Disciplines Concept, Interaction Design
Client Netherlands Cancer Institute
Team MacKayla van Binsbergen, Gabriel Castro, Wendy Plas, Peter Polacsek
Year 2019 - 2020

Through our client we where asked to extend the software part of TERRA with new playful minigames that can be used to provide physical and cognitive stimulation using the TERRA system. The TERRA system is an stationary exercise bicycle with custom controllers combining with a game software. The TERRA system is based on a neurobiological hypothesis that combining exercise and cognitive training in a game situation optimizes the cancer treatment effects on patients with gliomas (brain tumors).

Desk Research

To get a better insight into how to build new minigames with training cognitive functions, we did desk research in a cognitive impairments patients are having difficulties with namely attention, working memory, multitasking, information processing, reaction time and executive functions such as planning, organizing and decision making. And as follows seeing how to apply them into games.

User research

To get better understanding who our target group is, we talk with our client who is expert in this field. Here we came clear that the patients are around the age of 40 plus and are under an intense psycho-physical stress. They all are in different stages of the treatment and having different levels of physical and cognitive impairments. They have deficits in cognitive domains as attention, memory (short term), multitasking, information processing, reaction time and executive functions such as planning, organizing and decision making. They can be visible through increase fatigue, problems with work, and overall reduced quality of life.

The design needs to be pleasant, familiar and not anxiety-inducing. And needs to be cognitive challengable and rewarding and accessible to patients that have different cognitive levels. Because it’s made for an vulnerable population, we couldn’t test with our users. They first wanted to extended to project so far, that the client can test with the patients on to the whole game experience.

For physical therapists the game needs to be easy implementatable in daily practice and adjustable to patients with different cognitive and physical levels.


To see the relations between the patients deficits, game ideas and project requirements we created an affinity map.



To generate different options of possible ideas, we sketched out multiple minigame ideas. To test assumptions, and get feedback. We needed to test on classmates, because we weren't allowed to contact the actual patients.


To have a second conversation with client to get their input on the ideas, we created a mockup of the top 4 most voted game ideas.

Terra Terra Terra Terra


To test the basic mechanics of the game, we made a rough prototype of the chosen minigame. We had one research paper that sounds & visuals in combination better stimulate learning, that why we created a soundtrack for the game. To adjust our minigame visuals to the existing version of the Terra software, we refined the prototype visuals. Also we included different game difficulties based on users score, because patients have different levels of impairments, so the game should adapt to their conditions.

Terra Terra


Since we couldn't test on real patients, we tested with students to get feedback on how the game experience works. During the user test, it felt that the game needed more feedback and the gameplay wasn't very accurate. That's why we refined the sounds, improved the "hit area", and included visual feedback.



As end deliverable we made a version ready to be tested during rehabilition.

We also added a long term plan, because it would allow them to continue with the project. It consist of full storyline, gameflow guidelines and additional technologie options. The document could handed over to game developers to build a complete version of our vision of the game.

Terra Terra