Memori: A Serious Game for Diagnosing and Treating Visual Sequential Memory Deficit

Ays¸e Rumeysa Mohammed1, Ammar Rashed1, Shervin Shirmohammadi1,2 1College of Engineering and Natural Sciences, Multimedia Systems Lab Istanbul Sehir University, Istanbul, Turkey {aysemus | ammarrashed}@std.sehir.edu.tr, [email protected] 2Distributed and Collaborative Virtual Environments Research Lab (DISCOVER Lab) University of Ottawa, Ottawa, Canada [email protected]

Abstract—Visual Sequential Memory (VSM) allows a person Even though VSMD is important and can negatively affect to perform tasks such as remembering letters, numbers, objects various aspects of life, it is not diagnosed very accurately [30]. or shapes in the correct order. Its deficit can lead to challenges in If it is found early, treatment methods could significantly im- one’s personal life, including dyslexia and dyscalculia. Detecting Visual Sequential Memory Deficit (VSMD) is essential for those prove the condition [28] [29]. To help with the early diagnosis who suffer from its related consequences. But current clinical and treatment, in this work we propose Memori: a serious methods don’t have a high rate of diagnosis, and also for game to diagnose and treat children with VSM difficulties. treatment are limited to the few hours the person spends in This serious game has been developed in the context of our the clinic. In this paper, we propose an Origami based Serious European project “Intelligent Serious Games for Social and Game, called Memori, for the diagnosis and treatment of children with VSMD. We illustrate the rationale behind using Origami, Cognitive Competence” [31], the target group questionnaire the design process of our game, and its implementation. of which can be seen here [32]. Memori works by making the children use their sequential memory by following instructions Keywords—Serious Games; Game Design; Visual Sequential and trying to copy the folds of an origami game in the correct Memory; Origami; Play Therapy. order. As a byproduct, children with ADHD can be determined as well. Origami is the Japanese paper folding art that makes I.INTRODUCTION shapes of paper. Figures 1 show some examples of Origami shapes. We chose Origami because it is a game that has been VSM indicates a person’s competency of remembering shown to heavily involve VSM, as will be discussed in Section letters, numbers, objects or shapes in the correct order [1]. II. For diagnosis, Memori can tell the parents or the therapist VSM is crucial as it affects various aspects of life since if this child could possibly be affected by VSMD. Because we use this ability in our daily lives while remembering it is a game, children will be tempted to play it, making names, phone numbers, directions, recipes, etc. A person with diagnosis easier. For treatment, Memori can also serve as an VSMD; i.e., a person whose VSM is not working as well assistive technology in addition to clinical treatments. Since as a healthy person, could experience problems in various children receive limited hours of clinical treatment, our game aspects of life and be affected by different disorders such will allow them to receive treatment at home and as much as dyslexia [2] and dyscalculia [3]. Findings of the USA as needed under the supervision of a parent. Because Memori National Institutes of Health suggest that dyslexia affects 7% runs in WebGL [33], it can be played in any WebGL-compliant of the population [5]. Their definition of dyslexia is broader web browser (Mozilla Firefox, Google Chrome, Apple Safari, than Kooij who enounced 3% to 4% of people have dyslexia MS Internet Explorer, MS Edge) on any platform, including [6]. In Turkey, where our proposed system is designed and PC, tablets, and smartphones running Android and iOS. This will be tested, approximate prevalence of dyslexia is 5%- makes Memori very accessible for home usage. 7% of people [7]. Moreover, worldwide dyscalculia rates In Memori, after the first tutorial games, the system, de- reach 6% of the population [8] [9]. Additionally, a quarter of pending on the performance of the child in the tutorial, will children with dyslexia and dyscalculia exhibit Attention Deficit bring up other Origami games, and show to the child, fold Hyperactivity Disorder (ADHD) [10]. by fold, what the child must do. The child uses an actual Children who experience difficulty in VSM often show it paper and follows the instructions of the system. The parents or when having difficulty remembering numbers in sequence, the therapists will monitor the number of sequentially correct sequencing letters in similar words such as was/saw or re- folds, without stopping the child if the child makes a mistake. verse/reserve, copying from a book to a notebook, or recalling The performance of the child can be assessed using our events and tasks in series. In the absence of such abilities, proposed method in Section V. This process can be repeated possible problems arise: dyslexia [2], reading difficulties [4], as needed. and dyscalculia [3]. To the best of our knowledge, while there are some games C. Serious Games for Dyslexia Rello, et al. [35] developed a browser-based game, Dy- tective, to detect risk of dyslexia. The game is designed to have linguistic tasks that are shaped according to the typical mistakes done by dyslexic people. It can diagnose English and Spanish speaking school age children with dyslexia. Rello, et al. [36] created a game, DysEggxia, to improve the spelling of children with dyslexia. Its exercises have misspelt words for players to correct them. The words are gathered from texts written by dyslexic children. The experiment was Fig. 1. Origami examples: Elephant, Dragon, and Crane held for 8 weeks. During the first 4 weeks, 48 children played the game DysEggxia. Then they are switched to another word game, Word Search and played it for 4 weeks. At the end of available for visual memory, dyslexia and dyscalculia treat- the experiment, the results were compared and children who ment, as will be shown in Section II, there is no serious game played DysEggxia had less mistakes in word spelling. directly targeting VSM. In this paper, we will show the design of our game, and the rationale behind it. The rest of this paper D. Serious Games for Dyscalculia is organized as follows: in Section II we cover related work, Kuhn and the research team at the University of Munster¨ in Section III we present and discuss the game design, while developed Meister Cody - Talasia for diagnosing and treating in Section IV we show our implementation. We then elaborate children with dyscalculia. It is an educational game consisting on our future work, and conclusions. of 20 therapeutic exercises [38]. The game and difficulty levels are shaped according to the user profile on daily basis. Meister II.RELATED WORK Cody is designed in a way to improve working memory, number processing and calculation skills. We discuss the related work in the following subsections: Current Clinical Methods, Serious Games for Visual Memory, E. Origami for VSM in Therapy and Education Serious Games for Dyslexia, Serious Games for Dyscalculia, While playing Origami, a child will invoke his/her VSM and Origami in Therapy and Education. quite heavily. Gross suggests that while doing Origami, one needs use the following skills: following a sequence of direc- A. Current Clinical Methods tions, listening skills, reading skills, language skills, writing skills, social skills, mathematics, spatial relationships, memory VSMD can be diagnosed by Visual Sequential Memory and concentration [13]. According to Kaplan, performing a subtest of the Illinois Test of Psycholinguistic Abilities (ITPA) folding act requires following instructions, solving problems, [11] or Knox Cube Imitation Test (KCIT) [12]. KCIT is learning the steps in the proper order, thinking skills, self- a very efficient way that serves as diagnosing and treating. image, and success experience [14]. Other studies have come The problem with these methods is that they are confined to similar conclusions, that Origami requires skills that are to a clinical setting, and cannot be used at home. So their directly related to VSM [15] [16] [19] [20] [26] [27]. effectiveness is limited to the clinical exposure the child has. Origami has been used for therapeutic and educational purposes by many researchers in the past. Origami has also B. Serious Games for Visual Memory been shown to benefit learning disabled, dyslexic, physically Nagle et al. [34] designed a memory training game for or emotionally handicapped students [17]. Origami also helps measuring the effects of different task difficulty levels and user with fine motor control and hand writing, attentiveness, se- control choices in a serious game. The memory training game quential memory, and specifically helps children with learning takes place in virtual environment, a room, and players receive disorders to develop fine motor skills, observation skills, and a list of some objects they need to locate in the room. Objects visual sequential memory [18]. A child suffering from dyscal- are numbered and then placed in the room. The challenge was culia who cannot comprehend or manipulate numbers, forms to memorize the list items and their location numbers, to place or anything related to those can also benefit from Origami them in corresponding locations. by learning to follow the sequence and order of things [3]. Illanas, et al. [37] developed a mini-game, MemOwl, for For diagnosis, Origami can evaluate which basic difficulties memory stimulation. In this game, participants are shown some a child might have in the acquisition of topological concepts pictures for a specific time. Pictures consist of owls of different and spatial orientation [21] [18]. Origami is also utilized in colors. When the time is over, users need to pick the correct pediatrics for mental health, clinical fine/visual motor skills, picture. The number of owls increases and the time duration of memory, and sequencing [22]. picture display decreases by level difficulty. MemOwl targets The above work all show very promising effects that to improve attention, visual memory and short-term memory Origami applications can have on VSM, for both diagnosis and skills. treatment. In this paper, we are revisiting such applications of Origami, in the context of today’s technology and gaming en- only for modeling the paper objects, but also for the whole vironments. We design a platform-independent mobile serious game structure; game called Memori that shows to a child the step-by-step • For modelling, Blender is easier and simpler than most order of making various Origami shapes. Using the child’s of the other engines, like Maya or 3D-Max, yet quite performance, one can then diagnose the child for VSMD, as powerful. The simplicity of Blender is to the extent that well as treat children with VSMD at clinics and homes. we do not need to write any code for the game logic, as we will see in Section IV. III.PROPOSED GAME DESIGN • Using the Blend4Web [24] plugin allowed us to take the The design of the game is shown in Figure 2. As demon- game online by simply compiling the game in an HTML strated, the game will start by inquiring whether it is the first file and uploading it in a web server so that it can be time the child is playing or not. If it is the first time, then accessible through any device such as PC, tablet or even the player will start with the tutorial under the supervision of smart phones. This is for the fact that Blend4Web has a an instructor. Tutorial is designed to make the user become built-in webplayer utility that is automatically added to comfortable with the game environment and the game flow. the HTML file of the game when compiled. Although It also helps eliminating the training effect. At the end of the Blend4Web is still new and has a lot of limitations, the tutorial, if the performance of the child is not satisfactory, two most important challenges we faced were as follows: then the instructor will repeat the same or another tutorial. As – No switching between scenes. We overcame this by soon as the child achieves a sufficient performance, the child simply making a separate HTML file for each level will start playing independently. Diagnosis will be based on or scene and by having a button that can re-direct the the first time playing with each origami tutorial. On the other user to other scenes through URL redirection. Our hand, treatment will be based on the progress of the child game is stable in the sense that changing a level or playing the game independently. In tutorial, T-shirt origami is adding more levels is just appending the new level’s set along with the instructions of how to play and navigate HTML file to the webserver and link it to the game. through the game. For diagnosis, we decided to have Basic This gives an opportunity for any modeler to expand House, Sailboat and Duck origami shapes. On the other hand, the game with ease. for treatment we selected Heart, Windmill and Plane origami – Selecting just one animation type. We were limited to shapes. choose only one animation type to export to HTML, either “Shape Keys” or “Vertex Animation”. If we Start pick one of those then we cannot use “Modifiers” Play with the object animation of which we are to export. Tutorial Yes again Mainly we used Vertex Animation with armatures with the Yes First ? teacher time? and bones, yet for one shape we used Lattice modi- fiers which were significantly better in look but not END applicable for most of the origami shapes and require Performance Yes much more space. Treatment No Assessment No Assessment • Although using other game engines such as Unity [25] might be a first choice for many developers due to the power and speed of codes over logic trees and node edi- Is tors of Blender, designing paper-like objects and animat- Yes performance Select Shape Play ing them are relatively harder. Designing the objects on satisfactory? Blender and exporting them to Unity, though will allow us to utilize Blender more efficiently without the limitations of Blend4Web, proved to create many problems in having Fig. 2. The flow chart illustrating the game design. animations and “rigids” working properly. Since the game must be played by children at home, we To make the shapes for the Origami, we came up with two decided to make it very portable; i.e., accessible on laptops, approaches, described next: smartphones and tablets, running on any operating system. We also decided to use 3D graphics in order to give the game A. 1st Approach: Rigid Folding Using Armatures and Bones a realistic feeling. To meet these requirements, we need a 1) Pre-modelling Phase: First, we do the origami on a platform that supports 3D on various operating systems. For normal plain paper. We determine and highlight each folded that, we chose WebGL which supports 3D and runs on any edge in the paper (See Figure 3). Later, we identify the vertices web browser [33]. This makes our game very accessible. in the highlighted scheme of the folded paper. To generate the required 3D scenes and animations, we 2) Modelling Phase: In editor mode, we design our plane chose Blender [23]. There are three reasons we preferred object just as the scheme drawn on the paper (edges-vertices). Blender and found it a perfect platform for our game; not That also includes calculating the angles between the folded back plane objects.

Blend4Web introduced some problems with changing the textures dynamically throughout the animation, so we use Blender Cycles to change the textures how we desire and save them as new textures in image format, just like original ones. We duplicate the planes and map each of them with the textures we want to be shown with. Now once the plane is folded, we merely show the plane that has a line on the edge the plane was folded across, which is the texture we already prepared, and hide all other duplications of that plane. B. 2nd Approach: Lattice and Subdivision Surface Modifiers In order to make folding animation more realistic, we used a 2-dimentional lattice modifier. Although Blend4Web does not Fig. 3. Identifying the folded edges of the paper (in the origami shape) and designing the plane object (in Edit mode) accordingly. allow exporting “Modifiers” and “Vertex Animations” together for the same object, we animated (i.e. translated the position of) the lattice itself towards the plane with such angles that parts and the lengths of the edges in order to draw the scheme it would “fold” the paper as desired. While bones are joints accurately in the Blender grid space. To turn the plane into a to which certain vertices are attached (see Figure 5), we used paper-like object, we carried out the following procedure: Subdivision Surface modifier with the Lattice modifier and hence the paper is folded in a more realistic way (see Figure 6). • Add bones at specified edges. By animating the size parameters of the lattice, we could make • Add weights to the vertices that are to be moved by the the folding animation yet more realistic. Although, compared attached bones; see Figure 4. to the first approach using Bones, this approach looks better, • Overlapping weights of vertices distort the animation, so it has two limitations: we separate them by simply separating the armature of each group of bones. i) It requires more space since on average we need a lattice object for each two folds. The final HTML file of one shape is about 20 Mega Bytes which is not small. ii) More importantly, most of the shapes are not applicable with this approach as they have overlapping folds that cannot be modeled using lattice modifiers (see Figure 7).

IV. IMPLEMENTATION To implement the necessary animations for the Origami, we use Blend4Web logic node-editor. For that, we make two variables; current state and previous state. By only adding forward (green) arrow and back (red) arrow and bending the event of clicking at them to switching between the states and update the state variables. Updating the state variables, the user can fully control the scene timeline and play the origami animation step by step, forward or backward. With Blend4Web webplayer utility, the user can rotate and move the object in 3D space to get the perfect visuals of each step from any angle wanted. Switching between states is done via playing the timeline from current state to a new or next state and then updating the Fig. 4. Weights defined with vertex group that is linked to a bone. current state and previous state. The state variables are integers referring to instances in the timeline. Lastly, the “PLAY” We start adding the animations by rotating the bones/bone- Button is for playing the whole timeline, which is used in groups and setting frames. We duplicate the plane and attach the test (See Figure 11). all objects and animations. Later, we flip the direction of a) Solenoid Algorithm and Right Hand Rule: Since the duplication to give us mobility to render the paper we are using Blend4Web, we cannot work with Blender with two sides. Additionally, using different armatures for Game Engine (BGE) Logic editor; however Blend4Web different plane objects proved to create texture-mapping bugs. B4WLogicNodeTree has sufficient tools to build up the logic Furthermore, we add paper-like textures to the face and the tree of the game. Influenced by the right-hand rule in deciding Fig. 7. Lattice modifiers cannot handle overlapping folds. Fig. 5. Rigid folding using bones - 1st approach

logic blocks. b) “Reset Camera” Button: In case the user has diffi- culties navigating through the scene or getting away from the origami object, instead of adding constraints to the navigation within the scene, we added a “reset camera” button which whenever clicked shall reset the camera to the default position and thus allowing the user to navigate as desired, following the animation from any view angle and distance while having a default position to which the user can be returned with a single click (see Figure 11). Figure 8 is an illustration of an example game and its various stages. It shows a sequence of Origami folds in the game.

V. FUTURE WORK For the next step of our research, we intend to perform experiments to measure the effectiveness of our game in diagnosing and in improving VSM skills. To test our game, Fig. 6. Realistic folding using lattice modifier - 2nd approach we intend to have two different groups. One group will play Memori and the other will be using Know Cube for a certain time period. After that, the groups will exchange the games. the direction of the flow of electric current, the logic tree also Throughout the procedure, we will continue measuring the looks exactly the same: the thumb points in the direction of performance of the child and observe the progress. Based on the animation flow as shown in Figures 9 and 10. When Next the feedback acquired from the tests on different study groups, (green arrow) button is clicked, the animation flows according if needed, we can modify the games. Moreover, we plan to to the logic tree grouped in NEXT frame, which uses current as personalize the game by including user profiles and improve state determiner, and the same procedure is applied for BACK the engagement by adding gamification elements. (red arrow) button. The red arrows in the figures do not refer to Currently, the game comprises five origamis, one of them is the flow of the code execution, they are just for understanding the tutorial and the rest are ordered in an increasing difficulty how state variables (current, previous) change dynamically level. Child will perform the tutorial origami on the electronic with each click on Next or Back buttons. The thumb up/down platform with the help of the instructor so that the child can cannot be understood correctly without considering the other get used to the game flow and does not face complications. Fig. 8. A heart shaped origami example running in Memori

After that, the child will start playing independently. The instructor will note down the following data for each origami: the number of consecutive folds that the child successfully reaches; how many times the child hits the re-play, back and next button, time durations for each interaction with the game, demographic information about the child (age, gender, physical impairments, siblings, siblings with disabilities, etc). Based on the data gathered, we will measure the performance of the child. On the other hand, with the same data features, we will collect another dataset by applying ITPA and KCIT which actually diagnose the children with VSMD. Based on this data, which we consider to be the Gold standard, we will create our classification model which will then be used to diagnose the players of Memori. For treatment, we intend to have two different groups. One group will play Memori and Fig. 9. Logic Block for button “Back”: the state determiner is pre. the other will be using Knox Cube for a certain time period. After that, the groups will exchange the games. Throughout the procedure, we will continue measuring the performance of Blend4Web team who were very responsive regarding any the child and observe the progress. bugs found in their plugin. This study is developed under the grant from European Project “Intelligent Serious games for VI.CONCLUSION Social and Cognitive Competence”. For further information In this paper, we proposed the serious game called Memori please visit www.isg4competence.com to identify children with VSMD. The game can serve patients for diagnosis and treatment, in addition to their clinical treat- REFERENCES ment. Furthermore, because the game is developed on WebGL, its accesibility and simplicity is quite high. [1] D. C. Giles, and C. D. 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