Designing Gamified Activities with Haptic-Enabled Tangible Robots for Therapy and Assistance

In this thesis, we contribute to the field of rehabilitation robotics by designing haptic-enabledtangible robot-based activities and exploring their added value for therapy and assistance.The research specifically focuses on the design and development of gamified robot-enhancedtherapy and training activities for patients suffering from neurological disorders, childrenwith neurodevelopmental difficulties and elderly. We adopted an iterative design approach todevelop adaptive components tailored to the specific needs of the multiple target groups, andintroduced gamification as a way to increase users' engagement with the training.The key accomplishments of our research are: (1) We designed and developed robot-mediatedgamified handwriting activities by iteratively adapting, testing and integrating the systeminto occupational therapy environments for children with neurodevelopmental difficulties.We showed that haptic-enabled tangible robots can be a useful tool for handwriting trainingin multi-child therapy settings. (2) We designed and developed a novel robot-enhancedupper limb rehabilitation game, the Tangible Pacman Game, with various adaptive andconfigurable components and game elements. We showed that these adaptation elementsallow for personalized interventions tailored to individuals with varying level of impairments,ranging from stroke patients, to older adults and to children with hemiplegia, overall aged 3 to77 years old. (3) We investigated the effectiveness of our tangible robot-mediated activitieswith chronic stroke patients, and showed the effect of gamification on performance outcomesas well as patients' preferences via a controlled study. We showed that gamification leads to amore controlled motor performance and discovered that there are patients who do not likegamification, or for whom gamification is not well suited. (4) We extended the applicationof our approach into the context of healthy aging, investigating the effect of the TangiblePacman Game and its game elements on the motor performance of the elderly. We exploredage-related differences within a controlled study with a young control group, and showedpositive motor learning and skill transfer. (5) We developed further variants of our proposedsystem with additional adaptations and features to increase its effectiveness and acceptanceby: (5a) Designing dynamic game spaces with rearrangeable tiles, (5b) Incorporating IMUsto our games to detect and prevent compensatory motions, (5c) Developing co-located andremote multiplayer game modalities to promote social interaction, and elevating the tangiblerobots to the online space to bridge the patient's interaction with therapists or family membersin the context of recent social distancing rules.Throughout this thesis, we aimed to strike a balance between exploration and exploitation.In the exploration side, we interleaved design, development and testing in multiple stepsinvolving 7 therapy centers in 5 cities in 2 countries. This allowed us to successfully introduceand adapt our system to different therapy settings and persons affected by a large rangeof neurological difficulties and impairment levels. In the exploitation side, we conductedcontrolled studies, showing the effectiveness of our interventions on real target users. In total,the designs in this thesis touched 122 healthy participants, 96 target users and 18 domainprofessionals.