EEG-based Serious Games Design for Medical Applications

Qiang Wang, Olga Sourina, and Minh Khoa Nguyen

Nanyang Technological University
Singapore
e-mail: WANG0586 | EOSourina | RaymondKhoa@ntu.edu.sg


AbstractRecently, EEG-based technology has become more
popular in serious games designs and developments since
new wireless headsets that meet consumer demand for
wearability, price, portability and ease-of-use are coming to the
market. Originally, EEG-based technologies were used in
neurofeedback games and brain-computer interfaces. Now,
such technologies could be used in entertainment, e-learning
and new medical applications. In this paper, we review on
neurofeedback game designs and algorithms, and propose
design, algorithm, and implementation of new EEG-based 2D
and 3D concentration games. Possible future medical
applications of the games are discussed.
Keywords- EEG; game design; HCI; BCI; e-learning; medical
application; neurofeedback; fractal dimension
I. INTRODUCTION
Serious games usually have educational aims or health-
related aims besides entertainment. Generally, such games
could be classified as games for e-learning and medical
applications. Recently, EEG-based technology has become
more popular in serious games design and development
since new wireless headsets that meet consumer demand for
wearability, price, portability and ease-of-use are available in
the market.
Electroencephalogram (EEG) is a non-invasive technique
recording the electrical potential over the scalp which is
produced by the activities of brain cortex and reflects the
state of the brain [1]. Different from other mental state
interpreters, e.g. fMIR, EEG technique gives us an easy and
portable way to monitor brain activities with the help of
suitable signal processing and classification algorithms.
Three main EEG-related application fields have been
researched for several years: a) BCI applications that help
disabled people to communicate with machines [2-3]; b) BCI
applications for video games as game controllers [4]; and c)
Neurofeedback games [5]. With the development of wireless
EEG devices, expanding the EEG applications out of the lab
became possible.
In order to play EEG-based games, the user needs EEG
reading cap/electrodes and computer/playstation. The
software design consists of two main parts: signal processing
algorithms and visualization/game. In work [6], we proposed
to use fractal dimension (FD) model in neurofeedback
games.
In Section II A, review on EEG-based games for medical
application is given. In Section II B, signal processing
algorithms for EEG-based games are reviewed. In Section II
C, game engines for such games development are described.
Our game model, EEG processing algorithm and proposed
games design are given in Section III. An implementation of
the proposed 2D and 3D concentration games are discussed
in Section IV. In Section V, conclusion and future medical
applications of EEG-based games are discussed.
II. RELATED WORKS
A. Medical EEG-based Serious Games
Neurofeedback is the technique that presents the real-
time feedback to the user based on the EEG signals taken
from the scalp of the user in the form of video display and/or
sound [5]. Many researches reveal that the EEG and ERP
(Event Related Potential) distortion always accompany
psychological disorders such as Attention Deficit
Hyperactivity Disorder (ADHD) [7-8], Autistic spectrum
Disorders (ASD) [9-11], Substance Use Disorders (SUD)
including alcoholics and drug abuse [12-13], etc. Similar to
other parts of our body, the brain function can be trained as
well as the EEG can be rectified. Neurofeedback (NF) is an
alternative choice as a treatment to these disorders besides
the medical treatments.
Many neurofeedback games were assessed by the healing
effect of the ADHD, one of the most known psychological
disorders with significant EEG distortion. The / ratio
abnormal behavior was reported in [14]. Besides the ratio,
the distortion in slow cortical potential (SCP) was also
notified by [15]. Both the frequency neurofeedback training
and the SCP neurofeedback training can achieve a good
healing effect for ADHD [15].
ASD is a psychological disorder associated with
abnormalities of social interactions and communications as
well as serious restrictive interests and highly repeated
actions [9]. In work [15], EEG analysis during eye open and
resting condition was done for an eight-year-old girl with
ASD patterns [16]. The band and band of EEG signal act
abnormally, and the corresponding neurofeedback scheme
was designed to rectify abnormalities. After 21 sessions of
treatment, the patient enhanced the sustained attention and
decreased the ASD activities. Another research group also
pronounced an achievement in neurofeedback treatment with
standard Quantitative EEG (QEEG) protocol and aimed at
decreasing theta band power at the central and frontal brain
area [11]. Similar to ASD, General Anxiety Disorder (GAD)
with which the patient cannot stop worrying can cause
unacceptable social behaviors. GAD can also be treated with
EEG band suppression and symmetry training [17].
SUD including drug abuse or alcohol abuse always leads
to disasters in social behaviors. Neurofeedback could be an
2010 International Conference on Cyberworlds
978-0-7695-4215-7/10 $26.00 2010 IEEE
DOI 10.1109/CW.2010.56
270
affordable and considerable alternative treatment in SUD.
Chronic alcoholics showed significant diminution in band
of EEG signals. Corresponding neurofeedback treatment can
decrease the brain waves in these bands and showed an
effect of such alcoholic treatments [12]. For drug abuse,
decreased band power was also found as well as the excess
of fast beta band activities. In addition, a subject with drug
addiction has lower amplitude in P300 ERP component than
that of a controlled subject. The addiction can be relieved
with long term neurofeedback treatment [13].
Besides medical applications, neurofeedback can also
help a healthy person to enhance the brain functions.
Researchers indicated that cognitive performances, e.g. cued
recall performance, can be enhanced if a healthy person
learns to increase special components of EEG signals with
neurofeedback [18-19].
B. Algorithms
The signal processing algorithms used in BCI system
especially in neurofeedback systems can be generally
classified into two main methods, i.e. frequency analysis and
event related potential (ERP) analysis. Frequency training is
the most prevalent method in clinical applications together
with the QEEG protocol.
EEG signal can be divided into several different
frequency bands, i.e. band (<4Hz), band (4-7Hz), band
(8-12Hz), band (12-30 Hz) and band (>30 Hz). Specially,
the Sensorimotor rhythm activity (12 15 Hz) is also used in
several neurofeedback systems. Each frequency band is
related to different brain functions. Generally, band is
prevalent in infants EEG or EEG when the subject is
sleeping; band is prevalent in EEG when the subject feels
drowsiness; band is significant when the subject is relax;
band is associated with fast activities and band is related to
problem solving and memory work [20]. The power over
different bands were assessed and extracted from the patient
EEG signals and then compared to the QEEG database
(QEEG protocol) or statistical analysis was run to generate
the pathology and corresponding recovery protocols. The
frequency training method is the most prevalent method used
in the neurofeedback training systems and other EEG
applications because the frequency band power is easy to be
obtained and analyzed with the existing signal processing
tools.
ERP analysis is the process analyzing the EEG signal
synchronized with an event. Slow Cortical Potential (SCP)
and P300 are the important ERP approaches used in the
neurofeedback treatment. SCP reflects the changes in cortical
polarization, i.e. negative and positive trends, of EEG signals
which last from 300ms to several seconds after event
stimulus [21]. Abnormalities in SCP of ADHD patient were
studied in [15], and the corresponding neurofeedback
protocol could enhance the continuous performance. The
P300 component of ERP occurs during 300ms 600 ms after
event stimulus which is obtained by oddball paradigm in
which low-probability target items are inter-mixed with
high-probability non-target items. Researches indicated that
the amplitude of P300 component is related to the process of
allocation of attention resources and its latency reflects the
stimulus evaluation and classification time. The pathology of
P300 component in drug abuse patients was reported in [13],
and neurofeedback based on P300 component training was
proposed.
Although the signal processing algorithms embedded in
neurofeedback games are well applied in clinical treatments,
the linear features (power spectral density or amplitude)
extracted from EEG cannot represent the brain activities
perfectly due to the nonlinearity of EEG signal itself.
Nonlinear method, e.g. entropy analysis and fractal
dimension analysis, become popular in many EEG
processing for medical applications [22-25] and could be
applied to neurofeedback systems to model brain activities.
In this paper, we proposed and described 2D and 3D
concentration games based on the fractal dimension
algorithms.
C. Game Engines
EEG-based games consist of two parts: signal processing
and game implementation. Game implementation can be
effectively done with the help of game engines. Game
engines are tools that programmers use to design and
implement games. They provide ready-made utilities or tools
to develop a game. According to Jeff Ward [26], three types
of game engines are frequently seen: roll-your-own game
engines, mostly-ready game engines and point-and-click
engines.
Roll-your-own game engines, including OpenGL and
DirectX, require game makers to be well-versed in
programming and take a lot of time to build. However, they
give the game makers flexibility and more freedom in
building their own components for the game. Mostly-ready
game engine is most popular in the market. Renderer,
physics engine, collision detection, graphic, sound system,
etc. are usually available in these game engines. OGRE,
Panda3D, Unreal, etc. belong to this kind of game engine. A
point-and-click engine is the highest level game engine that
requires least programming knowledge. However, they are
quite limited with the ready-made functions provided. These
engines include for example, Alice and Game Maker. As
EEG-based games include signal processing, a game engine
should support programming language C++, Python or any
other scripting environments to allow EEG recognition and
interpretation.
III. EEG-BASED GAME DESIGN
A. EEG-based Game Design
Till now traditional neurofeedback games were
implemented for clinical applications with complicated EEG
devices which are hard to set up. Recently, more and more
portable and wireless EEG devices became available. More
effective EEG processing algorithms which can be applied
with fewer electrodes in real-time applications are on
demand. In this paper, we propose design of neurofeedback
concentration games based on fractal dimension model.
Different from traditional neurofeedback games, we focus on
the brain state monitoring of the EEG activities using fractal
dimension model. The main idea of concentration game is
271
using neurofeedback for encouraging the concentration state
by giving positive feedback if it is recognized from the EEG
signals. The EEG analysis method is based on fractal
dimension model which can capture the changes in brain
state.
In order to develop real-time application, fewer channels
and faster signal processing algorithms are expected. In our
implementation, only one channel located in occipital lobe is
selected because the occipital lobe is responsible for visual
perception and visual attention [27-28]. Entropy based fractal
dimension model [29] is used to distinguish brain states such
as relaxed and concentrated. Then, an immersive game
should be designed and behave according to the recognized
brain state.
B. Fractal Dimension Model
The most important novelty in this implementation of the
neurofeedback game is using the fractal dimension feature
instead of the power of EEG signals. Fractal dimension is the
measurement of complexity and irregularity of a signal.
Higher fractal dimension values mean that the signal is more
complex, while lower fractal dimension values mean that the
signal is more regular. In Fig. 1 (a) and (b), examples of
mono-fractal Weierstrass signals with low FD value 1.1 and
high FD value 1.7 are shown.
For our real-time implementation, Higuchi [30] and Box-
counting [31] algorithms were chosen for FD calculation.
In Higuchi method, the samples are first clustered into
several sub-sequences according to the poly-phase structure
shown in (1). The length of the sequences I(k) is calculated
according to the (2). The k denotes the number of the sub-
sequence and I
m
(k) denotes the length of the m-th sub-
sequence. The total length I(k) is proportional to k
-P
,
where F is the fractal dimension value and k is the time-
delay information. The fractal dimension calculation process
of Higuchi method is represented in Fig. 2.

X
k
m
: x(m), x(m + k), x(m + 2k), ,
x(m + int|(N - m)k]k) (1)
L
m
(k)=
1
k
l
l
l
l
`

` |x(m+ik)-x(m+(i-1)k)|
intI
N-m
k
]
=1
/

N-1
int |
N-m
k
| k
1
1
1
1

I(k) =
1
k
` I
k
(m)
k
m=1

(2)


Box-counting method can calculate the fractal dimension
value of the signal in time domain without any sub-sequence
extraction steps. The main step of box-counting method is
box construction. Unified and normalized boxes are
constructed in 2D space (time-amplitude) which cover one
segment of the signal. Finally, the number of boxes is
counted. The boxes constructing and counting processes are
shown in Fig. 3. The number of counted boxes N(J) is
proportional to J
-P
, where J denotes the length of the side
of the boxes.



Figure 1. Mono-fractal Weierstrass signal. (a) Fractal dimension value is
1.1. (b) Fractal dimension value is 1.7.
Higuchi method and Box-counting method are compared
in both the computation complexity and the accuracy.
Brownian Motion and Weierstrass mono-fractal signals for
which theoretical fractal dimension values are known were
used for the comparison. Although Higuchi method is slower
than Box-counting method, the accuracy of Higuchi method
is better than Box-counting method as it is shown in Fig. 4
on Brownian Motion and Weierstrass signals. In our work,
both algorithms are used for neurofeedback implementation.
C. Experiment on Brain States Classification
An experiment on brain state classification was set up to
distinguish relaxed and concentrated states. Five subjects
aged from 22 to 30 were invited to participate in the
experiment. In the first session, in order to induce relaxed
state, a comfortable environment was set up to help the
subject relax. In the second session, in order to induce
concentration state, the subjects were required to complete
several math problems. Only one electrode was used and
placed in O1 position according to 10-20 international
system [32] in occipital lobe which is associated to the visual
perception. EEG signals were recorded by the Emotiv device
with sampling frequency of 128Hz and 16-bit A/D
272
resolution. EEG signal was processed by fractal dimension
algorithms, and average fractal dimension values of both two
sessions were evaluated for all five subjects.



Figure 2. Fractal dimension calculation in Higuchi method.


Figure 3. Boxes construction in box-counting method, the dark boxes are
counted.
The results of the brain state recognition experiment are
shown in Fig. 5 with boxplot. The states of relaxation and
concentration have different fractal dimension values for all
five subjects. In both Higuchi and Box-counting algorithms,
the experiment results show that concentration level can be
distinguished for 80% of the subjects when a default
threshold was set to 1.9 in Higuchi method and 1.55 in Box-
counting method. For 100% of the subjects, the
concentration level can be recognized with a trained
threshold. It is clear that fractal dimension model can be
used for distinguishing the relaxation state and concentration
state with a simple threshold even though there are some
overlap which may be due to the individual difference in the
level of concentration. A short training session can be
applied to determine the default threshold to minimize the
individual effects.
Because this is not a clinical experiment, it is difficult to
make a comparison between effectiveness of our methods
with that of traditional neurofeedback games which are
based on frequency analysis. The comparison will be
arranged in the pain management experiments with the help
of the Tan Tock Seng Hospital in the future.


Figure 4. The comparison of Higuchi and Box-counting algorithms for
FD evaluation over (a) Brownian Motion signals and (b) Weierstrass
signals.

273
Figure 5. The comparison of (a) Higuchi method an
method in FD evaluation of the EEG signals in differe
subjects.
IV. GAMES IMPLEMENTATI
In our research, one 2D neurofeedba
Brain Chi and one 3D neurofeedbac
Dancing Robot are developed for con
control. Brain Chi is developed with
engine, while Dancing Robot is develope
[34] game engine. Both games are develo
C++.
A. Data Acquisition and Processing
EEG data is recorded by Emotiv [35]
device. Only O1 electrode (according to 10
system) in Occipital lobe is active, and t
location is transmitted to computer with
algorithm filters out the unrelated compone
band-pass filter first, then calculates the f
value of the input EEG signals in real-tim
method or Box-counting method and labels
brain states according to the adaptive thresho
threshold used for distinguishing the concen
relaxation state is set to 1.9 in Higuchi me
box-counting method. The threshold c
manually or can be trained in a 20s training
the setting compatible to individuals. The
and processing algorithm diagram is shown
hardware setup of our neurofeedback game
7.

Read data
from Emotiv
Fractal
Dimension
Algorithm
Adaptiv
Thresho
Calculati
Bandpass Filter
(2-42 Hz)
Figure 6. The data acquisition and processing alg
Player
Emotiv
EEG Device
Wireless
Communication
Figure 7. Hardware setup of the gam

nd (b) Box-counting
ent brain states for all
ION
ck game named
ck game named
ncentration level
SDL [33] game
ed with Panda3D
oped with Visual
EEG collection
0-20 international
the EEG in this
Bluetooth. The
ents with 2-42Hz
fractal dimension
me with Higuchi
s it with different
olds. The default
ntration state and
ethod and 1.55 in
an be changed
g session to adjust
data acquisition
in Fig. 6 and the
is shown in Fig.
ve
old
ion
Game
Command

gorithm diagram.
Desktop
Computer
n

me.
B. Game Strategy
In our games, if the concentrati
are rewarded to the player to
concentrate. If the brain state of th
negative feedback comes in to take
The game strategy can also be cha
when the player wants training fo
strategy diagram is shown in Fig. 8.


Figure 8. Game stratege for concen
Dancing Robot is a simple
game, the player is required to co
while the robot is dancing. A screen
is shown in Fig. 9. Its dancing
concentration level of the player.
headset concentrates to make the rob
accompanied by excited music.
sluggishly if the player is distracted.
employed for trainings purpose.
Brain Chi is a 2D single-play
screenshot of Brain Chi is show
controls the game simply by using
concentration. His/her task is to h
against evil bats using a protectio
protection ball is controlled by the c
player. To win this game, the play
ball by concentration to eliminate al
V. CONCLUSION AND FUTURE W
In this paper, we review
neurofeedback games, algori
neurofeedback games and game
efficiency of fractal dimension va
results of the experiment show tha
Box-counting method can be eq
feature extraction methods. The bra
with the difference in fractal dimen
and 3D EEG-based games: Bra
Robot were designed and implem
training. Fractal dimension method
neurofeedback games to enhan
classification algorithms.
There are also some aspects of
enhanced in the future. For examp
threshold in the game, we can ma
value to concentration level dire
ion state is found, points
encourage him/her to
he subject is distracted, a
the players points away.
anged to relaxation game
or relaxation. The game

ntration neurofeedback.
single-player 3D. In this
ontrol the speed of robot
nshot of Dancing Robot
speed depends on the
The player with his/her
bot dance faster, which is
The robot will dance
. An adaptive threshold is
yer EEG-based game. A
n in Fig. 10. The player
his/her brain power of
help a little boy to fight
on ball. The size of the
concentration level of the
yer needs to increase the
l the bats.
WORK
ed EEG-based games
ithm embedded in
engines. Experiment on
alue was arranged. The
at both the Higuchi and
qually effective used as
in states are recognizable
nsion value. Original 2D
ain Chi and Dancing
mented for concentration
d was embedded in the
nce the efficiency of
the project which can be
ple, instead of using one
ap the fractal dimension
ectly to achieve precise
274
control and training over the concentration level. On the
other hand, clinical experiments should be arranged in the
future to do the comparison between fractal dimension
approach with the traditional neurofeedback games signal
processing approaches.
Short clips of Brain Chi and Dancing Robot games
can be found by visiting the following link:
http://www3.ntu.edu.sg/home/EOSourina/



Figure 9. Dancing Robot screenshot.


Figure 10. Brain Chi screenshot.
ACKNOWLEDGMENT
This project is supported by grant NRF2008IDM-
IDM004-020 Emotion-based personalized digital media
experience in Co-Spaces of National Research Fund of
Singapore.
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