Cancer patients, and in particular head and neck and brain cancer patients are often dealing with impairments in cognitive function due to their treatment (radiation, chemotherapy, surgery). Examples include forgetfulness and problems with information processing, concentration and planning. These impairments have a significant impact on patient’s daily lives: they are mentally fatigued, can participate less in society and they have more trouble keeping up with therapy. Recent research has shown that physical (aerobic) exercise has a positive effect on patient’s quality of life in general but also, in particular, on the speed and effectiveness of cognitive rehabilitation therapy. In light of this research we were asked to combine aerobic exercise and brain training in a fun, immersive and game-like experience for an improved cognitive rehabilitation treatment and better therapy adherence. 
Empowering users
In dealing with a vulnerable population there were many considerations to keep in mind: the experience had to be safe, easily implementable, individually tailed to each patient's capabilities, progressively challenging and suitable for a 40+ target audience. Our primary goal however was to make users feel empowered in their day to day lives. With the goal of empowerment in mind, we made two key design decisions: to not confront our users with their current state of health, we refrained from having a human representation of them in the game. We also decided to include the concept of mirroring: as players improve within the game, their representation within the game improves, and vice versa. 
Building a world
With the help of research, ideation and a team member with a geography degree, we soon found the perfect analogy: terraforming. Our users are entrusted with exploring, transforming and nurturing a tiny world: from the discovery of a barren planet to gardening it into a thriving ecosystem, complete with lakes and rivers, mountain ranges, forests, and even new undiscovered species.
The Concept
Terra is played on a smart exercise bike connected to a Unity game environment, displayed on screen. The gameplay is based on a common physiotherapy treatment plan: alternating between high and low intensity cycling stages, players explore and terraform a planet using resources that they’ve earned in cognitive games. During low-intensity cycling stages users play a cognitive game tasking them to follow and complete recipes. The game targets brain-training strategies such as planning and divided attention. By completing a recipe the player earns new kinds of vegetation, terrain, or organisms to grow on their planet. Each high-intensity cycling stage subsequently gives players the chance to explore and nurture their world. The bike provided by sponsor ProCare allowed our team to implement two physical buttons (right and left) on the handle bar, which allows the player to navigate through the game.
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