TDT4501 - Specialization Project

Exergame or Game-Inspired ApplicationMotivating to Outdoor Physical Activity for

Adolescents and Young Adults with IntellectualDisabilities

Ida Wold

December 14, 2018

Abstract

People with intellectual disabilities often have a sedentary lifestyle and donot reach the recommended amount of daily physical activity. PokemonGo became a very popular and increased physical activity for people witha sedentary lifestyle, but the game is complex and often difficult to usefor people with intellectual disabilities. Games and applications should beadapted and customized for people with intellectual disabilities.

Some of the questions this project will try to answer relates to this topicand includes to following. Can a game or game-inspired app motivate tooutdoor physical activity for adolescents and young adult with intellectualdisabilities? What is important in navigational systems for people withintellectual disability? What is the best way to design applications andgames?

So far the project consist of a literature review and interviews with expertsto get guidelines for this type of game. These guidelines will later be usedto develop a game or game-inspired app and an empirical investigation onmotivation related to the this will be conducted.

Being social while doing physical activity is found to be most motivationalfor physical activity. A sense of accomplishment and caregivers around thatalso were motivated also helped. Navigating using maps were found to be toocomplex and systems using street view and audio would benefit people withintellectual disabilities. App or games should have a simple user interfacewith few distractions and relay heavily on symbols.

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Acknowledgment

I would like to thank my supervisors Letizia Jaccheri and Javier GomezEscribano from the Department of Computer Science at the NorwegianUniveristy of Science and Technology, for their guidance throughout theproject.

I wish to thank UiT and UNN and especially Henriette Michalsen, AudnyAnke and Gunnar Hartvigsen for their help in the project. For invitingme to a seminar on physical activity with e-health support for individualswith intellectual disability and including many interesting speakers in thisseminar. I would also like to thank the speakers at this seminar for theireducational and inspiring presentation.

Next I would also like to thank NFU for letting me join one of their outdooractivity events for people with intellectual disabilities, their caregivers andfamily.

Finally I would like to thank everyone participating in the interviews fortaking the time to participate in these interviews and sharing some of theirknowledge with me.

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Contents

1 Introduction 11.1 Related Games or Applications . . . . . . . . . . . . . . . . . 11.2 Research Questions . . . . . . . . . . . . . . . . . . . . . . . . 31.3 Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.4 Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.5 Outline of the Report . . . . . . . . . . . . . . . . . . . . . . 7

2 Background 82.1 Intellectual disabilities . . . . . . . . . . . . . . . . . . . . . . 8

3 Literature Review 93.1 Mobile Outdoor Exergames or Game-Inspired Application . . 93.2 Navigational Assistance for People with Intellectual Disabilities 123.3 Game and Application Design for People with Intellectual

Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

4 Interviews with Experts 184.1 Introduction/Background . . . . . . . . . . . . . . . . . . . . 184.2 Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194.3 Popular games and themes . . . . . . . . . . . . . . . . . . . 194.4 Motivational Factors . . . . . . . . . . . . . . . . . . . . . . . 204.5 Designing Applications or Games for People with Intellectual

Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234.6 Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264.7 Choosing the Outdoor Area . . . . . . . . . . . . . . . . . . . 284.8 Use of system and training in using the system . . . . . . . . 294.9 Extra features . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

5 Conclusion and Further Work 315.1 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315.2 Future Work . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Appendix 35Interview Questions . . . . . . . . . . . . . . . . . . . . . . . . . . 35Interview Questions Norwegian Translation . . . . . . . . . . . . . 37Answers to Interviews . . . . . . . . . . . . . . . . . . . . . . . . . 39

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1 Introduction

According to NFU (n.d.) intellectual disability(ID) consist of a variety ofdifferent diagnosis and have three criteria; reduced mental capacity, lackof adaptation and the condition needs to be visible before age 18. Peoplewith reduced cognitive function have reduced ability to think, pay attention,memorize, learn and understand languages.

Many adults with IDs have a sedentary lifestyle (Temple, Frey, & Stanish,2006). People with IDs have an increased risk of developing additionaldiseases and disorders (NAKU, 2018).

Temple (2007) mentions many contributing barriers for people with IDs tohave a sedentary lifestyle. Some of them include accessibility to physicalactivities, cost of physical activity, personal health, feeling lazy and theweather.

A game can lessen some of the barriers to physical activity mentioned byTemple (2007). A game can be used in locations close to where the usernormally stay and limit the barrier related to accessibility. It is also possiblethat users of the game will need little supervision and new equipment, it willtherefore not be an expensive activity.

According to Temple (2009) walking is one of the most popular activities forpeople with IDs. An exergame with walking as the main physical activitycan therefore be a good idea as motivation for physical activities.

According to Oh and Yang (2010) ”Exergames are any number of types ofvideo games / multimedia interactions that require the game player to phys-ically move in order to play”. The paper also talk about an inconsistent useof the term exergame, but here we use the definition mentioned above.

1.1 Related Games or Applications

There exist few research projects on exergames for people with intellectualdisabilities and research in this field is needed. A search on Google scholarfor exergames and intellectual disability suggest exergames for other groupslike people with autism spectrum disorder or elderly.

Friluftslev Tilrettelagt for Utviklingshemmede(FTU)

Den Norske Turistforeningen (DNT) have a subgroup for people with in-tellectual disabilities, called Friluftsliv Tilrettelagt for Utviklingshemmede

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(FTU). FTU’s goal is for people with intellectual disabilities and their fami-lies to enjoy nature (Tvilde, 2017). To make the nature experiences easier tofind and more available for people with intellectual disabilities an app wascreated, the FTU app. The app gives an overview of the events schedule forpeople with intellectual disabilities and present information in a way that iseasy for people with intellectual disabilities to understand(FTU , n.d.).

The app uses different levels of communication to describe the events. Thedifferent levels are symbols, simple text and a more complicated text. Tohelp people who struggle to read a text-to-audio function is also included.Figure 1 show the use of symbols and simple text to describe an event.

Figure 1: Screenshot showing the description of an event in the FTU App,picture from FTU (n.d.)

Pokemon Go

It would be impossible to write about games promoting walking outdoorswithout mentioning Pokemon Go. The game became very popular and hasbeen downloaded over 800 million times(Niantic, n.d.).

According to the description at Niantic (n.d.), to catch Pokemon you shouldwalk around your neighborhood. Your phone will vibrate when a Pokemon isclose and you then use a Pokeball to catch the Pokemon. Another part of thegame is to hatch eggs, this is done by walking a specified distance(Niantic,n.d.). This is some of the ways Pokemon go promotes physical activity.

The game has been proven to have a positive effect on physical health forparticular engaged players over a 30 days period and increases number of

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step with over 25% compared to before they started playing (Althoff, White,& Horvitz, 2016).

The description at Niantic (n.d.) also mention that Pokemon Go includessome social elements, such as joining teams and battle raids. In battle raidsup to 20 players can cooperate to defeat a powerful Pokemon. This givesthe players a possibility to catch a powerful Pokemon. People also play thegame and walk around with friends, even if that part of the game is notdesigned to be very social.

1.2 Research Questions

I wanted to find out how exergames should motivate to physical activity. Ialso wanted the physical activity to be outdoor activities like hiking, sincewalking is a popular activity for people with intellectual disabilities(Temple,2009). 50% of the physical activity for people with intellectual disabili-ties comes from the time spent at school(Queralt, Vicente-Ortiz, & Molina-Garcıa, 2016). I wanted to find something motivating to physical activity forpeople having or just about to finish school. The age group of adolescentsand young adults was therefore chosen.

Three sub questions were included, one focusing on motivating to outdooractivity and what motivational factors can be used. Another focusing onnavigational assistance systems for people with intellectual disabilities andsafety related to the navigation systems. Lastly I wanted to find out whatis important to remember when designing games or apps for people withintellectual disabilities.

The research questions for this project are:

RQ1 How should mobile exergames or game-inspired applicationsmotivate to outdoor physical activity for adolescents/youngadults with intellectual disabilities?

RQ1.1 What is motivational in mobile exergames and game-inspired appli-cations promoting outdoor physical activity for adolescents and youngadults with an intellectual disability?

RQ1.2 How should a navigational assistance systems for adolescents andyoung adults be designed?

RQ1.3 What is important when designing games and applications for ado-lescents/young adults with intellectual disabilities?

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1.3 Process

The project will have a design and creation strategy and will include multi-ple data generation methods. A game or game-inspired application will beproduced during the project and used in the empirical investigation. Theresearch process and methods can be seen in Figure 2

Figure 2: Research Process

Literature Review

The first step is a literature review, here the research will be split intothe different sub questions from 1.2. This has been done because the lack ofresearch on exergames for people with intellectual disabilities. As mentionedin Section 1.1, a search on exergames and intellectual disabilities suggestedgames for people with autism or elderly.

Interviews with Experts for Guidelines

The literature review will be used as starting point for the guidelines and ex-perts on people with intellectual disabilities, physical activity and games willbe interviewed for further knowledge after the literature review. The expertswill be interviewed because of limited information about exergames for ado-lescents and young adults with intellectual disabilities. It is also suggested

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by Tsikinas and Xinogalos (2018) to include educators when designing edu-cational games, so including people who hosts events with outdoors physicalactivity for this type of game, would have a similar effect.

Interviews with Experts for Opinions on Game Idea

In January 2019 the knowledge gathered so far in the process will be used topropose a game idea. These ideas will be presented with a simple prototypeusing a prototyping tool or a paper prototype. To evaluate the game ideaexperts on people with intellectual disabilities, technology and outdoors ac-tivity will again be contacted. The group of experts will consist of some ofthe people earlier contacted and some people new to the project.

Experiment to Test Game

The game idea will be changed based on the experts opinion and a new pro-totype will be developed. This prototype will be a working mobile game andan empirical investigation with adolescents or young adults with intellectualdisabilities using the proposed game. The test subjects will have a compan-ion with them through the experiment. Data gathered from this experimentwill be observations of the user playing the game, a questionnaire answeredby the user and some interviews with some of the companions.

1.4 Participants

UiT and UNN

The project is done in cooperation with the University in Tromsø - TheArtic University of Norway(UiT), Universitetssykehuset Nord-Norge(UNN)and their project Effect of physical activity with e-health support in indi-viduals with intellectual disabilities. A randomized controlled study, seeForskningsprosjekter.ihelse (n.d.). Currently the project is in the beginningphase and collecting data through interviews and analyzing the data. Thisproject is a PhD project in psychology.

The project have assembled a multidisciplinary team from multiple univer-sities in Norway as collaborators. This includes people with backgroundsin health and computer science. People from this team participated in theinterview in Section 4.

In addition to the project working on this game, other students are alsoworking on different exergames for people with intellectual disabilities. Thisprojects are master projects at UiT and NTNU and student projects in

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the course Advanced mHealth systems and applications available for masterstudents at UiT.

UNN hosted a seminar in Tromsø October 3. and 4. 2018, inviting allco-supervisors, students working on games motivating to physical activity,other employees at UNN and some invited speakers.

FTU App and Smart Cognition

The speakers at the seminar at UNN in October 2018 included the founderof FTU and he is currently event manager for two FTU locations. FTUarranges outdoors events all over Norway adopted for people with intellectualdisabilities and an app to inform about these events. The app is developedand maintained by Smart Cognition.

Smart Cognition is working on a leisure activities platform for people withintellectual disabilities using artificial intelligence and machine learning. Theplatform will automatically process information and present it in a wayadapted for understanding of the individual. Another speaker at the seminarwas the CEO of Smart Cognition and he has an education in computerscience. They were both interviewed for their opinions on the guidelines forthe game.

Intellectual Disability Nurse

An intellectual disability nurse (Vernepleier in Norwegian) and has workedat the Institute of Mental Health at NTNU (formally Høyskolen i Sør-Trøndelag). She has arranged many hiking trips for people with intellectualdisabilities and is currently one of the people hosting outdoors events forpeople with intellectual disabilities in Trondheim, through NFU. She wasinitially contacted about an outdoors event she was hosting for NFU andwas later interviewed for the development of the guidelines.

User Test

The prototype of the game will be tested on adolescents and young adultswith intellectual disabilities. Contacts from Trondheim Kommune and NTNUInstitute for Mental Health, NFU’s outdoor events and schools in Trødelagwith students who have an intellectual disability will be contacted to findusers.

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1.5 Outline of the Report

This report consist of a background information on intellectual disabilityin Section 2. Section 3 is a literature review looking into games promotingphysical activity, navigational systems for intellectual disabilities and howto design games for people with intellectual disabilities.

Further the report includes an interview with experts on physical activity,outdoors events and designing apps and games for people with intellectualdisability. These interviews give guidelines and tips for games motivatingadolescents and young adults with intellectual disabilities to do outdoorphysical activity. Section 4 includes these guidelines and tips.

Lastly Section 5 concludes the report and suggests further work that will belooked into in the master thesis in the spring of 2019.

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2 Background

2.1 Intellectual disabilities

Intellectual disability(ID) consist of a variety of different diagnosis and havethree criteria; reduced mental capacity, lack of adaptation and the conditionneeds to be visible before age 18(NFU, n.d.). They will have a differentlevels of challenges regarding motor skills, language understanding, socialcompetence and ability to do everyday tasks.

According to Bufdir (n.d.) intellectual disabilities can be divided into fourdifferent degrees based on IQ. These degrees are:

• Mild - IQ 50-69

• Moderate - IQ 35-49

• Severe - IQ 20-34

• Deep - IQ under 20

Intellectual disabilities can have many causes, both from before birth, duringbirth and after birth. They include chromosome abnormalities, metabolicdiseases, infections and diseases during pregnancy, like rubella, birth defectslike premature birth and low birth weight and after birth injuries related todiseases like meningitis and accidents(NFU, n.d.).

”Developmental Disabilities is an umbrella term that includes intellectualdisability but also includes other disabilities that are apparent during child-hood” (AAIDD, n.d.). Further they explain that some development dis-abilities are mostly physical like cerebral palsy and epilepsy, others can beboth cognitive and physical like Down Syndrome or fetal alcohol syndrome.Intellectual disabilities are mostly cognitive.

Autism spectrum disorder (ASD) is not an intellectual disability, but is andevelopment disability. It is a spectrum of disorders and affects communi-cation with other people and repetitive behavior(NIMH, n.d.).

People with intellectual disabilities use more time to learn and will haveissues with abstract concepts. If it is a moderate grade, they can haveissues understanding what they read and are dependant on things beingconcrete(NFU, n.d.).

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3 Literature Review

A literature review was conducted in the beginning of the project. Theliterature review looked into how games and game-inspired application mo-tivate to physical activity, navigational systems for people with intellectualdisabilities and designing application and games for people with intellectualdisabilities. Each of these topics are linked to a sub-research question andtogether will help answer the main research question. The literature reviewwill be used as a base for the game or game-inspired application and theempirical investigation into this game and its motivation towards physicalactivity.

To find the papers for this literature review the databases IEEE XploreDigital Library, ACM Digital Library and ScienceDirect were used. For pa-pers on navigational systems for people with intellectual disabilities GoogleScholar was used instead. This was because of the shortage of papers in theother databases. Only papers from 2014-2018 were chosen to get the newestresearch on these topics. For the navigational systems older papers were alsoincluded because of the shortage of newer papers as well. The papers for themobile outdoor exergames were found searching for ”mobile (exergame orexertion game or physical activity game) and intellectual disability”. Gamestargeting a specific illness, injury or elderly were excluded. Exergames forpeople with intellectual disabilities were as mentioned in Section 1.1 diffi-cult to find and games designed for people without an intellectual disabilitywere used. For designing games or application for people with intellectualdisabilities searches like ”design intellectual disability”, ”games intellectualdisability” and ”apps intellectual disability” were used. To find papers fornavigational systems for people with intellectual disabilities a search for”outdoor navigation intellectual disability” was used. One paper was givento me by my advisor, but was also included in the articles provided by thissearch.

3.1 Mobile Outdoor Exergames or Game-Inspired Applica-tion

Motivation for Physical Activity

There are many different methods to motivate people to be physically active.The challenges can be complex and require mental problem solving. Thisis the case in O-Mopsi by Franti, Mariescu-Istodor, and Sengupta (2017).O-Mopsi is a digital orienteering game used in urban areas. Unlike regu-lar orienteering the targets are not marked with an exact location and thetargets are not number, see Figure 3. The tasks in this game is therefore

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first to find the shortest route, walk to the correct area and then locate thetarget based on a photo.

Figure 3: O-Mopsi view of map containing targets

In some games the challenge can be larger and each step closer to the goalis the motivational factor. In Stickers for Steps suggested by Morrison andBakayov (2017) the goal is to collect all of the stickers. New sticker arereceived after a number of steps, this number increases throughout the dayand is reset at midnight. The game also contains a social part, where playersmeet face-to-face and can exchange stickers. This worked as an icebreakerand conversations about the game, walking routes and general topics oftenfollowed these exchanges. The social aspect of this game was enjoyed bythe users and seeing other people enjoying the game was reported as mak-ing the game more engaging. Figure 4 shows screenshots from Sticker ForSteps.

In Gemini Redux by Stanley, Eishita, Anderson, and Mandryk (2015) thechallenge for physical activity is not a part of the main game play and notrequired to play the game. The main game is designed as a massive multiplayer online role-playing game. The physical activity is used to strengthenan animal companion, which can be used in the game play. The physicalactivity is measured on a smartphone and includes an application, so thatthe user can keep track of the amount of physical activity in this period. Theapplication notifies and remained the player to do physical activity.

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Figure 4: Screenshots from Stickers For Steps. Shows view of required stepsuntil next pack of stickers, the sticker album and the sticker exchange view

Measurement of Physical Activity

To measure the level of physical activity, a simple step count is often used.This measurement is used by Stickers For Steps by Morrison and Bakayov(2017) and Gemini Redux by Stanley et al. (2015). These games use asmartphone to count the number of steps each player walks. All of thesegames are mobile games, that are played completely or partially on smart-phone. The tracking of physical actvity is only done on smartphones, so noadditional fitness trackers are required in these games.

Some games do not track the amount of physical activity, but use reachinglocations as the physical activity, this is what O-Mopsi by Franti et al. (2017)use. The focus in this game is not necessary the amount of physical activity,but the physical activity is a biproduct of playing the game. It is designedto be used only when walking, but it might be possible to use other formsof transportation to reach the locations.

Location-based goals is used by Pokemon Go as well, but Pokemon Godisplays number of steps and length walk per week. These measurementsare used in some extra features, so that the game is more reliable on physicalactivity(Niantic, n.d.).

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Exergame and increased Physical Activity

Some research has been conducted to find out if a specific game increasephysical activity. This is what Marquet, Alberico, and Hipp (2017) lookedat regarding Pokemon Go. This study use college student and divided theparticipants into two groups, one that declared them self as Pokemon Goplayers and on that did not. All participants counted there steps using aaccelerometer and the players also answered questions about their playingthree times a day. The participants physical activity was monitored for oneweek. The study did not find a significant difference in physical activitybetween players and non-players. It is discussed that this might be a resultof people joining the study either were interested in physical activity ordigital games and their belief is that Pokemon Go could have a positiveeffect on people with a sedentary lifestyle, which is what Althoff et al. (2016)found.

Stanley et al. (2015) looked into the increase of physical activity using thegame Gemini Redux. The experiment lasted for 10 days, where the firstday was used for baselining and a tutorial and the other 9 days to play thegame. This game did not report any increase in physical activity either.This was believed to be because of a disconnect between the physical ac-tivity strengthening the animal companion and the main game play. In thefuture they suggest including mini games as motivation for physical activ-ity and increase the connection to the physical activity and the main gameplay.

3.2 Navigational Assistance for People with Intellectual Dis-abilities

Navigational Assistance

Navigational systems for people with intellectual disabilities have differentmain tactics for the navigational service. Kramer, Covaci, and Augusto(2015) propose an application, POSEIDON. This application uses a mapand simple text for the main view and is designed for people with Down’ssyndrome. At key steps in the route pictures at street level are shown, thisfeature was found to be very helpful. Seeing the similarity between the mapand the real world was however found to be difficult for some. Figure 5 showthese features in the POSEIDON application.

Garcia de Maria, Carro, and Haya (2012) propose an application for peoplewith cognitive disabilities, Where Should I Go?(WSI-GO). The applicationhas two different modes ”audio mode” and ”visual mode”. The ”audiomode” consist only of audio directions. This mode was found most useful

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Figure 5: Map view and street level picture in Poseidon navigational system

for people with the less cognitive limitations, because of the limited timespent watching the screen. There were some problems with left and right inthe directions and it lead to some users turning the wrong way.

Garcia de Maria et al. (2012) in their ”visual mode” and Gomez, Montoro,Torrado, and Plaza (2015) propose to use street view pictures and simpletext, but have added different additional features. The use of street levelpicture to locate landmarks or other objects was reported as helpful byGarcia de Maria et al. (2012). Some issues with differences in the picturesand the real world caused some confusion and difficulty when navigationusing the ”visual mode”.

The ”visual mode” in WSI-GO proposed by Garcia de Maria et al. (2012)includes arrows in the street level pictures. The arrow points the user inthe correct direction, see Figure 6. Sound prompts(beeps) are used to notifyabout a change in the visual interface.

Figure 6: Street level picture from ”visual mode” in Where Should I Go?

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I AssisT-OUT proposed by Gomez et al. (2015) uses street level picturesand includes a progress bar to tell the user how much remains at currentstep is. Buttons has also been added to go to next or previous steps. Theuser interface for AssisT-OUT can be seen in Figure 7. The application hasalso included audio to text for people who struggle to read and vibrationsa decision points to notify that it is time to change direction. People withcognitive disabilities was found to have a higher chance of reaching thedestination using AssisT-OUT compared to Google Maps.

Figure 7: Screenshots of AssisT-OUT

Safety

Kramer et al. (2015) looked at safety related issues using the applicationand concluded that many of the users looked at the phone most of the time.this lead to the caregiver having to remained them to not to look at thephone when crossing roads. They suggest that notifications before crossingthe road should be added.

An help button is suggested by Gomez et al. (2015). This button can beused if the user get lost and needs help. When the button is pressed, thecaregivers are notified. They receive the location of the user and can locatethe user quickly.

Automatic or Manual Configuration

AssisT-OUT by Gomez et al. (2015) automatically gathers the street viewpictures for Google Street View. This limits the time needed to set up newroutes and makes recalculation of the route possible in the future.

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In both POSEIDON by Kramer et al. (2015) and WSI-GO by Garcia deMaria et al. (2012) the street level picture needs to be added manually. InPOSEIDON the route needs to be added manually by a caregiver and inWSI-GO the area needs to mapped.

3.3 Game and Application Design for People with Intellec-tual Disabilities

Role of Stakeholders in the Design Process

Tsikinas and Xinogalos (2018) looks into suitable design frameworks forserious games for people with intellectual disabilities. It includes a literaturereview in designing serious games for people with intellectual disabilitiesand looks at which design frameworks for serious games suits the suggestedprocess. In the end it is discovered that none of the design frameworks fitsperfectly and that they have to be adapted to design games for people withintellectual disabilities.

The role of stakeholder, like caregivers, parents or the individuals with intel-lectual disabilities are important and Tsikinas and Xinogalos (2018) remarksthe importance of actively including educators in the design of serious gamesfor people with intellectual disabilities.

Wilson, Sitbon, Brereton, Johanson, and Koplick (2016) suggested an ap-plication for people with intellectual disabilities to communicate their goals,by producing a picture of themselves reaching their goal, see Figure 8. Thisapplication was design in a co-design process consisting of people with in-tellectual disability and information technology students in a 1.5 year pe-riod.

Figure 8: Finished picture produced with Put Yourself in the Picture

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User Interface

Tsikinas and Xinogalos (2018) first notes that the user interface needs tobe simple and clear, with minimum input required. It should have largetext, high contrast between colors and few distractions. Cano, Fernandez-Manjon, and Garcıa-Tejedor (2016) created a video game for people withintellectual disabilities to learning to use the subway, see Figure 9. The gameincludes many situations that could occur when using public transport, likefinding the correct platform and strangers talking to you. This game alsosuggest that the size, color and speed of the text is important and thereforeshould be adjustable to fit the user. Wilson et al. (2016) found that theirshould only be one stream of possible action to make it intuitive for theuser.

Figure 9: Subway station in Madrid from the video game Downtown

Communication and Language

The language and communication is important in application and games forpeople with intellectual disabilities. Cano et al. (2016) have included bothwritten and spoken instructions. The language used is simple and clear,video tutorials is also included for all the tasks.

Wilson et al. (2016) have focused their application on the importance ofcommunication for people with intellectual disability, specifically communi-cating their goals in a way adopted for the user. They found that the visualcommunication was important and that it should be possible to use the ap-plication with icons only. Real picture as close to the users life as possiblewas preferred.

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Customization

How difficult a game should be can vary a lot for people with intellectualdisabilities. Tsikinas and Xinogalos (2018) found that the difficulty shouldbe customized because of this variance, so that the game suits the individual.The difficulty level should be increased gradually for everyone, but it shouldbe increased to continue learning. Cano et al. (2016) mention the needfor different difficulty level and include three levels, ”easy”, ”medium” and”hard”. Some more abstract and possible stressful features, like the timelimit can also be customized or turned off.

Cano et al. (2016) have a character that is possible to customize to look likethe user. This is done to help the user identify with the character. Tsikinasand Xinogalos (2018) also found that the protagonist appearance should becustomized to resemble to the user.

Collaboration

Wilson et al. (2016) found collaboration and being social to be important.The picture with the user reaching their goal could be shared by email totheir caregivers and parents and sending the picture to their parents wereappreciated. It was also popular to include multiple people in the picturesand be social during the sessions. In the future they suggest including socialmedia as well.

Monitoring

Monitoring progress and locate issues or difficult should also be includedin serious games(Tsikinas & Xinogalos, 2018). This helps the educatorsimprove the learning experience. Cano et al. (2016) have included a learninganalytic in their game to monitor progress and evaluate problems with thegame.

Feedback

Tsikinas and Xinogalos (2018) found it was important to continues givefeedback. The feedback should be positive, negative feedback should belimited or avoided.

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4 Interviews with Experts

4.1 Introduction/Background

Tsikinas and Xinogalos (2018) found it important that educators are ac-tively involved in the design process of serious games. Using the same logicin games or game-inspired apps promoting physical activity, it is importantto involve hosting or leading events for outdoors physical activity for peo-ple with intellectual disability. This is one of the reasons for having thisinterview.

The interviews also gave a view into the practical organization of these typeoutdoors events. It gave some insight into the life for people with intellec-tual disabilities and the people around them, including both caregivers andfamilies.

The questions are divided into four main categories. These categories are:

• General questions about games for people with intellectual disabilities

• Questions about motivation for exercise for people with intellectualdisabilities

• Questions about navigation for people with intellectual disabilities

• Questions about designing games for people with intellectual disabili-ties

This is a very similar division as the research questions, also including acategory for general questions. The Questions can be found in the Appendix.Notes from the interviews can also be found in the Appendix and is dividedby interview candidate. The interviews were semi-structured.

The following section, Section 4.2 describes the participants and way theywere contacted. Section 4.3 talks about popular games, activities and topicsfor people with intellectual disabilities. Section 4.4 looks into motivation forphysical activity for people with intellectual disability. The next section isSection 4.5 and talks about what is important to think of when designingthe game. Both when it comes to the user interface, individual adjustmentsand difficulty level. Section 4.6 describes the use of navigational systems forpeople with intellectual disabilities and security issues connected to naviga-tion. Section 4.7 looks into what is important to remember when choosingan area to play the game, and what area they suggest. Section 4.8 talksabout what is important when learning the game and the administration ofthe game. The last section, Section 4.9 consist of some ideas or additionalfeatures for the game suggested during the interviews.

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4.2 Participants

For the interviews a selection of people with different backgrounds and areasof expertise where chosen. Some of the candidates where contacted aboutparticipating in the interviews after first meeting them through the projecti Tromsø, see 1.4. Name1 was contacted because of her work organizingoutdoor activities for people with intellectual disabilities. Table 1 show code,education and place of work. More information about the participants canbe found in Section 1.4. Some of the people interviewed are also parents tosomeone with an intellectual disability.

Code Background Place of Work/Affiliation

Name1 ID nurse NTNU

Name2 Business DNT and Smart Cognition

Name3 Advisor PhD project UiT

Name4 Psychologist UNN and UiT

Name5 Computer Science Smart Cognition

Table 1: Information about the participants in the interviews

4.3 Popular games and themes

Popular games have been used to create exergames, like Pokemon Go (Ni-antic, n.d.) created based on the Pokemon game. In the interviews it ismentioned that both their cognitive abilities and interests can be diverseand games used by people with intellectual disabilities vary a lot. BothName3 and Name2 mentions picture lotto as a popular game that is usedquite a lot by people with intellectual disabilities. Name4 says that simpleboard games have been used like snakes and ladders. Animal Yatzy can alsobe used, but dices with numbers can be too complex.

Name2 talked about some of the activities he has held at the FTU events.This included obstacle courses, rebus runs and learning about nature, likebirds, insects and mammals with an ornithologist or a Barber pitfall trap.He think it is important to play throughout the hiking trip at these eventsand it should not just be a goal far into the future.

Music is mentioned by both Name1 and Name3 as something people withintellectual disability often enjoy. Name3 also talks about people watchingmusic videos and dancing to them.

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4.4 Motivational Factors

This section looks at what motivates to physical activity. The answers gatherthought the interviews have been collected in Table 2. As Name3 mentioned,what is motivating, will be vary a lot from person to person.

Motivational Factors Name1 Name2 Name3 Name4 Name5

Competition X X

Being Social X X X X X

Food and Campfire X X X X

Other Purpose X X

Something happeningalong the way X X X

Sense ofAccomplishment X X X

Predictability X X X X

Caregivers involvement X X X X

Rewards X X

Table 2: Possible motivational factors for physical activity for people withintellectual disabilities

Social Aspect

The most mentioned factor was being social and was mentioned by ev-eryone as a possible motivational factor, this is also mentioned by Mahy,Shields, Taylor, and Dodd (2010), Kuijken, Naaldenberg, van der SandenM. W., and van Schrojenstein-Latman de Valk H. M. J. (2016) and Temple(2009).Name5 mentions that being social is especially when they move outfrom their parents and into their own apartment. Name2 also said thatapproximately 80% is on disable benefits and do not work. This is alsosupported by Wendelborg, Kittelsaa, and Wik (2017), which found that80% of all 18 and 19 year old’s were on disabled benefits. This make manyadults with intellectual disabilities lonely and is mentioned in many inter-views.

When it comes to who it is most fun to do physical activity with, the answersdiffers some. Name2 said that it was most fun to meet someone otherthan their parents and families. Name5 on the other hand said that goinghiking with family was appreciated for people living in their own apartment,because they got to spend some time with their family.

Being social can be less important if the have a complex intellectual disabilityor in combination with autism. This is talked about by Name3. Name4 think

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that people with autism as well like to be apart of the group, but will mostlyobserve.

Competition and Cooperation

Competition can be a motivational factor for some. This is mentioned byboth Name2 and Name1 as something that is motivational for some peoplewith intellectual disabilities. Name2 does say that competition can havevaried success, but that doing activities together is something people withintellectual disabilities enjoy.

When it comes to cooperation between people with intellectual disabilitiesthe answers vary some, but most agree that it will be a bit difficult. Itwill not suit everyone and be dependant on the group. Both Name3 andName4 mentions teams sports and that some people can do team sports andcooperate. Having a caregiver helping and selecting the groups is mentionedby most people interviewed.

Importance of Caregivers

Most of the people interviewed also said that the people around the personwith an intellectual disability is very important. Name3 said the followingabout the caregivers role in motivating people with intellectual disability todo physical activity. ”They are very dependant on the people around them.That the caregivers also are motivated and maybe both like physical activityand makes it more pleasurable during the hike. Like talking together andhaving fun, just a pleasurable setting.” Name2 mentions that body languageis a large part of how many communicate, so the caregivers body languageis very important. Mahy et al. (2010) agrees with this and Temple (2009)fund that caregivers where important both when it comes to social andenvironmental support.

Another Purpose for Physical Activity

Having other purposes for the trips is mentioned by both Name3 and Name4.Some of the purposes mentioned includes; walking the dog, watching some-one play sports, going out with the trash, going to see your friends or eat-ing some food. This is also one of the factors mentioned by Mahy et al.(2010).

Food and campfires was specifically mentioned by almost everyone as mo-tivational when doing outdoor physical activity. Name5 said that if it was

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hiking trips in the wood, it is fun to make a campfire and some healthyfood.

Predictability and Well Communicated

Predictability and well communicated activities is important and almosteveryone mentioned this in their interview. Mesingset thinks the activityshould be clearly communicated and be predictable. Name2 also said thatclear messages about what is going to happen is very important, but alsothat you give comparable choices, like do you want to play an game whilewalking around or just go on a hike and talk. This can be related to theimportance of people with intellectual disabilities to communicate an theapplication ”Put Yourself in the Pictur” by Wilson et al. (2016).

Enjoyable

Most people interview mention something about the activity should be fun,you should play throughout the physical activity or something else shouldhappen while walking. Name2 focus a lot on playing your way throughphysical activity and gave an example using reflex spray to mark a trail andthen walking in the dark with flashlights. Mesingset thinks that walking on atrail when nothing else is happening often is demotivating and that walkingon smaller trails in the woods is more exciting. Kuijken et al. (2016) alsomentioned that the physical activity should be enjoyable.

Sense of Accomplishment

A sense of accomplishment is something that is mentioned throughout theinterviews. It is mentioned as something motivating to physical activity, areward, something you will get when being able to successfully navigate orcooperate with others and as a reason not to increase the difficulty level tooquickly.

When it comes to sense of accomplishment as motivation for physical activityfor people with intellectual disabilities, Name3 said the following, ”A lot ofpeople say that a sense of accomplishment is important. To feel that youachieve something, so to repeat something can often be good.”

Rewards

Rewards are mentioned as motivation for physical activity of both Name1and Name4. Mahy et al. (2010) also found that rewards were motiva-

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tional.

When it comes to what the rewards to be used in a game, there were manydifferent advice. Name3 mentioned that it is important that the reward isclear and recognized as a reward. Both Name2 and Name1 also said that inthis types of games physical rewards should not be included. Name1 usedthe following example, ”You can not say, when you get home now, you cango to the kiosk”.

Rewards Name2 Name3 Name4 Name5

Visual X X X X

Melody X X X

Speech X

Praise from others X X X

Table 3: Examples of rewards for physical activity through app or game

The suggested rewards can be found in Table 3. Visual rewards was sug-gested by everyone giving advice on the rewards and included suggestionslike stars, roses or smileys. A simple happy sound or Melody is recom-mended by almost everyone. Name3 also suggests a voice saying somethinglike, ”good or great”.

Many people mention praise from others as a great reward. Name2 suggestthat at events, you praise people having reached a milestone in the game,like number of events you have attended.

4.5 Designing Applications or Games for People with Intel-lectual Disabilities

When designing applications or games for people with intellectual disabilitiesthere is a lot to think about. This section looks at the advice mentioned inthe interviews, Table 4 show these advice and who mentioned them.

Simple User Interface

Everyone agrees that the user interface should be simple with as few dis-tractions as possible. Name5 said that people with intellectual disabilitiesneeds more time to perceive and process things, so the user interface shouldinclude few things to think about. Name4 mentions that it should not be un-necessary and disturbing elements on the screen. The simple user interfaceis also supported by Tsikinas and Xinogalos (2018).

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Name1 Name2 Name3 Name4 Name5

Simple X X X X X

Not Childish X X

Cool Design X X X

Recognizable X

Large Text/Buttons X X X

Contrast in colors X

MultipleCommunication Levels X X X X

Adjustable Based onInterests X X

AdjustableDifficulty Level X X X

Table 4: Suggestions on user interface through interviews

Games and Applications Should Not be Childish

Both Name1 and Name3 mentioned the importance of the design not beingchildish. As Name3 said about adolescents and adults with intellectual dis-abilities, it is important that it is not to childish. They are adolescents andadults and identify with people their age. Even if their level of competenceis the same as a child, they know that they are older.

Both Name3, Name4 and Name1 talks about the design being attractive orcool. Name3 also said that including something recognizable is very usefuland that it could give a sense of achievement or recognition.

Large Text and Buttons

Large buttons, text and surfaces is mentioned by Mesingset, Name4 andName5. It can be difficult to press the button if it is too small. Name5 alsomentions that some can have decreased vision and that good contrast whenit comes to color is important. Tsikinas and Xinogalos (2018) found a needfor large text and high contrast in colors.

Communication

Different levels of communication is also a topic in all of the interviews.Most agree that different levels of communication should be add. Name3said that in this project it would be more beneficial to design the app to onespecific target group and that it did not need to be suitable for everyonewith intellectual disabilities for a project of this size.

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Communication Levels Name1 Name2 Name4 Name5

Symbols/Pictures X X X X

Audio X X X X

Easy to read text X X X

Table 5: Different levels of communication suggested in interviews

The different levels of communication mentioned includes symbols or pic-tures, audio and easy to read text. Easy to read text and audio is included inthe video game Downtown by Cano et al. (2016). Everyone agreed on thesecommunication levels except for Name4, see Table 5. She thought that textwould be difficult to understand for most and should not be used to givefeedback. The importance of symbols are supported by Wilson et al. (2016),which designed an application that could be used only with symbols.

Name2 said that for people that cannot read the text in the platform heis working on should be removed and the symbols and audio is the onlyvisible option. This is important because it will only be disturbing and asmentioned earlier distractions should be avoided.

Individually Customized Games and Applications

Name4 said that people with intellectual disabilities can have very specificand consuming interests, so she would like there to be some way to adaptthe app or game to each persons interests. It could to choose a characterin the game from a list, but some choices are preferred. Customizing theprotagonist in the game to be similar to yourself is said to be important byCano et al. (2016); Tsikinas and Xinogalos (2018).

When it comes to adapting the difficulty level of game or app to the users itis preferred by some. Mesingset thinks it is important that the game or appis not too simple for people with mild intellectual disabilities, since the gamecould be perceived as suitable for children. At the same time navigation canbe difficult for people with more severe intellectual disabilities.

Changes and Increased Difficulty

The overall impression is that people with intellectual disabilities like torepeat task, especially task they accomplish. This was mentioned by almosteveryone interviewed and the sense of achievement was an important topicthroughout all of the interviews.

Some meant that the difficult should be increased, but most also mentionedthat the difficulty had to be increased slowly. Name4 thinks it is possible

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that people with intellectual disabilities will understand reaching the nextlevel or progress in the game. Name3 mentions a football coach she readan interview about. He said that they usually worked on the same taskyear after year and when he tried to add something new, it was not alwaysappreciated. Tsikinas and Xinogalos (2018) also found that the difficultyshould be increased slowly.

At the same time it is also important that their is something new. Thisis mentioned by Name1 as something that can increase the motivation andName4 thinks that it does not necessarily have to be more difficult, butdoing the exactly the same multiple times a week can become boring.

Name4 mentions increasing the length of the routes when they get intobetter physical form, but it should be increased slowly. Name1 agrees withthis and thinks the areas also could change. You could have some routes inthe woods and some close to home in more urban areas.

4.6 Navigation

Use of Navigational Systems

When it comes to navigational systems most of the people interviewed agreethat they think using systems with maps, like Google Maps will be difficult.This is also what Gomez et al. (2015) found. Name4 tells about people withsevere intellectual disabilities not being able to walk over to their neigh-bors using simple maps their parents have drawn up. Saying that mapsare abstract and can be difficult for people with intellectual disabilities tounderstand. Name5 notes that he has used a game called Stolpespillet withhis son and that he finds this a bit fascinating. People with milder intellec-tual disability will therefore be able to use maps, this is also mentioned byName1. Name2 said that the voice and the re-calibrating will be a big helpwhen using Google Maps. If you walk the wrong way, you are told to turnaround and walk the other way.

All agree that a specially adapted system will be beneficial and easier forpeople with intellectual disability to use. Different features were suggestedand Table 6 shows which features were suggested by each person inter-viewed.

Name2 said the following about navigational assistance systems designed forpeople with intellectual disabilities and if they would be easier than GoogleMaps to use. ”Yes, I believe so. It will be good, especially if it includeslike the, ehh, real view/street view”. The street view is something Name4and Name5 also brings up as an important feature. As mentioned beforemaps can be to abstract for people with intellectual disabilities. Kramer

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Feature Name1 Name2 Name3 Name4 Name5

Street View X X X

Audio X X

Notifications X

Table 6: Important features in a navigational system for people with intel-lectual disabilities

et al. (2015) said that this was found to be an important feature in theirapplication and Garcia de Maria et al. (2012); Gomez et al. (2015) both usestreet view picture as the main way of navigating. Name4 and Name3 bothsaid that right and left could be difficult to understand and Name4 said thatsomeone should point the direction you should walk.

Name3 said that audio should be included as well, since many cannot read.Notifications at decision points in the route is mentioned by Name1 as some-thing that could be beneficial both for people with intellectual disabilitiesand their caregivers.

Many mentions the role of the caregiver or parents when it comes to naviga-tion. They can be a good support in trying to navigate and when it comesto the safety during the hike.

Safety Features

Regarding possible safety features, two types were included in the interviews.The first is notifications a key points in the route, similar to what Krameret al. (2015) suggested. The second is an alarm button that notifies parentsor caregivers when the alarm is pressed and sends the location of the user.This is similar to what is suggested by Gomez et al. (2015).

The notifications is mentioned as something that could work, at both deci-sion points in the route and at pedestrian crossings. It is noted by Name3that these notifications is something that needs to be learned and learn-ing something new takes longer for people with intellectual disabilities thanpeople without. Name5 is not sure they will actually look at the notifica-tions.

The alarm was positively received by everyone, especially for people witha mild intellectual disability walking alone. Name1 mentions that peoplewith intellectual disabilities can have problems explaining their location, sosending the location will make it possible to locate them, as suggested byGomez et al. (2015). Name4 think that automatically connecting a callto the parents or caregivers can be a security for people with intellectualdisabilities when they are lost.

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Name2 on the other hand is worried that some could think it is fun if a lotof people come running and giving them attention when the alarm is set off.Name4 said people might not know they are walking in the wrong directionand only press the alarm when they are scared. This could lead to the alarmalso being set off when they are not lost, but scared.

In the end it is the caregivers or parents that are responsible for the safetyof the individual with an intellectual disability. As Name2 said, if they cometo the event alone then they do not need assistance to walk around and ifthey come with caregivers, it is their responsibility to maintain the safety.The safety needs to be a focus and he said that the safety at an event isimportant for people to come to these events.

4.7 Choosing the Outdoor Area

When choosing an area, there were three main concerns mentioned in the in-terviews; safety, the ground you walk on and the impact of the surroundingson the individual with an intellectual disability.

Regarding safety, traffic is the most mentioned issue and is mentioned byeveryone. According to Name3 it is important to keep the attention onthe traffic, both cars and bikes. When playing a game while walking inurban areas, it is easy to lose the attention. Name4 also mentions water andavoiding areas like docks. Open areas are easier to have control over for thecaregivers.

It is also important that the ground is flat and solid. Regarding this Name5mentions problems with balance among people with an intellectual disabili-ties and Name1 noted that some are dependant on wheelchairs.

The surroundings needs to be carefully considered. Name2, Name3 andName4 all mention that there should be few distractions and both Name3and Name4 said that there should be few people around. This is similarto the advice on the user interface and is mentioned both earlier in the in-terview and Tsikinas and Xinogalos (2018). This then gives urban areasa disadvantage and suggest that the woods could be better for this pur-pose.

Everyone interviewed think that playing the game in nature is a good idea,but some said that urban areas can be preferred in certain situations. Name4think that urban areas close to home can be preferred if it is a solitaryactivity, but if it is a group activity, people are more inclined to travel tothe event. Name1 think that hiking in nature will make it more excitingand different from an everyday evening hike.

Suggesting nature as the most suitable, could be affected by the people

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interview. Both Name2 and Name1 have spent a lot of time arranginghiking trips and nature events for people with intellectual disabilities andare passionate about these types of events for this group.

4.8 Use of system and training in using the system

When asking if parents and caregivers would be interested in helping andfacilitating the use of this game, the answers varied some. Some said thatsome parents and caregivers would be interested, others said that in generalthey were interested. The overall impression was that parents could be moreinterested than caregivers. Name2 said that especially for people under 16years, parents are often very engaged.

Name2 noted that there is a lot of caregivers working with one person withan intellectual disability and Name3 said that the caregivers often find thedigital tools difficult.

Name4 mentioned the importance of easy user manuals, uncomplicated ad-ministration and the possibility to get help when needed, if not systemswere often not used anymore. Both she and Name2 said that the systemshould include an easy to understand user manual with pictures and a videotutorial. This manuals can be used both by the caregivers, parents and theperson with an intellectual disability. Video tutorials were included in thegame Downtown by Cano et al. (2016).

4.9 Extra features

During the interviews some ideas for this type of app or game was broughtup. This was ideas to make the hike better and extending the experience ofthe trip.

Equipment List

Name1 suggested a checklist to remember all the equipment needed for thehike. Before you leave your home, you get a checklist that can be set up bythe parent or the caregiver and vary based on seasons. She said that peoplewith intellectual disabilities often struggle with finding appropriate clothesfor the season and weather, so having something based on seasons would bea big help. It does not have to be a list you have to follow, but could besuggestions. Including questions like ”Do you need a flash light?” or ”Doyou need a raincoat today?”. This could potentially decrease the weatherbarrier mentioned by Temple (2007) to some extent. If you are know how todress for the weather, the hiking trip will be better. Even if it is raining it

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will be better, because you will not get soaking wet. These suggestions canalso be based on today’s activity. If you are suppose to bring food for thecampfire, the question ”Should you bring sausages for the campfire today?”could be added.

Bring a Physical Copy of the Symbols Used in the Game or Ap-plication to the Events

Name2 mentions bringing something printed out as, to help with the com-munication. Some people with intellectual are used to communicate usingpictures and navigating for symbols on a small phone can be difficult whenyou are outside.

Monitoring progress

Monitoring the progress of the user when it comes to the amount of physicalactivity is suggested by Name4. The parents could check how often it is usedor how far each user walks on each trip. Maybe the parents could set somegoals and check if the goals are met. This type of monitoring was found tobe important in serious games by Tsikinas and Xinogalos (2018).

Monitoring can also be used as a communication and learning tool andextend the hiking experience. Name2 thinks this can be used in the learningprocess related to navigation and be a communication tool for this process.In areas were the user have struggled, you could go back and discuss whatto do in this situation. It is also possible that there just were somethingfascinating at this location and then it can be used as a communication tool.Maybe a tree has fallen to the ground and a lot of time has been used lookingat this, the monitoring can be used to find this spot and start a conversationabout it. Name5 thinks that adding pictures from the trip can be a great wayto communicate about the trip. The importance of communication tools forpeople with intellectual disabilities is talked about in Wilson et al. (2016).Also communicating throw pictures and using pictures to explain what youhave done earlier is mentioned as important. Further Name5 explains ifyou do not live with your parents, you can communicate with them aboutthe event or hiking trip you participated in earlier and this will extend andincrease the total experience of the event or hike.

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5 Conclusion and Further Work

5.1 Conclusion

This report suggests many guidelines and ideas for a game or game-inspiredapp motivating to physical activity for adolescents and young adults withintellectual disabilities. This guidelines includes motivational factors, andfound being social and sense of accomplishment as very important. It alsobecame clear that the parents and caregivers were very important in theexecution of these activities, but many were motivated as well. The peopleinterview in Section 4 is example of this motivation.

When it comes to designing games or applications adapted to people withintellectual disabilities, it is important that the user interface is simple andincludes few distractions. Having multiple levels of communication and a lotof symbols is essential. During the interviews from Section 4 it was pointedout that the game should not being too childish.

Maps are often to abstract for people with intellectual disabilities and thedifference between right and left can be difficult. Systems like Google Mapswill therefore be difficult to use. People with an intellectual disability willbenefit from a system design specifically for people with intellectual disabil-ities. It should include both street view pictures and audio.

The interviews in Section 4 look at security related to traffic and the cho-sen area. This gave some suggestion of what area are suitable for this typeof activity and what to think about when choosing an area for the game.The most important is few distractions and security, mostly related to traf-fic.

5.2 Future Work

In the future a game or game-inspired application promoting outdoor phys-ical activity for adolescents and young adults with intellectual disabilitiesbased on the guidelines found during this project should be suggested. Em-pirical investigation should be done on the game or game-inspired appli-cation and the guidelines will be changed based on the evidence from theinvestigation. This will be done by the suggested methods described inSection 1.3.

Figure 10 shows the planned research. What is planned as further workconsist of interviews with experts on technology or outdoors physical activityfor people with intellectual disabilities, evaluating the suggested prototype.A usability test by people with intellectual disabilities and their caregiverswill also be conducted.

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Figure 10: Research Process

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Appendix

Interview Questions

General

1. To what extent do you think caregivers/parents will want to be in-volved in the setup of the game?

2. How do you think a training phase for the game should be executed?

Exergame

1. What are the most motivating factors to participate in physical activ-ity?

2. How often do you believe people with intellectual disabilities need newmotivation to continue with physical activity?

3. What is the significance of group activities to motivate to physicalactivity for people with intellectual disabilities?

4. How do you think cooperation in a group playing a location-basedoutdoor exergame would work?

5. Is there any games or topics that are popular for most people with anintellectual disability?

Navigation

1. How do you believe people with intellectual disabilities will do whenusing mobile map systems e.g. Google Maps on their smartphones?

2. Do you think people with intellectual disabilities will benefit from cus-tomized app using street view, notifications, smaller steps, simplerdirection, audio etc.?

3. Which outdoor areas is it best to use in this type of game?

4. How do you think someone with an intellectual disability would feel ifhe or she was in charge of navigating for the rest of the group?

5. What do you think are the security issues for people with intellectualdisabilities when walking and gaming in urban areas?

6. Do you think security notices is a good idea and when would you useit?

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Design

1. What do you think is important to remember about the user interface?

2. Is there a need for individual adaptation of the user interface and howshould it be individualized?

3. How should positive and negative feedback be given?

4. Is it important that the game changes or that the difficulty increasesand how should this be done?

5. Would you add monitoring to the game (both during and after playing)and what is interesting information?

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Interview Questions Norwegian Translation

Generelt

1. Hvor mye tenker du at foreldre eller pleier/ledsagere vil være villig tila være med og sette opp spillet?

2. Hvordan tror du opplæring til spillet bør forega?

Treningsspill

1. Hva er de mest motiverende faktorene for at utviklingshemmede skaldelta i fysisk aktivitet?

2. Hvor ofte tenker du utviklingshemmede bør motta ny motivasjon fora fortsette med fysisk aktivitet?

3. Hvor viktig er gruppeaktiviteter for a motivere til fysisk aktivitet forutviklingshemmede?

4. Hvordan tenker du at samarbeid i en gruppe som spiller som er utendørs,navigering og lett trening vil fungere?

5. Finnes the noe spill eller temaer som er populære for flertallet avutviklingshemmede?

Navigering

1. Hvordan tror du utviklingshemmede vil navigere med bruk av mobilekart systemer f.eks. Google Maps pa mobilen?

2. Tror du utviklingshemmede vil ha en fordel av en spesialtilpasset appsom bruker gatebilder, varslinger, enklere og kortere forklaringer, lydosv. ?

3. Hvilket utendørs omrader tror du passer best til denne typen spill?

4. Hva tror du utviklingshemmede vil føle hvis han/hun er ansvarlig fora navigere for resten av gruppen?

5. Hvilke sikkerhets relaterte problemer tror du utviklingshemmede kanmøte pa nar de gar og spiller i byomrader?

6. Tror du sikkerhetsvarsler er en god ide og nar bør det brukes?

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Design

1. Hva er det viktigste a tenke pa med brukergrensesnittet pa spillet?

2. Er det viktig a tilpasse brukergrensesnittet til den enkelte og hvordanbør det tilpasses?

3. Hvordan bør positive og negative tilbakemeldinger bli gitt?

4. Er det viktig at spillet endrer seg eller at vanskegraden øker og hvordanbør dette gjøres?

5. Bør overvakning av spillet legges til (bade under og etter spilling) oghvilken informasjon er interessant?

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Answers to Interviews

Name1

Jeg er vernepleier, har jobbet mange plasser og de siste 17 arene som høgskolelærerved Hist/NTNU vernepleierutdanningen før jeg gikk av med AFP i fjor. Erna bare knyttet til NTNU i forbindelse med at studenter skal ha praksis iNepal.

Har arrangert større turer for utviklingshemmede. Er for tiden med aarrangere utendørsaktivitet for utviklingshemmede i Trondheim gjennomNFU

Generelt

1. Hvor mye tenker du at foreldre eller pleier vil være villig til a være medog sette opp spillet?

• Noen ville vært med a sette opp spillet. De spesielt interesserte

• I botiltakene er det ikke alle som legger til rette for turer i næromradet

2. Hvordan tror du opplæring til spillet bør forega?

• Skolesystemet og gymlærere kan det tenke seg at ville brukt spillet

• Spesialpedagoger kan bruke det i sammenheng med barne- og videregaendeskole

Treningsspill

1. Hva er de mest motiverende faktorene for at utviklingshemmede skaldelta i fysisk aktivitet?

• Konkurranse og premier

• At ledsagerne ogsa er motiverte og engasjerte selv

• Kjedelig løype, lite som skjer annet enn a ga er lite motiverende

• Være flere sammen

• Ha med mat og tenne bal

2. Hvor ofte tenker du utviklingshemmede bør motta ny motivasjon for afortsette med fysisk aktivitet?

• Fortløpende motivasjon

• Viktig a kommunisere hva som skal skje

• Ha en klar plan og en forutsigbarhet

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• Rett bekledning, slik at du ikke fryser eller blir kliss bløt. Ledsagereer de som ma sørge for dette

3. Hvor viktig er gruppeaktiviteter for a motivere til fysisk aktivitet forutviklingshemmede?

• Gruppeaktivitet fungerer bedre enn a trene alene.

• Ledsager er som oftest med pa tur. Fa som tar initiativet selv

• Møte noen, treffe pa kjente nar du gar pa tur er veldig motiverende

• Fa nye venner og bekjentskaper

4. Hvordan tenker du at samarbeid i en gruppe som spiller som er utendørs,navigering og lett trening vil fungere?

• Mange utviklingshemmede klarer nok ikke styre et slikt spill selv pga.kognitive vansker og er avhengig av ledsager

• Viktig at aktiviteten pa en mate blir ledet og at man far hjelp avledsager

• De med lett utviklingshemming ville klart det, men de med en meralvorlig grad mister lettere konsentrasjonen og ma ha hjelp til a kommeinn i oppgaven pa nytt

• Mange har ikke telefoner med internettilgang

• Hvis du far en homogengruppe kan de ga sammen og styre spillet, menda blir det vanskelig med en tilfeldig gruppe

5. Finnes the noe spill eller temaer som er populære for flertallet av utvikling-shemmede?

• Veldig varierende

• Musikk er populært

• Spesialpedagoger vet kanskje mer om det, evt. Habiliteringstjenesten

Navigering

1. Hvordan tror du utviklingshemmede vil navigere med bruk av mobilekart systemer f.eks. Google Maps pa mobilen?

• Det vil være vanskelig a bruke Google Maps for utviklingshemmede,men noen med lett utviklingshemming vil fa det til med noen justering,forstørringer osv.

• Veldig variert gruppe. Noen er fullstendig hjelpetrengende og utenverbalt sprak

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2. Tror du utviklingshemmede vil ha en fordel av en spesialtilpasset appsom bruker gatebilder, varslinger, enklere og kortere forklaringer, lyd osv.?

• Voksne med utviklingshemming kan fort oppleve at det blir for barnslig,hvis det blir for enkelt

• Dataspill er stas for mange

• Grafikken ma være enkel, men ikke barnslig

• Spesialtilpasset app (med bilder pa gateniva) vil være enklere for defleste

• Spillet bør ogsa ha noen overraskelser underveis

3. Hvilket utendørs omrader tror du passer best til denne typen spill?

• For de som bor i byen vil det være enklest a gjennomfør i næromradet(og ikke skogen), men da blir det gjerne bare en helt vanlig kveldstur

• Skogen vil være mer spennende

• Ytre motivatorer: Sosialt, spise kveldsmat med noen

• Noen elsker a ga pa tur, sa de vil ha den indre motivasjonen

• Noen i gruppen er rullestolbrukere ogsa

4. Hva tror du utviklingshemmede vil føle hvis han/hun er ansvarlig for anavigere for resten av gruppen?

• A lede kan være en fin utfordring og læring

• Det er mange prosjekter ogsa i Trondheim i forhold til det a ta egnevalg. Dette er noe mange ikke har fatt muligheter til før

• Det a ta egne valg og si sine meninger kan være vanskelig og hvis deikke gjør det kan de bli passive

• De ma fa muligheten til a leve ut sine meninger ogsa da

5. Hvilke sikkerhets relaterte problemer tror du utviklingshemmede kanmøte pa nar de gar og spiller i byomrader?

• De fleste med utviklingshemming ma ha ledsager og da reduseres fare-momentet

• De som klarer a ga pa butikken selv, ma nok ha med ledsager hvis desamtidig skal spille et spill

6. Tror du sikkerhetsvarsler er en god ide og nar bør det brukes?

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• Sikkerhetsvarsler ved veivalg kan være en god ide for a ikke ga segbort, ogsa for de uten utviklingshemmede

Design

1. Hva er det viktigste a tenke pa med brukergrensesnittet pa spillet?

• Enkelt

• Ikke barnslig

• Litt Kult

• Attraktivit sann designmessig

2. Er det viktig a tilpasse brukergrensesnittet til den enkelte og hvordan børdet tilpasses?

• For utviklingshemmede ma det være lettlest tekst (ikke mer avansert)og litt stor tekst

• Noen med utviklingshemming kan lese lettlest litteratur

• Lese opp tekst kan legges til

• Bilder og tegn kan ogsa legges til

3. Hvordan bør positive og negative tilbakemeldinger bli gitt?

• Viktigst a gi tilbakemelding nar noen gjør noe bra

• Korrigering, f.eks. snu og ga tilbake, vil alle tale

4. Is it important that the game changes or that the difficulty increases andhow should this be done?

• Det blir fort kjedelig hvis det er akkurat det samme gang etter gang,sa mulighet til a øke vanskelighetsgraden bør eksistere

• Variere med lengde pa tur og skog- eller bytur høres bra ut

• Premie a mestre

• Mat, f.eks. ga innom kiosken etter turen bør ikke være en premie

• Legge til en utstyrsliste pa starten før du drar ut av huset. Huske a hariktige sko, drikkeflaske, matpakke som er passende for turen du skalpa, sekk, hodelykt, piggsko og sitteunderlag

• Liste basert pa arstid høres lurt ut. Vanskelig for utviklingshemmedea kle seg etter arstiden, regn, føre og forhold

• Gi alternativer, spørsmal om trenger du dette

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5. Bør overvakning av spillet legges til (bade under og etter spilling) oghvilken informasjon er interessant?

• Liten tro pa at de vil kunne ga alene, sa da er ikke overvaking sa viktig

• Har opplevd at utviklingshemmede har tatt feil vei i et kryss og harhatt problemer med a fortelle hvor de er, sa noe som delte posisjonenhadde hjulpet

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Name2

Startet initialt FTU i DNT og er lokal FYU turleder 2 steder.

Arbeider og med etablering av fritids- og aktivitets plattform for utviklings-og funksjonshemmede med bruk av kunstig intelligens.

Bakgrunn som leder i næringslivet. Far til utviklingshemmet datter.

Generelt

1. Hvor mye tenker du at foreldre eller pleier vil være villig til a være medog sette opp spillet?

• Det vil variere veldig hvor mye tid foreldre eller boliger vil bruke pa asette opp et slikt spill

• Nar det gjelder turer varierer det om det er foreldre, kommunen,boliger, fritidstilbud osv. som tar initiativet

• Hos den yngre gruppen (opptil 16 ar) er foreldre veldig engasjerte

• Hvis det starter som ung med dette kan det bli en vane de tar medseg inn i voksne livet

• Hadde tur na der de naturlotto med hodelykt og løype merket oppmed refleksspray (ble som a leke seg gjennom turen)

• Litt kjedelig a ga tur med foreldre av og til, sa a møte flere pa tur ermye morsommere

• A leke seg igjennom turen istedenfor at malet ligger en time fram itid, blir noe helt annet

• Litt konkurranse aspekt i det ogsa

2. Hvordan tror du opplæring til spillet bør forega?

• Samle de som er interesserte og ha ferdig opplegg

• A sørge for at programmet er installert, nøye opplæring og prøve detut i praksis etterpa

• Ikke ha en større gruppe enn at opplæring og støtte underveis er mulig

• Skal det være pa den utviklingshemmedes enhet eller ledsageren sin.Egen profil?

• Ha en god toutorial (skriftlig, video f.eks. pa youtube). Det er oftemange personer knyttet til den utviklingshemmede, sa mange som skalha opplæring

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Treningsspill

1. Hva er de mest motiverende faktorene for at utviklingshemmede skaldelta i fysisk aktivitet?

• Det viktigste er forutsigbarhet.

• Aktiviteten er kommunisert pa en forstaelig mate. Symboler eller detspraket som den enkelte har

• At den utviklingshemmede har et valg, f.eks. vil du spille et tren-ingsspill eller bare ga pa tur? (komparative alternativer)

• Viktig med det sosiale rundt den fysiske aktiviteten, selv for de utenverbalt sprak

• Viljen til ledsagerne. Kroppssprak blir en stor del av kommunikasjonenfor de uten verbalt sprak

2. Hvor ofte tenker du utviklingshemmede bør motta ny motivasjon for afortsette med fysisk aktivitet?

• Det vil være variere veldig i forhold til kognitivt niva

• Noen sier at na skal vi ga, sa gar vi bort til lyktestolpen der ogsa er detgreit med det, mens andre ma motiveres mer eller mindre hele veienda

• Viktig at ledsager leser uttrykket til den utviklingshemmede og gir nyinformasjon da

• Utviklingshemmede trenger mer motivasjon enn en samtale for a kommeseg ut pa tur ogsa ga hele turen uten mer motivasjon

• Men det er lettere hvis de er flere fordi da kan man konsentrere segom framdriften i flokken

3. Hvor viktig er gruppeaktiviteter for a motivere til fysisk aktivitet forutviklingshemmede?

• Veldig individuelt. 90% liker a være en del av en gruppe.

• Spesielt nar de flytter hjemmefra (20-25 ar), for da blir det mer iso-lasjon.

• Samtidig er det mange som har veldig stor glede av a være litt pautsiden av flokken og bare observere

4. Hvordan tenker du at samarbeid i en gruppe som spiller som er utendørs,navigering og lett trening vil fungere?

• Tror det vil fungere super fint, hvis det blir kommunisert pa en matede forstar

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• De liker veldig godt a samhandle, gjøre ting sammen og ga sammen

• Konkurranse kan ha varierende suksess

5. Finnes the noe spill eller temaer som er populære for flertallet av utvikling-shemmede?

• Paraidrettskvelder, der forskjellig aktiviteter blir presentert gjennomFTU Molde. De vet kanskje mer om dette

• Naturrebus og naturlotto med hodelykter har vært knall moro

• Hinderløyper har vært morsomt

• System som premierer for hvert oppmøte pa arrangementer eller antallskritt i løpet av en periode. Skritt er jo litt avhengig av kognitivfunksjon igjen

• Jeg tror pa lek og forskjellige rebuser. Bade pa sommeren og vinteren

• Sette ut barberfeller og se pa insektene og smadyrene med forstørrelsesglassdagen etterpa

• Hadde med ornitolog pa tur og neste gang var oppgaven og se hvormange fugler man kunne finne og hvilke lyder de lagde

• Interaktivt skattekart med instrukser som ga 500m ogsa 3 skritt tilvenstre osv.

• I Norge er det jo litt sann at uansett hvor man er, sa er du 5 min unnaskogen, en park eller lignende. Mange plasser er det ogsa brede fortau

• Bilder ogsa kan skal man finne det pa bildet. F.eks. Nidarosdomen

• Bruke VR og droner

• Bruke droner til a følge med pa hvor den utviklingshemmede gar oglegge til en stemme som forklarer veien og en handholdt enhet kalibrerttil det kognitive nivaet til brukeren

Navigering

1. Hvordan tror du utviklingshemmede vil navigere med bruk av mobilekart systemer f.eks. Google Maps pa mobilen?

• Datteren min med moderat til tung utviklingshemming fikk en IPadfor mange ar siden og det tok hun intuitivt hvordan virket veldig raskt.Ble overrasket av det kognitive potensialet hennes gjennom hvordanhun handterte IPaden. Jeg tror det er store muligheter hvis man hartalmodighet

• Bruk av Google Maps kan være vanskelig, men stemmen hjelper. Beskjederom a snu hvis du gar feil. Sa tror det er potensialet i det

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2. Tror du utviklingshemmede vil ha en fordel av en spesialtilpasset appsom bruker gatebilder, varslinger, enklere og kortere forklaringer, lyd osv.?

• Ja, jeg tror utviklingshemmede vil ha en fordel av spesialtilpassedeapper for navigasjon

• Spesielt street view er viktig

• Bakkemannskapet er igjen viktig og hvis de vil, sa for de det til

3. Hvilket utendørs omrader tror du passer best til denne typen spill?

• Jeg ville begynt i naturen, fordi der er det mindre forstyrelser

• Tilrettelagte grusstier som de kjenner fra før og heller introdusere nyesteder etter hvert som forstaelsen av spillet blir bedre

• 80% av utviklingshemmede er arbeidsledige og har veldig mye fritid.I forhold til trening kan det være viktig og se pa muligheten til a læreferdigheter som de har nytte av i det virkelige livet

• De med lettere utviklingshemming kan fungere som gode veiledere oginstruktører for andre med tyngre utviklingshemming.

• Utviklingshemmede har veldig stor tiltro til hverandre

• Personer med lett utviklingshemming kan være gode rollemodeller ellermentorer og ha med i opplæring

4. Hva tror du utviklingshemmede vil føle hvis han/hun er ansvarlig for anavigere for resten av gruppen?

• For de som er i stand til a lede en gruppe vil det være en mestringsfølelse

• Det a gjøre noe spesielt for flokken er de veldig stolte av

• Vise at de klarer noe de ogsa

5. Hvilke sikkerhets relaterte problemer tror du utviklingshemmede kanmøte pa nar de gar og spiller i byomrader?

• Viktig a bruke sunt bondevett i forhold til sikkerhet i byomrader

• De som klarer a ga tur alene kan ga alene og for de som ma ha medledsager, har ledsager ansvaret for

• Ledsagere ma bedømme hvilket ansvar den utviklingshemmede kan faog hvor selvstendige de kan være

6. Tror du sikkerhetsvarsler er en god ide og nar bør det brukes?

• Legge aktiviteten i et oversiktlig omrade

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• Ha en puljeleder som har ansvaret. Viktig at denne personen er kvikknok til a forsta informasjonen

• Sikkerhet er viktig for at de skal komme pa arrangementer

• Varsler og alarmknapp vil være bra hvis det virker

• Alarmknappen kan bli morsom hvis mange kommer springende til deghvis man trykker pa den.

• Alarmknapp fungerer nok best hvis de er kognitive velfungerende, formange vil det nok være unyttig informasjon

• Hvis personen kommer alene pa arrangement klarer han a ga alene oghvis personen har med ledsager, sa er det ledsagerens oppgave a passepa sikkerheten

Design

1. Hva er det viktigste a tenke pa med brukergrensesnittet pa spillet?

• Bruk mye symboler. F.eks. de til Tobii Dynavox. Ta kontakt medGisle Dimmen og referer til meg

• Flere niva med kommunikasjon. Vi bruker symboler, lett tekst, merkomplisert tekst (til ledsagere) og syntetisk tale

• Vi har ogsa mulighet til a fjerne noen av nivaene siden det vil væreforstyrende. F.eks. fjerne teksten hvis man ikke kan lese

2. Er det viktig a tilpasse brukergrensesnittet til den enkelte og hvordan børdet tilpasses?

• En fordel a kunne tilpasses den enkeltes kognitive niva

• A starte med noe enkelt, slik at opplærlings- og iverksettelsesbarrierenblir for stor

• Utvikle det med tilpasninger etter hvert

3. Hvordan bør positive og negative tilbakemeldinger bli gitt?

• Positiv kognitiv coaching fungerer bra

• Negativ kognitiv coaching (nei, nei, nei eller uff og uff) fungerer veldigdarlig

• Det var veldig bra, men kanskje vi kan prøve noe annet

• Jeg ville ikke brukt fysiske forsterkere, f.eks. potetgull, godteri, osv.

• En stjerne eller rose i enheten

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• Digitalt stemplingskort som du far nytt stemple per samling du er medpa. Klappe for de som har nadd en milepæl

4. Is it important that the game changes or that the difficulty increases andhow should this be done?

• Jeg tror ikke det er viktig at det endrer seg

• Setter pris pa gjentagelser av ting de mestrer

• A justere etter ferdighetsnivaet vil være en fordel

• De som er veldig flinke kan fungere som turledere

5. Bør overvakning av spillet legges til (bade under og etter spilling) oghvilken informasjon er interessant?

• Kjempe god ide og ha med en overvakning av lokasjonen med tankepa navigasjonen

• Se pa omrader som var vanskelige og prøve igjen senere. Skapermestring

• Kommunikasjon om turen. Skjedde det noe spennende her. Var detet tre som hadde veltet

Nevnt pa slutten av intervjuet

• Muligheten til a printe ut informasjon om turer/kommunikasjon og hadet med pa turene.

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Name3

Professor ved UiT Norges arktiske universitet og veileder for prosjektet omeffekt av fysisk aktivitet med e-helse-støtte hos personer med utviklingshem-ming

Generelt

1. Hvor mye tenker du at foreldre eller pleier vil være villig til a være medog sette opp spillet?

• Foreldre er veldig behjelpelige hvis spillet er bra

• Hos støttepersonell er det mer individuelt (hvor mye de hjelper til meddigitale verktøy)

• Foresatte er ofte flinkere pa de digitale verktøyene

• Unge vil antageligvis være mer kompetente med spill

2. Hvordan tror du opplæring til spillet bør forega?

• I en opplærings-prosess bør det være: rolige forhold, lystbetont, ikkelange økter og till de mestrer det

• Viktig for utviklingshemmede a føle at de kan mestre dette

• Støtte hvis det blir vanskelig og se om de klarer mer selv senere engang

Treningsspill

1. Hva er de mest motiverende faktorene for at utviklingshemmede skaldelta i fysisk aktivitet?

• Veldig individuelt (hva som motiverer til fysisk aktivitet)

• Motiverende faktorer: Gode beskjeder om hva som skal skje, Mangesetter pris pa det sosiale, Mange sier det med mestring er viktig, Detat du føler at du far det til, sann at det ofte er det med gjentagelsekan være bra og Noen som sier at det at det kommer noe nytt ogspennende er motiverende

• Veldig avhengig av de som er rundt (nar det kommer til motivasjonfor fysisk aktivitet). At de støttepersonene ogsa er: motivert, likerfysisk aktivtet og at det skjer ting underveis (snakke sammen, ha dethyggelig). Rett og slett en hyggelig setting

2. Hvor ofte tenker du utviklingshemmede bør motta ny motivasjon for afortsette med fysisk aktivitet?

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• Nar det er et klart mal, sette seg ned a spise, se pa noen som holderpa med uteaktivitet, sa er det ofte nok motivasjon

• Kan kreves ytterligere motivasjon undervies, slik som snakking og syn-ging underveis, spesielt nar hun var yngre

• Nar en rute er kjent, trenges det mindre ytterligere motivasjon

• Det vil være individuelt. For noen vil det være nok a vite hvor de skalog noe som skjer nar de kommer fram. For de som ikke er sa glad ifysisk aktivitet kan det være nyttig at det skjer noe mer underveis

• Personalet kan si ”kom na sa gar vi pa tur” (uten a kommunisere etmal for turen)

• Aktiviteter hvor man skal finne poster underveis, f.eks. noe som lignerpa Pokemon Go

3. Hvor viktig er gruppeaktiviteter for a motivere til fysisk aktivitet forutviklingshemmede?

• I intervju har det kommet fram at en stor andel sier har sagt at det ikkeer sa viktig med gruppeaktiviteter. Gruppeaktivitet kan være mindreviktig med mer komplisert utviklingshemming, f.eks. i kombinasjonmed autisme

• Den store gruppen uten kompliserte former og lett til moderat gradav utviklingshemming setter ofte pris pa det

4. Hvordan tenker du at samarbeid i en gruppe som spiller som er utendørs,navigering og lett trening vil fungere?

• Det vil være litt krevende (med samarbeid, utendørsaktivitet og nav-igering), sa ma være personer med moderat eller lett utviklingshem-ming

• De som kan være med pa lagidrett vil mestre det (samarbeid, utendørsaktivitetog navigering)

• Tenk at det en skal utvikle skal kunne mestres av aldersgruppen 3-10ar,eller kanskje riktigere funksjonsmessig opp til 6 ar.

• Det er viktig at det ikke er for barnslig. De er ungdom/voksne. Deidentifiserer seg med andre ungsommer og voksne, men mange ser fort-satt op barnefilmer og leser barnebøker. Kompetansemessig er de ikkepa niva med personer uten utviklingshemming med samme alder

5. Finnes the noe spill eller temaer som er populære for flertallet av utvikling-shemmede?

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• Vet egentlig ikke om noen spill som er veldig populære blant utvikling-shemmede

• Ved moderat og alvorlig utviklingshemming brukes ofte Ipad til a finne,filmer, musikk og bilder

• Ved alvorlig utviklingshemming kan det være problemer med a flytte,slippe og bevege rundt ting pa skjermen

• Andre kan klare ganske avanserte spill, eksempelvis sette figurer rettpa en Ipad og sa utløer det handlinger.

• Musikk og film blir mye brukt blant utviklingshemmede. Ogsa erfartat musikkvideoer og dans kan være populært

• Lotto med bilder brukes mye er en aktivitet som mange liker og kangjøre sammen.

Navigering

1. Hvordan tror du utviklingshemmede vil navigere med bruk av mobilekart systemer f.eks. Google Maps pa mobilen?

• Jeg synes det høres komplisert ut (med navigering ved hjelp av GoogleMaps). Høyre/Venstre. Sti su skal følge

• Du kan teste det pa barn i 5-6 ars alderen og hvis de klarer det børpersoner med moderat utviklingshemming ogsa klare

• Hvis noe er enkelt for normalfungerende kan du tenke deg at de medlett utviklingshemming vil klare det

• Jeg er ganske usikker pa hvordan de vil klare a navigere med GoogleMaps

2. Tror du utviklingshemmede vil ha en fordel av en spesialtilpasset appsom bruker gatebilder, varslinger, enklere og kortere forklaringer, lyd osv.?

• Enkle systemer til a begynne med og heller avansere etter hvert

• De færreste kan a lese, sa og høre er bedre

3. Hvilket utendørs omrader tror du passer best til denne typen spill?

• Helst ikke trafikkerte omrader

• Fortau i boligstrøk med lite trykk og trafikk

• De gar vanligvis ikke alene og ma ha med ledsager

• Skogsomrader og stier er velegnet. F.eks. lysløyper

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• I byomrader vil det være mye trafikk, bygninger og folk og derfor væremindre egnet

4. Hva tror du utviklingshemmede vil føle hvis han/hun er ansvarlig for anavigere for resten av gruppen?

• Noen vil fungere som ledere (for en gruppe)

• De som far det til (og være ansvarlig for a navigere for resten avgruppa) vil føle mestring og bli stolt

5. Hvilke sikkerhets relaterte problemer tror du utviklingshemmede kanmøte pa nar de gar og spiller i byomrader?

• Først og fremst trafikken (som er et sikkerhetsrelatert problem ved aspille i et byomrade). Lett a miste oppmerksomheten

6. Tror du sikkerhetsvarsler er en god ide og nar bør det brukes?

• Varsler ved gangfelt ma læres først og det kan ta litt tid

• Alarmknapp kan være nyttig hvis man er ute alene. Personvern kanvære underordnet i denne settingen, sikkerhet er viktigere

Design

1. Hva er det viktigste a tenke pa med brukergrensesnittet pa spillet?

• Det vil være individuelt (hvordan brukergrensesnittet bør designes)

• Hvis du har en mer alvorlig grad av utviklingshemming sa bør bruk-ergrensesnittet være: enkelt, tiltalende, tydlig og noe de kjenner igjen

• For litt mer avanserte spillbrukere bør brukergrensesnittet være: tydligog gjenkjennbart

2. Er det viktig a tilpasse brukergrensesnittet til den enkelte og hvordan børdet tilpasses?

• Bør tenke pa hvem spillet blir laget til og at det ikke trenger a passetil alle

• Avansere etter hvert (vanskelighetsgrad i spillet)

• Hvis spillet skal passe til flest mulig bør du lage det sa enkelt sommulig

3. Hvordan bør positive og negative tilbakemeldinger bli gitt?

• Negative tilbakemeldinger bør du ikke gi. Heller si ga en annen vei

• Noe de kjenner igjen som kan være positivt, smilefjes, musikk eller lydeller stemme som sier bra

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4. Is it important that the game changes or that the difficulty increases andhow should this be done?

• Utviklingshemmede jobber i lang tid for sma framskritt

• Morsomt a bare klare

• I idrettslag er det ofte de samme oppgavene ar etter ar. Endringenesom blir lagt inn er det ikke sa sikkert at deltagerne er sa begeistretfor

• Gjentagelse og gjenkjennbart er ofte bra og avansering er ikke sa viktig

• Sma endringer (bildet endrer seg), øker det motivasjonen

• Pokemon Go var jo kjempe populært i en periode ogsa avtar det etterhvert

• Ikke tenk sa mye pa økende vanskelighetsgrad

5. Bør overvakning av spillet legges til (bade under og etter spilling) oghvilken informasjon er interessant?

• De fleste har med seg noen, men hvis de kommer bort fra hverandrekan det være lurt (med overvaking av lokasjonen til brukeren)

• Sikkerhet kan være viktigere enn personvernet for denne gruppa. Sjeldentat ingen vet hvor de er eller hva de gjør

• Ta opp det som har skjedd pa turen etterpa, f.eks. med bilder under-veis kan jeg tenke at er morsomt

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Name4

Utdannet psykolog

Holder pa a ta doktorgrad om effekt av fysisk aktivitet med e-helse-støttehos personer med utviklingshemming

Generelt

1. Hvor mye tenker du at foreldre eller pleier vil være villig til a være medog sette opp spillet?

• Det har jeg bade fatt bekreftet bade i intervju og erfart at de er ganskevillige til a bidra

• Enkelt og lettvint oppsett og administrasjon

• Mangel eller komplekse bruksanvisninger, mangel pa helpdesk hargjort at annen velferdsteknologi ikke har blitt brukt

• UiT vil koble inn et firma som kan hjelpe med drift og tilby hjelp ideres prosjekt

2. Hvordan tror du opplæring til spillet bør forega?

• Det optimale er at noen er tilstede ved opplæringen den første gangen

• Stegvis brukermanualen med visuell støtte og lett sprak som bade denutviklingshemmede og hjelperne kan bruke

• Hvis det ikke er mulig a være fysisk tilstede bør det være en enkelinstruksjonsvideo i tillegg til brukermanualen

Treningsspill

1. Hva er de mest motiverende faktorene for at utviklingshemmede skaldelta i fysisk aktivitet?

• A være sosial i den fysiske aktiviteten er veldig motiverende. Det garpa tvers av type utviklingshemming og interesser

• Vi har enda ikke fatt tak i den optimale belønningen for deltakelse ifysisk aktivitet

• For personer uten utviklingshemming er det mang som har en indremotivasjon for a være fysisk aktiv, den far man ikke helt tak i hosutviklingshemmede

• Fysisk aktivitet har et annet formal. Treffe venner, ga tur med hund,spise matpakke pa nar man kommer fram øker sjansen for deltakelsepa fysisk aktivitet

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• At personen rundt den utviklingshemmede er interessert i fysisk ak-tivitet øker sannsynligheten for deltakelse mer i fysisk aktivitet. Badederes motivasjon og støtte med det praktisk

• Haper at ytre motivasjon (belønning f.eks. smilefjes) etter hvert blirindre motivasjon

• Det er ikke alltid de selv skjønner sammenhengen mellom fysisk ak-tivitet og de positive effektene. Den fysiske aktiviteten pleier a hapositiv ringvirkning pa kosthold, søvn, osv.

2. Hvor ofte tenker du utviklingshemmede bør motta ny motivasjon for afortsette med fysisk aktivitet?

• Daglig paminnelse/belønning fungerer best for utviklingshemmede,spesielt de med mer alvorlig utviklingshemming. De er veldig tilst-ede her og na og er veldig opptatt av det som skjer i øyeblikket

• Progresjon trenger ikke skje før etter 2-3 maneder og kanskje endalengre

• Ofte liker utviklingshemmede det som er trygt, forutsigbart og en slagsrutine

• Det a lære nye ting er svært vanskelig for utviklingshemmede

• Programmet bør (uten at de merker det) ble vanskeligere etter hvert,men trenger ikke skje like fort som hos de med normal kognitiv funksjon

• Feedback eller belønning underveis ca. hvert 5 min kanskje. Visuelt –en tommel opp, smilefjes. Auditivt

• Tror ikke de har behov for at det blir vanskeligere underveis eller atde far nye oppgaver før de nar det nevnte malet etter ca. 15 min

• Individuell tilpasning er ønsket pga. vanskelig a finne noe som erbelønnende for de aller fleste. En Karakter, type musikk

• Oppmerksomheten pleier ofte ogsa a være en utfordring. Ofte er detnok med blinking, vibrasjon eller lyd

• Det a vise fram prestasjonene til noen er ogsa motiverende. Fa medal-jer som man kan vise fram

3. Hvor viktig er gruppeaktiviteter for a motivere til fysisk aktivitet forutviklingshemmede?

• Det er veldig viktig a være sosial

• Mange bor i egne leilighet og kan være ganske ensomme

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• Noen har utviklingshemming med autisme og har da ikke det behovetfor a være sosial, men ofte er det fint a være litt pa siden av gruppen

4. Hvordan tenker du at samarbeid i en gruppe som spiller som er utendørs,navigering og lett trening vil fungere?

• Mange er ikke sa flinke til a navigere pga. redusert visuospatiale evner

• Fin utfordring a prøve a finne poster sa lenge de ikke er for avanserte,men de ma nok ha med en ledsager til a hjelpe med kart, høyre/venstreog trafikken

• Har ikke vært sa mye innom samarbeid i intervjuene

• Fotball kan bli for komplekst og ga for fort for mange, slik at det blirskummelt

• Jeg tror at mange vil synes det er fint a være et lag og gjøre tingsammen

• 2-3 personer som blir enige om hvor de skal ga med hjelp av en ledsagerkan absolutt fungere. Kanskje en fordel om noen bestemmer hvemsom skal jobbe sammen. Oppgaven skal løses pa et litt større omrade,fotballbane eller park.

• Tydelig mal, enkelt eller noe de kjenner fra før. Ikke bildet av et tresom man skal finne i en park med mange trær

5. Finnes the noe spill eller temaer som er populære for flertallet av utvikling-shemmede?

• Jeg er veldig usikker. Har ikke vært sa mye innom det

• Det er veldig forskjellig nar det gjelder funksjonsniva

• De med lett utviklingshemming hadde sikkert klart a spille PokemonGo

• De litt enkle spillene som finnes, slik som stigespillet (for de med littlettere grad av utviklingshemming)

• Dyreyatzy har vært mye brukt i litt sann pedagogiske sammenhenger.Terningene har ikke prikker for det blir for komplisert

• Kan finne fellesnevneren eller hva som er belønnende og overføre dettil digitale spill

Navigering

1. Hvordan tror du utviklingshemmede vil navigere med bruk av mobilekart systemer f.eks. Google Maps pa mobilen?

• Det tror jeg vil bli vanskelig og mange vil slite med

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• Mange sliter med a forsta klokke og penger. Kart er ogsa ganskeabstrakt og krever ofte litt høyere mentale ferdigheter

• Har hørt at personer uten et verbalt sprak synes det er vanskelig a gatil en nabo selv om foreldrene har tegnet opp noen enkle tegninger

2. Tror du utviklingshemmede vil ha en fordel av en spesialtilpasset appsom bruker gatebilder, varslinger, enklere og kortere forklaringer, lyd osv.?

• Absolutt ja. Det vil de ha mye mer utbytte av enn a lese kart selv

• Det bør inkludere street view og noen som peker veien de skal ga

• Støtte med verbale beskjeder

• Konstant feedback og beskjeder om hva som skal skje akkurat na

3. Hvilket utendørs omrader tror du passer best til denne typen spill?

• Stier i naturen

• Park eller grønt omrader med stier eller apne omrader

• Park pa toppen av øya i Tromsø som er mye brukt. Akebakke ogbalplass, Ikke sa mye folk der, Apen og stort, sann at ingen gar seg vil

• I Tromsdalen bruker de mye lysløypa

• Viktig at de ikke har sa mye folk rundt. Noen har utfordringer medutagering, blir lett distrahert eller liker best nar det er stille rundt

• Kan være litt vanskeligere a finne et passende omrade i naturen i størrebyer, i hvert fall hvis det er en gruppe som gjør aktiviteten sammen

4. Hva tror du utviklingshemmede vil føle hvis han/hun er ansvarlig for anavigere for resten av gruppen?

• Jeg har hørt at noen synes er litt artig a være den som leder turen

• Føler seg stolt

• Artig a være den som er ansvarlig

• Hvis det legges til rette for det, sa tror jeg mange vil fa det til

• Jeg synes det er en kjempe ide at en for ansvaret for a være gruppelederog fa litt støtte fra noen med normal kognitiv funksjon.

• Man har hver sin tur a være gruppeleder ogsa rullerer det

5. Hvilke sikkerhets relaterte problemer tror du utviklingshemmede kanmøte pa nar de gar og spiller i byomrader?

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• Først og fremst trafikken. Mange har utfordringer med impulsivitetog ikke klarer a se konsekvensene av a ga ut i trafikken.

• Mange har utfordringer med a skjønne høyre og venstre og hvor bilenekommer fra

• Være nært vann, f.eks. brygger

• Noen kan bli stresset av mange folk, mye lyder og brak

6. Tror du sikkerhetsvarsler er en god ide og nar bør det brukes?

• Det kan hende det er hensiktsmessig med paminnelser i trafikkerteomrader, hvis de skal ga alene i en by

• Det er mange som bruker flere ar a lære seg og ta bussen og finneveien. En slik sikkerhetskompis kunne vært en app i seg selv

• En alarmknapp kan være en sikkerhet bade for den utviklingshemmedeog foreldrene hvis de skal ga alene

• Ved alarm blir koordinatene sendt til foreldre eller bolig eller at detkobles opp en samtale automatisk

• Jeg er litt usikker pa om de kommer til a skjønne at de har gatt segbort

• Trykker pa knappen først nar de blir redde og kanskje noen har fullkontroll pa hvor de er

Design

1. Hva er det viktigste a tenke pa med brukergrensesnittet pa spillet?

• Enkelt

• Visuelt stimulerende. Farger, ansikter og noe spennende a se pa

• Store ikoner og knapper

• Veldig lite andre forstyrende elementer og fa knapper

• Individuell tilpasning etter interesse. Hva slags figur man skal væreeller omgivelsene man gar i

• Funksjonene er selvforklarende

2. Er det viktig a tilpasse brukergrensesnittet til den enkelte og hvordan børdet tilpasses?

• Kan hende de med lett utviklingshemming har mer forutsetninger fara bruke en app som er mer avansert og at det kan bli kjedelig hvis detblir for enkelt

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• Forskjellig modus i forhold til bade type utviklingshemming og inter-esse. Velge alternativet som passer best til den enkelte

• Noen har litt sære interesser som blir litt altoppslukende

• Variasjon er ofte ikke sa viktig, sa interesser endrer seg ofte ikke overtid

• A velge den avataren man synes er mest interessant. Det er ikke detoptimale

3. Hvordan bør positive og negative tilbakemeldinger bli gitt?

• Ikke gi belønning eller korrigering i form av tekst, for det er ikke allesom kan lese

• Symboler. Alternativ supplerende kommunikasjon ASK. Ofte vant tildet fra barnehagen av og kjenner igjen

• Lyd. Fortelles veldig enkelt og konkret. Noen har hørselsvansker, menbruker da høreapparat

• Du er flink, kom igjen. Ikke bare 10 min igjen

• Visuell stimuli. Symbol eller smilefjes

• Viktigste er a forsterke det de holder pa med framfor a korrigere

4. Is it important that the game changes or that the difficulty increases andhow should this be done?

• Behovet for at det skal endres og bli vanskeligere er ikke like uttalt hosdenne gruppen som hos de uten utviklingshemming

• Det tar tid a lære noe nytt, sa nar de først har lært det, sa er det finta ha det sann

• Hvis det skal skje endring bør det være en liten endring

• Ikke sikkert de skjønner at de har kommet opp i level, kommet seglengre i spillet eller nærmer seg en boss

• Kanskje at det etter 2-3 maneder kommer et annet element, men atde som ikke ønsker det ikke trenger a bruke det. Viktig a sørge for atde har lært seg det før det endrer seg

• Hvis det skal gjøres daglig eller flere ganger i uka, sa er det greit a halitt variasjon, men den trenger ikke være stor

• Etter hvert som de kommer i bedre form kan det utvides i tid, mentrenger ikke bli mer kompleks

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5. Bør overvakning av spillet legges til (bade under og etter spilling) oghvilken informasjon er interessant?

• Nyttig at foresatte kan se hva slags utvikling de har

• Følge med pa hvor ofte og hvor lenge det brukes

• Foreldre kan legge inn malsetting og tilpasse det etter barnet sitt

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Name5

Er utdannet dataingeniør

Jobber for smart cognition som har utviklet FTU app og holder pa a utvikledigital plattform for formidling av tilrettelagt informasjon om fritidsak-tiviteter i hele landet

Generelt

1. Hvor mye tenker du at foreldre eller pleier vil være villig til a være medog sette opp spillet?

• Foreldre vil være interessert i a hjelpe med a laste ned, konfigurere oglegge til rette for spillet

2. Hvordan tror du opplæring til spillet bør forega?

• Bruker bør være sammen med foreldre eller parørende under opplærin-gen.

• Opplæring pa en samling sammen med andre

Treningsspill

1. Hva er de mest motiverende faktorene for at utviklingshemmede skaldelta i fysisk aktivitet?

•

2. Hvor ofte tenker du utviklingshemmede bør motta ny motivasjon for afortsette med fysisk aktivitet?

• Treffe venner

• Være sammen med familie, spesielt nar de ikke bor hjemme lengre

• Treffe familie og venner er det viktigst

• Tenne bal, enkel og sunn mat

• Ikke materielle belønninger

3. Hvor viktig er gruppeaktiviteter for a motivere til fysisk aktivitet forutviklingshemmede?

• Ukentlig paminnelser om fysisk aktivitet

• Behov for delmal underveis pa turen er mindre viktig

• Det viktigste er a motivere pa starten for a komme seg ut pa turen

• Det vil være litt forskjellig fra person til person hvor mye motivasjonde trenger i løpet av turen

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4. Hvordan tenker du at samarbeid i en gruppe som spiller som er utendørs,navigering og lett trening vil fungere?

• Det er viktig med det sosiale for utviklingshemmede

• Gjøre det samme som resten av gruppa

5. Finnes the noe spill eller temaer som er populære for flertallet av utvikling-shemmede?

• Ikke helt sikker pa hvordan det vil fungere (i forhold til navigering)

• Har spilt stolpejakten med sønnen: Morsomt a følge med pa markørenpa kartet, Bruke kartet til a forklare om omradet rundt, Sønnen likerspillet

• Litt usikker pa hvordan samarbeid ville fungert. De bør være fysisk inærheten av hverandre, slik at de kan snakke med hverandre

• Det har fungert veldig bra a spille stolpejakten med bare meg ogsønnen min

Navigering

1. Hvordan tror du utviklingshemmede vil navigere med bruk av mobilekart systemer f.eks. Google Maps pa mobilen?

• Litt fasinerende med stolpespillet og navigasjon

• Stolpespillet motivere litt, det a forsta hvordan ting henger sammen

2. Tror du utviklingshemmede vil ha en fordel av en spesialtilpasset appsom bruker gatebilder, varslinger, enklere og kortere forklaringer, lyd osv.?

• Jeg tror absolutt at spesialtilpassede navigasjonsapper (og apper generelt)vil være nyttig

• Spesial tilpasning inkluderer: Bilder og symboler, enkel tekst, kombi-nasjon av flere virkemidler

• Noen kan lese litt, andre ikke i det hele tatt

3. Hvilket utendørs omrader tror du passer best til denne typen spill?

• Varierer litt pa hvilket omrade som er best. Begge deler fungerer bra

• Noen har darlig balanse og trenger slett underlag

4. Hva tror du utviklingshemmede vil føle hvis han/hun er ansvarlig for anavigere for resten av gruppen?

• Ikke alle vil klare a lede

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• Det vil være veldig stas for de som leder og ogsa for de som følger etter

5. Hvilke sikkerhets relaterte problemer tror du utviklingshemmede kanmøte pa nar de gar og spiller i byomrader?

• Først og fremst trafikken som vil være et sikkerhetsproblem i by-omrader

• Bade gangfelt og ga ved siden av veien

6. Tror du sikkerhetsvarsler er en god ide og nar bør det brukes?

• Alarmknapp høres fornuftig

• Litt mer usikker pa varslinger. Kan hende de ikke følger med pa de

Design

1. Hva er det viktigste a tenke pa med brukergrensesnittet pa spillet?

• Ikke for mange ting a forholde seg til

• Store knapper eller flater man skal trykke pa

• God kontrast pa farger. En del har litt problemer med nedsatt syn

2. Er det viktig a tilpasse brukergrensesnittet til den enkelte og hvordan børdet tilpasses?

• Individuell tilpasning er svært viktig

• Er enig med at følgende omrader bør tilpasses: sprakniva, vanskegraderi forhold til navigering, temaer i spillet

3. Hvordan bør positive og negative tilbakemeldinger bli gitt?

• Riktig/positiv – smilefjes og glad lat/positiv lyd

• Feil/negativ – surfjes, varsler om du er i ferd med a gjøre noe galt,syntetisk stemme som sier hva du bør gjøre na

4. Is it important that the game changes or that the difficulty increases andhow should this be done?

• Over tid bør vanskegraden øke, slik at de føler at de strekker seg etternoe

• Ma samtidig være varsom med a forandre pa ting for ofte

• Veldig mange er mer fornøyde med ting de kjenner fra før

5. Bør overvakning av spillet legges til (bade under og etter spilling) oghvilken informasjon er interessant?

• Repetere

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• Dialog i etterkant

• Fin opplevelse etter selve turen og se tilbake pa turen

• Dele bilder, dialog om arrangementer

• A snakke om det man har vært med pa i etterkant

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