This currently is my primary research project

The Center for Disease Control and Prevention in the US recognizes that brain injuries (BI) are a major public health issue. Due to the wide-ranging effects and recovery paths associated with BIs, rehabilitation treatments vary widely and must be customized by therapists for each patient. Clinical experience and literature have identified that it is often challenging to motivate people who have had a BI to engage their rehabilitation. As a result, many therapists include games and gamified activities. The aim of this project is to support the use and creation of customized gameful approaches to help people who have had a BI recover faster and to the best of their abilities.

I define gameful approaches (a term I adopted from McGonigal), as those that embrace a range of methods to encourage people towards greater engagement in their physical and cognitive rehabilitation through games. I am focused on: (a) helping therapists choose and share information about commercial-off-the-shelf (COTS) games and (b) enabling designers to create better therapy-centered games to support BI rehabilitation.

Previous research has supported COTS games as effective motivators for performing rehabilitation exercises. While this work is encouraging there are limitations including sample size and explorations into variables that contribute to success. The first objective of this project is to create a Web-centric knowledgebase about COTS game use through studies that address those limitations. The knowledgebase will contain weighted variables that contribute to successful therapies using COTS games; variables include patient abilities and preferences, therapeutic goals, game mechanics, and game system affordances.

We (myself and many students) have been working with therapists at three rehabilitation hospitals. One finding in the exploratory phase of the project was key to guiding this project: therapists expressed frustration in finding relevant information about commercial games.

The second objective of this project is to leverage the Web-centric knowledgebase to create decision and information sharing tools to help therapists make evidence-based choices, customized for each patient that (a) match their patients preferences and abilities and (b) best meet their therapeutic goals.Given the complexity and structure of the problem, we are incorporating a case-based reasoning (CBR) system to match games to therapeutic goals and patients for the decision tools.

CBR systems provide matches by referencing previous solutions or ‘cases’; see the figure below for how we are conceiving a case. We began the creation of the case knowledgebase for the CBR system through paper-based diary studies with therapists. In the paper-based diary studies, therapists (n = 16) were given a notebook containing a two-page diary form and were asked to record details about play sessions over two-week periods; this information acted as 'seed cases' for the knowledgebase.



We built a prototype 'choose a game tool' from our seed cases. You can see our prototype for a 'choose a game' tool here (it will open in a new tab) Prototype. (Note: Log in as a 'tester', and if you are sent a questionnaire after the query, you can ignore that).

Twenty-nine therapists were involved with our initial 24 weeks of beta testing the 'choose a game' prototype. During beta testing of the prototype, therapists were sent a questionnaire about their therapy session; the initial query and questionnaire then acted as a digital version of the paper-based diary form, allowing for the collection of additional cases and strengthening the recommendations. In future work, we plan to add several additional tools for therapists to access the case knowledgebase, including ‘Browse games’, ‘Add a game’, and ‘Rate a game’ tools.

However, despite their potential, COTS games are often too challenging for many people who have had a BI. The third objective of this project is to inform and promote the design of therapeutic games specifically aimed at BI rehabilitation by enabling game designers. Using the knowledgebase case data, we aim to establish therapy-centered design patterns. We then will create tools for designers so they may access the patterns and knowledgebase data; this part of the project will support designers in the creation of games for BI rehabilitation.

Therapist: Lisa is a speech-language pathologist working with inpatients who have had a BI. She often uses tablet games to motivate patients. However, she is having problems motivating Jeff, a 31 year-old patient who was just admitted with a traumatic BI. After trying some mini-games in an app aimed at helping children with memory and problem solving, Jeff complained the games were ‘for babies’. A therapist friend told Lisa about a site that has information and decision tools about games. Accessing the site on her smartphone, she selects the “Choose a game” tool; she notes other tools, which include ‘Browse games’, ‘Add a game’, and ‘Rate a game’. The interface first asks her to declare her physical, social, and cognitive goals for the therapy session. She selects memory and problem solving; she sets problem solving as the highest priority goal. Next, she is asked non-identifiable information about Jeff, which includes a rating of his command following abilities. The system gives Lisa a non-user-specific ID for Jeff, in case she would like to use the system for Jeff later.

After submitting session parameters and filtering to show only tablet and Web-based games, she is presented with a list of mini games in the ‘Brain Baseline’ app. Game information includes bar graphs that indicate the match level for her session goals and comments from other therapists that include reported usability issues. Later, after trying several of the mini games with Jeff (most of which went well), she wants to share her own comments about some usability problems she had with some of the games. Using the “Add a comment’ tool she navigates directly to the games’ information page, and adds her comments.

Designer: Liam is in a graduate game design program. While his focus has always been in games for health, his father’s recent stroke has directed his interest in developing games to support brain injury rehabilitation. His father is having a lot of difficulty with standing endurance and hand eye coordination. His occupational therapist, Julian, has used some videogames focused on those therapeutic goals; however, Liam’s dad is very frustrated with his lack of success with many of the games. This inspires Liam to focus his capstone project on a game focused on hand-eye coordination that he believes will be more engaging and appropriate for his dad. His capstone instructor suggests that Liam check out a new site that offers tools for game design that are focused on BI therapy.

Liam navigates to the site on his tablet; the site offers options for ‘Choose a pattern’, ‘Browse patterns’ and ‘Browse knowledgebase’ tools. Liam selects ‘Choose a pattern’ and is first asked to declare therapeutic goals he aims his game to address. He selects standing endurance and hand-eye coordination. He is presented with several patterns, including, “Randomized Events” and “Focus and Distraction”. He clicks on “Randomized Events” and is presented with: (1) a problem statement (Practicing hand-eye coordination abilities involves perception and reaction to events); and (2) a solution (Make events appear in a randomized manner to introduce uncertainty. A fairly fast pace is often desired but speed needs to match patient abilities. A human opponent with a matching skill or an adjustable AI opponent is suggested). Also listed are several example games that therapist rated as addressing both hand-eye coordination and standing endurance well, links to videos of game play, and related game design patterns. After browsing the site and clicking on several patterns, Liam feels confident about ideating several game design concepts based on the design patterns and knowledgebase information

See Figure below for a summary of how I envision therapist and designer interaction with the knowledgebase.

Publications (email me if you would like a copy)

Putnam, C., Cheng, J., Lin, F., Yalla, S., and Wu, S. (2016). ‘Choose a Game’: Creation and Evaluation of a Prototype Tool to Support Therapists in Brain Injury Rehabilitation. Submitted to the 2016 annual conference on Human factors in computing systems (CHI '16), San Jose, CA, USA. (Acceptance rate: 23%)

Cheng, J., Putnam C.and Rusch, D. (2015). Towards Efficacy-Centered Game Design Patterns For Brain Injury Rehabilitation: A Data-Driven Approach. In Proceedings of the Annual ACM Conference on Conference on Computers and Accessibility, ASSETS '15, October 26-28, Lisbon, Portugal, (Acceptance rate: 23%)

Cheng, J. and Putnam C. (2015). Therapeutic Gaming in Context: Observing Game Game Use for Brain Injury Rehabilitation. In Proceedings of the 2015 annual conference extended abstracts on Human factors in computing system, CHI EA '15, April 18-23, Seoul, Korea. (Poster: Acceptance rate: 41%)

Lin, F., Putnam, C., Yalla, S.V. Cheng, J., Swaminathan, B., and Cotter, W. (2015). Using Motion‐based Gaming to Improve Rehabilitation Outcomes in Veterans with Traumatic Brain Injuries, VA Polytrauma Conference, May 04-05, Washington DC.

Putnam, C . and Cheng, J. (2014). Therapist-Centered Requirements: A Multi-Method Approach of Requirement Gathering to Support Rehabilitation Gaming. Accepted to the International Conference on Requirements Engineering, RE 2014, August 25-29, Kariskrona, Sweden. (Acceptance rate: 27%)

Putnam, C., Cheng, J. & Seymour, G. (2014). Therapist Perspectives: Active Video Games Use in In-patient Settings for People with Brain-Injuries. Games for Health Journal, 3(6), 366-370.

Putnam, C., Cheng, J, Rusch, D, Berthiaume, A and Burke, R. (2013). Supporting Therapists in Motion Gaming for Brain Injury Rehabilitation. In Proceedings of the 2013 annual conference extended abstracts on Human factors in computing system, CHI EA '13, April 29-May 2, Paris, France. (Poster: Acceptance rate: 46%)

Funded Researh Grants

Title: Cognitive Rehabilitation Potential of a Commercial Driving Simulation Videogames: Pilot Study for Brain Injury Rehabilitation
Role: Principal Investigator (PI)
Grantor: University Research Council | DePaul University
Amount: $3,500
Status: Funded Fall 2015
Title: Therapeutic Games for Brain Injury Rehabilitation: Exploring Tools for Designers
Role: Principal Investigator (PI)
Grantor: University Research Council | DePaul University
Amount: $3,490
Status: Funded Spring 2015
Title: Quantitative Assessment of Using Motion-Based Videogame to Improve Rehabilitation Outcomes in Patients with Brain Injuries
Role: Principal Investigator (PI)
Grantor: DePaul and Rosalind Franklin Universities
Amount: $80,994
Status: Funded Fall 2014
Title: Supporting Therapists for Rehabilitation of Brain Injuries using Motion-based gaming
Role: Principal Investigator (PI)
Grantor: University Research Council | DePaul University
Amount: $3375.00
Status: Funded Winter 2014
Title: Supporting Therapists In Motion-Based Gaming For Brain Injury Rehabilitation
Role: Principal Investigator (PI)
Grantor: DePaul and Rosalind Franklin Universities
Amount: $54,620.00
Status: Funded Fall 2013
Title: Supporting therapists who use motion-based video games: Building a system to help therapists choose commercially available games
Role: Principal Investigator (PI)
Grantor: University Research Council | DePaul University
Amount: $3500.00
Status: Funded Fall 2012

Rosalind Franklin and DePaul Retreat: Spring 2014 | PDF version of the poster in new tab.



Work-in-progress: CHI 2013: Supporting Therapists in Motion Gaming for Brain Injury Rehabilitation. | PDF version of the poster in new tab.