# A Haptic-Driven Serious Game for Cognitive Stimulation and Visual Impairment Mitigation in Older Adults Based on the Design-Play-Experience Framework: Cross-Sectional Mixed Methods Pilot Study

## TL;DR

This study created a haptic-based serious game to improve cognitive skills and reduce visual strain in older adults with mild visual impairments.

## Contribution

The study introduces a reusable design blueprint for haptic-driven cognitive training tools using the DPE framework.

## Key findings

- The game prototype achieved excellent usability with an average SUS score of 89.5.
- Participants found haptic feedback intuitive and reported reduced eye strain.
- Simplified game mechanics were perceived as both fun and challenging.

## Abstract

In the context of global aging, cognitive decline among older adults has become a prevalent issue, significantly impacting their daily lives. Serious games have demonstrated potential in enhancing cognitive abilities in this population. However, most existing serious games designed for older adults rely heavily on visual interfaces, which are often potentially detrimental for those with pre-existing visual impairments.

This study had two primary objectives: (1) to design a theoretical prototype for a haptic-driven serious game for older adults based on the Design-Play-Experience (DPE) framework, aiming to enhance cognitive abilities, including attention, logical reasoning, and decision-making while simultaneously mitigating challenges associated with visual impairment, and (2) to conduct a pilot study evaluating the prototype’s usability, accessibility, and user experience within the target population.

We used a cross-sectional, mixed methods pilot study with a single-group observational design, comprising a theoretical design and a pilot user study. First, the DPE framework was systematically applied to develop a game prototype by integrating haptic feedback technology (using built-in smartphone vibration motors) across its 3 core dimensions: design (haptic symbol system, accessible interface), play (dynamic difficulty adjustment), and experience (emotional engagement). Subsequently, a pilot study was conducted with 10 older adults recruited via convenience sampling (mean age 62.9, SD 3.35 years; 5 male, 5 female; all with self-reported mild visual impairments, such as presbyopia). Following interaction with the prototype, data were collected remotely using the System Usability Scale (SUS) and semistructured interviews administered via videoconferencing. Quantitative data from the SUS were analyzed using descriptive statistics, while qualitative data from the interviews were processed using thematic analysis.

Pilot user studies showed that the game prototype had good usability, with an average SUS score of 89.5 (SD 2.72; 95% CI 87.6-91.4), which is considered “excellent.” Thematic analysis of the interviews revealed three significant themes. The first theme was intuitive haptic feedback, which reflected that participants were able to quickly grasp and value the vibrational cues used to identify cards. The second theme was based on reduced eye strain, in which the combination of large fonts, high-contrast interfaces, and haptic feedback was praised for its effectiveness in relieving eye strain. The third theme was simplicity, where the simplified card game mechanics were considered both fun and challenging.

This study developed and validated a haptic, serious game for older adults. Its innovation lies in the systematic application of the DPE framework to achieve “haptic substitution for vision,” which differs from previous research that focused on general immersive experiences. The main contribution of this study is providing a reusable design blueprint for creating easy-to-use cognitive training tools. These findings have practical implications in the real world, providing a feasible approach for deploying low visual load interventions in communities and care facilities.