Competitive Versus Cooperative Forms of Therapeutic Gaming With Subacute Stroke Patients

Background: Two player games have been suggested to be more motivating than single-player games when applied to neurorehabilitation. This work aimed to contrast cooperative and competitive forms of therapeutic gaming. Methods: An air hockey computer game was played by twenty dyads of subacute stroke patients who did not know each other beforehand. Using an arm-weight compensating exoskeleton robot, each dyad tested four modes: i) single-player competitive, ii) single-player cooperative, iii) two-player competitive, and iv) two-player cooperative. For each mode, the patients rated statements of the Intrinsic Motivation Inventory (IMI) subscales interest/enjoyment and effort/importance. Hand velocity was used to estimate the participants’ actual effort in the task. Results: Sixteen patients preferred one of the two two-player modes. On intrinsic motivation, no effect of two-player modes as opposed to single-player modes could be found. However, patients rated competitive modes more interesting (
$\text{p}=$
0.044) in the IMI and exercised in those modes with higher effort (p < 0.001) compared to cooperative modes. Conclusions: Two-player modes played by unfamiliar co-players are preferred by some of the subacute patients and were as motivating and intense as single-player modes, but no more. This result contrasts with other studies with familiar co-players where the two-player modes were found to be more motivating.