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THERAPY-Magazin
Interactive cognitive-motor training with the Dividat Senso

How does game difficulty affect motivation in exergaming? A pilot study with Dividat Senso explores the link between cognitive challenge, emotional experience, and training success in older adults.

Author
Manuela Adcock
Head of Research, Dividat AD
Einfluss des Schwierigkeitsgrades unterschiedlicher Trainingsspiele auf Motivation, emotionales Spielerlebnis sowie physische und kognitive Beanspruchung.
Older people have been shown to have an increased risk of falling due to age-related changes in the body and brain. These changes influence their independence and ability to participate in everyday life. This is because everyday human life is predominantly based on action requirements that involve a second motor task and/or a cognitive task in addition to a motor task. For this reason, training recommendations point to a necessary combination of these requirements also in the training context.

With the help of challenging dual tasks, it’s possible to train both physical performance and cognition (specific brain functions). This can effectively counteract age-related changes and maintain and even improve the functional fitness, balance, steady walking and walking speed of older people.

Therefore, in therapeutic practice, it makes sense and is useful to couple forms of movement with coordinative and cognitive tasks in order to train the skills as close as possible to everyday life. It’s crucial that the trainee’s attention is focused evenly and simultaneously on the physical as well as the cognitive task.

Today, technology-based training systems are often used for dual task training. They make it possible to mitigate the consequences of under-straining or overstraining and provide exercisers a safe framework for training at their individual performance limits. The computer game, which represents the cognitive elements of the intervention, is specifically coupled with the movement task. The level of difficulty of the training game is modelled by a progression algorithm depending on the trainee’s performance. The attractive training environment is intended to promote motivation in particular, as this is an essential condition for frequent use of the equipment and training.

Training in virtual realities has a high impact on motivation per se. Ultimately, the play instinct flows into the training when computer games are used. In order for motor learning to be successful, however, it is crucial to keep the trainee’s motivation as constant as possible during the course of an exercise session and throughout the entire training process. In this context, preventing under-straining and overstraining as well as getting rewards through learning successes can be seen as essential determinants for maintaining motivation and optimising the training process.

The “Dividat Senso” forms the basis for such computer-supported interactive cognitive-motor training. The training system consists of both hardware and software. Sensors mounted on a base plate record the body’s centre of gravity, targeted forces and steps in a highly dynamic way. In combination with the intelligent software “Dividat Play”, gross motor movements are playfully linked to personalised cognitive tasks. The video games (exergames) interact with the pressure-sensitive plate. The software is designed to provide an optimal level of challenge; individually tailored to the trainee’s abilities. Even without previous computer experience, the video games are easy to use; they bring excitement and fun to training and are designed to increase motivation.
The effectiveness of cognitive-motor training with the Dividat Senso has already been proven in various studies in different fields of application in recent years (cf. van het Reve et al. 2014, Eggenberger et al. 2016, Schättin et al. 2016, Oku-bo et al. 2016, Schwanenburg et al. 2018, Rebsamen et al. 2019, de Bruin et al. 2019, Morat et al. 2019). However, the influences on, and relationships between, the level of difficulty, motivation, emotional experience, and physical and cognitive demands have not yet been investigated.

What influence does the level of difficulty of different game applications for interactive cognitive-motor training with the Dividat Senso have on motivation, emotional game experience and physical and cognitive demands? And what are the connections between the level of difficulty and motivation, the emotional experience of playing, and the physical and cognitive demands?

Jakob Tiebel, Rebecca Birchler and Manuela Adcock recently investigated this in an explorative field study, which is the first of its kind. “The starting point of our investigation was the observation and analysis of characteristics observed and collected in practice, their features and interrelationships. We wanted to find out what possible influence the level of difficulty of different game applications of interactive cognitive-motor training with the Dividat Senso has on motivation, emotional play experience, and physical and cognitive demands, in order to understand the relationships between the variables a little better.” This pilot study is the first to address this question. Evaluating the results first showed that the interactive cognitive-motor training with the Dividat Senso was overall experienced as exciting and motivating by the participants, which confirms the results of previous studies. “This can be seen as a predictor for continuing training in the future”, the authors said. “The high level of intrinsic motivation and self-regulation further suggests that the study participants found the activity interesting on its own merits and that they self-directed their behaviour towards the target activity.”

The most striking results were found in the product-moment correlations, which were used to examine the linear relationships of pairs of variables. Here, there were highly significant correlations between average and maximum heart rate and between motivation and emotional playing experience. The more a study subject was motivated to do a training game, the more positively they described the emotions felt during training. “While the correlation between average and maximum heart rate can be explained on its own, the correlation between motivation and emotional gaming experience supports our hypothesis that the gaming fun associated with exergaming has a motivational effect”, Jakob Tiebel explains.

It is particularly interesting that higher cognitive effort correlated positively with the participants’ motivation. “This could mean that the “mental challenge” had a motivation-enhancing effect.” Qualitative feedback supports this hypothesis. “Some of the study participants commented positively that the training game felt like brain training. Furthermore, for some games, a significant correlation between the variables of cognitive load and motivation could also be demonstrated.”

Due to the numerous limitations of this study, the results must be considered preliminary. They serve as a first impulse in the ongoing project to better understand the influence of the level of difficulty of different training games of interactive cognitive- motor training with the Dividat Senso on motivation, emotional play experience as well as physical and cognitive strain and to investigate correlations between the constructs. “Larger, methodologically more complex studies are needed to determine the direction and strength of these relationships more precisely. In particular, the relationships between cognitive effort and motivation and their influence on the subjective perception of stress should be researched further”, the authors say.
Ambulante Rehabilitation
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Standing & Balancing
THERAPY 2022-I
THERAPY Magazine
Wohnen im Alter & Langzeitpflege
Author
Manuela Adcock
Head of Research, Dividat AD
Manuela Adcock is Head of Research at Dividat AG and holds a doctorate from ETH Zurich. from the ETH Zurich. Manuela Adcock is a neuropsychologist with many years of clinical years of clinical experience at the University Hospital Zurich.
Author
Rebecca Birchler
Movement Scientist, Dividat AG
Rebecca Birchler completed her studies at ETH Zurich with a focus on Movement Sciences and Sports. During her master’s thesis, she evaluated home-based cognitive-motor training solutions in collaboration with Dividat. In her current role at Dividat, she supports clients in the practical implementation of cognitive-motor movement concepts.
Author
Jakob Tiebel
Business Owner, N+ Digital Health Agency
Jakob Tiebel studied applied psychology with a focus on health economics. He has clinical expertise from his previous therapeutic work in neurorehabilitation. He conducts research and publishes on the theory-practice transfer in neurorehabilitation and is the owner of Native.Health, an agency for digital health marketing.
References:
  1. Dividat AG ist ein Spin-off-Unternehmen der ETH Zürich, das Digitalisierung im Gesundheitswesen nutzt, um Selbstständigkeit und Gesundheit in allen Lebensphasen zu fördern. Dividat setzt das Wissen aus der Forschung in der Praxis um und generiert neue Erkenntnisse, auch durch eigene Studien mit Forschungspartnern im In- und Ausland. www.dividat.com

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