Rehabilitation of Handwriting Skills in Stroke Patients Using Interactive Games: A Pilot Study Abstract This paper describes an interactive application that aims to support the rehabilitation of handwriting skills in people that suffer from paralysis after a stroke. The purpose of the application is to make the rehabilitation of handwriting skills fun and engaging. Four platform- independent games with adjustable levels of difficulty were created in order to target varying levels of skills. The application also features a performance history, audio-visual feedback, and posture reminders. It was evaluated with medical staff and patients from the Hoensbroeck Rehabilitation Centre in the Netherlands. The initial results indicated that the games are more motivating and fun than traditional pen and paper exercises. The feedback received from therapists supports our claim that the games are a useful addition to the rehabilitation of handwriting. Keywords Stroke rehabilitation, interactive game, user-centered design, handwriting ACM Classification Keywords H5.2. Information interfaces and presentation (e.g., HCI): User Interfaces. K4.2 Computers and society: Social Issues���Assistive technologies for persons with disabilities Copyright is held by the author/owner(s). CHI 2009, April 4 ��� 9, 2009, Boston, Massachusetts, USA ACM 978-1-60558-247-4/09/04. Jennifer Curtis, Loes Ruijs, Maartje de Vries, Robert Winters User System Interaction Department of Industrial Design Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands {J.S.Curtis, L.S.Ruijs, M.H.E.d.Vries, R.Winters}@tue.nl Jean-Bernard Martens User-Centered Engineering Department of Industrial Design Eindhoven University of Technology Industrial Design P.O. Box 513 5600 MB Eindhoven The Netherlands J.B.O.S.Martens@tue.nl CHI 2009 ~ Spotlight on Works in Progress ~ Session 1 April 4-9, 2009 ~ Boston, MA, USA 3931

Introduction About half of the people surviving a stroke experience debilitating loss of arm and hand functioning to some degree [1,2]. Specifically, many stroke victims experience paralysis or weakening of the side of the body opposite the brain hemisphere in which the focus of a stroke occurred [8]. In order to regain function to the affected side of the body, the most facilitative course for rehabilitation involves intensive physical therapy. Physical therapy during rehabilitation involves training of activities with a focus on regaining daily life skills. Timmermans et al. [7] questioned stroke survivors in order to establish the most important and regularly used skills that they would like to regai n during rehabilitation. Writing out text by hand was one of the skills that ended up in the top 10 list of most highly desired skills to recover. Writing is a visual means of communication pervasive in society writing personal reminders, posting letters, and signing one���s own name on official documents are all examples of how writing is used in daily life. However, although writing is an automatic and commonly used skill for most, the mechanics of handwriting can be deceptively complex. Given that it is a task that requires a high degree of fine motor control, handwriting can be one of the most difficult skills for stroke survivors to regain. Next to that, current exercises during therapy for handwriting recovery are generally experienced as tedious and repetitive, forcing patients to spend many hours practicing basic text- related shapes and letters. Little prior work has aimed at creating a specific tool for the rehabilitation of handwriting. We only know of one device, the Haptic Handwriting Aid, that has been developed with the explicit aim of rehabilitating t his skill [5]. Using a Phantom Omni haptic device, it guides the user���s hand through the proper motions required to form individual letters and sentences. However, the device was only tested with healthy adults. Another study tested the use of a force feedback joystick i n the recovery of hand and grip function in stroke patients [6]. Although the researchers conjectured that the device might be beneficial to handwriting skills, t his hypothesis was not directly tested. Thus, there remains a need to develop and test additional tools for the rehabilitation of handwriting following stroke or other injury. The goal of this project was to use technology to create a game (or game system) that would engage stroke patients during their training in handwriting, in order to make the requisite exercises more fun. The project was carried out in cooperation with the Hoensbroeck Rehabilitation Centre, the Netherlands. Users For this project, two different user groups can be defined: patients and their therapists. Regarding the patient user group, this project focused principally on patients that fit the following criteria, derived from previous research at the center [7]: ��� Currently recovering from at least one previous stroke ��� Affected arm not completely paralyzed ��� Native Dutch speakers Patients with the following deficits were excluded: severe hemineglect severe spasticity aphasia apraxia as well as those with additional impairments that might prohibit completion of the user evaluation. The participating therapists comprised various specializations ergo-, physio-, and occupational therapists���all of whom guide and assist patients throughout the rehabilitation process. CHI 2009 ~ Spotlight on Works in Progress ~ Session 1 April 4-9, 2009 ~ Boston, MA, USA 3932