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  • Playful Tray: Adopting Ubicomp and Persuasive Techniques into Play-based Occupational Therapy for Reducing Poor Eating Behavior in Young Children

    UBICOMP 2007

    Dori Lin, Hao Chu, Arthur Chen, Jane Hsu, Polly HuangGraduate Institute of Networking and MultimediaNational Taiwan University

    Jin-Ling Lo, His-Chin ChouNational Taiwan University Hospital

  • Child Behavior TrainingChild behavior training as important but challenging parental responsibilityPotty training, tooth brushing, self-dressing, cleaning room, slow eating (focus of this work)The most common form of parental persuasion is verbal persuasion.if you dont finish your food, you are going to sit here for the rest of your life.Effective and Why not?Verbal persuasion alone lacks proper incentive to motivate child

  • A Case Study: Child Mealtime BehaviorTarget child long mealtime problem (over 30 minutes)Affect the participation of daily activitiesNegative parent-child interactionDinner time supposed to be valuable family time togetherCommon scenario: A child refuses to eat -> Mother upset -> Mother force feed -> Child upset

  • Play-based Occupational TherapyPediatric occupational therapy (O.T.)Leverage the desire of children to play to induce their behavior change willingly. A child may not like to sit & eat dinner, but likes to play.Add playfulness (game) into the eating activityEffective full of toys in pediatric O.T. clinic.

  • Play-Based O.T. Limitations(1) Children treated in clinics during regular office hours (NTU Hospital)Many child behavior problems not observable to therapistsEating (dinner time), sleeping (night time), etc.Effective treatment is difficult.(2) Train general performance skill rather than specific functional skillHand scoping skill vs. eating skillImprovement in general performance skills may not translate into specific functional skills

  • UBICOMP OpportunitiesEmbed digital technology into a child naturalistic living environmentSensing to observe child behavior anytime, anywhereGame playing to influence child behavior anytime, anywhereOccupational therapist perspective: From treatment clinicTo the child actual living environment (functional behaviors)UBICOMP perspective:From sense and track behaviors To engage children to change behaviorsAlso called Persuasive technology (by Fogg and others)

  • Playful Tray Prototype 1: Coloring GameSensingWeight sensors underneath tray detect child eating actionsEating actions are game inputPlayingAn interactive game of coloring a cartoon characterTo fully color the cartoon character, a child is motivated to eat.

    Is this design successful?

  • Why not?Show prototype #1 to our pediatric O.T. partners, their feedbacks are two questions:

    Do you think the child would pay attention to playing the game or eating (enjoying) food?What would happen if parents take away the tray after a while?Intervention (Effective) Post (Ineffective)

    Guess their opinions from their questions

  • Play-based Occupational Therapy ModelTreatment program is about designing a play activity (three elements).

    VolitionPerformanceHabituationBring enough enjoyment to attract a child to participate in the target activity.Ensure a child will have a successful experience. Set appropriate level of difficulty.Apply reinforcement to reward good performance, so increase change of repeating desirable behavior. Enough times to become a habit.

  • Design Consideration Attention (Child)Split between playing and eatingGame playing (secondary) not overtaking eating (primary, target)Enjoyment (Game)Bring just enough fun to attract children to eatingEngagement (Game)Simple (Not all young children can learn to operate complex devices)Use natural eating actions as game inputs Child must eat to continue playing (eating becomes self-inforced)

  • Prototype 1: ProblemsDisengagementGrabbed too much attention & distract children from proper eating.GobblingImpatient children ate too quickly (to color cartoon character).Single weight cell is sufficientFood is served in one bowl to a young child (at home or school).

  • Prototype 2: Racing Game TrayFor placing the bowlWeight sensing surfacePalm-top PC with touch screen

  • The Racing Game

  • The Racing GameNo reward for eating too fast

  • Racing Game Tray: FeedbacksTray was too thick (3 cm)Inconvenience for young children with short armsPlaying the same game boringDownload new gamesExpensiveDifficult to wash

  • Placemate skinWeight sensing moduleMobile PhonePrototype 3: Mobile Penguin Fishing Tray50% Thinner (1.5 cm)Light, foldable, washable, changeableBluetooth mobile phone accessoryDownload new gamesOnly buy the skin & weight sensing model

  • Install weight sensing module

  • Child selects a penguin to compete in a fishing game.Game start

  • Each bite causes one penguin to get a fishThe penguin getting more fish at the end winsChild is motivate to help in order to help penguin to win. Game start

  • Pilot User Study on Prototype #2Conducted by our pediatric O.T. teamSubjects: four young children with reported long mealtime problems (30 min to over 1 hr)

  • User Study ProcedureChilds Mealtime Behavior ChecklistInterview - to clarify behavioral detailsRecord eating activities without the trayRecord eating activities with the tray within 1 week

  • Measurement methodCode behaviors of both children & parents from taped videosOur eating coding behavior table was modified from Moore.Self-feeding (Positive, Negative)Child active feeding or related behaviorsInteraction (Positive, Negative)Actively initiated behaviors and synchronous responsive behaviors of the feeding partnersSocialToward a feeding partner but unrelated to feeding

    Positive (promote self-feeding); Negative (interrupt self-feeding)

  • (1) Self-feeding: a child place food into his/her own mouthMotherChildPositive: A mother allows or promotes self-feeding, such as verbal encouragement, praises, etc.Positive: A child attempts self-feeding, such as holding utensils, putting food into mouth, etc.Negative: A mother discourages, disallows, or interrupts self-feeding, such as pushing the childs hands away, telling the child that she will feed the child, etc.Negative: A child rejects self-feeding, such as saying no or pushing away given food.(2) Interaction: Actively initiated behavior and the synchronous responsive behavior of the feeding partnerMother as the actorChilds responsive behaviorPositive: A mother attempts to arouse a childs interest, such as talking about food, models, food games, etc. A mother refocuses the childs attention on food when the child is distracted.Positive: A child accepts food when it is offered, or self-feeds food.Negative: A child ignores the mothers cue, refuses, or walks away from the mothers cue.Negative: A mother intrusively attempts to direct feeding, such as force-feeding the child, holding a childs head, body, or hand, and threatening the child.Positive: A child responds by self-feeding.Negative: A child ignores the mothers attempts, refuses, or walks away from the mothers attempts.Mothers responsive behaviorChild as the actorPositive: A mother synchronously responds to promote continuous feeding, such as interpreting a child feeding cues, responding to a childs needs, etc.Positive: A child initiates an attempt to eat, such as looking at food, talking about food, requesting food/drink, or touching food.Negative: A mother synchronously responds to interrupt the childs feeding.Positive: A mother synchronously responds to promote continuous feeding, such as interpreting the child feeding cues, responding to the childs needs, etc.Negative: A child shows disinterest, discouragement, or stops eating or chewing.Negative: A mother synchronously responds to interrupt the childs feeding.

  • Measurements (with vs. without the tray)Mealtime durationChild on-task / off-task behavior ratioParent on-task / off-task behavior ratio Parent positive / negative behavior ratio

  • Result: Mealtime Duration(A:23, B:40, C:41, D:25) -> (23, 25, 29, 9) Except for Child A, children B, C, D all had reduced mealtime from 29% ~ 64%.

    Chart2

    2323

    4025

    4129

    259

    without the tray

    with the tray

    Participants

    Mealtime duration (min)

    Mealtime duration

    Sheet1

    5288186199A1.45.92323

    80763741912B1.44.84025

    4079505628C0.72.44129

    403938216D1.72.8259

    0.00.0

    22431410199A0.72.3

    43302011912B1.12.3

    2725343628C0.70.8

    81020146D0.51.7

    Sheet1

    00

    00

    00

    00

    without the tray

    with the tray

    Children subjects

    Child's on-task/off-task behavior

    Child behavior

    Sheet2

    00

    00

    00

    00

    without the tray

    with the tray

    Children subjects

    Parent's on-task/off-task behavior

    Parent behavior

    Sheet3

    00

    00

    00

    00

    without the tray

    with the tray

    Participants

    Mealtime duration (min)

    Mealtime duration

  • Measurements (with vs. without the tray)Mealtime durationChild on-task / off-task behavior ratioOn-task behaviors: positive behaviorsOff-task behaviors: negative + social behaviorsHigh ratio is good. Parent on-task / off-task behavior ratio Parent positive / negative (P/N) behavior ratio

  • Improvement in all childrenChildren were more focused on self-feeding with the playful tray

    0.8~1.6

    2.3~5.9Child On-task/Off-task Behavior Ratio

    Chart9

    1.40540540545.8666666667

    1.42857142864.75

    0.71428571432.3939393939

    1.66666666672.7857142857

    without the tray

    with the tray

    Pa