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Using Xbox 360 Kinect Games on Enhancing Visual Performance Skills on

Institutionalized Older Adults with Wheelchairs

I-Tsun Chiang

Graduate Institute of Sports and Health

National Changhua University of Education

Changhua, [email protected]

Jong-Chang Tsai

Graduate Institute of Applied Sport Science

National Changhua University of Education

Changhua, [email protected]

Shang-Ti Chen

Graduate Institute of Sports and Health

National Changhua University of EducationChanghua, Taiwan

[email protected]

AbstractThe purpose of this study was to explore health

benefits in somatosensory video games, Xbox 360 Kinect, on

institutionalized older adults with wheelchairs. A total of 53

participants were recruited and divided into an experimental

group (n = 22, 78.55 6.70 years old) and a control group (n =

31, 79.97 7.00 years old). The experimental group

voluntarily agreed to complete Xbox 360 Kinect trainings three

times per week, for 30 minute each session. The Vienna Test

System and the Soda Pop test were used to measure the simple

reaction and the eye-hand coordination of their visual

performance skills. A Mann-Whitney nonparametric test for

two independent samples was used to evaluate training effects.

Results showed that the interventions significantly improved

their visual performance skills and the elderly in the

experimental group improved significantly on the reaction test

(p< 0.001) and eye-hand coordination (p< 0.001). The study

concluded that Xbox 360 Kinect is a potential tool to improve

visual performance skills for the institutionalized elderly with

wheelchairs.

Keywords-Xbox 360 Kinect; vienna test; receation time;

somatosnesory video game; wheelchairs; visual performance skill;

aging and aged

I. INTRODUCTION

With the trends of global aging, medical advances andlongevity, the quality of life and health care for older adultshas been dramatically noticed as one of the most significant

global issues. Aging mechanism decreases attention abilityand increases the risk of all [1]. From Physio-psychologicalperspective, the loss of brain tissue in aging process makesthe degeneration of cognition and may cause a variety ofillnesses (e.g., dementia), which negatively impact on theirdaily living skills and independent functions. Moreover, italso increases the national and individual expenses of long-term cares and medical costs economically [2] [3].

Although aging is an irreversible trend, current studiesfound that appropriate training programs may have

preventive benefits on promoting cognitive abilities andalleviating the degeneration of aging brains [4-10]. Physicalexercises and sport participations are commonly used topromote their health and maintain their brain and bodyfunction. For example, the Jensens study pointed out thatphysical activities and body movements can create positivevalues on promoting cognitive abilities [11]. In addition tophysical activities, recent studies stated that challenges anddifficulties in computer games are also able to active nervefunctions effectively [12]. Therefore, somatosensory videogames that combine computer games and physical activitiesmay be an innovation of providing alternative leisureopportunities for older adults.

Traditional video games that reply on joysticks or relatedcontrollers to receive players feedback and signals havebeen criticized as harmful products to health because theyare contributions of a sedentary lifestyle. However, with theadvances of technology, somatosensory video games werereleased and made the revolution of video games happened.Compared with traditional video games, somatosensoryvideo games abandon traditional joystick-like controllers butsense users gestures and body movements to interact withthe video games. Originated from pilots training programs,virtual-reality interaction technology began to been used asan entertainment since 1980s but Nintendo Wii primaryleaded the new generation in the video game industry in2006. The Wii video games have transformed into health

toys and have been endorsed by the department of Health inthe U.K. [13]. In 2010, Microsoft released Xbox 360 andSony also published Play Station Eye to join thesomatosensory video game markets.

Institutionalized older adults with wheelchairs who havehistories in stroke, fall and other accidental injuries alwayshave very limited mobility and sedentary lifestyles. Withrelatively fragile body conditions, those older adults need tohave physical/leisure activities that are able to promote theirhealth and prevent the negative impacts of aging anddisabilities. According to previous studies, digital games

2012 Fourth IEEE International Conference On Digital Game And Intelligent Toy Enhanced Learning

978-0-7695-4663-6/12 $26.00 2012 IEEE

DOI 10.1109/DIGITEL.2012.69

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have significant benefits on cognition improvement for olderadults because the sounds and lights of digital games thatemploy figures, voices, charts and visual stimulations tointeract with users can facilitate a variety of activities toalleviate the degeneration of the brain, to promote visualperformance skills and to improve emotional well-being[14][15]. Among all kinds of somatosensory video games,

Xbox 360 Kinect that does not need to hold any remotecontrollers is friendly for the elderly with wheelchairs.Therefore, the purpose of this study is to use this video gameon this population and to understand if it can enhance theirvisual performance skills.

II. R ESEARCH METHODOLOGY

A. Inclusion and Exclusion Criteria

The study was conducted at a nursing home which have335 residents in Changhua city, Taiwan. In the nursinghome, the study was advertised as training sessions for aSomatosensory Video Games in 2011. Oral introductionsand video demonstration with PowerPoint presentation were

provided during 1-week recruitment. In order to perform inthis game, participants were required to have verbalcommunication ability and basic physical functions toparticipate and approved by head nurses who knows theirhealth conditions.

B. Participants

In order to respect personal rights in making decisions oftheir own daily life schedules, non-random purposivesampling were utilized in this study to comply withInstitutional Review Board (IRB) regulation. A total of 53participants were recruited in this study. All institutionalizedolder adults with wheelchairs participated in the study werepre-approved by the medical/managing staff and signedinformed consent forms approved by the human subjects

committee at the Taipei Physical College (ApprovalReference No. 20110023, 8/23/2011) before participating inthe study.

C. SVG programs

A quasi-experimental design was used in this study.Experimental group voluntarily agreed to complete SVGtrainings three times per week, for 30 minute each sessionwhich included 5-minute warm up, 20-minute interactivegaming, and 5-minute cool down. Control group did notreceive any additional training but maintained regular dailyschedules and programs that were provided by the nursinghome. In the study, Xbox-360 Kinect was selected to bethe interventional modality. Mouse mayhem, follow the

arrow and matchmaker are three games which areappropriate to older adults with wheelchair inDr.Kawashima's Body and Brain Exercises and wereselected by the investigators who have long termprofessional working experiences the population. Table Ishowed the training progress notes in this study.

TABLE I. SVGS TRAINING PLANS

Time Intervention program

week 1 Mouse mayhem x 12


Follow the arrow x 5


Matchmaker x 3


week 4 Mouse mayhem x 4Matchmaker x 4


1) Follow the arrow (Fig. 1) A total of 20 questions

within one minute are in this game. Red arrows pop out

from five different directions and players have to point out

those arrows by using two arms within 5 seconds to get

ponts.

Figure 1. Follow the arrow

2) Matchmaker(Fig. 2) A total of 15 questions are in

this game and the completed finish time is recorded to

justify players performance. Lots of different colorful

shapes and figures will pop on the screen and the players

have to match the same shapes by using both of their hands

to get the points. Total number of the game is 15.

Figure 2. Matchmaker

3) Mouse mayhem (Fig. 3) Total time of the game isone minute. The task in the game is to touch mice that

pop out from four different pines which are located at four

different corners on the screen. There are three kinds of

mice in the game. Regular green and gold mice are allowed

to touch and contribute to get points. Then, gold mice with

hedgehog hair shall be avoid to touch or points would be

deducted.

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Figure 3. Mouse mayhem

D. Measurement

In order to understand their improvement of visualperformance skills, Vienna Test System and computersoftware, S9 (Simple reaction-yellow, measurement ofreaction time only), are used in this study. In addition, eye-hand coordination was tested by using Soda Pop test.

1) Reactions: Vienna Test System (Simple reaction-

yellow, measurement of reaction time only)a) Testing time:3 minutes

b) Reliability The Cronbachs Alpha of the recreationtime is 0.963 [16].

2) Eye-hand coordination:Soda Pop test three soda pop

cans (355ml) are placed in every other circle (8.26cm)

starting from the side of the hand being tested. When the test

began, participants were asked to use their dominant hands to

grasp the first can and turn upside down into the adjacent

circle No.2 within the drawn line and No. 3 can to the No. 4

circle and No. 5 to the No.6 circle. The participant then

returns to the first can turned, replaces it in the original

position and proceeds with the other two cans. This whole

process is repeated twice [17]. Every participants wasrequested to complete the test twice and the higher scores

were used for the data analysisFig. 4.

Figure 4. Soda Pop test

E. Data Collection and Analysis

SPSS 18.0 was used to analyze the data. A Mann-Whitney nonparametric test for two independent sampleswas used to evaluate training differences in the experimentaland control groups for changes in reactions and eye-handsCoordination.

III. R ESULTS

The data set of 19 females and 3 males in theexperimental group and 18 females and 13 males in thecontrol group participated in this study. In the post-testperiod, 4 participants rejected to complete the test due to thebody discomfort and 1 participant only completed eye-handcoordination test and could not complete the reaction time

test due to the eye discomfort in control group. Accordingto the results of statistics, except the gender, there are nosignificant differences in their age, body weight and Mini-Mental Status Examination (MMSE) between the groups.Table II shows the demographic information of theparticipants.

TABLE II. PARTICIPANT DEMOGRAPHICS (N=53)

Items Experiments(n=22) Controls(n=31) t

Gender 3M:19F 13M:18F 2.42*

Age(y) 78.55 6.70 79.97 7.00 -0.74

Weight(kg) 58.19 10.76 57.10 12.60 0.33

MMSE 23.85 5.77 20.16 7.89 1.84

*p< 0.05

A. Reaction TestThe Table II shows that there is no significant difference

of the recreation time between experimental and controlgroup before the intervention. However, after one-monthXbox 360 video game training, two groups had significantdifference in their recreation time (p< 0.001). The reactiontime of experimental group decreased from 634.65 ms to467.14 ms and the time of control group increased from741.10 ms to 944.00 ms.

TABLE III. RESULTS OF THE MANNWHITNEY ANALYSIS ON OLDERADULTS WITH WHEELCHAIR WHOSE PRE AND POST TESTS SIMPLE REACTIONOF EXPERIMENTAL AND CONTROL GROUPS.

The study groups n Mean(SD) z statistics

Pre-test -1.91Experiments 22 634.65(597.11)Controls 31 741.10(506.38)

Post-test -3.58***

Experiments 22 467.14(234.45)Controls 27 944.00(689.94)

***p< 0.001

msec

0

200

400

600

800

1000

1200

1400

1600

1800

Experiments

Controls

Pre-test Pos-test

***

Figure 5. Mean values and SDs for reaction test before and after Xbox360 kinect traning (***p < 0.001).

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B. Eye-hand coordination

In eye-hand coordination, two groups had biggersignificant difference (z statistics = -4.28, p < 0.001) afterone-month Xbox 360 video game training although there isalready significant difference between two groups in the pre-test (z statistics = -2.08, p < 0.05). The eye-handcoordination of experimental group decreased from 24.91

seconds to 18.90 seconds and the time of control groupincreased from 35.97 seconds to 37.58 seconds.

TABLE IV. RESULTS OF THE MANNWHITNEY ANALYSIS ON OLDERADULTS WITH WHEELCHAIR WHOSE PRE AND POST TESTS EYE-HANDSCOORDINATION OF EXPERIMENTAL AND CONTROL GROUPS.

The study groups n Mean(SD) z statistics

Pre-test -2.08*

Experiments 22 24.91(10.54)

Controls 31 35.97(21.16)

Post-test -4.28***

Experiments 22 18.90(10.20)

Controls 28 37.58(26.65)

*p< 0.05; ***p< 0.001

Pre-test Pos-test

sec

0

10

20

30

40

50

60

70

Experiments

Controls

*

***

Figure 6. Mean values and SDs for eye-hand coordination before andafter Xbox 360 kinect traning (*p< 0.05; ***p< 0.001)

IV. DISCUSSION

According to the findings, one-month Xbox 360 Kinectvideo game training (three times per week, for 30 minuteeach session) can successfully improved visual performanceskills (recreation time and eye-hand coordination) oninstitutionalized older adults with wheelchair.

Because aging process leads the degradation of thenervous system which will make the central nervous systemconduction have lower accuracy and the endocrine/nervoussystem become weakened, the reaction time of older adultstend to getting slow [19]. In addition, a variety of age-related illnesses also speed up the degradation process [20].However, reaction time plays an important key onmaintaining their activities of daily living (ADL). Forexample, the reaction time can help the elderly to interact

with daily living and help to solve sudden emergencies, suchas falls. In this study, the differences between the groupswere 106.45 ms in the pretest but have bigger difference (p

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