IEEE Systems, Man and Cybernetics Magazine - October 2020 - 61

Based on the SUS, the perceived usability of the system scored an average of 80.33 (SD = 11.37). The usability was perceived similarly [F(2,14) = 0.003; p = 0.954]
between men and women. The same tendency was
found regarding the participants' previous experience
with video games [F(2,14) = 0.003; p = 0.949]. The
results indicate that the system was perceived as
usable, regardless of gender or previous experience with
video games.
Regarding the par ticipant's perceived difficulty
(see "Difficulty" in Figure 4), the games scored a mean
of 2.77 (SD = 1.37), which indicates that they were low
challenging. The perceived fun (see "Fun" in Figure 4)
scored a mean of 7.57 (SD = 1.39), indicating that the
games were fun. For the two design approaches (A1
and A2), the perceived difficulty was similar [F(2,14)
= 0.159; p = 0.693]. However, the test showed a different perception of fun [H(2) = 4.474; p = 0.034] with an
average score of 8.22 (SD = 1.10) for (A1) (see "A1 Fun"
in Figure 5), whereas A2 (see "A2 Fun" in Figure 5)
scored an average of 6.95 (SD = 0.535). These results
indicate that the two approaches did not affect the
perceived difficulty but they affected the perceived
fun, with a preference for A1 over A2. In addition, the
perceived difficulty and fun factors for each approach
were analyzed by gender and previous experience with
video games. However, the results did not show any
significant difference.
Motivation, as a general score measured by the SIMS,
averaged 5.37 (SD = 0.85) for intrinsic motivation, 4.32
(SD = 1.62) for identified regulation, 2.96 (SD = 1.61) for
external regulation, and 2.28 (SD = 1.28) for amotivation.
No significant differences were found when categorizing
by gender and previous experience with video games.
These results suggest that the participants were positively
motivated by the system.
Conclusion and Research Perspectives
Traditional poststroke therapy at the hospital is useful to
regain the lost capabilities of patients. Nevertheless, the
patients' motivation and adherence to a rehabilitation
regime is still a problem. To address this problem, this
article proposed a game-based in-home rehabilitation
approach for poststroke patients. A two-part system
architecture was designed to allow for remote monitoring and intervention by the therapist. A game-based system was designed following two approaches. The first
design approach, A1, consisted of selecting games or
ludic activities and adapting them to achieve therapy
objectives. The second design approach, A2, included
selecting and virtualizing the physiotherapy exercises
being used at the hospital.
An experimental study was carried out to test three
aspects of the system: first, a usability test of the system as a
whole; second, the impact of the two design approaches (A1
and A2) on users' perception of fun and difficulty; and

10
8
6
4
2
0
Difficulty

Fun

Figure 4. The difficulty and fun score.

10
8
6
4
2
0
A1 Fun

A2 Fun

Figure 5. The fun scores for the design approaches

(A1 and A2).

finally, how the developed system affected users' motivation.
The results showed that the system as a whole was usable
regardless of gender or previous experience with video
games. The games were perceived as easy and fun to use.
However, the games developed following A1 were perceived
as more enjoyable. Finally, the results showed that the participants' motivation increased after using the system.
For the perspective of our research, we plan to validate
the system in a clinical context involving patients and therapists. Additionally, the therapist's interface will be further
developed to provide the functionalities claimed by the
proposed approach.
Acknowledgment
We acknowledge the financial support of the National
Council of Science and Technology of Mexico.
About the Authors
Paul Tamayo-Serrano (paul.tamayo-serrano@uvsq.fr)
earned his B.S. degree in computer systems from the University of Occident, Mexico, and M.Sc. degrees in computer
science and information science from the Technological
Institute of Culiacan, Mexico, and the Autonomous
O c tob e r 2020

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IEEE Systems, Man and Cybernetics Magazine - October 2020

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