Wheelchair-Based Game Design for Older Adults
Kathrin M. Gerling, Regan L. Mandryk, Michael R. Kalyn · 2013 · Proceedings of the 15th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS) · doi:10.1145/2513383.2513436
Summary
This paper addresses the design of motion-based video games that are accessible to institutionalized older adults using wheelchairs. More than half of Canadians over 65 in residential care use wheelchairs, and wheelchair use severely limits opportunities for physical activity and leisure, putting users at risk of sedentary death syndrome. The research presents KINECTWheels, a toolkit built on the Microsoft Kinect SDK that recognizes both wheelchair movements (forward, backward, turn left, turn right) and upper body gestures (clap hands, raise arms, lift legs), enabling developers to integrate wheelchair-based input into motion-based games. The paper reports two studies. Study One evaluated the technical feasibility of KINECTWheels with 12 younger participants (average age 25.67) using a gesture analysis tool, measuring recognition rates, completion times, and cognitive/physical load via NASA-TLX and ISO 9241-9 questionnaires. Study Two evaluated Cupcake Heaven, a wheelchair-based game designed specifically for older adults, with eight older adult wheelchair users (average age 75) at a senior living centre in Saskatoon, Canada. In Cupcake Heaven, players move their wheelchair forward and backward to collect candy while avoiding vegetables, lift their arm to pass items to a character, and clap to discard unwanted items.
Key findings
In Study One, the overall gesture recognition rate was 85.9%, with wheelchair-based gestures (93.4%) achieving significantly higher recognition than body-based gestures (78.5%). Wheelchair movements forward and backward achieved 100% recognition. Gestures took approximately 2.5 seconds to complete, and wheelchair-based input was perceived as more physically demanding but equally comfortable and more fun than body-based input. In Study Two with older adults, all participants were able to interact with Cupcake Heaven successfully. Participants reported positive experiences, describing the game as "fun" and "mentally and physically stimulating." Critically, one participant noted the game helped him see the wheelchair "in a different light" — as something usable for more than just sitting. The game produced a medium level of physical demand, and while the ISO questionnaire showed low fatigue, researchers observed participants becoming visibly tired, suggesting wheelchair-based games can provide needed physical exertion. Large differences in wheelchair control ability and game comprehension among participants highlighted the challenge of designing for heterogeneous audiences even within the same care facility. Some participants struggled with coordinating simultaneous movements and following multiple on-screen events.
Relevance
This research reframes the wheelchair from a restrictive device into an enabling technology for play and physical activity — a powerful conceptual shift for both game design and rehabilitation. For accessibility practitioners, the work demonstrates that motion-based games can be made wheelchair-accessible using commercially available hardware (Kinect), without requiring custom-built equipment. The design guidelines are broadly applicable: easy gesture recall through natural mappings, adapting to player range of motion, managing exertion levels, and age-inclusive design that accounts for novice wheelchair users. The study also identifies two compelling applications beyond entertainment: wheelchair training for older adults who are newly using wheelchairs (games could build navigation skills more engagingly than traditional therapy), and empathy-building games for able-bodied people to experience wheelchair-based challenges. The finding that even residents in the same care unit have vastly different abilities underscores the importance of adaptive difficulty and pacing in accessible game design.
Tags: game accessibility · wheelchair · older adults · motion-based games · Kinect · physical activity · assistive technology · aging
Standards referenced: ISO 9241-9