Serious games – serious digital games – which are mainly used in education or health, can help people with knee injuries or children with writing difficulties. The ZHAW has innovative projects for this.
You move through the middle of a city - past modern building fronts, with the sky above you. Sometimes you have to duck, sometimes jump up into the air. Sometimes you stand on one leg, sometimes you have to tap passing points. The tasks become more demanding, ambition awakens. At the latest in the "Dome", where you have to "catch" rapidly changing color areas, you start to sweat.
Anyone who trains with "The Dome" in an ExerCube is challenged. An ExerCube is like a large cube in which users are surrounded by three video walls and act as the main characters in a video game while training. "The game 'The Dome' is cognitively and physically demanding," says Eveline Graf, Head of the Movement Laboratory at the ZHAW Institute of Physiotherapy. "It playfully motivates you to repeat individual movements over and over again." In rehabilitation after knee injuries, which is what the game is designed for, there's no getting around it.
"It playfully motivates you to repeat individual movements over and over again."
Eveline Graf, Head of the Movement Laboratory at the ZHAW
Before immersing yourself in the virtual world, trackers are attached to your wrists and ankles. They enable the cameras to capture the movements. Then you position yourself on a marker between the three walls, stretch out your arms and have your height determined. Now the game can start. "It includes typical physiotherapy exercises that are important after a cruciate ligament rupture," says Michelle Haas, research assistant. In addition to stability, agility and speed are trained. The game provides visual and acoustic feedback on how well this works. Finally, it lists the service provided in detail.
The exergame "The Dome" was developed by the ZHAW Department of Health together with the ZHdK Department of Design and Sphery AG and financed by the Digitization Initiative of Zurich Universities (DIZH). It is aimed at people who have injured the cruciate ligament and are at an advanced stage of rehabilitation. They are familiar with the exercises and are in the phase before they can resume regular training. "There is often no training plan for this transition," says Michelle Haas, who wrote her Master's thesis on the project. The risk of re-injury is correspondingly high.
The fact that the game is dedicated to knee injuries has to do with the fact that they occur in many sports and are very common. They are drastic and require nine to twelve months of therapy, says project manager Graf. "Many athletes don't reach their original level."
"The Dome" helps those affected to gain confidence. It encourages them to push themselves to the limit. The digital tool appeals to several senses. The exercisers are exposed to various stimuli and are distracted so that the injured knee is forgotten. Your movements are less controlled than in a classic physiotherapy session. In the ExerCube, they come close to real-life situations on the football pitch or tennis court, for example. "The game closes a gap in rehabilitation," emphasizes Eveline Graf. It also prepares people mentally to return to their sport. Not only professionals, but also amateur athletes would be addressed.
"Exergames can complement traditional physiotherapy," the scientist continues. "You can increase the intensity of the training." The therapist's task is to use a game that is adapted to the individual situation. "The Dome" currently has three levels. One day, it could continuously adapt to users' progress. The project partners are continuing to pursue their "ExerUP" project, which was launched in 2021. Among other things, they want to find out how effective and attractive the game is. And Eveline Graf notes with satisfaction: "We get enthusiastic reactions - the training is fun."
Children who have difficulties with writing should also make progress in a playful way. They should practise intensively, but often find this boring and tedious, says Frank Wieber, deputy head of research at the ZHAW Institute of Public Health. "What they should do and what they actually do is sometimes very different." A serious game can motivate them to practise their graphomotor skills regularly.
"Even if we are doing more and more digitally in our everyday lives, writing by hand remains central."
Frank Wieber, ZHAW Institute of Public Health
It is worth tackling writing difficulties early on, emphasizes Annina Zysset, research assistant. They are among the most common learning disorders. They made it difficult for schoolchildren to follow lessons and participate. They could also lead to emotional frustration and low self-esteem. "The earlier you treat them, the better." An interdisciplinary team from the ZHAW, the ZHdK and the PH Zurich has developed the "Konditorei Kritzel" for this purpose; it has received financial support from the canton's DIZH digitalization initiative. The game encourages you to perform swing exercises as accurately as possible, with the right pressure and in a certain amount of time. The task on the tablet is to decorate a multi-tiered cake. The patterns change from floor to floor, sometimes you can give free rein to your creativity. Once the work is complete, it still has to be delivered. The route to the corresponding address must be marked on a map.
To keep the players on their toes, they receive continuous feedback. They are rewarded for good performance. They have a sense of achievement and experience that they are making progress.
"Even though we are doing more and more digitally in our everyday lives, writing by hand remains central," says Frank Wieber. It helps to consolidate and reproduce knowledge. The fact that regular training leads to improvements is scientifically well documented. A game could also help to destigmatize writing difficulties. It is attractive and entertaining: "Everyone wants to play it - even children with no problem."
"Konditorei Kritzel" is deliberately designed to be low-threshold, adds Annina Zysset. The game adapts individually and can be used by teachers without further effort. It hardly needs any instructions and works without an Internet connection or personal accounts. The digital tool will initially be used in schools. It is time-limited; a level is completed after 20 minutes.
"You have to think carefully about whether to bring children to a screen," says Frank Wieber, acknowledging that ethical questions arise. For example, children with attention deficit hyperactivity disorder (ADHD) have an increased risk of developing addictive behavior. They have above-average difficulties with writing and are part of the project's target group. "The decisive factor is how you use the opportunities offered by serious games," says the psychologist. The game itself, but also how it is used, must be ethically justifiable.
"Konditorei Kritzel" picks up users on several levels, reports Zysset. "There is something for everyone: for the creative, the ambitious and the playful." The pilot tests have confirmed this. Children enjoyed playing the game - and improved their motor skills in the process: "They practise without even realizing it."