Serious Game based on FiDisorder

Zelai Sáenz de DeustoTech Institu

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Abstract— Within the group of individuala number of people who interact wtechnologies, which makes them the mainproject. The project described in this paper consimplementing a multimedia application wof Serious Games.

The main aim is to create a system cSerious Games oriented to first aid educcertain situations, basic knowledge aboutspecialties... all employing the use of newthe Android operating system implementor tablets.

Not only technological results have beopinions of users and specialists taapplication’s validation and initial testing into account.

Keywords-autism; First Aid Education

health; Android; database; tablets

I. INTRODUCTION

Autism is a neurodevelopmental disoare detected in the first years of life affects and alters the areas of cominteraction and behavior. It is a lifelongdrastically limit the life of the person causing significant stress in the family.

Autism is not a disease, it is a synsymptoms that characterize a degenerabio-psycho-social. This disability isdisorder, permanent and profound. Oftenaccompanied by abnormal behavior, suinterests of repetitive and stereotyped rand unusual obsessions towards objects o

Appears during the first three years common in men than in women of all typand social class around the world. Peoplhave an average lifespan like peoppopulation.

Studies in Asia, Europe, and Noidentified individuals with an ASD wprevalence of 0.6% to over 1%.[1] A reKorea and published in the American Jreported a prevalence of 2.6%. [2].

It is estimated that between 1 in 80 aaverage of 1 in� 110 children in the UnASD [3]

irst Aid Education for individuals wir (ASD) using Android Mobile Devic

Urturi, Amaia Méndez Zorrilla, Begoña García Zte of Technology. DeustoTech-LIFE Unit. University Avda. Universidades, 24. 48007 Bilbao. Spain mail: {amaia.mendez, mbgarciazapi}@deusto.es

ls with ASD there are well with the new n beneficiaries of this

sists of designing and within the framework

composed of a set of cation: what to do in t healthcare, medical technologies such as

ted on mobile phones

een analyzed, but the aking part in the have also been taken

n;Serious Games for s; smartphones;

N

order. The main signs and it significantly

mmunication, social g disorder and it will

who has it besides

ndrome, a cluster of ative disorder of the s a developmental n these symptoms are uch as activities and rocking movements, or events.

of life and is more pes of race, ethnicity le with this disability ple in the general

orth America have with an approximate ecent study in South ournal of Psychiatry

and 1 in 240 with an nited States have an

Figure 1. Chart showing thNational Centre for Health S

The group of disordersgroups:

1. Disruption of social relto the world around tabnormal with people, obdistinguish events. 2. Communication Disosenses and their responsetouch, pain, balance, smhandles his body. Speechdelayed, or do not appeaobvious intellectual abiliti3. Mental disorder: lack o The percentage of indi

sufficient capacity to liveindependent) is relatively logreat help throughout life. Breceive appropriate resourceexist into society properly, and acquiring a greater degre

Due to these reasons, thisof life of individuals with Amuch as possible through themobile devices such asimplementing Serious Games

Computer games have biPods and smartphones oradvantages of tablet devicesmulti-touch and gestures to g

ith Autism Spectrum ces

Zapirain of Deusto.

he increase in autism diagnosis from the Statistics [4].

s can be classified into three

lationships. They does not relate them. Their relationships are bjects and animals. They do not

rder. Any combination of the es are affected (vision, hearing, mell, taste) and how the child h and language capabilities are ar at all, even though there are ies.

of mental flexibility.

viduals with ASD who have e independently (or partially w, and most of them require a

But it’s established, that if they es and support, are able to co-improving their quality of life, e of autonomy. s study aims to improve quality ASD and enhance autonomy as e use of the latest technologies in s smartphones and tablets, s [5]. been increasingly mediated via r tablet devices. One of the s, besides allowing users to use get rapid device feedback, is the

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potential to use the device to engage more than one user at a time in a social context [6] Studies[7] suggest that computer-assisted instruction incorporating multimedia elements, and particularly, visually-rich elements, can be used to engage and effectively teach children with ASD.

The Serious Games have been designed so that, besides their pure entertainment value, they convey relevant ideas or messages about various aspects not related to the gaming industry. A Serious Game is associated with the education and learning of new concepts and skills, but can also works as training and simulation of various activities of real life. In other words, a serious game should have an evident connection between the real- and virtual world, and a purpose beyond pure entertainment.

According to a study of the behavioral sciences institute of learning [8] the user benefits (related to a serious game) are:

• Methodology Learning By Doing. Retention rates would be:

o 5% of what you hear o 20% when there are multimedia elements o 80% of what we do

• Being able to simulate real situations • The existence of an element of play.

The project will be aimed at individuals with ASD

themselves (who study or work) and people who work with them, such as psychologists, and family members. The specialists will be provided with objective reporting of activities. This kind of information will help them to achieve greater influence on people with this disability. This information can be viewed through a single web application.

The article is structured as follows: Section 2 describes

the objectives and Section 3, the methods used. Section 4 explains the design of the application and Section 5 summarizes the evaluation of the obtained results, and finally, some concluding remarks are presented in the last section.

II. OBJECTIVES

The overall objective of this project is to create a system composed of several Serious Games oriented to first aid education, minor diseases, and knowledge of medical specialties ... all employing the use of new technologies such as the Android operating system, implemented on mobile phones or tablets.

This general approach can be broken down into several

specific objectives, as described below. • Develop a "Serious Game” aimed at learn how to

deal with first aid situations in a fun and dynamic way.

• Identify and evaluate a range of objective variables such as: the movements made by the user, the level of success…

• Design an interface that suits the needs of the autistic population, making use of ICT, specifically through the use of touch-enabled mobile devices such as smartphones and tablets.

• Promoting e-inclusion: equal opportunities for access and participation of people with autism in the Information Society.

For the accomplishment of these goals and due to ethical

issues, the consent form has been signed by the parents of the children participating in this experiment.

III. METHODS

The tools employed for the development of this game/application are described below.

A. Mobile Operating System Choice

ICT Evolution and in particular the increased speed of data transfer over the Internet, and various mobile device platforms development have made e-health and tele-health systems move one step forward and reach the m-health spectrum.

Currently, the only mobile operating systems that have reached significant market share are Android (Google) and iOS (Apple) [9]

The author has chosen Android operative system to develop the Serious Games in this project.

B. MYSQL

A database will be used to store the results obtained from the last session. These results can later be used to form a report. The database used, is MySQL, a relational, multithreaded and multiuse database management system licensed under the GNU GPL. Its multithreaded design allows it to withstand large loads very efficiently.

C. PHP SCRIPTS

They are responsible for managing the database. All of them make use of an encryption script.

D. Web

Web development following W3C standards (XHTML + CSS) to ensure compatibility across browsers, which relies on a series of scripts in PHP for exclusive use via web.

IV. DESIGN

The architecture used to develop the application is a three-layer one. The main goal of the architecture is the segmented design which separates the logical layer from the business layer (Fig. 2). This means that tasks can be divided in order to work comfortably by levels, abstracting some levels from others.

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Architecture Description The three layers are described below: • Presentation Layer. The various multimedia

elements making up the application are situated in this layer. They display and capture the user information in order to deliver it to the business layer.

• Business Layer. This layer houses the internal logical needed to provide core functionality of the mini-games. Having an independent business layer provides great adaptability to the application because it allows the incorporation of new mini-games to this Serious Game without compromising other system components. Each mini game is independent, although they can easily communicate between them. The resulting information is sent to be displayed in the presentation layer, on the phone screen, or to be used in concurrence with the database, to store all the data generated during the last session.

• Database Layer. This layer is made up of the database manager, which will back up the business layer in the storing and data-obtaining processes. In the database some parameters will be stored like the name of the user, the actual date and hour, the number of right and wrong combinations… etc.

Figure 2. Architecture

The logic of the application is described below. The diagram of Fig. 3 explains in more detail how the application works.

First of all, the user has several game-modules (sets of mini games or activities) to choose from, each one with different levels of difficulty.

After finishing the activity, the application will connect to the server with HTTP / HTTPS connection requests, will access to the database and will store the data generated during gameplay (like errors made during play), and will update the record for that user, if necessary. Once the data has been saved, it will generate a more detailed report about the user, explaining in which activity errors have been made, and what can the reason could be. The monitors and support

people can review the reports to evaluate the improvement grade, also to help them with real life activities in which they failed, or had a lesser score.

Figure 3. General Diagram of First Aid Serious Game

Encryption

Because private data about the activities of each user is sent through the Internet, it is desirable to encrypt this information.

This module is responsible for signing the data from your phone for later verification by the server, and decrypting the datagrams from the latter. This results in a security layer for the obtained data, to make sure no malicious theft can occur.

It uses an asymmetric encryption system, with a private key that is housed on the server and a public key in the application.

As an independent module, the encryption algorithm can easily be altered without much impact on the other modules of the application. Situations where this might be needed are a security breach or the emergence of more robust or optimized algorithms for mobile devices.

Description of Mini-Games/Activities At the beginning of each mini game, the user will be

asked to enter the name (or nickname) which will be referenced in the final report. They can also choose a picture from an avatar (an image from a girl, boy, a person who wears glasses, student, worker…etc) which identifies them during gameplay.

The application consists of 3 sets of mini-games: 1- Order the sequences (see Fig. 5)

It consists of ordering sequences of images that previously have been scrambled randomly. In order to guess the correct sequence, they can simply touch the images on the screen in the order they desire.

These sequences are related to various aspects of first aid such as: what to do when you get a cut, burn, headache, what to do to call a doctor… etc. All the pictures have a

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little explanation down. The player will have a limited time to solve as many

sequences as possible and get a good score. If the order is right, the user will carry on with more difficult sequences and finally he will obtain his score. The person playing (or people who works with them) can choose whether or not to include a time-limit. The inclusion of this constraint should depend on the kind of person who is playing in the specific session, their autism grade and his/her level of stress while playing. Upon completion of this activity and after storing the appropriate parameters in the database, a new report associated with that user will be generated. In the report will state the correct and incorrect sequences, the time needed to resolve each one... etc. everything which is necessary to help the family members or psychologists to know in what sequence user has failed real life concepts they do not yet fully understand.

2- Association images and medical specialties (Fig. 6) In these games you are playing:

• To identify the roles of people in a hospital using the color of uniforms they are working in.

• To identify a medical specialty, by choosing which area of the body that it deals with.

The user will have to choose between different pictures

and decide which one has the correct association, by touching the corresponding image. As in the other activity, choosing the right answer will lead to more difficult associations.

3- How to move inside a hospital or a health center. In this set of games you are playing:

• To find help • To identify the indications inside an hospital • To speak with specialists.

V. RESULTS

This section describes the results obtained in two facets: technical results and the feedback received from the user satisfaction questionnaires completed by the pilot users and experts.

Test Execution The users chosen by the experts to participate in the

evaluation are 10 children and adults, both male and female. All people who have participated in the pilot have

demonstrated capacities to perform activities independently, and during the test, people who take care about them were there to help the testers in case of problems.

To perform the test a smartphone and two tablets (with 7” and 10” screen) were used.

Technical Results Each mini game is accessed by a previous login method. This screen is kept extremely simple due to the nature of

the users.

Figure 4. Initial Screen

Individuals with ASD are involved in different situations

in their daily life, the game shows most of the typical ones.

Figure 5. Order the sequences

Whenever the user performs an activity for the first time

(first time in a new mini game), the user is given instructions on how to play, after which the training exercises start. The instructions are a set of videos with graphical and writing explanations, which the user can understand easily.

Figure 6. Identifying roles

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Satisfaction Results At the moment there are only partial results, because the

application is in pilot phase. No one can tell the impact on learning the application can have on individuals with ASD.

The opinions from the people who take care about them, were sought in a simple personal interview, in which they were asked the following questions, answering on a scale from 1 to 5.

Table 1. Support persons Questionnaire.

QUESTION SCORE (average) 1-Did you enjoy using the tool? 3,0

2- Was the user interface easy to use for individuals with ASD? 3,8

4- Is a good idea to use text and images in the video tutorials?

3,2

3- Would you make any changes? Yes

Asked if the interface is appropriate and easy to use for

individuals with Asperger’s Syndrome, the support people have responded positively. But developer is continually adapting the application to users, taking into account all feedback received.

After the test, participants answered several questions, and following data were obtained:

• 70% of them prefer multi-touch screen to a screen with keyboard.

• 60% like using tablets with big screens instead of smartphones.

• 20% don’t like to play with games or use smartphones/tablets.

VI. CONCLUSIONS

The presented game is a project with real applications aimed at the collective of individuals with ASD who has a high degree of independence.

When designing interfaces for learning games, developers should 1) not assume that individuals with Asperger’s Syndrome have the same preferences as typically-developing people or 2) that ASD children are a “type,” with rigidly defined characteristics. Autism is a spectrum disorder, which means that while affected individuals show may show common learning challenges and strengths, they will do so to varying, to unique degrees.

The application, which was developed using Android

mobile devices, has proved that it is possible to enrich and increase the education/therapy impact through the introduction of information and communication technologies.

Individuals with this disorder have accepted the mobile devices well, but the results are even better with the tablets because of their larger size.

After the experiment and the evaluation of the project, the following benefits can be underlined:

• Social Benefits The concept therapy is changed by game concept, to improve the children motivation [10] With educational games, individuals with ASD feel more relax doing the activities. • Medical Benefits

The application collects some parameters united to the therapy. They permit an objective evaluation of learning/therapy process. An example should be the measurement of the necessary time to access to the following level in the video game. This paper will reflect only the first results. In the nearby

future it will increase the number of people with autism who use the application and users will be extended to other groups.

Specialists have recently been demanding that Serious Games of this kind be included in their daily practice because they provide a more recreational vision on activities assessing and measuring the progress of certain therapies.

ACKNOWLEDGMENT

This work was supported in part by Telefonica Moviles and the Basque Country Department of Education, Universities and Research. The author also want to thank the cooperation of APNABI (Association of Parents of individuals with Autism in Vizcaya).

REFERENCES

[1] Summary of Autism/ASD Prevalence Studies

http://www.cdc.gov/ncbddd/autism/documents/Autism_PrevalenceSummaryTable_2011.pdf

[2] Am J Psychiatry. Prevalence of Autism Spectrum Disorders in a Total Population Sample. American Journal of Psychiatry. 9. May 2011

[3] Prevalence of Autism Spectrum Disorders. Autism and Developmental Disabilities Monitoring Network, United States, 2006 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm

[4] CDC Centers for Disease Control and Prevention

http://www.cdc.gov/ncbddd/autism/data.html

http://fightingautism.org/idea/autism.php

[5] Corti K. Games-based business & management skills development. White Paper. 2001. http://www.pixelearning.com/docs/justifying_games_for_learning.pdf

[6] Gal, E., Bauminger, N., Goren-Bar, D., Pianesi, F., Stock, O., Zancanaro, M., & et al. Enhancing social communication of children with high-functioning autism through a co-located interface. Artificial Intelligence and Society, 24(1), 75-84. 2009.

[7] Barakova, E., Gillessen, J., & Feijis, L. Social training of autistic children with interactive intelligent agents. Journal of Integrative Neuroscience, 8(1), 23-34. 2009.

[8] Aldrich, C. Learning by Doing: A Comprehensive. Guide to Simulations, Computer Games, and Pedagogy in e-Learning and Other Educational Experiences. John Wiley and Sons: Pfeiffer, 2005.

[9] Nokia’s report: http://www.symbianlatino.com/2011/04/nokia-transfiere-el-desarrollo-de.html

[10] Squire K.. ”Video games in education”. International Journal of Intelligent Games & Simulation. Vol.2 No 1. February 2003.

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