Design and Evaluation of a Networked Game to Support Social Connection of Youth with Cerebral Palsy
Hamilton A. Hernandez, Mallory Ketcheson, Adrian Schneider, Zi Ye, Darcy Fehlings, Lauren Switzer, Virginia Wright, Shelly K. Bursick, Chad Richards, T.C. Nicholas Graham · 2014 · ASSETS '14: Proceedings of the 16th International ACM SIGACCESS Conference on Computers & Accessibility · doi:10.1145/2661334.2661370
Summary
This paper presents Liberi, a networked video game custom-designed to foster social interaction among youth with cerebral palsy (CP). Youth with CP—particularly those classified at GMFCS level III who require mobility aids—experience social isolation due to mobility limitations and reduced opportunities for peer interaction. Liberi is a cycling-based game played using a stationary recumbent bicycle designed for people with physical disabilities, combined with a joystick and single-button game controller. The game features a persistent virtual world with a central plaza and six mini-games spanning cooperative, competitive, and team-based play styles. The design follows three high-level principles: frictionless group formation (automatic grouping, always-on voice chat, avatar presence indicators, easily joinable activities), dynamic balancing for player ability (uniform avatar speed regardless of pedaling cadence, group goals instead of individual goals, dynamic difficulty adjustment), and support for varied play styles. The game was developed using a participatory design approach with youth with CP over seven design sessions.
Key findings
A ten-week home-based study with ten participants (ages 12-18, seven with spastic diplegia and three with spastic triplegia) demonstrated that Liberi was highly effective at fostering social interaction. Players spent an average of 69% of their time playing with others when others were available, and sessions were approximately 13 minutes longer when other players were online (50.2 vs 37.1 minutes, p<0.01). Players grouped inclusively with whoever was online rather than forming exclusive cliques. Voice chat proved essential—players used it to coordinate gameplay, negotiate which games to play, coach each other, and socialize about topics beyond the game. Social exchanges extended beyond gameplay to discussions about school, friends, and weather. Cooperative games were strongly preferred (seven of ten participants), with Wiskin Defence being the most popular. However, dynamic difficulty adjustment posed challenges: when a less-able player joined, increased difficulty could make the game too hard for the group. One parent contacted the research team a month after the study, hoping to create an ongoing gaming community for the participants.
Relevance
This research demonstrates that carefully designed networked games can serve as meaningful social platforms for youth with motor disabilities, addressing the significant problem of social isolation. For game designers, the three design principles—frictionless grouping, ability balancing, and play style variety—provide a practical framework for creating accessible multiplayer experiences. The finding that dynamic difficulty adjustment can backfire when players have different ability levels is an important cautionary lesson: scaling difficulty based on player count without considering individual abilities can inadvertently exclude the very players the game is designed to include. The study also shows the value of always-on voice communication over opt-in systems, as it removes barriers to social interaction. For accessibility practitioners more broadly, this work highlights that accessible technology design should address social participation and community building, not just functional access.
Tags: cerebral palsy · game accessibility · social interaction · motor impairments · inclusive design · exergaming · participatory design · youth