Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients
Abstract
:1. Introduction
2. Related Concepts on Serious Games
2.1. Serious Games Aimed at Care Training
2.2. Serious Games Targeting Stroke Rehabilitation
3. Materials and Methods
3.1. Model of Knowledge Transfer
3.2. Implementation of the iTrain Game
- Stroke survivor’s needs;
- Scenarios;
- Interactive objects;
- Characters.
- Hunger;
- Mood;
- Rest;
- Hygiene;
- Clinical stability.
4. Evaluation and Results
5. Discussion and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
iTrain | iTrain serious game and other training materials [21] |
QOL | Quality of Life |
GDS | Geriatric Depression Scale |
SUS | Software Usability Survey |
AI | Artificial Intelligence |
ML | Machine learning |
RL | Reinforcement Learning |
VR | Virtual Reality |
AR | Augmented Reality |
EEG | Electroencephalogram |
EMG | Electromyography |
FMG | Forcemyography |
SIERRA | Serious game framework by [60] |
TPACK | Serious gaming framework by [35] |
AGAR | Serious gaming framework by [70] |
STRONGER | Serious gaming framework by [26] |
Reha@Stroke | Mobile serious game framework by [61] |
ICD-10 | 10th revision of the International Statistical Classification of Diseases and Related Health Problems |
UX | User Experience |
UEQ | User Experience Questionnaire |
PERSP | Perspicuity in UEQ questionnaire |
EFF | Perspicuity in UEQ questionnaire |
STIM | Stimulation in UEQ questionnaire |
NOV | Novelty in UEQ questionnaire |
ATT | Attractiveness in UEQ questionnaire |
VWSX | Nos paenitet Vincenzo pro paupere eligendo de plebe Id birota comparandi loco formosi Alfiste Romano Carracutum |
References
- Béjot, Y. Forty Years of Descriptive Epidemiology of Stroke. Neuroepidemiology 2022, 56, 157–162. [Google Scholar] [CrossRef] [PubMed]
- Donkor, E.S. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res. Treat. 2018, 2018, 3238165. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sennfält, S.; Norrving, B.; Petersson, J.; Ullberg, T. Long-Term Survival and Function After Stroke. Stroke 2019, 50, 53–61. [Google Scholar] [CrossRef] [PubMed]
- Tsao, C.W.; Aday, A.W.; Almarzooq, Z.I.; Alonso, A.; Beaton, A.Z.; Bittencourt, M.S.; Boehme, A.K.; Buxton, A.E.; Carson, A.P.; Commodore-Mensah, Y.; et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation 2022, 145, e153–e639. [Google Scholar] [CrossRef] [PubMed]
- Eichenberg, C.; Schott, M. Serious Games for Psychotherapy: A Systematic Review. Games Health J. 2017, 60, 127–135. [Google Scholar] [CrossRef]
- Francillette, Y.; Boucher, E.; Bouchard, B.; Bouchard, K.; Gaboury, S. Serious games for people with mental disorders: State of the art of practices to maintain engagement and accessibility. Entertain. Comput. 2021, 37, 100396. [Google Scholar] [CrossRef]
- Lau, H.M.; Smit, J.H.; Fleming, T.M.; Riper, H. Serious games for mental health: Are they accessible, feasible, and effective? A systematic review and meta-analysis. Front. Psychiatry 2017, 7, 209. [Google Scholar] [CrossRef] [Green Version]
- Shah, A.; Kraemer, K.R.; Won, C.R.; Black, S.; Hasenbein, W. Developing digital intervention games for mental disorders: A review. Games Health J. 2018, 7, 213–224. [Google Scholar] [CrossRef] [Green Version]
- Maskeliūnas, R.; Kulikajevas, A.; Blažauskas, T.; Damaševičius, R.; Swacha, J. An interactive serious mobile game for supporting the learning of programming in javascript in the context of eco-friendly city management. Computers 2020, 9, 102. [Google Scholar] [CrossRef]
- Swacha, J.; Maskeliūnas, R.; Damaševičius, R.; Kulikajevas, A.; Blažauskas, T.; Muszyńska, K.; Miluniec, A.; Kowalska, M. Introducing sustainable development topics into computer science education: Design and evaluation of the eco jsity game. Sustainability 2021, 13, 4244. [Google Scholar] [CrossRef]
- Gounaridou, A.; Siamtanidou, E.; Dimoulas, C. A Serious Game for Mediated Education on Traffic Behavior and Safety Awareness. Educ. Sci. 2021, 11, 127. [Google Scholar] [CrossRef]
- Maskeliunas, R.; Damaševičius, R.; Lethin, C.; Paulauskas, A.; Esposito, A.; Catena, M.; Aschettino, V. Serious game iDO: Towards better education in dementia care. Information 2019, 10, 355. [Google Scholar] [CrossRef] [Green Version]
- Maskeliūnas, R.; Damaševičius, R.; Kulikajevas, A.; Marley, J.; Larsson, C. Evaluation of MyRelief Serious Game for Better Self-Management of Health Behaviour Strategies on Chronic Low-Back Pain. Informatics 2022, 9, 40. [Google Scholar] [CrossRef]
- Lau, S.Y.J.; Agius, H. A framework and immersive serious game for mild cognitive impairment. Multimed. Tools Appl. 2021, 80, 31183–31237. [Google Scholar] [CrossRef]
- Maskeliūnas, R.; Blažauskas, T.; Damaševičius, R. Depression behavior detection model based on participation in serious games. In Rough Sets, Proceedings of the International Joint Conference, IJCRS 2017, Olsztyn, Poland, 3–7 July 2017; Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics); Springer: Cham, Switzerland, 2017; Volume 10314 LNAI, pp. 423–434. [Google Scholar]
- Vieira, C.; Ferreira da Silva Pais-Vieira, C.; Novais, J.; Perrotta, A. Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review. JMIR Serious Games 2021, 9, e20066. [Google Scholar] [CrossRef]
- Makri, M.; Tsolaki, M. Innovative Serious Games for People with Dementia developed through intergenerational interventions. In Proceedings of the 15th International Conference on PErvasive Technologies Related to Assistive Environments (PETRA’22), Corfu, Greece, 29 June–1 July 2022. [Google Scholar] [CrossRef]
- Ašeriškis, D.; Damaševičius, R. Gamification of a project management system. In Proceedings of the ACHI 2014—7th International Conference on Advances in Computer-Human Interactions, Barcelona, Spain, 23–27 March 2014; pp. 200–207. [Google Scholar]
- Stamm, O.; Dahms, R.; Reithinger, N.; Ruß, A.; Müller-Werdan, U. Virtual reality exergame for supplementing multimodal pain therapy in older adults with chronic back pain: A randomized controlled pilot study. Virtual Real. 2022, 26, 1291–1305. [Google Scholar] [CrossRef]
- Šalkevicius, J.; Damaševičius, R.; Maskeliunas, R.; Laukienė, I. Anxiety level recognition for virtual reality therapy system using physiological signals. Electronics 2019, 8, 1039. [Google Scholar] [CrossRef] [Green Version]
- iTrain Project Website. Available online: https://itrain-project.eu/en/home/ (accessed on 2 September 2012).
- iTrain Game in Google Play Store. Available online: https://play.google.com/store/apps/details?id=edu.ktu.itrain (accessed on 2 September 2012).
- iTrain Game in Apple App Store. Available online: https://play.google.com/store/apps/details?id=edu.ktu.itrain (accessed on 2 September 2012).
- Good, D.C.; Bettermann, K.; Reichwein, R.K. Stroke Rehabilitation. Neurorehabilitation 2011, 17, 545–567. [Google Scholar] [CrossRef]
- Regazzoni, D.; Vitali, A.; Rizzi, C. Towards a Broad Use of Gamification Based on Hand Tracking in Post Stroke Patients. In Proceedings of the ASME 2019 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference, Anaheim, CA, USA, 18–21 August 2019. [Google Scholar] [CrossRef]
- Noveletto, F.; Hounsell, M.; Soares, A.; Eichinger, F.; Sagawa, Y.; Filho, P.B. Stronger: A serious game framework for post-stroke rehabilitation. Ann. Phys. Rehabil. Med. 2018, 61, e487. [Google Scholar] [CrossRef]
- Maskeliunas, R.; Damaševicius, R.; Blažauskas, T.; Paulauska, A.; Paulauskas, L.; Chiatti, C. IDO: Modelling a serious educational game based on hands on approach for training dementia carers. Int. J. Eng. Technol. 2018, 7, 143. [Google Scholar] [CrossRef]
- Shapi’i, A.; Arshad, H.; Baharuddin, M.S.; Sarim, H.M. Serious Games for Post-Stroke Rehabilitation Using Microsoft Kinect. Int. J. Adv. Sci. Eng. Inf. Technol. 2018, 8, 1654. [Google Scholar] [CrossRef]
- Brar, G.; Lambert, S.; Huang, S.; Dang, R.; Chan, T.M. Using Observation to Determine Teachable Moments Within a Serious Game: A GridlockED as Medical Education (GAME) Study. AEM Educ. Train. 2020, 5, e10456. [Google Scholar] [CrossRef] [PubMed]
- Hu, H.; Lai, X.; Yan, L. Improving Nursing Students’ COVID-19 Knowledge Using a Serious Game. CIN Comput. Inform. Nurs. 2021, 40, 285–289. [Google Scholar] [CrossRef] [PubMed]
- Tan, A.J.Q.; Lau, C.C.S.; Liaw, S.Y. Paper title: Serious games in nursing education: An integrative review. In Proceedings of the 2017 9th International Conference on Virtual Worlds and Games for Serious Applications (VS-Games), Athens, Greece, 6–8 September 2017. [Google Scholar] [CrossRef]
- Min, A.; Min, H.; Kim, S. Effectiveness of serious games in nurse education: A systematic review. Nurse Educ. Today 2022, 108, 105178. [Google Scholar] [CrossRef] [PubMed]
- Johnsen, H.M.; Briseid, H.S.; Brodtkorb, K.; Slettebø, Å.; Fossum, M. Nursing students’ perceptions of combining hands-on simulation with simulated patients and a serious game in preparing for clinical placement in home healthcare: A qualitative study. Nurse Educ. Today 2021, 97, 104675. [Google Scholar] [CrossRef]
- Novoseltseva, D.; Lelardeux, C.P.; Jessel, N. Factors Affecting Success in a Digital Simulation Game for Nurse Training. In Games and Learning Alliance, Proceedings of the 9th International Conference, GALA 2020, Laval, France, 9–10 December 2020; Lecture Notes in Computer Science; Springer International Publishing: Cham, Switzerland, 2020; pp. 263–272. [Google Scholar] [CrossRef]
- Chee, E.J.M.; Prabhakaran, L.; Neo, L.P.; Carpio, G.A.C.; Tan, A.J.Q.; Lee, C.C.S.; Liaw, S.Y. Play and Learn with Patients—Designing and Evaluating a Serious Game to Enhance Nurses’ Inhaler Teaching Techniques: A Randomized Controlled Trial. Games Health J. 2019, 8, 187–194. [Google Scholar] [CrossRef]
- Streicher, A.; Smeddinck, J.D. Personalized and Adaptive Serious Games. In Entertainment Computing and Serious Games; Springer International Publishing: Cham, Switzerland, 2016; pp. 332–377. [Google Scholar] [CrossRef]
- Johnsen, H.M.; Fossum, M.; Vivekananda-Schmidt, P.; Fruhling, A.; Slettebø, Å. Developing a Serious Game for Nurse Education. J. Gerontol. Nurs. 2018, 44, 15–19. [Google Scholar] [CrossRef]
- Ganzeboom, M.; Bakker, M.; Beijer, L.; Strik, H.; Rietveld, T. A serious game for speech training in dysarthric speakers with Parkinson’s disease: Exploring therapeutic efficacy and patient satisfaction. Int. J. Lang. Commun. Disord. 2022, 57, 808–821. [Google Scholar] [CrossRef]
- James, S.; Ziviani, J.; King, G.; Boyd, R.N. Understanding Engagement in Home-Based Interactive Computer Play: Perspectives of Children With Unilateral Cerebral Palsy and Their Caregivers. Phys. Occup. Ther. Pediatr. 2015, 36, 343–358. [Google Scholar] [CrossRef]
- Woźniak, M.; Połap, D.; Napoli, C.; Tramontana, E. Application of bio-inspired methods in intelligent gaming systems. Inf. Technol. Control 2017, 46, 150–164. [Google Scholar]
- Vidani, A.C.; Chittaro, L.; Carchietti, E. Assessing Nurses’ Acceptance of a Serious Game for Emergency Medical Services. In Proceedings of the 2010 Second International Conference on Games and Virtual Worlds for Serious Applications, Braga, Portugal, 25–26 March 2010. [Google Scholar] [CrossRef]
- Agogué, M.; Levillain, K.; Hooge, S. Gamification of Creativity: Exploring the Usefulness of Serious Games for Ideation. Creat. Innov. Manag. 2015, 24, 415–429. [Google Scholar] [CrossRef]
- Wehbe-Alamah, H.; Farmer, M.; McFarland, M.; Tower, A.; Jones, M.; Shah, V.; El-Hayek, J. Development of an Extensible Game Architecture for Teaching Transcultural Nursing. Online J. Cult. Competence Nurs. Healthc. 2015, 5. [Google Scholar] [CrossRef]
- Zeffiro, V.; Fuccio, R.D.; Vellone, E.; Alvaro, R.; D’Agostino, F. A Serious Game and Negotiation Skills in Nursing Students: A Pilot Study. In Methodologies and Intelligent Systems for Technology Enhanced Learning, 10th International Conference. Workshops; Springer International Publishing: Cham, Switzerland, 2020; pp. 91–98. [Google Scholar] [CrossRef]
- Padilha, J.M.; Machado, P.P.; Ribeiro, A.; Ramos, J.; Costa, P. Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial. J. Med. Internet Res. 2019, 21, e11529. [Google Scholar] [CrossRef]
- Mili, F.; Barr, J.; Harris, M.; Pittiglio, L. Nursing Training: 3D Game with Learning Objectives. In Proceedings of the First International Conference on Advances in Computer-Human Interaction, Sainte Luce, France, 10–15 February 2008. [Google Scholar] [CrossRef]
- Cook, N.F.; McAloon, T.; O’Neill, P.; Beggs, R. Impact of a web based interactive simulation game (PULSE) on nursing students’ experience and performance in life support training—A pilot study. Nurse Educ. Today 2012, 32, 714–720. [Google Scholar] [CrossRef]
- Tresser, S. Case Study: Using a Novel Virtual Reality Computer Game for Occupational Therapy Intervention. Presence Teleoperators Virtual Environ. 2012, 21, 359–371. [Google Scholar] [CrossRef]
- Johnsen, H.M.; Fossum, M.; Vivekananda-Schmidt, P.; Fruhling, A.; Slettebø, Å. Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game. Int. J. Med. Inform. 2016, 94, 39–48. [Google Scholar] [CrossRef]
- Mubin, O.; Alnajjar, F.; Mahmud, A.A.; Jishtu, N.; Alsinglawi, B. Exploring serious games for stroke rehabilitation: A scoping review. Disabil. Rehabil. Assist. Technol. 2020, 17, 159–165. [Google Scholar] [CrossRef]
- Utthayotha, S.; Choosri, N. Survey of Serious Game Controllers for Stroke Rehabilitation. In Proceedings of the 2020—5th International Conference on Information Technology (InCIT), Chonburi, Thailand, 21–22 October 2020. [Google Scholar] [CrossRef]
- Cyrino, G.; Tannus, J.; Lamounier, E.; Cardoso, A.; Soares, A. Serious Game with Virtual Reality for Upper Limb Rehabilitation after Stroke. In Proceedings of the 2018 20th Symposium on Virtual and Augmented Reality (SVR), Foz do Iguacu, Brazil, 28–30 October 2018. [Google Scholar] [CrossRef]
- Noveletto, F.; Bertemes-Filho, P.; Hounsell, M.S.; Soares, A.V. A Serious Game for Training and Evaluating the Balance of Hemiparetic Stroke Patients. In IFMBE Proceedings; Springer International Publishing: Cham, Switzerland, 2015; pp. 1128–1131. [Google Scholar] [CrossRef]
- Eichinger, F.L.F.; Soares, A.V.; Noveletto, F.; Júnior, Y.S.; Filho, P.B.; Domenech, S.C. Serious game for locomotor rehabilitation of hemiparetic stroke patients. Fisioter. Mov. 2020, 33, e003316. [Google Scholar] [CrossRef] [Green Version]
- Jung, H.T.; Daneault, J.F.; Nanglo, T.; Lee, H.; Kim, B.; Kim, Y.; Lee, S.I. Effectiveness of a Serious Game for Cognitive Training in Chronic Stroke Survivors with Mild-to-Moderate Cognitive Impairment: A Pilot Randomized Controlled Trial. Appl. Sci. 2020, 10, 6703. [Google Scholar] [CrossRef]
- Jung, H.T.; Lee, H.; Kim, K.; Kim, B.; Park, S.; Ryu, T.; Kim, Y.; Daneault, J.F.; Lee, S.I. Predicting Cognitive Impairment Level after a Serious Game-based Therapy in Chronic Stroke Survivors. In Proceedings of the 2019 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI), Chicago, IL, USA, 19–22 May 2019. [Google Scholar] [CrossRef]
- Doumas, I.; Everard, G.; Dehem, S.; Lejeune, T. Serious games for upper limb rehabilitation after stroke: A meta-analysis. J. Neuroeng. Rehabil. 2021, 18, 100. [Google Scholar] [CrossRef]
- d’Ornellas, M.C.; Cargnin, D.J.; Prado, A.L.C. Thoroughly Approach to Upper Limb Rehabilitation Using Serious Games for Intensive Group Physical Therapy or Individual Biofeedback Training. In Proceedings of the 2014 Brazilian Symposium on Computer Games and Digital Entertainment, Porto Alegre, Brazil, 12–14 November 2014. [Google Scholar] [CrossRef]
- Ferreira, B.; Lourenco, J.; Menezes, P. A Serious Game for Post-Stroke Motor Rehabilitation. In Proceedings of the 2019 5th Experiment International Conference (exp.at’19), Funchal, Portugal, 12–14 June 2019. [Google Scholar] [CrossRef]
- Hossain, M.S.; Hardy, S.; Alamri, A.; Alelaiwi, A.; Hardy, V.; Wilhelm, C. AR-based serious game framework for post-stroke rehabilitation. Multimed. Syst. 2016, 22, 659–674. [Google Scholar] [CrossRef]
- Baranyi, R.; Czech, P.; Hofstatter, S.; Aigner, C.; Grechenig, T. Analysis, Design, and Prototypical Implementation of a Serious Game Reha@Stroke Support Rehabil. Stroke Patients Help A Mob. Phone. IEEE Trans. Games 2020, 12, 341–350. [Google Scholar] [CrossRef]
- Noveletto, F.; Soares, A.V.; Eichinger, F.L.F.; Domenech, S.C.; Hounsell, M.d.S.; Filho, P.B. Biomedical Serious Game System for Lower Limb Motor Rehabilitation of Hemiparetic Stroke Patients. IEEE Trans. Neural Syst. Rehabil. Eng. 2020, 28, 1481–1487. [Google Scholar] [CrossRef] [PubMed]
- Heins, S.; Dehem, S.; Montedoro, V.; Dehez, B.; Edwards, M.; Stoquart, G.; Rocca, F.; De Deken, P.; Mancas, M.; Lejeune, T. Robotic-assisted serious game for motor and cognitive post-stroke rehabilitation. In Proceedings of the 2017 IEEE 5th International Conference on Serious Games and Applications for Health (SeGAH), Perth, Australia, 2–4 April 2017; pp. 1–8. [Google Scholar] [CrossRef]
- Souza, A.M.d.C.; Santos, S.R.d. Handcopter Game: A Video-Tracking Based Serious Game for the Treatment of Patients Suffering from Body Paralysis Caused by a Stroke. In Proceedings of the 2012 14th Symposium on Virtual and Augmented Reality, Rio de Janeiro, Brazil, 28–31 May 2012. [Google Scholar] [CrossRef]
- Hou, X.; Sourina, O. Emotion-enabled haptic-based serious game for post stroke rehabilitation. In Proceedings of the 19th ACM Symposium on Virtual Reality Software and Technology—VRST’13, Singapore, 6–9 October 2013. [Google Scholar] [CrossRef]
- Valencia, N.; Cardoso, V.; Frizera, A.; Freire-Bastos, T. Serious Game for Post-stroke Upper Limb Rehabilitation. In Biosystems & Biorobotics; Springer International Publishing: Cham, Switzerland, 2016; pp. 1445–1450. [Google Scholar] [CrossRef]
- Song, X.; Ven, S.S.V.D.; Liu, L.; Wouda, F.J.; Wang, H.; Shull, P.B. Activities of Daily Living-Based Rehabilitation System for Arm and Hand Motor Function Retraining After Stroke. IEEE Trans. Neural Syst. Rehabil. Eng. 2022, 30, 621–631. [Google Scholar] [CrossRef] [PubMed]
- Joseph, S.; Thanakumar, I.; Karunakaran, V.; Raj, E.; Benson, S.; Jancy, P.L. Investigation of In-home Augmented Reality assisted Rehabilitation Therapies for Disabled Patient. In Proceedings of the 2021 International Conference on ICT for Smart Society (ICISS), Bandung, Indonesia, 2–4 August 2021; pp. 1–7. [Google Scholar] [CrossRef]
- Webster, D.; Celik, O. Systematic review of Kinect applications in elderly care and stroke rehabilitation. J. Neuroeng. Rehabil. 2014, 11, 108. [Google Scholar] [CrossRef] [Green Version]
- Funabashi, A.M.; Aranha, R.V.; Silva, T.D.; Monteiro, C.B.; Silva, W.S.; Nunes, F.L. AGaR: A VR Serious Game to Support the Recovery of Post-Stroke Patients. In Proceedings of the 2017 19th Symposium on Virtual and Augmented Reality (SVR), Curitiba, Brazil, 1–4 November 2017. [Google Scholar] [CrossRef]
- Trombetta, M.; Henrique, P.P.B.; Brum, M.R.; Colussi, E.L.; Marchi, A.C.B.D.; Rieder, R. Motion Rehab AVE 3D: A VR-based exergame for post-stroke rehabilitation. Comput. Methods Programs Biomed. 2017, 151, 15–20. [Google Scholar] [CrossRef]
- Ma, M.; Bechkoum, K. Serious games for movement therapy after stroke. In Proceedings of the 2008 IEEE International Conference on Systems, Man and Cybernetics, Singapore, 12–15 October 2008. [Google Scholar] [CrossRef] [Green Version]
- Dobrovsky, A.; Borghoff, U.M.; Hofmann, M. Improving Adaptive Gameplay in Serious Games Through Interactive Deep Reinforcement Learning. In Topics in Intelligent Engineering and Informatics; Springer International Publishing: Cham, Switzerland, 2018; pp. 411–432. [Google Scholar] [CrossRef]
- Frutos-Pascual, M.; Zapirain, B.G. Review of the Use of AI Techniques in Serious Games: Decision Making and Machine Learning. IEEE Trans. Comput. Intell. AI Games 2017, 9, 133–152. [Google Scholar] [CrossRef]
- Dobrovsky, A.; Borghoff, U.M.; Hofmann, M. Applying and Augmenting Deep Reinforcement Learning in Serious Games through Interaction. Period. Polytech. Electr. Eng. Comput. Sci. 2017, 61, 198. [Google Scholar] [CrossRef] [Green Version]
- Boloka, T.; Makondo, N.; Rosman, B. Knowledge Transfer using Model-Based Deep Reinforcement Learning. In Proceedings of the 2021 Southern African Universities Power Engineering Conference/Robotics and Mechatronics/Pattern Recognition Association of South Africa (SAUPEC/RobMech/PRASA), Potchefstroom, South Africa, 27–29 January 2021. [Google Scholar] [CrossRef]
- Gourari, A.E.; Raoufi, M.; Skouri, M.; Ouatik, F. The Implementation of Deep Reinforcement Learning in E-Learning and Distance Learning: Remote Practical Work. Mob. Inf. Syst. 2021, 2021, 9959954. [Google Scholar] [CrossRef]
- Ausin, M.S.; Maniktala, M.; Barnes, T.; Chi, M. Exploring the Impact of Simple Explanations and Agency on Batch Deep Reinforcement Learning Induced Pedagogical Policies. In Artificial Intelligence in Education, Proceedings of the 21st International Conference, AIED 2020, Ifrane, Morocco, 6–10 July 2020; Lecture Notes in Computer Science; Springer International Publishing: Cham, Switzerland, 2020; pp. 472–485. [Google Scholar] [CrossRef]
- The SIMS Computer Game. Available online: https://www.ea.com/games/the-sims (accessed on 2 September 2012).
- The Unreal Game Development Engine. Available online: https://www.unrealengine.com/en-US (accessed on 2 September 2012).
- Anjos, J.M.; Neto, M.G.; dos Santos, F.S.; de Oliveira Almeida, K.; Bocchi, E.A.; de Souza Lima Bitar, Y.; Duraes, A.R. The impact Of high-intensity interval training On functioning And health-related quality Of life In post-stroke patients: A systematic review With meta-analysis. Clin. Rehabil. 2022, 36, 726–739. [Google Scholar] [CrossRef]
- Ugur, H.G. The Effect of Home Care for Stroke Patients and Education of Caregivers on the Caregiver Burden and Quality of Life. Acta Clin. Croat. 2019, 58, 321–332. [Google Scholar] [CrossRef] [Green Version]
- Caro, C.C.; Costa, J.D.; Cruz, D.M.C.D. Burden and Quality of Life of Family Caregivers of Stroke Patients. Occup. Ther. Health Care 2018, 32, 154–171. [Google Scholar] [CrossRef]
- Pucciarelli, G.; Ausili, D.; Galbussera, A.A.; Rebora, P.; Savini, S.; Simeone, S.; Alvaro, R.; Vellone, E. Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study. J. Adv. Nurs. 2018, 74, 1875–1887. [Google Scholar] [CrossRef]
- Schinwelski, M.J.; Sitek, E.J.; Wąż, P.; Sławek, J.W. Prevalence and predictors of post-stroke spasticity and its impact on daily living and quality of life. Neurol. Neurochir. Pol. 2019, 53, 449–457. [Google Scholar] [CrossRef]
- Yu, J.; Lee, W.; Kim, M.; Choi, S.; Lee, S.; Kim, S.; Jung, Y.; Kwak, D.; Jung, H.; Lee, S.; et al. Effectiveness of simulation-based interprofessional education for medical and nursing students in South Korea: A pre-post survey. BMC Med. Educ. 2020, 20, 476. [Google Scholar] [CrossRef]
- Smith, V.A.; Lindquist, J.; Miller, K.E.M.; Shepherd-Banigan, M.; Olsen, M.; Campbell-Kotler, M.; Henius, J.; Kabat, M.; Houtven, C.H.V. Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group. Front. Public Health 2019, 7, 122. [Google Scholar] [CrossRef]
- McClurg, C.; Powelson, S.; Lang, E.; Aghajafari, F.; Edworthy, S. Evaluating effectiveness of small group information literacy instruction for Undergraduate Medical Education students using a pre- and post-survey study design. Health Inf. Libr. J. 2015, 32, 120–130. [Google Scholar] [CrossRef]
- Fitzgibbons, S.C.; Chen, J.; Jagsi, R.; Weinstein, D. Long-Term Follow-Up on the Educational Impact of ACGME Duty Hour Limits. Ann. Surg. 2012, 256, 1108–1112. [Google Scholar] [CrossRef]
- Jagsi, R.; Shapiro, J.; Weissman, J.S.; Dorer, D.J.; Weinstein, D.F. The Educational Impact of ACGME Limits on Resident and Fellow Duty Hours: A Pre???Post Survey Study. Acad. Med. 2006, 81, 1059–1068. [Google Scholar] [CrossRef]
- Yesavage, J.A.; Brink, T.; Rose, T.L.; Lum, O.; Huang, V.; Adey, M.; Leirer, V.O. Development and validation of a geriatric depression screening scale: A preliminary report. J. Psychiatr. Res. 1982, 17, 37–49. [Google Scholar] [CrossRef]
- Krishnamoorthy, Y.; Rajaa, S.; Rehman, T. Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: Systematic review and meta-analysis. Arch. Gerontol. Geriatr. 2020, 87, 104002. [Google Scholar] [CrossRef] [PubMed]
- Mortara, M.; Catalano, C.E.; Fiucci, G.; Derntl, M. Evaluating the Effectiveness of Serious Games for Cultural Awareness: The Icura User Study. In Games and Learning Alliance, Proceedings of the Second International Conference, GALA 2013, Paris, France, 23–25 October 2013; Lecture Notes in Computer Science; Springer International Publishing: Cham, Switzerland, 2014; pp. 276–289. [Google Scholar] [CrossRef]
- Lewis, J.R. The System Usability Scale: Past, Present, and Future. Int. J. Human-Computer Interact. 2018, 34, 577–590. [Google Scholar] [CrossRef]
- Panzeri, A.; Ferrario, S.R.; Vidotto, G. Interventions for Psychological Health of Stroke Caregivers: A Systematic Review. Front. Psychol. 2019, 10, 2045. [Google Scholar] [CrossRef] [PubMed]
- Hu, P.; Yang, Q.; Kong, L.; Hu, L.; Zeng, L. Relationship between the anxiety/depression and care burden of the major caregiver of stroke patients. Medicine 2018, 97, e12638. [Google Scholar] [CrossRef] [PubMed]
- Graf, R.; LeLaurin, J.; Schmitzberger, M.; Freytes, I.M.; Orozco, T.; Dang, S.; Uphold, C.R. The stroke caregiving trajectory in relation to caregiver depressive symptoms, burden, and intervention outcomes. Top. Stroke Rehabil. 2017, 24, 488–495. [Google Scholar] [CrossRef]
- Laugwitz, B.; Held, T.; Schrepp, M. Construction and Evaluation of a User Experience Questionnaire. In HCI and Usability for Education and Work, Proceedings of the 4th Symposium of the Workgroup Human-Computer Interaction and Usability Engineering of the Austrian Computer Society, USAB 2008, Graz, Austria, 20–21 November 2008; Holzinger, A., Ed.; Springer: Berlin/Heidelberg, Germany, 2008; pp. 63–76. [Google Scholar]
- Mitre-Ortiz, A.; Muñoz-Arteaga, J.; Cardona-Reyes, H. Developing a model to evaluate and improve user experience with hand motions in virtual reality environments. Univers. Access Inf. Soc. 2022. [Google Scholar] [CrossRef]
- Schrepp, M. User Experience Questionnaire Handbook. 2015. Available online: https://www.researchgate.net/publication/281973617_User_Experience_Questionnaire_Handbook?channel=doi&linkId=56004c7008aeafc8ac8c64bb&showFulltext=true (accessed on 12 September 2022). [CrossRef]
- iTrain Udemy MOOC Course (Lithuanian Version). Available online: https://www.udemy.com/course/tiesiogines-prieziuros-darbuotoju-dirbanciu-su-insulta-paty/ (accessed on 4 November 2012).
- Ignacio, J.; Chen, H.C. The use of web-based classroom gaming to facilitate cognitive integration in undergraduate nursing students: A mixed methods study. Nurse Educ. Pract. 2020, 46, 102820. [Google Scholar] [CrossRef]
- McCutcheon, K.; O’Halloran, P.; Lohan, M. Online learning versus blended learning of clinical supervisee skills with pre-registration nursing students: A randomised controlled trial. Int. J. Nurs. Stud. 2018, 82, 30–39. [Google Scholar] [CrossRef]
- Coughlin, P.; Featherstone, C. How to Write a High Quality Multiple Choice Question (MCQ): A Guide for Clinicians. Eur. J. Vasc. Endovasc. Surg. 2017, 54, 654–658. [Google Scholar] [CrossRef] [Green Version]
- Sharifzadeh, N.; Kharrazi, H.; Nazari, E.; Tabesh, H.; Khodabandeh, M.E.; Heidari, S.; Tara, M. Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review. JMIR Serious Games 2020, 8, e13459. [Google Scholar] [CrossRef]
- Haoran, G.; Bazakidi, E.; Zary, N. Serious Games in Health Professions Education: Review of Trends and Learning Efficacy. Yearb. Med. Inform. 2019, 28, 240–248. [Google Scholar] [CrossRef] [Green Version]
- Baker, R.S.; Ogan, A.E.; Madaio, M.; Walker, E. Culture in Computer-Based Learning Systems: Challenges and Opportunities. Comput.-Based Learn. Context 2019, 1, 1–13. [Google Scholar] [CrossRef]
- der Kleij, F.M.V.; Feskens, R.C.W.; Eggen, T.J.H.M. Effects of Feedback in a Computer-Based Learning Environment on Students’ Learning Outcomes. Rev. Educ. Res. 2015, 85, 475–511. [Google Scholar] [CrossRef]
- Gentry, S.; Ehrstrom, B.L.; Gauthier, A.; Alvarez, J.; Wortley, D.; van Rijswijk, J.; Car, J.; Lilienthal, A.; Car, L.T.; Nikolaou, C.K.; et al. Serious Gaming and Gamification interventions for health professional education. Cochrane Database Syst. Rev. 2018, CD012209. [Google Scholar] [CrossRef] [Green Version]
- Theofanidis, D.; Gibbon, B. Nursing interventions in stroke care delivery: An evidence-based clinical review. J. Vasc. Nurs. 2016, 34, 144–151. [Google Scholar] [CrossRef]
- Achilike, S.; Beauchamp, J.E.S.; Cron, S.G.; Okpala, M.; Payen, S.S.; Baldridge, L.; Okpala, N.; Montiel, T.C.; Varughese, T.; Love, M.; et al. Caregiver Burden and Associated Factors Among Informal Caregivers of Stroke Survivors. J. Neurosci. Nurs. 2020, 52, 277–283. [Google Scholar] [CrossRef]
- Zhu, W.; Jiang, Y. A Meta-analytic Study of Predictors for Informal Caregiver Burden in Patients With Stroke. J. Stroke Cerebrovasc. Dis. 2018, 27, 3636–3646. [Google Scholar] [CrossRef]
- Camak, D.J. Addressing the burden of stroke caregivers: A literature review. J. Clin. Nurs. 2015, 24, 2376–2382. [Google Scholar] [CrossRef]
Action a Player Might Do | Interactable Item | Description | Correct Choice | Semi-Correct Choice | Bad Choice | Need Modifiers |
---|---|---|---|---|---|---|
Emergency responses. (FAST) (F for FACE) | Random action | The person can feel or see a drop or weakness in one part of the face. The person is touching or showing his face | Tell the person to smile and observe whether have symmetry in his face | Put the person in front of a mirror and tell him to smile | Not to take into account that the person might already have a facial weakness due to primary stroke | Person smiles and mood improves |
Emergency responses. (FAST) (S for SPEECH) | Random action | The person has difficulty speaking or understanding speech. The person is asked to say his name and the current day | Ask the person his name and what day is it and wait for the person to respond to your questions | Say the first letter of his name and wait to see if he can complete the word | Not to give time to the person to answer the questions | Person can speak clearly and with correct words |
Lack of motivation | Random action | The person presents apathetic, not interested in carrying over any activity even among those that he/she liked before the stroke. | When the carer proposes the person engage in a conversation, watch a movie, read a book, take a stroll, play cards, or meet friends, the answer is NO | Ask the person what is his/her favorite hobby (or most loved friend). Wait for the reply and schedule with him/her a date to start practicing the hobby (meeting the friend) | Make the person go for a walk OR invite a friend at home and push the person to have a chat. Stop offering the person to engage in any activity and leave him/her stay still | The person starts a routine including physical/leisure activity or social interactions |
Sadness, depression random action | The person complains of feeling miserable, anxious and cries from time to time. | During an interaction with the carer, the person starts crying and says that he/she is hopeless. | Explain to the person that it is normal to feel sad or worried after a stroke and that there are several treatment options that may be helpful | Try to distract the person by engaging him/her in some activity | Sit near the person and cry together with him/her | The person stops crying and feels more relaxed |
Food preparation | Thickening powder | It might be difficult for stroke survivors to swallow different consistencies of food at the same time. To avoid choking and pneumonia, always make sure that they do not mix food consistencies (e.g., a soup with croutons) and if needed have their liquids thickened. | To thicken liquid food and separate different food consistencies | To thicken liquid food | To mix different food consistencies and not thicken liquid food | Removes hunger, avoids pneumonia |
Liquid Preparation | Straw | The stroke survivor has swallowing difficulties (dysphagia) and needs assistance with drinking. A straw can be used as an aid to facilitate drinking and avoid choking in stroke survivors who suffer from swallowing difficulties. | To put a straw in a glass of thickened liquid | To put a straw in a glass of unthickened liquid | No use of straw | Removes thirst, avoids dehydration and pneumonia |
Characteristic | Value | Frequency (n) | Percentage (%) |
---|---|---|---|
Age group | 24–39 years old | 18 | 39.1 |
40–59 years old | 20 | 43.5 | |
over 60 years old | 8 | 17.4 | |
Gender | Female | 19 | 41.3 |
Males | 27 | 58.7 | |
Employment | Employed | 41 | 89.1 |
Housewife | 3 | 6.5 | |
Unemployed | 1 | 2.2 | |
Other | 1 | 2.2 | |
Level of education | Secondary school | 9 | 19.7 |
College | 6 | 13.0 | |
High school | 29 | 63.0 | |
>High school | 2 | 4.3 | |
Marital status | Married | 27 | 58.7 |
Single | 4 | 8.7 | |
Divorced/separated/widowed | 15 | 32.6 | |
Economic status | Poor | 5 | 10.9 |
Not poor | 41 | 89.1 | |
GDS score (Pre) | Depression | 13 | 25.7 |
No depression | 33 | 65.1 | |
GDS score (Post) | Depression | 13 | 28.3 |
No depression | 33 | 71.7 |
Pre-Test | |||
---|---|---|---|
N | M (SD) | p | |
Game group = 17 | 2.11 (0.42) | −3.11 | 0.02 |
MOOC group = 12 | 3.22 (0.67) | −3.78 | 0.04 |
Pre-Test | |||
Game group = 17 | 3.08 (0.63) | −1.81 | 0.19 |
MOOC group = 12 | 3.52 (0.77) | −1.41 | 0.11 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Maskeliunas, R.; Damasevicius, R.; Paulauskas, A.; Ceravolo, M.G.; Charalambous, M.; Kambanaros, M.; Pampoulou, E.; Barbabella, F.; Poli, A.; Carvalho, C.V. Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients. Information 2022, 13, 564. https://doi.org/10.3390/info13120564
Maskeliunas R, Damasevicius R, Paulauskas A, Ceravolo MG, Charalambous M, Kambanaros M, Pampoulou E, Barbabella F, Poli A, Carvalho CV. Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients. Information. 2022; 13(12):564. https://doi.org/10.3390/info13120564
Chicago/Turabian StyleMaskeliunas, Rytis, Robertas Damasevicius, Andrius Paulauskas, Maria Gabriella Ceravolo, Marina Charalambous, Maria Kambanaros, Eliada Pampoulou, Francesco Barbabella, Arianna Poli, and Carlos V. Carvalho. 2022. "Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients" Information 13, no. 12: 564. https://doi.org/10.3390/info13120564