iSpine: A Motion -Sensing Edutainment System for Im ...b98501020/iSpine-paper.pdf · iSpine: A Motion -Sensing Edutainment System for Im proving Children’s Spinal Health Abstract

iSpine: A Motion-Sensing Edutainment System for Improving Children’s Spinal Health

Abstract We present iSpine, a Kinect-based edutainment system co-designed with children and domain experts for improving spinal health through motion-based therapeutic exercises and educational content. Our system incorporates a reward system and a pet-based storyline to motivate users and was conducted over a 4-week field study with 7 children. Our contributions and results are as follows : 1) children had significantly improved their asymmetry in range of motion (ROM) – an important indicator for diagnosing scoliosis – from 19 ◦ to 7 ◦, 2) significantly improved their scores on spinal health concepts from 78% to 94%, 3) strongly favored iSpine to the current spinal health curriculum, and 4) showed strong interest in using iSpine daily.

Author Keywords Scoliosis; Kinect; motion-based gaming; edutainment; vertebrae health; childhood education, educational game; playful learning.

ACM Classification Keywords H.5.2. Information Interfaces and Presentation: Interaction Styles Introduction Scoliosis is a medical condition in which a person’s spine is abnormally curved. It could lead to permanent nerve damage, unprovoked pain, and deformed appearances, and afflicts 0.3%, 0.9%, 3%, and 12% of the populations

Copyright is held by the author/owner(s).

CHI 2013 Extended Abstracts, April 27–May 2, 2013, Paris, France.

ACM 978-1-4503-1952-2/13/04.

Sheng-Jhe Hsu National Taiwan University Department of Networking and Multimedia No.1, Sec. 4, Roosevelt Rd., Da’an Dist., Taipei City 106, Taiwan [email protected] Wen-Sheng Tseng National Taiwan University Department of Electrical Engineering No.1, Sec. 4, Roosevelt Rd., Da’an Dist., Taipei City 106, Taiwan [email protected]

Fu-Chieh Hsu National Taiwan University Department of Computer Science and Information Engineering No.1, Sec. 4, Roosevelt Rd., Da’an Dist., Taipei City 106, Taiwan [email protected] Yung-Ying Lo National Taiwan University Department of Computer Science and Information Engineering No.1, Sec. 4, Roosevelt Rd., Da’an Dist., Taipei City 106, Taiwan [email protected]

Student Game Competition CHI 2013: Changing Perspectives, Paris, France

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figure 3. The screenshot of x-ray image which can help children visualize the spinal health condition.

figure 1. The traditional way to teach students the spinal health care concept via textbooks.

figure 2. The most popular game elements among students. The horizontal axis represents the number of games that contain these game elements.

in America, Singapore, Taiwan, and Finland, respectively [2]. While early spinal health education is especially important for children and adolescents and their developing bones and habits, current education primarily relies on textbooks and has limited student motivation and engagement (Figure 1). Thus, we conducted interviews with an occupational therapist, two physiotherapists, and three experienced elementary school teachers in Taiwan, and discovered three problems of current approaches for children: 1) lack of interest in textbook-based material and instruction, 2) lack of individual feedback and reward in classroom-based exercises, and 3) lack of concreteness in spinal health concepts due to the children’s difficulty in understanding a body part that they cannot directly observe. To address these challenges, we collaborated with children, physiotherapists, game designers, and teachers to co-design and develop iSpine. iSpine was designed to incorporate motion-based tracking of the 9 therapeutic exercises and question prompts of the 33 spinal health concepts, and then integrated them with the gaming elements and reward system that appealed to and kept children motivated.

Related Work Our objectives are to improve children’s physical health and motivate them to learn important health concepts through an intelligent edutainment interface. We first explore prior works that focus on exergames which have been successfully applied to the rehabilitation therapy. Some systems use video-capture technology to investigate the training effects on extending range of motion or controlling directions [4]. Others design a

suitable gaming station integrating a video game for helping children with mobility impairment reach energy expenditure level [5]. Observing that wearing arm ergometer or trunk strap are necessary for participants in the rehabilitation systems mentioned above, we also survey the literature on motion-based interaction which enable children to have more physical freedom in gaming. Research work aims to guide, monitor and evaluate children with Juvenile Idiopathic Scoliosis (JIS) through the therapeutic exercises [1]. Realizing the potential of natural interactions and the concept of “prevention is better than cure”, we focus on normal children with greater emphasis on long-term physical lifestyle habits and motion-based edutainment system for prevention purposes compared to others. Not only limited to physical condition, the complementary mental instruction is important also. Both of educational game for families with asthmatic children [2] and school-based ubiquitous computing deployment [3] help children strengthen health care awareness. Our iSpine system takes inspiration from these related works as we developed features for effectively improving physical fitness, motivation of learning, and health care awareness of our target adolescent user base. Design We interviewed twelve children of first grade and got 26 popular games. The nine common characteristics and associated statistics of the traits from those games are showed in Figure 2. We then extracted the following important design elements, virtual-pet feature, story arc, reward system, motion-based interactivity, virtual tutor, pet selection and x-ray. Game Design Content Our game consists of nine physical exercises that were


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originally designed by orthopedists in Hong Kong. We carefully discussed these exercises with our consulted experts (i.e., occupational and physical therapists in Taiwan), and integrated their feedback into modified motions appropriate for the students in our game. In addition to the physical exercises, our game also consists of thirty-three questions about spinal health care prompted in-game and also designed by our consulted experts. Game Flow At the start of the gaming application, children are given the option to choose from one of three initially available pets. Each time children log into the game, they are able to enjoy watching their pets that interact with the gaming world such as walking or lying on the pasture environment, depending on the current health condition of the pets. The condition of the pets worsens as time passes. We also added into our application the ability for children to see an x-ray image of their pets and theirs spinal configuration when they touch them in the game (Figure 3). When children find their pets’ health gets worse, they can click the gym and the game will move to the gym view. In the gym, the 3D avatar will demonstrate the motions for children. When the children perform correctly, the energy bar on the right hand side of the screen will rise by 1/10. The motion capture image is on the top left hand side of the screen that can help children adjust their motions. When the energy bar is filled, a droplet will drop. After absorbing the droplet, the pets’ energy bar will increase by 1/12. The higher the energy bar, the more healthy the pets are (Figure 4). When children finish the exercise, they will be asked for two questions about spinal health care and get one fragment for each question if they answer correctly. Once they collect twenty fragments, namely a whole egg, they can exchange for one more pet till they get all the three pets (Figure 5).

Data Collection and Analysis During our trial sessions where children interacted with our iSpine gaming application, we enabled our system to record the children’s valuable interaction information. The collected information includes numerical data of the angles formed by specific body parts within their exercise poses. iSpine records children’s pose angles to verify their body symmetry. We calculated the angle made by the body from the two vectors A and B, as shown in Figure 6(a) and Figure 6(b). Vector A is determined by the line formed from the torso to elbow, and vector B is the horizontal line formed from the torso as its origin.

Evaluation We have evaluated our iSpine on seven first grade elementary school students between the ages of seven through eight, including three boys and four girls. In addition, one of the children has S curve scoliosis.

Pre-Test During the pre-testing phase, we asked the children to answer them on their own paper sheet while sitting separately from each other. The correct answers were not revealed to them during the pre-test phase.

Game Playing The core game-playing phase of our evaluation lasted over a span of four weeks.

Post-Test To gauge improvements made on the children’s knowledge of health concepts following our game-playing phase, we replicated the pre-test phase conditions for a post-test phase by asking the children participants to answer the same thirty-three questions that they were prompted to answer. A questionnaire was also provided to the children to provide feedback on what they thought of our game.

figure 5. Screenshot of children’s

progress in collecting egg fragment.

figure 4. The screenshot of the virtual tutor that leads children to exercise and gives feedback. 1) the remaining time and energy the child have already collected for the pose. 2) the current health condition of the pets, which depends on the accuracy of the child’s motions. 3) the mirror of the child.

figure 6. Illustration of body pose tracking. iSpine can com- pute the angle between children’s arm and torso. (a)The first pose. (b) The ninth pose.

(a)

(b)


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Results The average answer correctness rate during our pre- and post-tests are 78% to 94%, respectively, as Figure 7 shown. After four weeks of exercise involvement, we can see that the average asymmetric angle for the first pose (figure 6 (a)) of the normal children improved from 19◦ to 7◦ , and the angle of child with scoliosis improve from 16◦ to 3◦ (figure 8). For the ninth pose (figure 6 (b)), the average asymmetric angle of the normal children improves from 24◦ to 10◦ and the angle of child with scoliosis improves from 32◦ to 21◦ degrees, (figure 9) indicating that with or without development of scoliosis, children within these ages show strong potential to improve their movement quality with the aid of our interaction system.

We have also included the results (Figure 10) from our pre- and post-test evaluation questionnaires using a five-point Likert scale as well. For children’s preferences on the current approach to spinal exercise, the average score was 4.9 with iSpine compared to 1.3 without iSpine. The other question related to children’s willingness to continue doing spinal exercises, the average was 4.7 with iSpine compared to 1.0 without iSpine. The two results indicate that children had greater interest, willingness, and perseverance to learn and exercise the concepts related to spinal health care.

Conclusion An unusually large number of children are afflicted with the severe condition of scoliosis. We were therefore motivated in developing iSpine, a motion-sensing edutainment system designed to teach children important spinal health concepts and physical fitness. Our evaluation successfully indicated that children 1) strongly preferred iSpine over their current spinal health curriculum, which strengthened their interests in continuing to use iSpine daily, 2) gained greater

understanding about the spinal health concept after using iSpine, and 3) demonstrated strong potential in improving their physical habits with the assistance of our motion-based interactive system.

References [1] P. Feistritzer-Gröbl, A. Nischelwitzer, V. Saraph, H. Holzer : Game Based Physiotherapy for Treatment of Children with Juvenile Idiopathic Scoliosis. In Proceedings of Measuring Behavior 2012. Utrecht, The Netherlands.

[2] Hong, H.,Jeong, H.Y., Arriaga, R.I., and Abowd, G.D. Triggerhunter: designing an educational game for families with asthmatic children. In CHI '10 Extended Abstracts on Human Factors in Computing Systems (CHI EA '10). ACM, New York, NY, USA, 3577-3582.

[3] Poole, E.S., Miller, A.D., Xu, Y., Eiriksdottir, E., Catrambone, R., and Mynatt, E. D. The place for ubiquitous computing in schools: lessons learned from a school-based intervention for youth physical activity. In Proceedings of the 13th international conference on Ubiquitous computing (UbiComp '11). ACM, New York, NY, USA, 395-404.

[4] Chen, Y.-P., Kang, L.-J., Chuang, T.-Y., Doong, J.-L., Lee, S.-J., et al., Use of virtual reality to improve upper- extremity control in children with cerebral palsy: a single-subject design. Physical Therapy 87, 11 (2007), 1441–1457.

[5] Widman, L., McDonald, C., and Abresch, T. integrated with computer gaming for aerobic training in adolescents with spinal cord dysfunction. The Journal of Spinal Cord Medicine 29, (2006), 363–370.

[6] Health Grades, Inc. Statistics by country for scoliosis. http://www.rightdiagnosis.com/s/scoliosis/ stats-country.htm, February 2012.

figure 10. The results of children’s five-point Likert scale.

figure 9. The asymmetry angle of the ninth pose.

figure 8. The asymmetry angle of the first pose.

figure 7. The percentage of correct answers of the seven children before and after using iSpine. It improved from 78% to 94%.


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