The use of game modes to promote engagement and social involvement in multi-user serious games: a within-person randomized trial with stroke survivors

J Neuroeng Rehabil. 2021 Apr 14;18(1):62. doi: 10.1186/s12984-021-00853-z.


Background: Serious games are promising for stroke rehabilitation, with studies showing a positive impact on reducing motor and cognitive deficits. However, most of the evidence is in the context of single-user rehabilitation, and little is known concerning the impact in multi-user settings. This study evaluates the impact that different game modes can have on engagement and social involvement during a two-user game. Specifically, we want to understand the benefits of game modalities based on competition, co-activation, and collaboration and analyze the influence of different motor and cognitive deficits and personality traits.

Methods: We developed a two-player setup-using tangible objects and a large screen interactive table-for upper limb rehabilitation purposes. We implemented a game that, while keeping the same basic mechanics, can be played in the three different modes (Competitive, Co-active, and Collaborative). We ran a within-person randomized study with 21 stroke survivors that were paired and played the game in its three versions. We used the Game Experience Questionnaire-Core Module to assess engagement and the Social Presence Module to assess Social Involvement. For personality, motor, and cognitive function, users answered the International Personality Item Pool (short version), Fugl-Meyer Assessment-Upper Extremity, Modified Ashworth Scale, and Montreal Cognitive Assessment, respectively.

Results: The Collaborative mode promoted significantly more Behavioral Involvement. The Competitive mode promoted more Flow and Challenge than the Co-active mode with participants with better cognitive performance, with low extraversion, or with higher motor skills. Participants with higher cognitive deficits reported more Competence with the Co-active mode.

Conclusions: Our results indicate that, for multi-user motor rehabilitation settings, the collaborative mode is the more appropriate gaming approach to promote social involvement, showing a high potential for increasing adherence and effectiveness of therapy. Additionally, we show that a player's motor and cognitive ability and personality should be considered when designing personalized tasks for multiplayer settings.

Keywords: Engagement; Game mode; Rehabilitation; Serious games; Social involvement; Stroke.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Extraversion, Psychological
  • Humans
  • Male
  • Middle Aged
  • Social Interaction*
  • Stroke / physiopathology
  • Stroke Rehabilitation / methods*
  • Survivors
  • Treatment Outcome*
  • Upper Extremity / physiopathology
  • Video Games / psychology*