Serious Game-Based Training for Improved Control of a Temporalis Electromyography Interface for Controlling Powered Wheelchairs

<b><i>Background:</i></b> Amyotrophic lateral sclerosis (ALS) is characterized by a significant decrease in mobility due to its neurodegenerative etiology. Throughout the progression of ALS, patients lose independence in their motor control. An electromyography (EMG) interface that enables control of a powered wheelchair can restore autonomous movement. The use of serious game-based training that mimics EMG-temporalis wheelchair controls can be used as training prior to wheelchair usage in the real world. <b><i>Purpose:</i></b> <i>Limbitless Runner</i>, a forearm EMG training game, found improved player performance with no significant difference noted between the free and structured play training. This study aims to investigate the generalizability of this finding when applied to a temporalis EMG system. <b><i>Methods:</i></b> Participants were given <i>Limbitless Runner's</i> quantifiable, structured training mode, the "ring challenge," for a scored pretest. Participants were then assigned to one of three cohorts for training: <i>Limbitless Journey, Limbitless Runner</i> "free play mode," or the <i>Limbitless Runner</i> "ring challenge." To assess improvement in user's performance, the ring challenge was repeated and scored. Quantitative surveys, including the Game User Experience Satisfaction Scale (GUESS) and the System Usability Scale (SUS), were given to gauge users' perceptions of the games. <b><i>Results:</i></b> All cohorts showed a user score improvement; however, the ring challenge (Cohort 2) showed the highest improvement, from an average of 22.9 rings in the pretest to 31.1 rings posttraining. The SUS and GUESS scores were not significantly different between the two different video games, demonstrating that both versions can be satisfying or acceptable platforms for users.