Personalized Game Suite: A unified platform to sustain and improve the Quality of Life of Parkinson’s Disease patients

• ¹ Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
• ² Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Greece
• ³ Department of Medical Physics, Aristotle University of Thessaloniki, Greece
• ⁴ Khalifa University, Electrical and Computer Engineering, United Arab Emirates

The use of apps/games in healthcare interventions is gaining popularity (Konstantinidis et al., 2016), but there is still a gap in the understanding on how these types of interventions are used for the management of Parkinson disease (PD). In fact, gamification in healthcare (mHealth) can help people initiate healthier activities in various areas, such as losing weight, sleeping more, making healthier food choices, improving fitness, and monitoring health metrics. In this vein, there are six key elements that can help to understanding the concept of gamification, namely: i) perception of play; ii) clear rules; iii) concrete objectives and intermediate goals; iv) group dynamics; v) motivation with rewards; and vi) continuing the challenge (Marcus, 2013). Motivated by the above perspectives, and targeting intelligent early detection and intervention in PD area, we intend to explore here the Personalized Game Suite (PGS) approach, as part of the H2020 i-Prognosis project (www.i-prognosis.eu), that introduces for the first time the integration of different serious games (i.e., ExerGames, DietaryGames, EmoGames and Hand writing/Voice (H/V) Games) in a unified platform targeting PD. The basic component of the PGS is the game, based on different goal-oriented activities through a virtual environment. More specifically: • ExerGames will focus on the main exercises used in the intervention of early stages of PD as part of a rehabilitation programme based on the multidisciplinary and European guidelines for PD (Keus et al., 2014), highlighting the potentialities of physical activity as an effective strategy to delay or reverse motor and functional loss in individuals in early stages of PD. • DietaryGames will attempt to affect the nutritional status of individuals towards healthier and balanced dietary habits as part of a re-education programme. For instance, after a nutritional content of popular ingredients used in households, based on UK Eatwell Plate approach (Food Standard Agency, FSA), a selection of foods asking the player to make healthy combinations taking into account specified calories, food groups, water and emotional state (Dias et al., 2016) will be provided. • EmoGames will focus on expressive face encouragement for early PD patients with collateral detection - use of eye blinking. More specifically, they will not target the learning of facial expressions but the encouragement of the player to achieve facial expressions of which s/he is aware, based on semantically annotated, in terms of emotion, content, e.g., photos, text, as well as empathic induction of expressions based on facial expression images. Moreover, blinking-based navigation through game blocks will be enabled in an attempt to foster natural blinking reestablishment. • H/VGames will target on enhancing the handwriting patterns of early PD patients by prompting to write/draw specific letters and numbers with guidance lines and within specific space limits while providing real-time feedback of the performance; in addition, this games will be adaptable to the players’ own writing styles and profiles. Additionally, voice and breathing training games prompting the player to pronounce specific vowels/words at constant or alternating voice intensity levels, use shorter sentences and train vocal cords will be developed towards hypophonia limitation. Moreover, the PGS will collect the in-game metrics and games performance of all the sessions in a semantically annotated database (similarly to Bamparopoulos et al., 2016), supporting a multiplayer component in the sense of grouping and challenges. The users will have to compete or collaborate in the sense of accomplishing tasks as a group (interacting with a variation of games) apart from playing the exact same game at the same time which may negatively affect attitude towards use due to user’s likes, time commitment, etc., and may lead to drop out. Overall, it is our intention to gamify the management of the PD patient’s condition, in order to improve it and/or sustaining and/or slowing down its progressive deterioration. As a result, the principles of patient-centered care via the inclusion of behavior change programs from different apps/games for patients/caregivers adapted to the early stages of the PD will be considered, taking into account safety, feasibility, personalization and socialization issues. From this perspective, it will be possible to: a) provide opportunities for the progressive use of self-assessment tools/games into more specific and integrated monitoring tools; b) use the app/games to set up simple routine to better manage patient’s healthy life (e.g., have reminder for exercising, selection of healthier combination of ingredients); c) help family/friends/caregivers to understand the evolution of PD through games and activities; and d) plan different kind of apps/games/scenarios according to the needs of the patients. In general, exercise could improve cognition in humans with PD through the promotion of neuronal proliferation, neuroprotection, neurogenesis, and potentially reduction in brain inflammation, promoting neurorestoration through activation of signaling cascades by neurotrophic factors (Zigmond et al., 2012; Murray et al., 2014; Konstantinidis et al., 2016a). To this end, the realization of PGSc sets the basis for establishing a holistic approach that could aim at improving not only motor symptoms, but also behavioural and cognitive impairments in PD, informing health care providers and policy makers for its inclusion in routine management and neurorehabilitation for PD.