Towards Procedural Level Generation for RehabilitationDajana DimovskaCopenhagen Game CollectivePilestræede 45, 1Copenhagen, [email protected] JarnfeltCopenhagen Game CollectivePilestræede 45, 1Copenhagen, [email protected] SelvigCopenhagen Game CollectivePilestræede 45, 1Copenhagen, [email protected] N. YannakakisIT University of CopenhagenRued Langgaards Vej 7Copenhagen, [email protected] paper introduces the concept of procedural content gen-eration for physical rehabilitation. In this initial study aski-slalom game is developed on the Wii platform that pro-cedurally places the gates of the game according to playerperformance. A preliminary game evaluation study is con-ducted on patients with injured legs and showcases the effi-ciency of the procedural gate generation mechanism tailoringthe game difficulty to match rehabilitation goals. The studyalso validates certain usability asp ects of the patients.Categories and Subject DescriptorsI.2.1 [Artificial Intelligence]: Applications and ExpertSystems—Games; H.1.2 [Models and Principles]: User— Machine Systems—Human factorsKeywordsProcedural level generation, Wiihabilitation1. INTRODUCTIONThe Nintendo Wii game console is the best-selling con-sole available today [3] utilizing physical interaction via con-trollers such as the Wii Remote and the Wii Balance Board.The Wii Balance Board allows game interaction through footpressure and body weight balancing on the board. Thesefeatures push video game design to incorporate body move-ment as a key control modality. In particular, Wii Sports(2006) constitutes of different sport games such as boxing,bowling, golf, and tennis in which the player’s avatar can becontrolled via a physical motion, e.g. bowling using the WiiRemote. In We Ski (2008), the player is skiing by control-ling the pressure on the Wii Balance Board. On that basis,Wii technology gives players new motivations to immersePermission to make digital or hard copies of all or part of this work forpersonal or classroom use is granted without fee provided that copies arenot made or distributed for profit or commercial advantage and that copiesbear this notice and the full citation on the first page. To copy otherwise, torepublish, to post on servers or to redistribute to lists, requires prior specificpermission and/or a fee.PCGames 2010, June 18, Monterey, CA, USACopyright 2010 ACM 978-1-4503-0023-0/10/06 ...$10.00.themselves both mentally and physically. This has inspiredmany hospitals and rehabilitation centers in the USA [14] touse existing Wii physical games for rehabilitation purposes.The use of Wii technology for physical rehabilitation is alsoknown as Wiihabilitation.Existing commercial Wii games, however, are not designedfor rehabilitation which, in turn, may over-challenge peoplewith partly disabled extremities. Moreover, different pa-tients have different rehabilitation goals to reach and a fixedWii game does not tailor the gameplay for the patient tomeet specific rehabilitation milestones. A solution to thoseusability problems would be the development of an adap-tive Wii physical game that can adjust game parameters tomatch the patient’s physical ability level.The main aim of this initial study is the development andevaluation of an adaptive Wii game for rehabilitation, whichcan procedurally generate content in real-time and, further-more, provide effective training to each patient given thelevel of her physical ability. For this purpose, an adaptiveski-slalom game played with the Wii Balance Board is devel-oped and tested on patients of a rehabilitation center. Thegame procedurally generates the placement of the slalomgates based on heuristics of player performance. The pre-liminary user study presented here reveals that the game ad-justs the ski-slalom track effectively to match patient skills.This paper is novel in that it introduces the concept of pro-cedural content generation (PCG) and player modeling forphysical rehabilitation utilizing the Wii Balance Board.2. BACKGROUNDResearch in physical rehabilitation [1, 5] has shown thatexercises for patients recovering from physical disabilitiesand injuries are more effective when the exercises are in-tegrated within a game. Patients get more engaged andmotivated through a game environment and they tend toforget the pain caused by and the dull repetitive nature ofrehabilitation exercises. Physical interactivity, portability,low-cost and commercial availability make the Wii Remoteand Wii Balance Board the ideal controllers for developingphysical rehabilitation games [8].With the popularization of physical interactive game plat-forms considerable research has been conducted for captur-ing player immersion [11], engagement [2] and player affec-tive states [7, 16] in physical interactive games. On theFigure 1: A screenshot of the ReSkii game.other hand, very few studies investigate the design of adap-tive mechanisms for maximizing player experience in suchaugmented-reality game platforms [16].PCG in games has been used for a wide variety of pur-poses including terrain [6, 10] and space [9] generation, en-vironmental modeling [13], and race track [15] generation.However, to the best of the authors’ knowledge there hasbeen no study investigating procedurally generated contentfor Wii games and its impact to the rehabilitation process.3. THE RESKII GAMEInterviews were conducted with physiotherapists to assistthe design of the Wiihabilitation game. The design of thefinal test-b ed game is based on the physiotherapists’ knowl-edge and observations about their patients recovering fromleg injuries. The following research hypotheses were formedon the basis of those interviews:• H1: Foot pressure performance is lower on injured orpartly-disabled legs (e.g. a patient with a right legdisability is expected to miss more right turns in aski-slalom game).• H2: Foot pressure performance is increased in easiertasks (e.g. easier right ski-slaloms will improve thescore of a player with a right leg injury)• H3: Gradually increasing the difficulty of a game taskwill force the player to exercise with the problematicleg thereby accelerating rehabilitation.In order to validate the stated hypotheses and demon-strate the impact of adaptation and PCG on rehabilitationwe developed a test-bed game. It was our aim that thedeveloped PCG game will not only accelerate the rehabili-tation process but also make exercises more fun
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