Percussion Hero: A Chest Physical Therapy Game for People with Cystic Fibrosis and their Caregivers Book Sadprasid Faculty of Computer Science, University of New Brunswick, Canada ksadpras@unb.ca Ethan Eddy Biomedical Engineering, University of New Brunswick, Canada eeddy@unb.ca Aaron Tabor HCI Lab, University of New Brunswick, Canada aaron.tabor@unb.ca Erik Scheme Department of Electrical and Computer Engineering, University of New Brunswick, Canada escheme@unb.ca Scott Bateman Faculty of Computer Science, University of New Brunswick, Canada scottb@unb.ca ABSTRACT Chest physical therapyÐincluding chest percussion, vibration, and postural drainageÐis an important part of cystic fbrosis (CF) treat- ment. Chest percussion and vibration are exercises that require coordinated efort between patient and caregiver, during which the caregiver performs manual, rhythmic blows to the patient’s chest and back. When practiced regularly alongside postural drainage techniques, percussion therapy mobilizes and removes fuid buildup in the lungs, reducing infammation and risks of infection that could lead to hospitalization. Despite the importance of chest physical therapy for those with CF, adherence is often low. Low adherence to at-home therapies is common to the treatment of many diseases, yet one distinct challenge of chest physical therapy is the caregiver interventionÐa role often assumed by a family member or loved one. The caregiver role is challenging for chest therapy because it is active, focused, and strenuous. While research has proposed many solutions for increasing patient engagement during simi- lar airway clearance exercises, the critical role of the caregiver has often been overlooked. In this paper, we present Percussion Hero, a cooperative, rhythm-based game designed to improve chest physical therapy adherence by actively targeting both patients and caregivers during therapeutic exercises. CCS CONCEPTS · Human-centered computing; · Human computer interac- tion; KEYWORDS Cystic fbrosis, chest physical therapy, caregivers, game design, serious game ACM Reference Format: Book Sadprasid, Ethan Eddy, Aaron Tabor, Erik Scheme, and Scott Bateman. 2021. Percussion Hero: A Chest Physical Therapy Game for People with Permission to make digital or hard copies of part or all of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for proft or commercial advantage and that copies bear this notice and the full citation on the frst page. Copyrights for third-party components of this work must be honored. For all other uses, contact the owner/author(s). CHI PLAY ’21, October 18–21, 2021, Virtual Event, Austria © 2021 Copyright held by the owner/author(s). ACM ISBN 978-1-4503-8356-1/21/10. https://doi.org/10.1145/3450337.3483508 Cystic Fibrosis and their Caregivers. In Extended Abstracts of the 2021 Annual Symposium on Computer-Human Interaction in Play (CHI PLAY ’21), October 18–21, 2021, Virtual Event, Austria. ACM, New York, NY, USA, 7 pages. https://doi.org/10.1145/3450337.3483508 1 INTRODUCTION Cystic fbrosis (CF) is a life-limiting condition that impacts quality of life for both patients and their caregivers. Normally diagnosed before the patient reaches the age of two, CF requires complex treat- ment regimens including chest physical therapy (CPT), a treatment comprised of percussion, vibration, and postural drainage exercises. These exercises are usually performed by the primary caregiver, a role often assumed by a family member or loved one [1]. When practiced routinely, CPT is an efective treatment that removes ex- cess sputum in the lungs, reducing the risks of airway obstructions, infection, infammation and permanent organ damage [11]. How- ever, despite these known benefts, adherence is a known concern with an adherence rate of 40-47% in at-home therapy [9, 24, 30]. Similar to many other at-home therapies, common barriers include lack of motivation, lack of time, discomfort and forgetfulness [17]. However, since CPT heavily relies on caregiver participation, ad- herence also sufers when the caregiver is unavailable or unwilling to participate. While games have been proposed as a tool to increase adherence to breathing and airway clearance therapies (e.g., [4, 7, 14, 29]), these existing games have focused exclusively on the patient, and on self-treatment. The critical role that caregivers play in the deliv- ery and efectiveness of coordinated exercises like CPT has been overlooked. With this signifcant role, treatment strategies and tools that consider the needs and challenges faced by caregivers, as well as the patient, have been suggested to improve adherence [1]. In this paper, we present Percussion Hero, a rhythm-based CPT game designed to engage both patients and their caregivers. In Percussion Hero, patients and their caregivers form a łmusical duož on a quest to restore music and freedom throughout their galaxy by playing rock concerts to the currently oppressed inhabitants. The gameplay specifcally targets the three core components of CPT (i.e., percussion, vibration, and postural drainage exercises), and is controlled using a custom stethoscope-based input controller to sense each therapeutic activity. The game incorporates these three exercises to create cooperative game mechanics that encourage 361