prevent sedentarism and find new tools to support the large populations of patients that suffer chronic conditions as result of aging. Such solutions have the potential to transform healthcare by optimizing resource allocation, reducing costs, improving diagno ses and enabling novel therapies, thus increasing quality of life. The primary goal of the “AHA: Augmented Human Assistance” project is to de velop novel assistive technologies to promote exercise among the elderly and patients of motor disabilities. For exercise programs to be effective, it is essential that users and patients comply with the prescribed schedule and perform the ex ercises following established protocols. Until now this has been achieved by hu man monitoring in rehabilitation and therapy session, where the clinicians or therapists permanently accompany users or patient. In many cases, exercises are prescribed for home performance, in which case it is not possible to validate their execution. In this context, the AHA project is an integrative and cross-discipli nary approach of 4 Portuguese universities, the CMU, and 2 Portuguese industry partners, that combines innovation and fundamental research in the areas of hu man-computer interaction, robotics, serious games and physiological computing (see partner list in Appendix A). In the project, we capitalize on recent innova tions and aim at enriching the capabilities and range of application of assistive devices via the combination of (1) assistive robotics; (2) technologies that use well-understood motivational techniques to induce people to do their exercises in the first place, and to do them correctly and completely; (3) tailored and relevant guidance in regard to health care and social support and activities; and (4) tech nologies to self-monitoring and sharing of progress with health-care provider enabling clinicians to fine-tune the exercise regimen to suit the participant’s ac tual progress. We highlight the development of a set of exergames (serious games controlled by the movement of the user’s body limbs) specifically designed for the needs of the target population according to best practices in sports and human kinetics sciences. The games can be adapted to the limitations of the users (e.g. to play in a sitting position) so a large fraction of the population can benefit from them. The games can be executed with biofeedback provided from wearable sensors, to pro duce more controlled exercise benefits. The games can be played in multi-user settings, either in cooperative or competitive mode, to promote the social rela tions among players. The games contain regional motives to trigger memories from the past and other gamification techniques that keep the users involved in the exercise program. The games are projected in the environment through aug mented reality techniques that create a more immersive and engaging experience than conventional displays. Virtual coach techniques are able to monitor the cor rectness of the exercise and provide immediate guidance to the user, as well as providing reports for therapists. A socially assistive robot can play the role of the coach and provide an additional socio-cognitive dimension to the experience to complement the role of the therapist. A web service that records the users’ per formances and allows the authorized therapists to access and configure the exer cise program provides a valuable management tool for caregivers and clinical staff. It can also provide a social network for players, increasing adherence to the therapies. We have performed several end-user studies that validate the proposed ap proaches. Together, or in isolation, these solutions provide users, caregivers, health professionals and institutions, valuable tools for health promotion, disease monitoring and prevention.
- Automating senior fitness testing through gesture detection with depth sensorsPublication . Gonçalves, A. R.; Cameirão, M. S.; Bermúdez i Badia, S.; Gouveia, E. R.Sedentarism has a negative impact on health, life expectancy and quality of life, especially in older adults. The assessment of functional fitness helps evaluating the effects of ageing and sedentarism, and this assessment is typically done through validated battery tests such as the Senior Fitness Test (SFT). In this paper we present a computer-based system for assisting and automating SFT administration and scoring in the elderly population. Our system assesses lower body strength, agility and dynamic balance, and aerobic endurance making use of a depth sensor for body tracking and multiple gesture detectors for the evaluation of movement execution. The system was developed and trained with optimal data collected in laboratory conditions and its performance was evaluated in a real environment with 22 elderly end-users, and compared to traditional SFT administered by an expert. Results show a high accuracy of our system in identifying movement patterns (>95%) and consistency with the traditional fitness assessment method. Our results suggest that this technology is a viable low cost option to assist in the fitness assessment of elderly that could be deployed for at home use in the context of fitness programs.
- Evaluating body tracking interaction in floor projection displays with an elderly populationPublication . Cameirão, Mónica; Gonçalves, AfonsoThe recent development of affordable full body tracking sensors has made this technology accessible to millions of users and gives the opportunity to develop new natural user interfaces. In this paper we focused on developing 2 natural user interfaces that could easily be used by an elderly population for interaction with a floor projection display. One interface uses feet positions to control a cursor and feet distance to activate interaction. In the second interface, the cursor is controlled by ray casting the forearm into the projection and interaction is activated by hand pose. The interfaces were tested by 19 elderly participants in a point-and-click and a drag-and-drop task using a between-subjects experimental design. The usability and perceived workload for each interface was assessed as well as performance indicators. Results show a clear preference by the participants for the feet controlled interface and also marginal better performance for this method.
- Fitness applications for healthy older adults using large projection displays: methodology, design, assessment, and field validationPublication . Gonçalves, Afonso Rodrigues; Bermúdez i Badia, SergiDue to low birth rates and rising life expectancy, the population of developed countries is aging. Concurrently, physical inactivity is an identified major health risk and significantly more prevalent in older adults, who experience the consequences related to inactivity more frequently. Exergames for the elderly are an affordable option to prevent sedentarism and complement traditional exercise training, which can otherwise suffer from low adherence and personalization. They facilitate moderate-intensity physical activity levels and positively impact fitness, health, balance, postural control, mobility, and motivation. However, due to the lack of knowledge of seniors’ game preferences and technology literacy, there are challenges in designing exergames that match the users’ needs and motivators with game elements. While there is an extensive body of research in this field, there are critical gaps: most of the research is done in laboratory environments, is focused on balance and ignore other motor performance domains, use commercial games which are not designed for older adults, and fail to explore the longitudinal effects of exergames. In this thesis, there are three sequential contributions: 1) Develop a technology to facilitate exergaming in the elderly population by integrating easy-to-use full body interaction with large projection displays. Resulting in software for low-cost virtual reality surround screen projection systems, validated through user studies and compared with the conventional alternatives. 2) Leverage the technology and design customized exergames to promote fitness in older adults by: a) Evaluate the capability to automate fitness assessment using gesture detectors by testing their performance in the field with 22 elderly end-users and compare it to traditional methods administered by an expert. Resulting in a high accuracy system, consistent with the traditional fitness assessment method. b) Study older adults’ interaction preferences with floor projection displays by developing and testing two natural user interfaces with 19 elderly participants. The participants’ preference for a feet controlled interface was identified when usability, perceived workload, and performance indicators were assessed. c) Apply human-centered design methodologies in the gamification of fitness training routines by focusing on insights from inquiries to improve game elements and game iterations based on playtesting sessions to produce exergames. Resulting in a set of four exergames created to train the critical functional fitness areas of older adults. 3) Measure the benefits in older adults’ motor performance, quality of life, and physical activity levels during a longitudinal multidimensional training combining custom-made exergames and traditional exercise in a complementary fashion. Achieved through a 12-week long randomized controlled trial of bi-weekly exercise sessions with 31 elderly participants. Outcome measures on fitness, balance, and health-related quality of life were measured at the start, during, and after the intervention, and physical activity levels were measured at each session. This resulted in exergame players having a significant increase in strength compared to control, and both conditions improving balance and the mental component of health-related quality of life, with improvements in the latter being greater for exergame players. Additionally, during exergames’ sessions, participants spent less energy but maintained the recommended physical activity levels for more extended periods. Our results show that integrating personalized exergames designed for multidimensional fitness training in traditional settings can effectively enhance older adults’ motor performance and mental well-being. This technology is a viable low-cost option to be deployed in the context of elderly fitness programs.
- Measured and perceived physical responses in multidimensional fitness training through exergames in older adultsPublication . Munoz, J. E.; Gonçalves, A.; Gouveia, E. R.; Cameirão, M. S.; Bermúdez i Badia, S.Exergames have been used to increase physical activity levels to produce health benefits in older adults. However, only a small number of studies have quantified the physical activity levels produced by custom-made Exergames and their capacity to elicit recommended levels of exercise. This study investigates the effectiveness of custom-made Exergames, designed for multidimensional fitness training, in eliciting recommended levels of exercise. We rely on both objective (accelerometry) and subjective (perceived exertion) information collected in two different modalities of exercise, consisting of 40- minutes sessions: Exergaming and conventional training (Control). A between-subjects analysis was done involving two groups of active older adults (n=33). Participants in the Control Between condition performed physical activity in conventional group fitness training, while the intervention group used individualized Exergaming as training modality. In addition, a sub-group of the Exergaming participants also performed a conventional training session (Control-Within), which enabled a within-subjects comparison. Results show that participants spent significantly more time in moderate-to-vigorous intensities during Exergaming, interestingly, perceiving significantly lower exertion levels. The between-subjects analysis only presented statistically significant differences for the perceived exertion scale. This study helps to unveil the impact of custom-made Exergames in physical activity levels during training when compared to conventional training for the older adult population.
- From body tracking interaction in floor projection displays to elderly cardiorespiratory training through exergamingPublication . Gonçalves, Afonso; Nóbrega, Filipa; Cameirão, Mónica; Muñoz, John E.; Gouveia, Élvio; Bermúdez i Badia, SergiThe opportunity to develop new natural user interfaces has come forward due to the recent development of inexpensive full body tracking sensors, which has made this technology accessible to millions of users. In this paper, we present a comparative study between two natural user interfaces, and a cardiorespiratory training exergame developed based on the study results. The focus was on studying interfaces that could easily be used by an elderly population for interaction with floor projection displays. One interface uses both feet position to control a cursor and feet distance to trigger activation. In the alternative interface, the cursor is controlled by forearm ray casting into the projection floor and interaction is activated by hand pose. These modes of interaction were tested with 19 elderly participants in a point-and-click and a drag-and-drop task using a between-subjects experimental design. The usability, perceived workload and performance indicators were measured for each interface. Results show a clear preference towards the feet-controlled interface and a marginally better performance for this method. The results from the study served as a guide to the design of a cardiorespiratory fitness exergame for the elderly. The game “Grape Stomping” uses ground projection and mapping to display real-size winery elements. These virtual elements are used to simulate, in a playful way, the process of grape maceration through repeated stomping. A playtest session with nine elderly users was completed and its insights are presented in addition to the description of the game.
- Evaluation of a low-cost virtual reality surround-screen projection systemPublication . Gonçalves, Afonso; Borrego, Adrián; Latorre, Jorge; Llorens, Roberto; Bermúdez i Badia, SergiTwo of the most popular mediums for virtual reality are head-mounted displays and surround-screen projection systems, such as CAVE Automatic Virtual Environments. In recent years, HMDs suffered a significant reduction in cost and have become widespread consumer products. In contrast, CAVEs are still expensive and remain accessible to a limited number of researchers. This study aims to evaluate both objective and subjective characteristics of a CAVE-like monoscopic low-cost virtual reality surround-screen projection system compared to advanced setups and HMDs. For objective results, we measured the head position estimation accuracy and precision of a low-cost active infrared (IR) based tracking system, used in the proposed low-cost CAVE, relatively to an infrared marker-based tracking system, used in a laboratory-grade CAVE system. For subjective characteristics, we investigated the sense of presence and cybersickness elicited in users during a visual search task outside personal space, beyond arms reach, where the importance of stereo vision is diminished. Thirty participants rated their sense of presence and cybersickness after performing the VR search task with our CAVE-like system and a modern HMD. The tracking showed an accuracy error of 1.66 cm and .4 mm of precision jitter. The system was reported to elicit presence but at a lower level than the HMD, while causing significant lower cybersickness. Our results were compared to a previous study performed with a laboratory-grade CAVE and support that a VR system implemented with low-cost devices could be a viable alternative to laboratory-grade CAVEs for visual search tasks outside the user’s personal space.
- Effects of prolonged multidimensional fitness training with exergames on the physical exertion levels of older adultsPublication . Gonçalves, Afonso Rodrigues; Muñoz, John Edison; Gouveia, Élvio Rúbio; Cameirão, Mónica da Silva; Bermúdez i Badia, SergiWhile exergames have been used with older adults in an attempt to promote higher physical activity (PA) levels, and its subsequent health benefits, there is a lack of research that objectively quantifies the PA levels that custom-made exergames can produce throughout an extended training program. In this paper, we describe a 3-month intervention study that aimed to measure the participants PA levels during exergames’ sessions and their effectiveness in eliciting the recommended activity levels. Over the course of the study, two groups of older adults participated in either a conventional multidimensional fitness training program of two sessions of exercise per week (n = 16) or in an equivalent combined program (n = 15), of one conventional and one exergame session per week. Both the objective PA levels (through accelerometry) and subjective effort (perceived exertion) were collected in each session. Results revealed that while participants spent more time in moderateto-vigorous PA during exergaming than during conventional sessions, they also spent less energy, thus working out at lower intensities but for a more sustained amount of time. The self-reported exertion was consistently higher for the sessions of the combined exercise program. We showed that a set of custom-made exergames can be successfully used by trainers to set up personalized training sessions and can be used in combination with regular exercise for sustained long-term training, exposing differences between the two training regimes in terms of efficiency, elicited PA, and perceived effort.
- Lessons learned from gamifying functional fitness training through human-centered design methods in older adultsPublication . Muñoz, John Edison; Gonçalves, Afonso; Gouveia, Élvio Rúbio; Cameirão, Mónica S.; Bermúdez i Badia, SergiThe design of meaningful and enjoyable Exergames for fitness training in older adults possesses critical challenges in matching user's needs and motivators with game elements. These challenges are often due to the lack of knowledge of seniors' game preferences and technology literacy as well as a poor involvement of the target population in the design process. Objective: This research aims at describing a detailed and scrutinized use case of applying human-centered design methodologies in the gamification of fitness training routines and illustrates how to incorporate seniors' feedback in the game design pipeline. Materials and Methods: We focus on how to use the insights from human-centered inquiries to improve in-game elements, such as mechanics or esthetics, and how to iterate the game design process based on playtesting sessions in the field. Results: We present a set of four Exergames created to train the critical functional fitness areas of older adults. We show how through rapid prototyping methods and multidisciplinary research, Exergames can be rigorously designed and developed to match individual physical capabilities. Moreover, we propose a set of guidelines for the design of context-aware Exergames based on the lessons learned. Conclusion: We highlight the process followed; it depicts 19 weeks of various activities delivering particular and actionable items that can be used as a checklist for future games for health design projects.
- A virtual reality bus ride as an ecologically valid assessment of balance: a feasibility studyPublication . Gonçalves, A.; Montoya, M. F.; Llorens, R.; Bermúdez i Badia, S.Balance disorders can have substantial adverse implications on the performance of daily activities and lead to an increased risk of falls, which often have severe negative consequences for older adults. Quantitative assessment through computer ized force plate-based posturography enables objective assessment of postural control but could not successfully represent specifc abilities required during daily activities. The use of virtual reality (VR) could improve the representative design of functional activities and increase the ecological validity of posturographic tests, which would enhance the transferability of results to the real world. In this work, we investigate the feasibility of a simulated bus ride experienced in a surround-screen VR system to assess balance with increased ecological validity. Participants were frst evaluated with a posturography test and then with the VR-based bus ride test, while the reactions of their centre of pressure were registered. Lastly, participants provided self-reported measures of the elicited sense of presence during the test. A total of 16 healthy young adults completed the study. Results showed that the simulation could elicit signifcant medial–lateral excursions of the centre of pressure in response to variations in the optical fow. Furthermore, these responses’ amplitude negatively correlated with the participants’ posturography excursions when fxating a target. Although the sense of presence was moderate, likely due to the passive nature of the test, the results support the feasibility of our proposed paradigm, based in the context of a meaningful daily living activity, in assessing balance control components.