Michele Pirovano

An integrated low-cost system for at-home rehabilitation

We show here how integrating novel natural user interfaces, like Microsoft Kinect, with a fully adappatients current statustive game engine, a system that can be used for rehabilitation at home can be built. A wide variety of game scenarios, a balanced scoring system, quantitative and qualitative exercise evaluation, automatic gameplay level adaptation to patients current status, and audiovisual feed-back are all implemented inside the Intelligent Game Engine for Rehabilitation here introduced, and are aimed at maximizing patients motivation and rehabilitation effectiveness. The system is integrated into a multi-level platform that provides continuous monitoring by the hospital and it has been developed inside the framework of the EU funded Rewire project.

Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames☆

Abstract We present here a comprehensive definition of therapeutic exergames from which a methodology to create safe exergames for real therapy pathways is derived. Three main steps are identified. (I) A clear identification of all the exercise requirements, not only in terms of goals of the therapy, but also in terms of additional constraints. Characteristic parameters for determining the challenge level and to assess progression are also defined in this phase. (II) The exercise is transformed into a Virtual Exercise, in which all the exercise elements are implemented inside a simple virtual environment. In this step the discussion between clinical and ICT teams allows maximizing the effectiveness of exergames implementation. (III) The final exergame is realized by introducing on top of the exercise all the game elements suggested by good game design to maximize entertainment. A clear line between exercises and games is drawn here. We illustrate the methodology with exergames designed for (1) balance and posture and (2) neglect rehabilitation, implemented and tested with post-stroke patients training autonomously at home. The methodology can have a broader impact as it can be applied also in other gaming fields in which the requirements go beyond entertainment.

An intelligent game engine for the at-home rehabilitation of stroke patients

The recent availability of advanced video game interfaces (such as the Microsoft Kinect, the Nintendo WiiMote and Balance Board) is creating interesting opportunities to provide low-cost rehabilitation at-home for patients. In this context, video games are rising as promising tools to guide patients through their recovery experience and to increase their motivation throughout the rehabilitation path. However, to be applied to clinical scenarios, video games must be designed to adhere to the clinical requirements and to meet doctors/patients expectations. They also need to be integrated within multi-level platforms that can allow different levels of monitoring, e.g., at a personal level by the therapist, at the hospital level by the doctors, and at the regional level by the government agencies. In this paper, we overview an intelligent game engine for the at-home rehabilitation of stroke patients The engine provides several games that implement actual rehabilitation exercises and have been developed in strict collaboration with therapists. It is integrated in a patient station that provides several types of monitoring and feedback using virtual and/or human therapists.

IGER: A Game Engine Specifically Tailored to Rehabilitation

Exergames for rehabilitation, both in the physical and cognitive fields, have been the target of much research in the last years. Such exergames, however, are often created for a specific impairment and cannot be generalized to other domains. More generally speaking, the lack of shared design and development guidelines for rehabilitation games can be highlighted. The Intelligent Game Engine for Rehabilitation (IGER) described here has been developed with the intent to provide a framework for building rehabilitation exergames that are functional, accessible and entertaining. Several features, mandatory for rehabilitation, have been incorporated: configuration, adaptation, monitoring, data logging and feedback through a virtual therapist. Besides describing how these features have been implemented in IGER, we describe here also a few games we created with it and their rationale.

Intelligent Game Engine for Rehabilitation (IGER)

Computer games are a promising tool to support intensive rehabilitation. However, at present, they do not incorporate the supervision provided by a real therapist and do not allow safe and effective use at a patients home. We show how specifically tailored computational intelligence based techniques allow extending exergames with functionalities that make rehabilitation at home effective and safe. The main function is in monitoring the correctness of motion, which is fundamental in avoiding developing wrong motion patterns, making rehabilitation more harmful than effective. Fuzzy systems enable us to capture the knowledge of the therapist and to provide real-time feedback of the patients motion quality with a novel informative color coding applied to the patients avatar. This feedback is complemented with a therapist avatar that, in extreme cases, explains the correct way to carry out the movements required by the exergames. The avatar also welcomes the patient and summarizes the therapy results to him/her. Text to speech and simple animation improve the engagement. Another important element is adaptation. Only the proper level of challenge exercises can be both effective and safe. For this reason exergames can be fully configured by therapists in terms of speed, range of motion, or accuracy. These parameters are then tuned during exercise to the patients performance through a Bayesian framework that also takes into account input from the therapist. A log of all the interaction data is stored for clinicians to assess and tune the therapy, and to advise patients. All this functionality has been added to a classical game engine that is extended to embody a virtual therapist aimed at supervising the motion, which is the final goal of the exergames for rehabilitation. This approach can be of broad interest in the serious games domain. Preliminary results with patients and therapists suggest that the approach can maintain a proper challenge level while keeping the patient motivated, safe, and supervised.

Fuzzy Tactics: A scripting game that leverages fuzzy logic as an engaging game mechanic

Abstract Artificial intelligence (AI) plays a major role in modern video games by making them feel both more realistic and more fun to play. Game intelligence usually works alongside the game logic, in the background, invisible to the players who enjoy the resulting character behaviors, the adaptive gameplay, and the procedurally generated content. However, artificial intelligence can also have a central role and become a major component of the overall gameplay (as for instance in the video game Black & White). In this paper, we define the genre of scripting video games and introduce Fuzzy Tactics, a video game we developed that has an innovative gameplay based on fuzzy logic and uses fuzzy rules as its core game mechanic and user interaction mechanism. In Fuzzy Tactics, players lead their troops into battle by specifying a set of fuzzy rules that determines the battle behavior of the units. Fuzzy logic is the only mean that players have to interact with the game and to command to their troops. Thus, it becomes the main game mechanic that allows us to (i) extend the depth of the game, (ii) keep the interaction intuitive, while also (iii) increasing the replayability and the educational value of the game.

The design of a comprehensive game engine for rehabilitation

Physical and cognitive rehabilitation under the form of therapeutic videogames has been growing in popularity over the last years. Many rehabilitation games (or exergames) have been created with the intent to promote functional rehabilitation in a highly motivational environment. However, such exergames are often created as standalone products typically designed to target a specific exercise. Accordingly, they are usually difficult to integrate in a more structured therapy and also have very different and varied features. There is therefore a need in this area for a more holistic approach with game engines specifically designed for rehabilitation that would represent the next step in this field to guarantee efficacy, accessibility and motivational factors of exergames. In this paper, we present our Intelligent Game Engine for Rehabilitation (IGER) that tries to address these issues; we highlight the features it supports, we present some of the games we created with it, and the initial results we achieved so far.

Algorithms Based on Computational Intelligence for Autonomous Physical Rehabilitation at Home

Exergames provide efficient and motivating training mechanisms to support physical rehabilitation at home. Nonetheless, current exergame examples lack some important aspects which cannot be disregarded in rehabilitation. Exergames should: (i) modify the game difficulty adapting to patient’s gameplay performance, (ii) monitor if the exercise is correctly executed, and (iii) provide continuous motivation. In this study, we present a game engine which implements computer intelligence-based solutions to provide real-time adaptation, on-line monitoring and an engaging gameplay experience. The game engine applies real-time adaptation using the Quest Bayesian approach to modify the game difficulty according to the patient’s performance. Besides, it employs a fuzzy system to monitor the execution of the exercises according to the parameters set by the therapists and provides on-line feedback to guide the patient during the execution of the exercise. Finally, a motivating game experience is provided using rewards and adding random enrichments during the game.

Robust Silhouette Extraction from Kinect Data

Natural User Interfaces allow users to interact with virtual environments with little intermediation. Immersion becomes a vital need for such interfaces to be successful and it is achieved by making the interface invisible to the user. For cognitive rehabilitation, a mirror view is a good interface to the virtual world, but obtaining immersion is not straightforward. An accurate player profile, or silhouette, accurately extracted from the real-world background, increases both the visual quality and the immersion of the player in the virtual environment. The Kinect SDK provides raw data that can be used to extract a simple player profile. In this paper, we present our method for obtaining a smooth player profile extraction from the Kinect image streams.

IGER: An Intelligent Game Engine for Rehabilitation *

We present here a novel game engine, designed specifically to guide rehabilitation at home. Besides the classical functionalities: animation, rendering, collision detection and so forth, adaptation to the patient status and monitoring are embedded inside the engine. Moreover, a virtual therapist is also provided that can advice and support the patient throughout the rehabilitation sessions. Some game examples built on this engine are described.