The 7th IEEE International Conference on E-Health and Bioengineering - EHB 2019

Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania, November 21-23, 2019

Innovative Method for Visual Acuity and Memory

Functions Evaluation and Recovery due to “Serious”
Games on Tablet and Smart Phone Gadgets
Barbu Cristian Braun
Transilvania University Brasov, Romania
braun@unitbv.ro

Abstract—The paper highlights the development and testing
of a new unconventional method with applications in the
screening and training of visual function and memory for scholar
and preschool children. This consists in the development and
testing of “serious” games for tablet-type gadgets, at the base of
which stand the programming of graphical software interfaces,
this being the main issue in the research activity. The test sets
obtained after programming as graphical interfaces compatible
with the tablet-type gadgets were applied in the case of 20
preschool children, one of them having problems in solving the
tests. Another important aspect of the research focused on testing
the efficiency of "serious" games, as a training method for visual
recovery for the children which had problems in solving the tests.
Keywords—visual function, memory, games, recovery
Unconventional methods invoke the examination in a
relaxing environment. These methods do not 100% guarantee
the objectivity of the results, but it is much more attractive for
children and, for this reason, in recent years in many situations
these are preferred [2], [7]. Generally it is recommended that
the games to be varied, progressive, stimulating, to present
different colors, graphical interfaces, or even sounds.
Regarding the aspect of stimulation of the child, it can be
rewarded gradually and in different ways, depending on the
degree of resolution and the level of difficulty of the tests [8].
It is recommended that unconventional methods to be
applied together with classical methods (for a short period of
time) being used both for screening (to detect any visual
problems) and also for visual recovery training [9], [10].

I. THE IMPORTANCE OF MONITORING THE VISUAL FUNCTION
IN CHILDREN
Visual system developing for children is very important
one due to the fact that at this age many vision impairments
can still be corrected. As a result, from preschool age, the
visual function must be very carefully evaluated and
monitored. It is known that up to age of 14 years, the eyes and
visual function are continuously developing and only then
hyperopia is completely resolved [1], [2].
Among the main problems related to the development of
visual function in children they can be mentioned: amblyopia,
strabismus, hyperopia, Nistagmus etc. The early detection of
such problems has proved to be extremely important, so that
through visual training activities, in many cases it was
possible to improve and even partially or totally recover the
visual function in children. In order to detect problems in the
visual function in children, both conventional and
unconventional methods are used [3], [4].
Conventional methods invoke usually classical equipment
and apparatus, connected or not with IT devices (e.g.
ambliofor, sinoptofor, auto-refractometer). These methods
have the advantage of being safe, certified and objective, but it
have the great disadvantage that children often get bored
quickly, become impatient, lose their concentration relatively
quickly and become difficult to examine [5], [6].
II. PROPOSED METHOD DESCRIPTION
The main novelty aspects in this research refer to a
strategy developing through which objective procedures to
investigate the visual and memory functions in children are in
an efficient way applied within “serious” games for modern
devices like smart-phone or tablet [11]. The proposed solution
is very attractive one for children, knowing that nowadays
these are more and more attracted by games on smart-phone or
tablet, being totally motivated to solve different and
progressive gaming – tests, through which their response
capacity is efficient evaluated. Compared to the current
solutions, by which the visual function evaluation in children
can be done using different classical games (Heidi, LEA,
Dina-vision tests etc.) the proposed solution have as main
innovative aspect the fact that the designed, programmed and
tested software interface allows an efficient and total objective
evaluation within visual screening activities. Moreover, this
aspect is also valid in case of recovery training procedures
related to visual and memory function or to hand-eye
coordination improvement, for children with certain
deficiencies of this type [11].
A. Tests presentation
As “serious” games, it were developed three software
testing interfaces, with different colors and animations, in the
form of games on the tablet or laptop, as attractive to children.

978-1-7281-2603-6/19/$31.00 ©2019 IEEE

In fact, each software interface represents a set of tests,
meaning three progressive degrees of difficulty.
The software interface designing, necessary for assisted
evaluation, being flexible one means a novelty aspect, being
first of all about that such an assisted methodology could be
successfully applied for different age children, with different
diseases. Besides, it could ensure screening investigation and
also recovery training procedures. Due to interface
architecture and by programming the used algorithms for
automatic results determining concerning the evaluation due to
the tests solving, the proposed solution comes to the aid of the
targeted children, as well as the help of the examiner.
All tests are focused on visual acuity, visual memory and
hand – eyes coordination.
In the first set of tests the child is asked to turn off 20
circular buttons, in ascending order in number and size, when
they light up during running. The response to the stimuli must
be done progressively, one by one and at a rate imposed
during the running of the game. The background color
alternates dynamically from light gray to white and in the
center of the screen there is a rectangular shaped blue
stimulus. The buttons are initially turned off (gray on red
background) and their turning on implies changing their
background from red to yellow. Manual turning off validation
is proven by a yellow illumination of each turned off button
(figure 1). In function of the response (number of proper
manual turned off buttons) a score is automatically generated.
Fig. 1. Software interface presentation corresponding for the 1st set of tests
This test set contains 3 degrees of difficulty: the 1st degree
meaning low difficulty, invokes 3 times turning on of the
stimuli with long exposure (3 seconds). In this case the
response time for turning off the stimuli is the highest, and for
its reproduction order it does not involve memorization,
because the turning on sequence is repeated. The 2nd degree
(normal difficulty) means 2 times turning on of the buttons
with shorter duration exposure (2 seconds) and the last degree
(high difficulty) invokes only once the turning on the stimuli
sequence. Also the exposure time is the shortest (1 second). In
this case the memorization of the buttons turning order is
necessary, due to the fact that the sequence is no longer
repeated during the test running.
The second set of tests differs from the first by the fact that
during its running, dynamic colored strips appear differently in
the background, and the order of the buttons is also modified.
In this case, the color of the buttons is also gray on the red
background, but when turning on, the background is colored
green. The manual turning off validation implies the coloring
in green of the buttons. Score according and difficulty level
are similar with the other sets of tests.
The last set of test differs from the first two set of tests by
the fact that, in this case, the child has to turn off the
highlighted stimuli in descending order numeric and size
standpoint.
B. Software interfaces description
In this paper there is presented the way in which the
software interface corresponding to the 1st set of tests was
programmed and tested.
In order to create the option by which the user can choose
the degree of difficulty of the test, a selective text type entity
was defined, addressing a structure of type Switch - Case,
containing 3 iterations, specific to each degree of difficulty, in
part. Such of Switch – Case structure was also used in order to
create the possibility of the user to select the age category of
the tested child, this considerably increases the degree of
flexibility of the test sets. Three ages categories were
envisaged (between 5 and 7 years, 7 to 9 years and 9 to 12
years). Depending on the categories of the selected age, within
the specific structure, time constants with different values
were defined, these establishing the exposure times of the
stimuli turning on, during the test running. For instance, if the
difficulty degree is medium, for the 1st age category the time
constant was set to 3000 (3 seconds), for the 2nd category it
was defined to 2000 (2 seconds) and for the last category it
was 1000 (1 second) (figure 2). The similar algorithm was
programmed also in case of low and high difficulty levels.
To inform the test subject or the examiner (if the tested
person is less than 8 years old) 2 dialog boxes have been
defined with the role of displaying the message specifying the
task to be performed within the test.
Fig. 2. Exemplifying a programming subroutine specific to the 2 entities
regarding the choice of difficulty degree and age category
These were programmed to show the message at a certain
time after the test is started, due to a condition related to the
index of iteration that determine the testing running via a
While – Loop condition structure. Accomplishing the
condition for displaying messages was conditioned through a
Boolean structure. To display the messages in both dialog
boxes two strings were defined, containing the necessary text
messages (figure 1). The first message (regarding the
numerical reproduction of the igniting stimuli) is addressed to
children over the age of 7 years, while the second message
((regarding the reproduction as an order of magnitude of the
igniting stimuli) is addressed to children under 7 years.
The 20 buttons as stimuli each was designed as a pair of
two Boolean entities, one of control type (manual switching),
the other of indicator type (automatic switching) as shown in
figure 3. The logical states specific to each Boolean entity
have been converted to a binary code, the numerical values
being subsequently concatenated into a 1-D matrix. Based on
this you can identify which buttons were turned on and which
was the order of their manual turning off (as response) during
the test. Starting from this algorithm, two entities string type
were programmed to reproduce both the correct order, in
which the buttons were turned on, and the order in which the
subject turned off the stimuli.
Fig. 3. Programming routine addressing the Boolean entities composing all
stimuli buttons
On the interface running for a stage of testing, the subject
own or the examiner has to follow several steps, being user
friendly. In case of testing preschool children, completing the
first 3 steps requires the intervention of the examiner. Else
these steps can be complete by own tested person. The first
step is to choose the degree of difficulty. In case of screening
it is recommended to choose the intermediary level. For
training recovery activity, the testing it will mean the
progressive progression of the 3 degrees of difficulty. The
second step is to select the age category for testing
Once the first 2 stages have been completed, the test
messages are expected to appear in the text boxes, the
examining person transmitting to the child what he has to do
in that test. After that the tested person enters his role, having
to reproduce the buttons that were turned on in the order
specified in the test requirement (fig. 1). Finally, after
completing the test, the last step consists in displaying the
score awarded and interpreting the result by the examiner or
the specialized person (figure 4). Besides, a LED turns green
on if the solving degree is greater than 50% (the obtained
score is higher than 5.50), together with a positive message
(figure 4). Else another LED turns red with a negative
message together with a message recommending a eyes
specialist consultation (figure 4). The LEDs were related to a
Boolean structure, the obtained score being compared with the
minimum necessary score (5.50). Also two strings were
defined to inform about the test results via one of the two
dialog text.
Fig. 4. Example of obtained score after current test solving
For the programming of the algorithm through which the
final score is automatically generated due to each test solving,
some relationships were used in terms of partial scores
awarded:
n m
S = 1+  σ −  ε (1)
i j
i =1 j =1
where: S – final score / current test; n – number of steps
concerning the turned on stimulus during a testing cycle; m –
total number of positive errors that a subject that a subject can
do while testing; σi – partial score obtained referring to the
response for each turned on LED; εj – current
decommissioning for each positive error;
n
σi = (2)
q
where q – number of turned on stimulus during testing;
N −q
εi = (3)
n
In case of entrainment for visual and memory function
recovery, for periodical testing sessions, the results
quantification means an average score (AS) for all tests for all
tests performed during the respective session. It can be
determined due to the equation (4).
p
S k
AS = k =1
(4)
p
where: Sk – obtained score for each testing cycle; p – number
of tests for one recovery session (p >= 3).
For programming, all presented equations have been used
as algorithms for automatic determining of the scores related
to subjects’ responses during testing.
III. RESULTS
The method was applied for 20 pre-school children aged
between 5 and 7 years. Two of the three children solved the 3
sets of tests in an average proportion of over 50%, obtaining
the final score over 5.50, while the third child solved the sets
of tests in a smaller proportion. The scores obtained for the all
children in the 3 tests are presented in the table below
TABLE I. OBTAINED SCORES FOR THE THREE TESTS BY THE CHILDREN TABLE II. OBTAINED AVERAGED SCORES BY THE CHILD WITH
AMPLIOPIC EYE AFTER THREE MONTHS OF RECOVERY TRAINING
Test sets
Evaluated child 1st test 2nd test 3rd test Difficulty level
st Test intermediary
1 child 6.53 6.91 6.53 number low difficulty high difficulty
2nd child 6.77 7.06 6.77 difficulty
st
3rd child 4.13 5.4 5.11 1 test 6.83 6.12 5.41
4th child 8.03 7.82 7.75 2nd test 7.33 6.55 5.56
5th child 7.27 7.00 7.27 3rd test 7.13 6.88 5.71
6th child 7.00 6.73 8.09
7th child 6.73 7.27 7.27 IV. CONCLUSION
8th child 8.91 8.64 9.18 Due to the improved results after 3 months of training for
9th child 9.73 9.45 9.45 concerned child, it has been proven that such unconventional
10th child 7.82 7.27 7.54 methods, could be successfully applied, especially to
11th child 9.18 8.36 8.09 preschool children. As a result, these sets of “serious” games
12th child 5.63 6.18 6.45 for tablet, are intended to be implemented on a larger scale, in
13th child 8.64 8.64 8.36
kindergartens and schools, primary cycle. These could be used
14th child 5.09 5.09 4.54
15th child 10 10 8.91
by caregivers, optometrists, teachers for visual screening and
16th child 6.73 5.64 5.64
training recovery activities.
17th child 7.27 7.00 6.73
18th child 8.09 7.54 8.09 ACKNOWLEDGMENT
19th child 6.73 7.00 6.45
20th child 8.64 8.91 8.36
This case study of the research was possible within the
framework of the completion of diploma projects at the
Due to the numeric score obtained for all tested subjects, a specialization of Optometry, between 2018 and 2019.
variation diagram could be generated as shown in figure 5.
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