Framework for Game Development for Parkinson Disease Patient Using Exergames

CHAPTER 1 INTRODUCTION

The physician Ingles James Parkinson who called it Trembling Paralysis and described its main symptoms, which is why the disease now bears his name, described Parkinson's disease in 1817. It is also called Primary Parkinsonism or Idiopathic disease of a cause, in the other forms that if known or suspected, constitute secondary Parkinsonism. It affects approximately 1% of the population over fifty (50) years old although in some people they can begin their symptoms before the fourth decade. It occurs in a similar way in men and women although there is currently a predominance of men. The estimated prevalence of Parkinson's disease worldwide is 100 to 200 per 100,000 population over 50 years of age. It is expected that its incidence will increase as the people of the baby boom generation age. The first symptoms of Parkinson's disease are gradual. Patients may begin to feel tired or shaky, feel bad, be difficult to get up from a chair, notice that the voice becomes excessively low and irregular calligraphy, may also feel irritable, depressed for no apparent reason, the patient remains for a long period of time in one position or usually moves an arm or leg abnormally. The state of knowledge of the mechanisms that cause the cardinal signs of Parkinson's are:

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• Disorders in balance and coordination.
• Rigidity
• Tremor
• Alterations of postural reflexes
• Difficulty in speech
• Among other.

PD patients are advised to exercise and although rehabilitation technicians initially rehabilitate patients, research has indicated that there is little or no improvement in the balance and coordination capacities. This is because in the exercise program, there is no motivation, and patients do not have the correct systematics in the period of rehabilitation. Most of the exercise systems proposed by the rehabilitation technicians lack methodological guidelines. In addition to appropriate methods and procedures at the time of applying physical burdens to patients, their rehabilitation, in addition to the physical agents used, go back to passive mobilizations. Assisted active exercises used to improve their joint range and not in coordination and balance, identifying themselves as a scientific problem. The objectives pursued by this study include the application of exergames to improve balance and coordination in patients with Parkinson's disease.

Development

The cause of this disease is still discussed, it was not admitted until a few years ago the existence of genetic factors. Current research from various collaborators suggest the importance of genetic factors in the etiology of the disease, identifying the Parkinson's gene in the long arm of chromosome 6 in several families with this entity defining a pattern of recessive Ausotonic inheritance, the identification of the gene has led to important research in the basic sciences. Currently, some triggering factors such as depression and stress are being discussed. Many researchers believe that a combination of the aforementioned theories, genetic predisposition, environmental toxins and accelerated aging can be the causes of the disease. In 1997, the World Health Organization (WHO) declared April 11 World Parkinson's Day, coinciding with the anniversary of Dr. James Parkinson. With the celebration of this date, it is intended to raise awareness and raise awareness among the population of the importance of this disease that currently affects more than 4 million worldwide.

Theoretical Framework

The use of exergames and videogames is part of the commitment that the State Research Center (SRC) has made since its introduction by non-pharmacological therapies. The workshop, which uses the popular video game console Wii and the game BIG BRAIN ACADEMY Wii Degree, aims to design, evaluate and implement a new form of therapy that produces an improvement and functional maintenance in the cognitive and social areas of the patient, enhancing residual capacities of the person with dementia. To achieve greater effectiveness it is used with people in the first levels of cognitive impairment, with the aim of delaying the development of dementia.

Experience indicates that with its use, improvements have been detected in the mood of PD patients, it helps to relate them to the rest and is motivating. The patient also improves his states of anxiety and depression and stimulates superior cognitive functions such as attention, perception, memory, orientation, calculation, reasoning and language. With the Wii video game, several aspects related to memory or attention are worked on, which is why the work of the therapists who adapt the level of the game to the characteristics of each patient in order to avoid their frustration is essential. One of the advantages of this tool is that it is played with very simple controls, so most of them do not have problems adapting to them.

In search of covering these needs of PD patients in general, the video game industry has managed to understand the concept of natural interaction. They have developed new peripherals and consoles that use emerging technologies, improving the gaming experience of their platforms, allowing the inclusion of parents and grandparents of a family nucleus in a role of active participation within their environment. The suppression of peripherals such as the keyboard and mouse in the different control platforms have allowed the constant hybridization of interaction devices by gestures. While the use and interpretation of the gestures allow great applicability in different scenarios (as in exergames), emerging technologies used by consoles such as Sony's PlayStation Move , Xbox Kinect from Microsoft , or Wii from Nintendo , offer data entry through gestures without contact with surfaces.

The constant use of interactive systems can make a therapy, a rehabilitation process or physical exercise in general more enjoyable and motivating. In older adults, analyzing user use and experience proposed by exergames with different systems, positive results have been demonstrated in therapies by combining elements of physical exercise with entertainment, and this population tends to improve different behavioral attitudes, staying physically active, positive, and funny perception towards exergames. Additionally, increases in energy expenditure, muscle mass and motivational level have been shown in children with cerebral palsy undergoing active video therapy.

The PlayStation Move is a type of sensor where multiple studies of the use of active exergames have been made. Yavuzer and Senel (2012) evaluated effects of PlayStation EyeToy games in people with motor disability in upper limbs caused by cerebrovascular accident (CVA). The results showed in the use of these interactive platforms an economical alternative, easy to operate and pleasant for patients in their rehabilitation processes, improving mobility ranges of the limbs, the balance of the body, and the quality of the posture, among others.

The XBOX 360 console with Kinect provides a gaming experience without controls, where players without the need to use any peripheral, use movements and gestures of their body, as well as the voice to perform in different exergames. The use of Kinect sensor as a technological tool in rehabilitation processes has aroused great interest in the field of physical therapy for the possibilities of kinematic analysis using non-invasive techniques of motion capture, which allow the objective quantification of positions and angles in real time, being able to quantify in a certain way the energy expenditure. This energy expenditure promoted by the Exergames is greater in those dynamics where fast movements are made in the upper or lower limbs and increases proportionally when the user advances the level of difficulty in the exergames.

In general, the use of exergames has shown increases in oxygen consumption, energy expenditure, heart rate and perceived effort rate. These increases can be considered to exceed the threshold of moderate AF, which results in important health benefits and an impact to counteract sedentary lifestyle and diseases derived from it. It has been found that within the topology of the Exergames, there are some that improve in greater quantity, the physiological variables mentioned above. One of the ways to evaluate the level of AF recommended to improve health, is established through energy expenditure. Lyons and Tate (2014) found that Exergames with large energy expenditures are often perceived as less pleasant activities, apparently an intervention program with high intensity of play for obese and inactive participants does not guarantee high attendance and participation. Despite not having been directly measured energy expenditure in the present study, all the evaluated found innovative and fun to work with, which allows establishing that a well-designed Exergame, could generate a high impact on populations such as the elderly.

With the multiple observations made in the use of the Exergames in PD environments, and considering that the perception of the people evaluated before the virtual tools within the gymnasiums and CAF was positive, it is allowed to leave aside the stigmas of the disruptive technologies in as for fear or shyness in its first use. The majority of users develop naturally and comfortably during the time of the routine. The aspects of interactivity need to be analyzed such as ease of use, naturalness of the proposed interactions, and navigability with the menus, operation and behavior of the motion capture sensor in situ, spaces needed for implementation, among others.

This type of exergames usually contain sounds and visual effects that notably improve the perception of accompaniment- personalization of the exercise by the user: the situation becomes more immersive when encouraging and corrective comments are used; relevant and rhythmic background music throughout the course of the routine. From the analysis in the graphic part, it could be useful to use designs from multiple scenarios where the user will perform the activity: an appropriate scenario can significantly improve the time of use and the recidivism of the user with the Exergame.

The advantage of using the Kinect sensor and not the rest of the consoles that Exergames uses, lies in its ability to process video in real time and capture own movements from different parts of the user's body, and not only the movement of the sensors in their hands . Additionally, thanks to the depth camera can be programmed only to track and recognize people in different scenes, in this way and regardless of the other objects present in the environment, the system reacts optimally to the movements of users without the need for establish special conditions of lighting or privacy.

The use of Exergames as a tool for FA is part of a global trend marked by the use of new technologies in increasingly diverse environments. The increase in so-called technophilia can become an especially attractive alternative in vulnerable populations such as adolescence (22). For a personalized health perspective, the games provide a new source of information about the user, their preferences, abilities, abilities and their style of play. Technological sensors such as the Kinect allow the collection of data related to the kinematics of each player; these measures are used in the Exergames as game scores, actions per second, number of repetitions, time expenditure for each activity and even energy expenditure. In addition to video game consoles such as Nintendo Wii , Sony Play StationMove and Xbox 360 with Kinect , is added the development of applications for mobile devices that offer a wide range of tools and functions such a...