Is it possible to innovate healthcare through Applied Games, data analysis and a co-design process?

TOP! Together to play suite of healthcare video games helps rehabilitate children with complex neurological problems by comparing session data — providing an innovative rehabilitation therapy and monitoring of a child’s progress.

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TOP! Together to Play, is a video game suite co-designed by OpenDot and Fondazione TOG (TOG Foundation) with the support of Dotdotdot, WeAreMuesli, Istituto Mondino, PHuSeLab UniMi which promotes the therapy of children with complex neurological diseases. TOP! aids video game and eye-tracking rehabilitation and learning sessions. Used therapeutically, this technology enables the tracking and monitoring of the eye movements of patients suffering from severe cognitive deficits. It records explorations, difficulties, and progress and then mines the data.

TOP! is the result of a long co-design process between designers, makers, therapists, doctors, and patients’ families, which puts the design back into empathy by constructing a Human Centered design process which unites therapeutic and scientific needs.

As scientific aspects become more vertical and the technology increasingly complex, the design role must relate therapy and tools to serve the individual’s needs, listen and provide new combinations. While important, technology is a tool within the design process and not the solution.

TOP! includes three video games categories: learning (cause/effect; focus; vertical/horizontal shifts), cognitive and playability. The suite consists of a software developed by Dotdotdot designed with an easy-to-use User Experience and User Interface, which allows the control and management of the single-game session by the therapist. A tablet-using therapist can modify parameters such as time, focus or speed of the output on the screen. All sessions are recorded and viewed through a comparative DataViz, obtaining individual child statistics which are compared with other patients. Fondazione TOG is testing TOP! on more than 20 children between 3 and 12 years old.

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Project Genesis

For five years Fondazione TOG, OpenDot and Dotdotdot are co-designing to innovate the health and care field. As part of the successful partnership, has been established a Co-design method for health and care that includes a manifesto with a vision, and tools to facilitate the design process.

Indeed, there was much mutual professional, and personal growth as working in this area required attention to the fragility, empathy and responsibility of everyone in the pediatric disability field.

TOP! Together to Play project is another excellent example of how to put what we have learned into practice. It is the result of a co-design, by several players, with different skills, working together to overcome disciplinary differences.

Once the objectives and the design context were defined, one of the first steps was to meet Prof. Sabrina Signorini (Centro di Neuroftalmologia dell’Età Evolutiva, Fondazione Istituto Neurologico “C. Mondino”) [Centre for Evolutionary Age Neurophthalmology, “C. Mondino” Neurological Institute Foundation] in the hospital and observe how a Neuro-Ophthalmological diagnosis was made.

The User Experience designed by TOG and OpenDot emerged from a study of details within the reference context, providing fundamental insights for the prototype and implementation phase.

Therapists, clinicians and families who participated in the design sessions within the Fab Lab could empathise and become creators and designers of the final solution.

It was possible to think together openly and comprehensively about diagnostic and therapeutic needs and how design and technology could provide an adequate response.

Eye-tracking is not a technological innovation nor is the use of video games for educational purposes in rehabilitation therapies, but TOP! innovation originated from the intuition that comes from comparison and observation.

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Applied Game, eye-tracking, and innovation

By analysing already-available-products and observing and closely studying the rehabilitation practices, the need to separate the patient’s device from that of the operator/therapist was identified.

Current market solutions have a duplicity problem, which causes disorientation to a child who is asked to use their eyes to interact with the device when the therapist accesses it using the keyboard and touchscreen.

Providing separate devices for caregivers and care receivers allows the perception of tool exclusivity. The child feels that the device belongs to them; they create an avatar and play in an extremely personal and exclusive way.

This allows the caregiver to interact in real-time and evaluate oculomotor movements, control the position and flow of the child’s gaze without disturbing the process.

Another fundamental aspect of the project concerns the collection of game session data for qualitative and quantitative rehabilitation analysis.

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Data analysis and alternative use conditions

Ocular tracking devices have been used for years to map the eye’s main movements (saccades, focus and following), but under “protected” and replicable conditions.

With the help of the PHuSeLab (University of Milan), the goal is trying to extend the use conditions and the application boundaries of the data generated by the device.

First step of the trial’s idea was to simulate traditional and replicable research conditions, such as suggesting an identical video to different subjects or to the same patient at different times. This enabled the evaluation of motor evolution along with therapy development. The objective is to evaluate the progress of subjects using data from different work sessions. This includes domestic and non-hospital sessions, and more familiar and comfortable environments — data that would be difficult to compare in a standard situation.

Algorithms based on Machine Learning and Artificial Intelligence help us understand if it is possible to generate models from a heterogeneous database. It would be possible to guide caregivers during the treatment by providing them with real-time insight at the end of each exercise or session.

A final, even more challenging, experimental aspect will be to aggregate the database that represents the patient’s emotional state. This is usually difficult to detect, especially when it comes to children with cerebral palsy or complex neurological diseases. In this case, pupil dilation-linked muscular movements, which are directly connected to the subject’s emotional states under the same lighting conditions will be used. This type of data is vital for giving direct feedback to the therapist during the session on the subject’s emotional comfort state, and understanding the post-session analyses.

Alessandro Masserdotti, CTO and co-founder of Dotdotdot and OpenDot, unveiled the suite for the first time at the TecnoTOG scientific conference (Palazzo Reale, Milan, 5 October 2019) and explained its innovative aspects.

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We are a multidisciplinary interaction design studio founded in Milan in 2004, in which experimentation is at the core of innovation.

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