NKI - Terra Bike Game

Exercise and cognitive training game to help cancer treatments

How can we create new minigames that help around different cognitive impairments for patients with glioma?


Game Design
3D Design
Digital Prototyping


Sept. 2019 - Okt. 2019


Netherlands Cancer Institute


MacKayla van Binsbergen
Gabriel Castro
Peter Polacsek

Cognitive exercise training

The Terra System is based on a neurobiological hypothesis that combining exercise on a stationary bicycle and cognitive training in a game situation optimizes the cancer treatment effects on patients with glioma (brain tumors). The client wants to extend it further, so the question is.

"How might we extend the already excisting software part of Terra with new playful minigames that can be used to provide training to more cognitive functions?"



Through an expert interview with our client, we came clear that the patients we are designing for are in different stages of the treatment and having different levels of physical and cognitive impairments. They have deficits in cognitive domains as attention, working memory, 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 has the requirement that it 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. For physical therapists the game needs to be easy implementatable in daily practice and adjustable to patients.

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



To generate different options for 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 the client to get their input on our ideas, we created a mockup of the top 4 most voted game ideas.



To test the basic mechanics of the game, we made a rough prototype of the chosen minigame. We had one research paper that said sounds & visuals in combination better stimulates learning. That's why we also 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 user's scores, because patients have different levels of impairments, so the game should adapt to their conditions.



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.

End game

As end deliverable we made a whole two minute version of the game experience, that can be tested during rehabilitation in the Netherlands Cancer Institute.

Long term plan

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


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