MRO-W Final Reports 2008-2009

Purpose

The novel approach towards interaction by the Nintendo Wii provides opportunities to examine new ways in which video games can be used to promote physical activity.   In this project we ended up examining how the Wii Fit can be used to support balance, improve core muscles, posture and improve flexibility.  We examined how the floor placed pressure sensor (also referred to as a balance board) and gameplay can be adapted so that it appeals to the needs of older adults.   As the Nintendo Wii and Wii Fit was primarily designed for a younger demographic, the purpose of this study was to further understand how the elderly go about using the Wii Fit on the Nintendo Wii and directly observe any interaction design problems that may take place when engaging with the video game.

Goals

Our research project consisted of two phases.

Phase 1. - Requirements Gathering

The first half of the project consisted of identifying what the specific needs of the elderly are and how they relate towards video gameplay.  Initial assumptions were that games that focused on cognition would be of interest to the elderly.   A review of the literature showed that games that focused on cognition had mixed results with the target population when it came to improving cognition or maintaining interest.  These results from the literature were also validated during our informal interviews with older adults at the local retirement community.  ??After further interviews and the use of cultural probe packets (which helped us identify themes and key concerns of the target population), we identified that balance, flexibility and posture are key issues of this target demographic, and that the novel interaction model of the Nintendo Wii could be used to address these needs. 

Phase 2. - Development

The focus of the second phase was on modifying the Nintendo Wii and the Balance Board so that it it addressed the needs of the target population.   Modifications were done to the balance-board (hardware) and to the gameplay (software).  

a. Hardware Modification

The existing Balance Board that comes with the Wii Fit is small and does not provide a place for the user to hold onto.  In order to provide a more ergonomic controller for elderly adults, the platform was embedded into a larger structure with a handrail to the front and sides.  The enlarged structure provides the user with a larger surface onto which they can step, and the handrail provides further hand support for the individual.

b. Software Modification

The existing games that support the Wii Balance Board are targeted to a younger target population.  Gameplay consists of short timed sequences with auditory and visual distractions.  We used Macromedia Flash to develop a game that would interface with the modified Balance Board and provide a gameplay experience that focused on the specific physiological needs of elderly adults.  The game we designed ("Apple Basket") required the player to use their center of balance to guide an apple into a basket.   If the player is able to keep the apple in the basket for five seconds (by maintaining control over their center of gravity), the basket would move, shrink, and thee player would then again have to guide the apple into the now smaller basket.  A specific design decision incorporated in the custom game is that there is no time limit, instead the player competes against themselves by trying to get the apple into ever smaller baskets.  

Particpant Study Overview

After hardware and software development was finished, we tested our prototype game and modified Balance Board against the standard Nintendo Balance Board and its existing Wii Fit games.  Results from our study are discussed below.

Participants

Our participants consisted of 3 males and 3 females, all over 65 years of age. Participants filled out a questionnaire on their confidence balance abilities. The average for our participants was an 88% confidence in their balance while performing everyday tasks.

Procedures

Each of our participants played several games with different types of Balance Boards. Each participants tried our flash based apple game with the standard Nintendo Wii Balance Board, 2 Nintendo games (Table Tilt and Ski Slalom) with the standard Nintendo Wii Balance Board, 2 Nintendo games (Table Tilt and Ski Slalom) with the large Balance Board with a walker as a handrail, and 2 Nintendo games (Table Tilt and Ski Slalom) with the large balance board (without the walker).

Findings and Observations
When running our user tests we observed the participants interacting with the board designs and the games.

When players were doing poorly on a game their frustration was very clear through their body language, facial expressions, and even through their comments of the game. They would comment the game play being too fast, particularly for those with vision problems, as well as the board not being sensitive enough to their movements.

The walker added onto the board was helpful for those participants with lower balance confidence but hindered the performance of those who felt as though they had limited to no balance issues.

Women seemed to enjoy the open-ended qualities of the apple game where as the male participants seemed to enjoy the ability to measure their performance through timed challenges and point-based scoring systems.

Limitations to our study

A few limitations arose during our user studies. These included our user base for running the test and the design of the user test study.
 
While running our user tests, we found that all 6 of our participants were fairly comfortable with their balance abilities. Those who had slightly less confidence in their balance cited outside issues such as previous medical issues with the ear (central to balance) or weight. Due to time and resource constraints, our team was only able to run studies with these 6 participants, leaving us with a very limited population.
 
Due to these time and resource constraints we were unable to run longevity studies as originally planned. Without longevity studies it is unclear how the use of our design affects the improvement in balance, prevention of balance loss, and confidence in a user’s balance when performing day-to-day activities. Longevity studies would provide us with more solid data to see the long-term affect of using the Wii as a means to aid in preventing balance loss and improving existing motor skills.
 
Continued work on this project would need to include a longevity study with a wider range of participants. The participants would need to use the game and board for several months with periodic evaluations on balance abilities, confidence in their balance for everyday activities. A larger number of participants would need to be included in the study and would need to have a wider range of balance issues, preferably more who have lower confidence in their balance abilities or are at high risk for falls etc.

Conclusion

In our study we identified a specific user need of a target population, namely balance and flexibility concerns among elderly, and designed hardware and software that would address these specific concerns.  Our initial testing shows that the modified Balance Board provides a surface that installs more confidence among our target population. Test subjects would initially state that they had good balance, and that they did not need the assistance of a handrail.  However, after using the modified Balance Board they would state that the presence of the hand rail (even if they did not use it) made them feel more confident and gave a sense of security.  Sentiment towards the custom game was mixed.  Users expressed that the custom game was fun, but the Wii Fit games were seen as being more challenging and interesting.  The male users in particular expressed enjoyment towards the fact that the Wii Fit games provided  "a measure of achievement."  Observation however showed that participants were less frustrated when they used the custom game, and that they would be more willing to continue working towards completing the challenge.  Future changes to the custom game will focus on providing more feedback and recognition of personal achievements while also providing a more aesthetic experience that matches that of the games offered by the Wii Fit.  Ideally this will result in gameplay that will be considered fun and interesting by the target population resulting in more extensive and engaged involvement which will ideally lead towards improved balance and posture.