Helping children with Intellectual Disability to understand healthy eating habits with an IPad based Serious Game

A. Rodríguez Isasi, A. López Basterretxea, A. Méndez Zorrilla, B. García Zapirain

DeustoTech- Life Unit, DeustoTech Institute of Technology, University of Deusto, Bilbao, Spain

{amaia.mendez, mbgarciazapi}@deusto.es

Abstract- The Project described by means of this article consists on the design and implementation of an application within the field of the serious games. A game aimed at instilling healthy eating habits to children/adolescents with ID. For the accomplishment of this project some multi-touch platforms (IPad) were used, given the good reception by people with ID towards the use of new technologies. The application is based on a set of games with different functionalities and aims, which include a piece of advices for the eating process. Furthermore, a pet has been designed with the aim of making the application more attractive in the interest of motivation. The results obtained after the tests carried out with real users were positive and encouraging. The users felt confortable when using the application and some improvements were applied base don the feedback provided by professional instructors and by the children themselves.

Keywords - Intellectual Disability, IPad, eating habits, Serious Games

I. INTRODUCTION

People suffering from ID usually need extraordinary help for the accomplishment of daily activities [1]. Within the ID, this Project focuses precisely on people with Down syndrome, a genetic alteration produced by the presence of an extra chromosome. This syndrome usually causes generalized muscle hypotonic, a variable degree of cognitive disability, attention and memory deficit and growth restriction, in addition to a higher tan normal risk of developing certain diseases, among which there are food-related diseases, such as diabetes. Moreover, more than half of people with the Down syndrome suffer from obesity, which increases those health problems. Therefore, special attention is needed in the education of children/adolescents with Down syndrome regarding food and the assimilation of healthy eating habits. [2]. Within the aids supporting common education systems, it is widely spread the use of new technologies in different aspects (and applied to different groups of users), such as to help people with other disabilities, like visual ones. Some examples of those technologies are partial screen enhancement programmes, or those that reed written contents, or expanded keyboards, easier to use [3], or even special mobile devices which reach to include touch screens-Braille [4] [5]. This improvements for the use of technology

extend further, increasing the number of applications developed with teaching and supporting aims, such as, the applications based on augmented reality technology, created by Qualcomm, carried out to help people with ID to reach a successful labour integration. [6] [7]. In particular for users of lower age (although it is applied in all kinds of areas), the genre of the serious games is currently being exploited. There is a multitude of applications within this field that are intended to users with ID for different platforms, existing among them:

• “Lucas and the case of the stolen Painting”, avideogame created for PC in 2010 thanks to thecooperation of the Orange foundation and Down’sSyndrome foundation in Madrid aimed at Youngpeople with disabilities. The adventure of this gamedevelops around different parts of the world, inwhich the player must solve riddles whileinteracting with objects and characters, and the plotwill be modified depending on the decisions taken.[10].

• “The adventures of Spoti”. Is an Online interactivegame created for people with Down’s syndromebetween 6 and 10 years old thanks to thecooperation of the Down’s syndrome in Spain andthe Eroski foundation. This application is focusingon the food education of the youngest users with theaim of reducing the childhood obesity within thiscollective. To do so, a series of activities of healthyfood and physical activity are dealt with by meansof little interactive games [11].

• “Picaa”. This project was developed by thespecification, development and evolution of theGEDES software research group [12] of theUniversity of Granada between 2010 and 2011 for IPad, IPhone and IPod Touch devices. It is anapplication designed for the creation of didacticactivities adapted to students with specialeducational needs, mainly in the following levels:cognitive, visual and auditory, with 5 types ofdifferent activities. [13].

Most of the current-existing applications were carried out for PC platforms, being the supply in other devices rather scarce, mostly when new mobile and touch technologies offer so many possibilities for the implementation of appropriate games for users with ID. This is one of the reasons why this project was developed for I pad, to try to cover a field in which no further projects were contributed in relation the

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help for education of people with special needs applications, taking benefits from the features this might offer (mobility, touch screen…). In addition, many of the applications available are focused in other aspects of education or poise [14], and there are no many the ones dealing with such an important issue, which the correct diet, being this point emphasized in this game. Some of the applications, such as “the adventures of Spoti”, previously mentioned actually aim to promote healthy eating habits, but all of them are aimed at other supports. Considering the importance of the acquisition of healthy habits and customs concerning food in ages between 8 and 12 years, the game has been designed following the tastes and characteristics of the children at that age. An application that may provide an extra help was tried to be carried out by means of a series of little games for the task being more entertaining and easy, encouraging the users’ autonomy without setting aside the teachers’ help. Furthermore, a pet has been included which shall guide the users through a series of advices for the game being more attractive, since the aim of the project is to instil positive values at the same time as the users play and have fun.

II. OBJECTIVES

Being the main aim the improvement of the eating habits in children with Intellectual Disability, the following specific objectives are described thereupon:

• To design and develop an application for iPadwithin the genre of the serious games intended topromote healthy eating habits to users with ID,especially to children with Down’s syndrome.

• To offer support to education by means of a varietyof entertaining games, making fun and bearable theuse of the application.

• To design a test protocol to demonstrate the benefitsof the game in the behaviour of the users.

III. MATERIAL AND METHODOLOGY

In this section the technical and human resources the researchers counted with to carry out the development and the application tests.

A. Human resources

In the tests carried out with a group of children with ID (in particular those with Down’s syndrome) 11 users participated, aged between 9 and 15, from which 5 were girls and 6 were boys. Among the whole group only 5 had already used or knew the iPad.

Various instructors also participated giving support during the test, as well as providing information concerning the content of the application.

B. Technical resources

The development of the application has been designed for the IPad platform, property of Apple, based on IOS 6, the code programming thus being carried out in Apple’s own environment: Xcode. The IPad was chosen for its mobility, multi touch screen, multimedia capability, interaction through movement…for these being interesting features to take advantage of in the application. The database has been implemented through Sqlite.

IV. DESIGN

The application is focused on nourishing good hygiene and nutrition habits, following the structure shown down below in Figure 1.

Figure1. High-level diagram

The architecture of the application follows the design in three layers: database layer, logical layer, interface layer.

The application has a database layer implemented through Sqlite to store different parameters on the basis of the results obtained by the players (time, amount of errors…). In this way, it is possible for the instructors to gain control over the progress of each child, or determine what kind of activities produce greater difficulty. The development of the logical part is based on Apple IOS, thus the code programming being carried out by Apple’s own environment. Xcode, as the main objective is an application for IPad.

In the user interface layer, the players (children) have access to the games about nutrition, and the instructors have access to the settings to view statistics, change the language, etc.

In the following sections we shall be allowed to see in depth the operation.

Figure 2. Low-level Diagram

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As we can observe in Figure 2, the application starts with a screen in which the user must enter the personal data (name). Such name remains recorded; together with the data saved until the application is closed or the user is changed they will remain saved with that name. Once accepted, it will branch directly into the main menu, from which the games and the settings can be accessed (prior to have access to the buttons that led to the described options, the player must press over the pet chosen to guide and motivate children, which shall be presented trough a small introductory text, and the buttons will appear). In this last section it is possible to change the language of the application (examples, conclusions…) between Basque and Spanish up to day (due to their mother language), return to the introductory screen and check the table of the results obtained in the database.

A. Explanation of Games

The games are divided into minigames, as it can be seen in Figure 3, since, being an application for children, it will be more entertaining.

Figure 3. System block diagram

Before starting the game, each game comprises an explanation of its functioning (with the aim of not being allowed to skip it without reading it, the starting button takes some moments to appear). Once the game completed, certain parameters are saved (time or, errors mainly… depending on the game) associated with the previously added username. Likewise, a screen with a teaching conclusion related to the subject matter of the game will appear. The options to continue take a few seconds to be visible, on the same basis of the explanation prior to the game. Once they are qualified, the user is allowed to continue with the following game or return to the title screen.

Game 1

Figure 4. Game 1 block diagram

In the first game (see Figure 4 and 5), the player must advance by selecting the appropriate products to develop a salad by choosing the appropriate one between the two foods that appear. Once one of them is pressed, if it is suitable it will set to a plate displayed in the bottom part of the screen, and two products to choose appear once again. In the event of choosing the unhealthy food, two more products to choose appear again, but neither of them sets to the plate. When all the proper ingredients are taken, the conclusion appears showing other possible ingredients which may be added to a salad.

Figure 5. Game 1 Screenshot

Game 2

This minigame is focused on the importance of a well-balanced breakfast. In the beginning, the player faces

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different foods to choose, from which some of them should be picked and dragged to the table.

Figure 6. Game 2 block diagram

When the finishing button is pressed (see Figure 6), the chosen breakfast is checked to be complete and varied. In the event of that not being the case, a message indicating an error appears (certain product that is not adequate, one milk would be enough, etc.). Once a correct breakfast is composed, a conclusion highlighting the importance of breakfast appears (see Figure 7).

Figure 7. Game 2 Screenshot

V. RESULTS

In this section, we describe the obtained results: technical, satisfaction and user experience results.

Figure 8. Main menu Screenshot

By means of satisfaction questionnaires the following results were obtained:

• The character had a substantial acceptance (100%)and all the users had fun playing, and even they affirm that they would play again (see Figure 8). Screenshots of the serious game can be observed in figures 5 and 7.

• No significant differences were observed betweengirls and boys, or among users of different ages.

• In general the users had no difficulties, but it mustbe reported the case of one specific user, who in addition to ID suffers from pervasive developmental disorder (PDD).

• Among the users participating in the tests, it can beobserved that some of them already knew the iPad, as well as mobile phones. However, any advantage or better scoring was reported in the results.

To be able to keep a track of the progresses, the application saves certain values in a database available to the instructors. This way, it is possible to analyse the results obtained by the children in the different activities the application offers. Finally, the project is distinguished by being a bilingual application (taking into account the mother tongue of the users), giving the option to play changing the language both the texts and the voice.

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VI. CONCLUSIONS

This paper has reported the preliminary results of a study aimed at the children with Down Syndorme using iPad and an application to improve eating habits. Considering that the results obtained with the application were encouraging in different fields. It has been thought to carry out future improvements. On the one hand, within the game some modifications were added, such as add another game, insert rewards, add the option of game in English… On the other hand, it has been considered to carry out more tests with other groups of users with Down’s syndrome, aged between 9 and 15, as it has been carried out, and to extend the tests to other collectives, such as children with pathologies within ID. Furthermore, it is interesting to carry out new tests to check the results of the modifications applied after the first test with real users, that is to say, the introduction of voice for the explanations, the expanding of the texts…

ACKNOWLEDGEMENTS This work was partially supported by the Basque Government Department of Education, Universities, Research, AECID and Bizkailab. The authors would like als thank to all the participants involved in the study, the cooperation of FSDPV. Also to Zelai Sáenz de Urturi researcher from DeustoTech LIFE Unit for her collaboration and support.

REFERENCES

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[8] G. A. El Khayat, T. F. Mabrouk, A. Elmaghraby. “Intelligent Serious Games System for Children with Learning Disabilities”. 17th International Conference on Computer Games, 2012. [9] A. Elmaghraby, A. Mendez, B. Garcia, W. Sheta, S. el Shehaby. “Serious Games and Health Informatics: A Unified Framework”. 17th International Conference on Computer Games, 2012. [10] Videojuego de aventura para discapacidad http://fundacionorange.es/fundacionorange/comunicados/2010/lucas_videojuego.html. Abril 2010. [11] "Las aventuras de Spoti". http://www.sindromedown.net/Spoti/default.htm. Enero 2012. [12] Grupo GEDES. http://gedes.ugr.es/datos_inicio/. Enero 2013. [13] "Picaa" http://asistic.ugr.es/picaa/?page_id=16. Enero 2013 [14] J. Torrente, Á. del Blanco, M. OrtegaMoral, L. Bourg, B. Fernández Manjón. “Juegos accesibles y la integración laboral”. Abril 2012.

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