RehabCity: Gamified Simulations of Activities of Daily Living

RehabCity has been designed based on a participatory approach as an attempt to actively involve stakeholders (e.g. health professionals and patients in our case) in the design process of the rehabilitation game to ensure that the result is usable and meets the user’s needs. The process started by collecting standard paper and pencil training tasks widely used in clinical environments. Subsequently, together with a rehabilitation physician, we selected the 12 ones with more impact in the successful performance of ADLs. Then, 20 health professionals experienced with brain-injured patients (physicians, occupational therapists, speech therapists, neuro-psychologists and physiotherapists) provided input on how to operationalize the difficulty, memory, executive functions, attention and language demands of each task. Finally, tasks that could be integrated through the performance of common ADLs were implemented in RehabCity, such as visuospatial orientation, attention and executive functions.

Although the paper and pencil training and evaluation performed in the clinic allows for a very controlled and specific intervention in one or several cognitive domains, it lacks of an ecologically valid context. Real life activities, most of the time, involve interdependency of multiple cognitive domains. The main goal of the RehabCity is to provide an integrative and engaging cognitive training experience that not only simulates ADLs, but it tries to do so in an ecologically valid context. Thus, we recreated in VR a simulated city neighborhood of 386x358m2 to integrate the cognitive training tasks derived from the participatory design process and to deliver them in a very controlled manner in the context of real life ADLs. RehabCity is organized in a quasi-regular grid structure of streets with sidewalks, containing over 200 realistic buildings, several parks and moving vehicles. In this simulated city, four of the most commonly visited places by patients have been reproduced: a supermarket, a post office, a bank, and a pharmacy. Further, to increase the ecological validity, all of these places display billboards and products of the real spaces and trademarks that are commonly found in Portugal. This helps the patient in relating the in-game goals to the real world. 

Because the main goal of rehabilitation is to re-enable people with impairments to perform effectively their ADLs, numerous systems were developed with the purpose of simulating the ADLs in a Virtual Reality (VR) environment. Although VR simulations are more ecologically valid that the computerization of paper and pencil tasks, these systems focus only on training specific ADLs in an isolated context. By merging a gaming and an integrative ADLs approach we propose RehabCity, an online deployed game for the rehabilitation of cognitive deficits. A simulated city populated with streets, sidewalks, commercial buildings, parks and cars has been reproduced to provide an ecologically valid environment where some common ADLs are reproduced. In the RehabCity game, several sequential goals are provided to the player, which have to be performed through navigation in the city. RehabCity uses short-term goals and frequent feedback on progress to increase the sense of self-efficacy, and as a result, the motivation and engagement to work towards the next goal. Further, RehabCity goals can be customized and personalized to each player, as well as the level of assistance provided by the game.  

You can access the RehabCity from here (RehabCity web applet) by following the instructions on the web site.

Reference:

Vourvopoulos, A., Faria, A. L., Ponnam K., Badia, S Bermúdez i Badia. RehabCity: Design and Validation of a Cognitive Assessment and Rehabilitation Tool through Gamified Simulations of Activities of Daily Living, 11th international conference on Advances in computer entertainment technology, Funchal, Portugal, Nov. 11-14, 2014.