Jul 23, 2013

Monkeying Around with Autism Assessments: Kinect-based game by Vectorform and Kaiser Permanente therapists offers a barrel of possibilities!

"The goal was to build a game that is extremely accessible, non-complex and includes simple mechanics that children with autism can quickly understand to retain their attention, prevent over-stimulation, encourage play, and prevent frustration." -Vectorform "Monkey Business" Team

I recently had the chance to visit the team at Vectorform's Royal Oak (MI) headquarters and experience a demo of one of their newest applications, a Kinect-based game developed to assist in the assessment of children with autism. The game, known as Monkey Business, was designed in collaboration with physical, occupational, and speech therapists from Kaiser Permanente, a large health care service provider in California. The project was supported by Kaiser Permanente's Innovation Fund for Technology group.

I was impressed!

As I watched the demo, it was clear that much time and attention was given to the input of the therapists at Kaiser Permanente. The avatar in the game is a friendly monkey who embodies the mannerisms of a friendly, curious child.  The artwork is visually appealing and not too busy. The sound effects relate to the interaction at hand and provide feedback to the child as they engage in various game-like tasks designed to assess visual-motor, gross motor, and basic receptive language skills.  Another good feature of this application is the simplicity of the screens designed for input of the child's information and viewing data regarding progress.

In my opinion, the Monkey Business assessment game has the potential for use in school settings, and would be enhanced if additional assessment activities are provided in the application.  Expanded activities within the Monkey Business environment could support a range of treatment, education, and related intervention efforts. In addition to supporting assessment and intervention of children with autism, the Monkey Business concept would be especially useful in working with children who have experienced a traumatic brain injury.

Below are screen shots and descriptions of a few activities from the Monkey Business game:

Lily Pad Jumping Test
In the jumping test, the child is asked to jump across a pond, from one lily pad to another.  The child is provided with a set of toy lily pads on the floor.  As the child jumps, the Kinect sensor picks up movement and displays the jumps on the screen in the form of the monkey.

Balance Beam Test
The following screen shot depicts the monkey avatar crossing a stream on a balance beam. The monkey's movements reflect the child's movements across a real balance beam in front of the Kinect sensor and a large screen display.

Block Building Test
In the block building test, the monkey avatar encourages the child to build a tower of blocks to match the one displayed on the large screen.  The child uses real blocks, placed on a table, to build a tower while the monkey provides encouragements.  Objects other than blocks can be used, as the Kinect sensor is capable of identifying a variety of objects that can be use for building and stacking.

Clinician Screens
The screens designed for inputting and reviewing data regarding the child are designed with simplicity and ease-of use in mind, as shown in the pictures below:

In the present version of Monkey Business, a TV remote is used to control the application. It is possible that future versions of Monkey Business could integrated with a Smartwatch to input student information and control the activities in the application.  

Comment: As a school psychologist who works with children, teens, and young adults with autism and other significant disabilities, I know how difficult it can be to conduct assessments using traditional test materials.  If a student has difficulty interacting with unfamiliar adults, has communication challenges, or has motor difficulties, it may not be possible to administer an assessment that generates meaningful or valid results.  Even if the student is capable of completing some of the traditional test tasks, much time and effort is required on the part of the evaluator to sustain their interest, effort, and attention.   

To get a better picture of a student's emerging skills, I use interactive multimedia applications during my assessments of children with autism.  Newer technologies such as interactive whiteboards, larger touch-screen monitors, and tablets have proven to be useful tools in assessment.   A significant drawback to my approach is that it is cobbled together and might be difficult to replicate by other evaluation teams.  I see a growing need for a range of technologically-enhanced tools for assessment, including applications that offer opportunities for playful engagement.  Monkey Business holds potential to fill the bill.

What next?

I'd like to share some stories about the people who make things come to life at Vectorform. During my visit, I learned that they are involved in a number of projects related to health care and are always brainstorming new ways to harness technology for their various clients.  

Over the past several years, I've followed Vectorform's journey as they've jumped off of the desktop and transformed from web-developers to Post-WIMP explorers of natural user interfaces and interaction.  The most recent area of exploration is Google Glass. 

Intrigued by Google Glass?  So am I.  

During my visit to Vectorform, I had a chance to see the world - or rather Vectorform's basement conference room - through Google Glass.  As soon as I put them on I was flooded with ideas, and will expand on my ideas, and those of others, in future posts.

In the meantime, take the time to read an excellent post by Kevin Foreman, Vectorform's Director of Product Vision.  In "The Glass Experience", Kevin provides an in-depth reflection of his experience wearing Google Glass throughout his daily routine.  He also explains the inner workings of the hardware, the strengths and limitations of the Glass system, details about the user interface, the "on-board" accessories, and a few comments about what it is like to be a new Glass-wearing celebrity.

Here are just three of the innovators I met during my recent visit to Vectorform, left to right: Jennifer Tonio, Marketing Manager, Kevin Foreman, Director of Product Vision, and Patric Samona, Director of Health Solutions.

Below are a few links related to the use of games for the assessment and intervention of autism, along with links to information about the use of games and emerging technologies for rehabilitation, health care and health promotion:

Microsoft Kinect and Autism (SlideShare) Susan McCarthy, Little Angel's School 2/09/13

Italian Team Uses the Kinect to Treat Autistic Children Andrea Lorini, Epoch Times, 12/13/12

Microsoft Surface Multi-touch Application for Pediatric Neuropsychology Assessment (Featuring Vectorform) Lynn Marentette, TechPsych Blog, 8/26/09   

Xbox One, Kinect 2.0 and the future of health technology Marcelo Calbucci, Mobihealth News, 5/26/13

Accessible Games for Health and K-12 Education: Lessons from the Classroom (SlideShare) Lynn Marentette, 5/9/08, Games for Health Conference Presentation

Researchers: Microsoft Kinect is a Money-Saving Telemedicine Device Gabriel Perna, Healthcare Informatics, 2/15/13

Lowes, LP., Alfano LN, Yetter BA, Worthen-CHaudhari, L, Hinchman W, Samona P, Flanigan KM, Mendell JR Proof of Concept of the Ability of the Kinect to Quantify Upper Extremity Function in Dystrophinopathy
PLoS Curr. 2013 Mar 14; 5   doi:  10.1371/currents.md.9ab5d872bbb944c6035c9f9bfd314ee2

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