Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation

Mohanraj Thirumalai, William B Kirkland, Samuel R Misko, Sangeetha Padalabalanarayanan, Laurie A Malone, Mohanraj Thirumalai, William B Kirkland, Samuel R Misko, Sangeetha Padalabalanarayanan, Laurie A Malone

Abstract

Background: Active video game (AVG) playing, also known as "exergaming," is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play.

Objective: The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments.

Methods: In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants' perceived usability.

Results: The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users' range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as "good," while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as "excellent." We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable.

Conclusions: This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller's potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial.

Trial registration: ClinicalTrials.gov NCT02994199; https://ichgcp.net/clinical-trials-registry/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf).

Keywords: Wii Fit; active video gaming; equipment design; exercise; physical activity; physical disability; rehabilitation; sedentary lifestyle; usability; video games; wheelchairs.

Conflict of interest statement

Conflicts of Interest: None declared.

©Mohanraj Thirumalai, William B Kirkland, Samuel R Misko, Sangeetha Padalabalanarayanan, Laurie A Malone. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 06.03.2018.

Figures

Figure 1
Figure 1
Commercial off-the-shelf Wii Fit Balance Board.
Figure 2
Figure 2
Wii Fit Balance Board electrical components.
Figure 3
Figure 3
Adapted Wii Fit Balance Board with added ramp, adjustable-height handrails, and control box mounted on the right-side handle.
Figure 4
Figure 4
Bottom view of the adapted Wii Fit Balance Board braced for rigidity.
Figure 5
Figure 5
Custom electronics schematic for the adapted Wii Fit Balance Board enabling voltage readings from the load cells to be captured, analyzed, manipulated, and retransmitted to the electronic control unit.
Figure 6
Figure 6
Wheelchair user using adapted Wii Fit Balance Board.

References

    1. Barnett A, Cerin E, Baranowski T. Active video games for youth: a systematic review. J Phys Act Health. 2011 Jul;8(5):724–37.
    1. Biddiss E, Irwin J. Active video games to promote physical activity in children and youth: a systematic review. Arch Pediatr Adolesc Med. 2010 Jul;164(7):664–72. doi: 10.1001/archpediatrics.2010.104.
    1. Dutta N, Pereira MA. Effects of active video games on energy expenditure in adults: a systematic literature review. J Phys Act Health. 2015 Jun;12(6):890–9. doi: 10.1123/jpah.2013-0168.
    1. LeBlanc AG, Chaput J, McFarlane A, Colley RC, Thivel D, Biddle SJH, Maddison R, Leatherdale ST, Tremblay MS. Active video games and health indicators in children and youth: a systematic review. PLoS One. 2013;8(6):e65351. doi: 10.1371/journal.pone.0065351.
    1. Norris E, Hamer M, Stamatakis E. Active video games in schools and effects on physical activity and health: a systematic review. J Pediatr. 2016 May;172:40–46.e5. doi: 10.1016/j.jpeds.2016.02.001.
    1. Peng W, Crouse JC, Lin J. Using active video games for physical activity promotion: a systematic review of the current state of research. Health Educ Behav. 2013 Apr;40(2):171–92. doi: 10.1177/1090198112444956.
    1. Deutsch JE, Guarrera-Bowlby P, Myslinski MJ, Kafri M. Is there evidence that active videogames increase energy expenditure and exercise intensity for people poststroke and with cerebral palsy? Games Health J. 2015 Feb;4(1):31–7. doi: 10.1089/g4h.2014.0082.
    1. Fritz SL, Peters DM, Merlo AM, Donley J. Active video-gaming effects on balance and mobility in individuals with chronic stroke: a randomized controlled trial. Top Stroke Rehabil. 2013;20(3):218–25. doi: 10.1310/tsr2003-218.
    1. Higgins HC, Horton JK, Hodgkinson BC, Muggleton SB. Lessons learned: staff perceptions of the Nintendo Wii as a health promotion tool within an aged-care and disability service. Health Promot J Austr. 2010 Dec;21(3):189–95.
    1. Hurkmans HL, Ribbers GM, Streur-Kranenburg MF, Stam HJ, van den Berg-Emons RJ. Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study. J Neuroeng Rehabil. 2011 Jul 14;8:38. doi: 10.1186/1743-0003-8-38.
    1. Iosa M, Morone G, Fusco A, Castagnoli M, Fusco FR, Pratesi L, Paolucci S. Leap motion controlled videogame-based therapy for rehabilitation of elderly patients with subacute stroke: a feasibility pilot study. Top Stroke Rehabil. 2015 Aug;22(4):306–16. doi: 10.1179/1074935714Z.0000000036.
    1. Malone LA, Rowland JL, Rogers R, Mehta T, Padalabalanarayanan S, Thirumalai M, Rimmer JH. Active videogaming in youth with physical disability: gameplay and enjoyment. Games Health J. 2016 Oct 03; doi: 10.1089/g4h.2015.0105.
    1. Mouawad MR, Doust CG, Max MD, McNulty PA. Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study. J Rehabil Med. 2011 May;43(6):527–33. doi: 10.2340/16501977-0816.
    1. Robert M, Ballaz L, Hart R, Lemay M. Exercise intensity levels in children with cerebral palsy while playing with an active video game console. Phys Ther. 2013 Aug;93(8):1084–91. doi: 10.2522/ptj.20120204.
    1. Rowland JL, Malone LA, Fidopiastis CM, Padalabalanarayanan S, Thirumalai M, Rimmer JH. Perspectives on active video gaming as a new frontier in accessible physical activity for youth with physical disabilities. Phys Ther. 2016 Apr;96(4):521–32. doi: 10.2522/ptj.20140258.
    1. Rowland JL, Rimmer JH. Feasibility of using active video gaming as a means for increasing energy expenditure in three nonambulatory young adults with disabilities. PM R. 2012 Aug;4(8):569–73. doi: 10.1016/j.pmrj.2012.03.011.
    1. Bonnechère B, Jansen B, Omelina L, Van Sint Jan S. The use of commercial video games in rehabilitation: a systematic review. Int J Rehabil Res. 2016 Dec;39(4):277–290. doi: 10.1097/MRR.0000000000000190.
    1. Staiano AE, Flynn R. Therapeutic uses of active videogames: a systematic review. Games Health J. 2014 Dec;3(6):351–65. doi: 10.1089/g4h.2013.0100.
    1. Barry G, Galna B, Rochester L. The role of exergaming in Parkinson's disease rehabilitation: a systematic review of the evidence. J Neuroeng Rehabil. 2014 Mar 07;11:33. doi: 10.1186/1743-0003-11-33.
    1. Cheok G, Tan D, Low A, Hewitt J. Is Nintendo Wii an effective intervention for individuals with stroke? A systematic review and meta-analysis. J Am Med Dir Assoc. 2015 Nov 01;16(11):923–32. doi: 10.1016/j.jamda.2015.06.010.
    1. Dos Santos LRA, Carregosa AA, Masruha MR, Dos Santos PA, Da Silveira Coêlho ML, Ferraz DD, Da Silva Ribeiro NM. The use of Nintendo Wii in the rehabilitation of poststroke patients: a systematic review. J Stroke Cerebrovasc Dis. 2015 Oct;24(10):2298–305. doi: 10.1016/j.jstrokecerebrovasdis.2015.06.010.
    1. Wall T, Feinn R, Chui K, Cheng MS. The effects of the Nintendo™ Wii Fit on gait, balance, and quality of life in individuals with incomplete spinal cord injury. J Spinal Cord Med. 2015 Nov;38(6):777–83. doi: 10.1179/2045772314Y.0000000296.
    1. Brichetto G, Spallarossa P, de Carvalho MLL, Battaglia MA. The effect of Nintendo® Wii® on balance in people with multiple sclerosis: a pilot randomized control study. Mult Scler. 2013 Aug;19(9):1219–21. doi: 10.1177/1352458512472747.
    1. Forsberg A, Nilsagård Y, Boström K. Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists. Disabil Rehabil. 2015;37(4):338–44. doi: 10.3109/09638288.2014.918196.
    1. Monteiro junior RS, Dantas A, de Souza CP, da Silva EB. Acute responses of a physical training session with a Nintendo Wii on hemodynamic variables of an individual with multiple sclerosis. Games Health J. 2012 Dec;1(6):456–9. doi: 10.1089/g4h.2012.0062.
    1. Nilsagård YE, Forsberg AS, von Koch L. Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Mult Scler. 2013 Feb;19(2):209–16. doi: 10.1177/1352458512450088.
    1. Pau M, Coghe G, Corona F, Leban B, Marrosu MG, Cocco E. Effectiveness and limitations of unsupervised home-based balance rehabilitation with Nintendo Wii in people with multiple sclerosis. Biomed Res Int. 2015;2015:916478. doi: 10.1155/2015/916478. doi: 10.1155/2015/916478.
    1. Plow M, Finlayson M. Potential benefits of Nintendo Wii Fit among people with multiple sclerosis: a longitudinal pilot study. Int J MS Care. 2011;13(1):21–30. doi: 10.7224/1537-2073-13.1.21.
    1. Yuan B, Folmer E. Blind hero: enabling guitar hero for the visually impaired. 10th international ACM SIGACCESS Conference on Computers and Accessibility; October 13-15, 2008; Halifax, NS, Canada. 2008. pp. 169–176.
    1. Allman T, Dhillon R, Landau M, Kurniawan S. Rock vibe: Rock Band® computer games for people with no or limited vision. 11th International ACM SIGACCESS Conference on Computers and Accessibility; October 26-28, 2009; Pittsburgh, PA, USA. 2009. pp. 51–58.
    1. Iacopetti F, Fanucci L, Roncella R, Giusti D, Scebba A. Game console controller interface for people with disability. CISIS 2008. Second International Conference on Complex, Intelligent and Software Intensive Systems; March 4-7, 2008; Barcelona, Spain. 2008. pp. 757–762.
    1. Garrido Y, Marco Á, Segura J, Blanco T, Casas R. Accessible gaming through mainstreaming kinetic controller. In: Nijholt A, Reidsma D, Hondorp H, editors. Intelligent Technologies for Interactive Entertainment. Cham, Switzerland: Springer International Publishing AG; 2009. pp. 68–77.
    1. Wiemeyer J, Deutsch J, Malone LA, Rowland JL, Swartz MC, Xiong J, Zhang FF. Recommendations for the optimal design of exergame interventions for persons with disabilities: challenges, best practices, and future research. Games Health J. 2015 Feb;4(1):58–62. doi: 10.1089/g4h.2014.0078.
    1. Gulliksen J, Göransson B, Boivie I, Blomkvist S, Persson J, Cajander Å. Key principles for user-centred systems design. Behav Inf Technol. 2003;22(6):397–409.
    1. Brooke J. SUS: a quick and dirty usability scale. Usabil Eval Ind. 1996;189(194):4–7.
    1. Bangor A, Kortum P, Miller J. An empirical evaluation of the system usability scale. Int J Hum Comput Interact. 2008;24(6):574–594.
    1. Sauro J. Measuring usability with the system usability scale (SUS) Denver, CO: MeasuringU; 2011. Feb 02, [2018-02-21].
    1. World Health Organization . International Classification of Functioning, Disability and Health. Geneva, Switzerland: WHO; 2001.
    1. World Health Organization . How to use the ICF: A Practical Manual for Using the International Classification of Functioning, Disability and Health (ICF). Exposure draft for comment. Geneva, Switzerland: WHO; 2013. Oct, [2018-02-21]. .
    1. Faulkner L. Beyond the five-user assumption: benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput. 2003 Aug;35(3):379–83.
    1. Malone LA, Padalabalanarayanan S, McCroskey J, Thirumalai M. Assessment of active video gaming using adapted controllers by individuals with physical disabilities: a protocol. JMIR Res Protoc. 2017 Jun 16;6(6):e116. doi: 10.2196/resprot.7621.
    1. Wilken JM, Roy CW, Shaffer SW, Patzkowski JC, Blanck RV, Owens JG, Hsu JR. Physical performance limitations following severe lower extremity trauma in military service members. J Orthop Trauma. 2018 Jan 08; doi: 10.1097/BOT.0000000000001103.
    1. Rimmer JH. Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions. Phys Ther. 1999 May;79(5):495–502.
    1. Rimmer JH, Rowland JL, Yamaki K. Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population. J Adolesc Health. 2007 Sep;41(3):224–9. doi: 10.1016/j.jadohealth.2007.05.005.
    1. Simor FW, Brum MR, Schmidt JDE, Rieder R, De Marchi ACB. Usability evaluation methods for gesture-based games: a systematic review. JMIR Serious Games. 2016 Oct 04;4(2):e17. doi: 10.2196/games.8013.
    1. Nawaz A, Skjæret N, Helbostad JL, Vereijken B, Boulton E, Svanaes D. Usability and acceptability of balance exergames in older adults: a scoping review. Health Informatics J. 2016 Dec;22(4):911–931. doi: 10.1177/1460458215598638.

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