Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic

John Muñoz, Samira Mehrabi, Yirou Li, Aysha Basharat, Laura E Middleton, Shi Cao, Michael Barnett-Cowan, Jennifer Boger, John Muñoz, Samira Mehrabi, Yirou Li, Aysha Basharat, Laura E Middleton, Shi Cao, Michael Barnett-Cowan, Jennifer Boger

Abstract

Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible.

Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI.

Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts.

Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users.

Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic.

Keywords: COVID-19; VR; co-development; dementia; design; elderly; exercise; exergames; gaming; head mounted displays; older adults; participatory design; persons living with dementia; physical activity; user-centered; virtual reality.

Conflict of interest statement

Conflicts of Interest: None declared.

©John Muñoz, Samira Mehrabi, Yirou Li, Aysha Basharat, Laura E Middleton, Shi Cao, Michael Barnett-Cowan, Jennifer Boger. Originally published in JMIR Serious Games (https://games.jmir.org), 19.01.2022.

Figures

Figure 1
Figure 1
Components of the triadic interaction between the research team, industry partners, and LTC homes. LTC: long-term care; MCI: mild cognitive impairment; PLWD: person living with dementia/MCI; R&D: research and development; VR: virtual reality.
Figure 2
Figure 2
One-page level design of the Exerfarm Valley concept. (A) Four-level design sketch representing the activities and main game levels envisioned (including Seas the Day). (B) Seas the Day level design discussed with the development team of the virtual reality company specifying the spatial characteristic of the elements in the virtual environment.
Figure 3
Figure 3
Brainstorming sessions. (A) Introductory session carried out involving multiple stakeholders of the project. (B) Exploratory sessions carried out with exercise therapists to introduce the head-mounted displayed-virtual reality technology and collect ideas about game mechanics.
Figure 4
Figure 4
Seas the day screenshots showing the game levels of Tai Chi (warm up, left), rowing (conditioning, middle), and fishing (cool-down, right).

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