Behind the scenes: how does Active Cues develop their games?
Active Cues develops games for people with a cognitive disability, such as people with learning difficulties, dementia or autism-spectrum disorder. The games are developed using the co-design method: together with the target group. What does that process look like and what makes a game a Tovertafel game? User-centered designer Judith and game developer Rajiv tell us more about game development.
How does a game idea emerge?
Judith: “The inspiration for a new game can come from different directions: research of students on a work placement, feedback from people in practice, or from wishes from a target group. 'Something with photos' was one such idea, suitable both for people with dementia as for people with learning difficulties.”
The Nostalgia Puzzle game emerged from a desire for a game with photos combined with a wish to do something with a nostalgic activity like puzzling for people with dementia. Judith: "In a care home, I once worked on a puzzle for children with an elderly man with dementia. That was quite a struggle. The puzzle had a childish image but still proved too difficult for him. He simply lacked the ability to place a piece of the puzzle in the right position. But the social aspect of the activity and the connection to times past still brought him immense pleasure."
How do you then turn such an idea into a new game?
Rajiv: “Together with our visual designer we consider how we can mould those ideas into a game. That takes some real effort. Research, as well as observations, has taught us that people with dementia have fewer game experiences to enjoy as the disease progresses. A ten-year-old boy may, for instance, enjoy being able to reach higher levels. Someone with late stage dementia doesn't enjoy that at all; they appreciate relaxation and reminiscing. People with learning difficulties favour completely different game experiences.”
How are those game experiences expressed in the Tovertafel games?
Rajiv: “To stay with the Nostalgia Puzzle for a moment, we remove the elements that result in frustration, such as having to carefully place a puzzle piece, and use only those elements that result in moments of happiness. For people with dementia, we place emphasis on a sense of wonder and the experiential instead of the challenge. We try, in a sense, to make a game that reads the players' minds and automatically does what the players expect. We focus on success."
Judith: "When our game developers have come up with a first prototype, we take it out into the field to one of our co-design locations to test it. Our game developers frequently join us on these outings to keep in close contact with our target group. Such a game test often unfolds in a way no one would have expected."
Do many ideas end up in the bin?
Rajiv: “About 7 out of every 10 ideas ultimately won't end up on the Tovertafel. A game may prove to be too difficult for the players or fails to keep them focussed. Several locations, for instance, suggested the idea of 'peeling' potatoes. This game ended up creating fewer moments of happiness than we and the care workers had anticipated. One elderly lady with dementia cried out in exasperation: "I've got plenty of potatoes to peel at home." That means the end for that game. But it might re-emerge in a different form.”
Judith: “We observe our target group as objective as possible while they are playing the new game. But our observations alone are not enough. That is why we always evaluate the games with care workers and play therapists: they know their residents, clients, or children best.”
When is a game truly finished?
Rajiv: “The Nostalgia puzzle game was a favourite from the start. But only when we and care experts see that the game achieves its aim is it made available. Does it help people with dementia to relax? Does it foster social interaction between people with learning difficulties? Does it help children with autism spectrum disorder to learn social skills? These are the questions we continue to ask ourselves.”
Hester defends her PhD thesis on Tovertafel research
HESTER defends her PhD thesis on Tovertafel research
Delft University of Technology describes it as a “good example of how scientific research can lead to valuable care innovation in practice’. On Monday the 24th of April, Hester Anderiesen-Le Riche received her PhD title from this university after successfully defending her research on the Tovertafel: Playful design for Activation. Co-designing serious games for people with moderate to severe dementia to reduce apathy.
‘In care institutes, 90 percent of residents with dementia suffer from apathy. The goal of my PhD research was to reduce passivity in older people with dementia by developing a product that stimulates physical activity and social interaction. It had to be a playful product or game that would also contribute to older people’s enjoyment, says Hester.
These goals formed the basis of her PhD research, in which several studies were done to learn more about the target group and the context of their living conditions. Through multiple design steps, combined with scientific research, the so-called ‘research by design’, the final concept of the Active Cues Tovertafel was developed.
Hester: ‘The prototype of this serious game was used to do test with residents of care institutes and care personnel. And, in contrast to our expectations of what would be possible, the residents played a very interesting participatory role in the further development of the product.’
One care professional who was closely involved in the Tovertafel’s early development is Marja Dijkwel, a nurse at Careyn (homecare, nursing and care). ‘People here still play with the Tovertafel each and every day. The Tovertafel offers people with dementia the opportunity to get into contact with each other and move about. When I see how much fun our care workers and residents have with the Tovertafel, I am proud that based on my expertise, I could play a role in its development.’
Playing with light
‘What is essential for the interaction between the people with dementia and the projected light is that the games are intuitive and accurate’, says Hester. ‘Otherwise, people soon lose interest. Added to that is that all Tovertafel games are based on recognisable projections so that the interactions are familiar and to allow the residents to reminisce about experiences and personal stories from their past.'
The PhD thesis is finished, but the development of the Tovertafel games will go on. Together with the target group, Active Cues will keep on working on games that truly contribute to people's quality of life.
During November, we filmed our first Tovertafel video in the UK at Littlebourne House Residential Home near Canterbury in Kent. Littlebourne was also our first installation in the South East of England. The residents particularly enjoyed sweeping up the leaves during autumn.
“I think it’s lovely to see everyone around the table together interacting,” the activities coordinator, Kate Cooper, said. “The staff know how to use the Tovertafel. It’s very easy. It’s just wonderful. It really is.” Kate loved how it had become a part of Littlebourne’s day and saw the positive effects of the Tovertafel. When residents played with the Tovertafel in the morning, they were more alert for other activities during the afternoon.
We were lucky to be joined by a family member, Kay Barrett, who agreed with Kate: “The nicest thing about it is that the residents are all sitting around the table and everybody can have a go at it”. No matter who you are or where you come from, anyone can play with the Tovertafel.
The German city of Gronau, just across the border near Enschede, has a new sight to see; last week, the Bethesda-Seniorenzentrum received the first Tovertafel in all of Germany.
While closely watched by the German deliverers of moments of happiness, Markus and Henry, Netty (Active Cues' sales manager), care workers of the Seniorenzentrum, and local press, the Bethesda coffee table suddenly turned into an interactive field of flowers. Residents Bertha, Hannelore, Margot and Ernst were pleasantly surprised by how their table had seemed to come alive. A journalist of the Gronauer Nachrichten cites one resident: “Das ist ja schön”
Markus and Henry are Active Cues' German partners. Markus first saw the Tovertafel at Medica 2015. He was so inspired by the innovation that he was determined to bring the Tovertafel to the German market. Together with Henry, he has been spreading moments of happiness with the Tovertafel since late 2016. Henry: “We can't wait to create more moments of happiness with the Tovertafel in Germany.”
Why did Reinhard von Loh, director at Bethesda-Seniorenzentrum, have to have a Tovertafel? It doesn't take him long to answer: “Die Tovertafel ist einfach magisch.”
We installed our first Tovertafel outside of London at Margaret House in Royston, Hertfordshire. Margaret House is committed to staying at the forefront of best practice and innovation in relation to dementia care.
Thomas Kelly, the owner of Margaret House, said that he had never seen such innovation during his 30 years in care.
Margaret House were so happy with their Tovertafel that they spoke about it on BBC Radio. Their youngest player is 2 years old and the oldest is 102. They told us how the Tovertafel really engages the residents bringing not only joy and fun, but also physical exercise. The flowers, leaves and fish games are the most popular.
The Guardian newspaper attended a demonstration at Care UK’s Oak House care home in Slough, Berkshire. Juliet Rix, the journalist, and Julie Bignell, the care home manager, were taken by the effects of the Tovertafel on the residents.