CGAMES 2013
The 18th International Conference on Computer Games
Helping children with Intellectual Disability to understand
healthy eating habits with an IPad based Serious Game
A. Rodríguez Isasi, A. López Basterretxea, A. Méndez Zorrilla, B. García Zapirain
DeustoTech- Life Unit, DeustoTech Institute of Technology, University of Deusto, Bilbao, Spain
{amaia.mendez, mbgarciazapi}@deusto.es
Abstract- The Project described by means of this article
consists on the design and implementation of an application
within the field of the serious games. A game aimed at
instilling healthy eating habits to children/adolescents with
ID.
For the accomplishment of this project some multi-touch
platforms (IPad) were used, given the good reception by
people with ID towards the use of new technologies.
The application is based on a set of games with different
functionalities and aims, which include a piece of advices for
the eating process. Furthermore, a pet has been designed
with the aim of making the application more attractive in the
interest of motivation.
The results obtained after the tests carried out with real users
were positive and encouraging. The users felt confortable
when using the application and some improvements were
applied base don the feedback provided by professional
instructors and by the children themselves.
Keywords - Intellectual Disability, IPad, eating habits,
Serious Games
I.
INTRODUCTION
People suffering from ID usually need extraordinary help for
the accomplishment of daily activities [1]. Within the ID,
this Project focuses precisely on people with Down
syndrome, a genetic alteration produced by the presence of
an extra chromosome. This syndrome usually causes
generalized muscle hypotonic, a variable degree of cognitive
disability, attention and memory deficit and growth
restriction, in addition to a higher tan normal risk of
developing certain diseases, among which there are foodrelated diseases, such as diabetes. Moreover, more than half
of people with the Down syndrome suffer from obesity,
which increases those health problems. Therefore, special
attention is needed in the education of children/adolescents
with Down syndrome regarding food and the assimilation of
healthy eating habits. [2].
Within the aids supporting common education systems, it is
widely spread the use of new technologies in different
aspects (and applied to different groups of users), such as to
help people with other disabilities, like visual ones. Some
examples of those technologies are partial screen
enhancement programmes, or those that reed written
contents, or expanded keyboards, easier to use [3], or even
special mobile devices which reach to include touch screensBraille [4] [5]. This improvements for the use of technology
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extend further, increasing the number of applications
developed with teaching and supporting aims, such as, the
applications based on augmented reality technology, created
by Qualcomm, carried out to help people with ID to reach a
successful labour integration. [6] [7].
In particular for users of lower age (although it is applied in
all kinds of areas), the genre of the serious games is currently
being exploited. There is a multitude of applications within
this field that are intended to users with ID for different
platforms, existing among them:
• “Lucas and the case of the stolen Painting”, a
videogame created for PC in 2010 thanks to the
cooperation of the Orange foundation and Down’s
Syndrome foundation in Madrid aimed at Young
people with disabilities. The adventure of this game
develops around different parts of the world, in
which the player must solve riddles while
interacting with objects and characters, and the plot
will be modified depending on the decisions taken.
[10].
• “The adventures of Spoti”. Is an Online interactive
game created for people with Down’s syndrome
between 6 and 10 years old thanks to the
cooperation of the Down’s syndrome in Spain and
the Eroski foundation. This application is focusing
on the food education of the youngest users with the
aim of reducing the childhood obesity within this
collective. To do so, a series of activities of healthy
food and physical activity are dealt with by means
of little interactive games [11].
• “Picaa”. This project was developed by the
specification, development and evolution of the
GEDES software research group [12] of the
University of Granada between 2010 and 2011 for I
Pad, IPhone and IPod Touch devices. It is an
application designed for the creation of didactic
activities adapted to students with special
educational needs, mainly in the following levels:
cognitive, visual and auditory, with 5 types of
different activities. [13].
Most of the current-existing applications were carried out for
PC platforms, being the supply in other devices rather scarce,
mostly when new mobile and touch technologies offer so
many possibilities for the implementation of appropriate
games for users with ID. This is one of the reasons why this
project was developed for I pad, to try to cover a field in
which no further projects were contributed in relation the
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help for education of people with special needs applications,
taking benefits from the features this might offer (mobility,
touch screen…).
In addition, many of the applications available are focused in
other aspects of education or poise [14], and there are no
many the ones dealing with such an important issue, which
the correct diet, being this point emphasized in this game.
Some of the applications, such as “the adventures of Spoti”,
previously mentioned actually aim to promote healthy eating
habits, but all of them are aimed at other supports.
Considering the importance of the acquisition of healthy
habits and customs concerning food in ages between 8 and
12 years, the game has been designed following the tastes
and characteristics of the children at that age. An application
that may provide an extra help was tried to be carried out by
means of a series of little games for the task being more
entertaining and easy, encouraging the users’ autonomy
without setting aside the teachers’ help. Furthermore, a pet
has been included which shall guide the users through a
series of advices for the game being more attractive, since
the aim of the project is to instil positive values at the same
time as the users play and have fun.
The development of the application has been designed for
the IPad platform, property of Apple, based on IOS 6, the
code programming thus being carried out in Apple’s own
environment: Xcode.
The IPad was chosen for its mobility, multi touch screen,
multimedia capability, interaction through movement…for
these being interesting features to take advantage of in the
application.
The database has been implemented through Sqlite.
II. OBJECTIVES
Figure1. High-level diagram
Being the main aim the improvement of the eating habits in
children with Intellectual Disability, the following specific
objectives are described thereupon:
The architecture of the application follows the design in
three layers: database layer, logical layer, interface layer.
•
•
•
To design and develop an application for iPad
within the genre of the serious games intended to
promote healthy eating habits to users with ID,
especially to children with Down’s syndrome.
To offer support to education by means of a variety
of entertaining games, making fun and bearable the
use of the application.
To design a test protocol to demonstrate the benefits
of the game in the behaviour of the users.
III. MATERIAL AND METHODOLOGY
In this section the technical and human resources the
researchers counted with to carry out the development and
the application tests.
A. Human resources
IV. DESIGN
The application is focused on nourishing good hygiene and
nutrition habits, following the structure shown down below
in Figure 1.
The application has a database layer implemented
through Sqlite to store different parameters on the basis of
the results obtained by the players (time, amount of
errors…). In this way, it is possible for the instructors to gain
control over the progress of each child, or determine what
kind of activities produce greater difficulty.
The development of the logical part is based on Apple IOS,
thus the code programming being carried out by Apple’s
own environment. Xcode, as the main objective is an
application for IPad.
In the user interface layer, the players (children) have
access to the games about nutrition, and the instructors have
access to the settings to view statistics, change the language,
etc.
In the following sections we shall be allowed to see in depth
the operation.
In the tests carried out with a group of children with ID (in
particular those with Down’s syndrome) 11 users
participated, aged between 9 and 15, from which 5 were girls
and 6 were boys. Among the whole group only 5 had already
used or knew the iPad.
Various instructors also participated giving support during
the test, as well as providing information concerning the
content of the application.
B. Technical resources
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Figure 2. Low-level Diagram
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As we can observe in Figure 2, the application starts with a
screen in which the user must enter the personal data (name).
Such name remains recorded; together with the data saved
until the application is closed or the user is changed they will
remain saved with that name.
Once accepted, it will branch directly into the main menu,
from which the games and the settings can be accessed (prior
to have access to the buttons that led to the described
options, the player must press over the pet chosen to guide
and motivate children, which shall be presented trough a
small introductory text, and the buttons will appear). In this
last section it is possible to change the language of the
application (examples, conclusions…) between Basque and
Spanish up to day (due to their mother language), return to
the introductory screen and check the table of the results
obtained in the database.
The 18th International Conference on Computer Games
Game 1
A. Explanation of Games
The games are divided into minigames, as it can be seen in
Figure 3, since, being an application for children, it will be
more entertaining.
Figure 4. Game 1 block diagram
In the first game (see Figure 4 and 5), the player must
advance by selecting the appropriate products to develop a
salad by choosing the appropriate one between the two foods
that appear. Once one of them is pressed, if it is suitable it
will set to a plate displayed in the bottom part of the screen,
and two products to choose appear once again. In the event
of choosing the unhealthy food, two more products to choose
appear again, but neither of them sets to the plate. When all
the proper ingredients are taken, the conclusion appears
showing other possible ingredients which may be added to a
salad.
Figure 3. System block diagram
Before starting the game, each game comprises an
explanation of its functioning (with the aim of not being
allowed to skip it without reading it, the starting button takes
some moments to appear). Once the game completed, certain
parameters are saved (time or, errors mainly… depending on
the game) associated with the previously added username.
Likewise, a screen with a teaching conclusion related to the
subject matter of the game will appear.
The options to continue take a few seconds to be visible, on
the same basis of the explanation prior to the game. Once
they are qualified, the user is allowed to continue with the
following game or return to the title screen.
Figure 5. Game 1 Screenshot
Game 2
This minigame is focused on the importance of a wellbalanced breakfast. In the beginning, the player faces
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different foods to choose, from which some of them should
be picked and dragged to the table.
The 18th International Conference on Computer Games
V. RESULTS
In this section, we describe the obtained results: technical,
satisfaction and user experience results.
Figure 6. Game 2 block diagram
When the finishing button is pressed (see Figure 6), the
chosen breakfast is checked to be complete and varied. In
the event of that not being the case, a message indicating an
error appears (certain product that is not adequate, one milk
would be enough, etc.). Once a correct breakfast is
composed, a conclusion highlighting the importance of
breakfast appears (see Figure 7).
Figure 7. Game 2 Screenshot
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Figure 8. Main menu Screenshot
By means of satisfaction questionnaires the following results
were obtained:
• The character had a substantial acceptance (100%)
and all the users had fun playing, and even they
affirm that they would play again (see Figure 8).
Screenshots of the serious game can be observed in
figures 5 and 7.
• No significant differences were observed between
girls and boys, or among users of different ages.
• In general the users had no difficulties, but it must
be reported the case of one specific user, who in
addition to ID suffers from pervasive
developmental disorder (PDD).
• Among the users participating in the tests, it can be
observed that some of them already knew the iPad,
as well as mobile phones. However, any advantage
or better scoring was reported in the results.
To be able to keep a track of the progresses, the application
saves certain values in a database available to the instructors.
This way, it is possible to analyse the results obtained by the
children in the different activities the application offers.
Finally, the project is distinguished by being a bilingual
application (taking into account the mother tongue of the
users), giving the option to play changing the language both
the texts and the voice.
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VI. CONCLUSIONS
This paper has reported the preliminary results of a study
aimed at the children with Down Syndorme using iPad and
an application to improve eating habits.
Considering that the results obtained with the application
were encouraging in different fields. It has been thought to
carry out future improvements.
On the one hand, within the game some modifications were
added, such as add another game, insert rewards, add the
option of game in English…
On the other hand, it has been considered to carry out more
tests with other groups of users with Down’s syndrome, aged
between 9 and 15, as it has been carried out, and to extend
the tests to other collectives, such as children with
pathologies within ID. Furthermore, it is interesting to carry
out new tests to check the results of the modifications
applied after the first test with real users, that is to say, the
introduction of voice for the explanations, the expanding of
the texts…
[8] G. A. El Khayat, T. F. Mabrouk, A. Elmaghraby.
“Intelligent Serious Games System for Children with
Learning Disabilities”. 17th International Conference on
Computer Games, 2012.
[9] A. Elmaghraby, A. Mendez, B. Garcia, W. Sheta, S. el
Shehaby. “Serious Games and Health Informatics:
A Unified Framework”. 17th International Conference on
Computer Games, 2012.
[10] Videojuego de aventura para discapacidad
http://fundacionorange.es/fundacionorange/comunicados/201
0/lucas_videojuego.html. Abril 2010.
[11] "Las aventuras de Spoti".
http://www.sindromedown.net/Spoti/default.htm. Enero
2012.
[12] Grupo GEDES. http://gedes.ugr.es/datos_inicio/. Enero
2013.
[13] "Picaa"
http://asistic.ugr.es/picaa/?page_id=16. Enero 2013
[14] J. Torrente, Á. del Blanco, M. OrtegaMoral, L. Bourg,
B. Fernández Manjón. “Juegos accesibles y la integración
laboral”. Abril 2012.
ACKNOWLEDGEMENTS
This work was partially supported by the Basque
Government Department of Education, Universities,
Research, AECID and Bizkailab. The authors would like als
thank to all the participants involved in the study, the
cooperation of FSDPV. Also to Zelai Sáenz de Urturi
researcher from DeustoTech LIFE Unit for her collaboration
and support.
REFERENCES
[1] M. L. Wehmeyer, S. Obremski "La deficiencia
intelectual"
http://cirrie.buffalo.edu/encyclopedia/es/article/15/. Enero
2013
[2] “Down España”
http://www.sindromedown.net/index.php?idMenu=6&idIdio
ma=1. Enero 2013
[3] A. Cingolani "Nuevas tecnologías para las
discapacidades".
http://www.slideshare.net/AlessiaSalento/nuevastecnologias-para-las-discapacidades-presentation. Enero
2013
[4] Y. Ju, E. Illescas "Aplicaciones móviles para personas
con discapacidad visual". http://www.ceditec.etsit.upm.es.
Enero 2013
[5] "B-Touch Mobile"
http://www.yankodesign.com/2009/06/15/touchphone-forthe-blind/. Enero 2013
[6] Realidad aumentada, Qualcomm
http://latam.qualcomm.com/products/augmented-reality.
Febrero 2011
[7] "Realidad aumentada para ayudar a la integración laboral
de discapacitados"
http://www.europapress.es/portaltic/movilidad/software/noti
cia-realidad-aumentada-ayudar-integracion-laboraldiscapacitados-20120229080009.html. Febrero 2012
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