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Pereira F, Bermúdez i Badia S, Ornelas R, S. Cameirão M. Impact of game mode in multi-user serious games for upper limb rehabilitation: a within-person randomized trial on engagement and social involvement. J Neuroeng Rehabil 2019; 16:109. [PMID: 31470877 PMCID: PMC6716923 DOI: 10.1186/s12984-019-0578-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serious games have been increasingly used for motor rehabilitation. However, it is not well known how different game features can be used to impact specific skills properly. Here, we study how the mode (competitive, co-active, collaborative) in which a multi-user game is presented impacts engagement and social involvement. METHODS We collected data from 20 pairs of community-dwelling older adults (71.5 ± 8.7 years) in a study following a within-persons design. The participants performed a two-player upper limb rehabilitation game with three conditions (Competitive, Co-active, and Collaborative modes). Engagement and social involvement were assessed through the Core Module and Social Presence Module, respectively, from the Game Experience Questionnaire. To infer the impact of personality and cognitive function, users answered the International Personality Item Pool (short version) and the Montreal Cognitive Assessment, respectively. RESULTS Results show that the Collaborative game mode promotes more social involvement when compared to Competitive and Co-active modes. This result is mostly explained by those participants with higher cognitive skills, and those that are more extrovert. Extrovert participants feel more empathy and are behaviorally more involved when playing the Collaborative mode. Also, the Collaborative mode is shown to be appropriate to promote interaction with participants that previously had a distant relationship, while the Competitive mode seems to be more beneficial to promote empathy between players with a closer relationship. CONCLUSIONS The Collaborative game mode elicited significantly higher social involvement in terms of Empathy, Positive Affect, and Behavioral Involvement. Hence, this game mode seems to be the most adequate choice to be used in multiplayer rehabilitation settings, where social interaction is intended.
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Affiliation(s)
- Fábio Pereira
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Campus Universitário da Penteada, 9020-105 Funchal, Portugal
- ITI-LARSyS and Madeira ITI, Pólo Científico e Tecnológico da Madeira, Caminho da Penteada, 9020-105 Funchal, Portugal
| | - Sergi Bermúdez i Badia
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Campus Universitário da Penteada, 9020-105 Funchal, Portugal
- ITI-LARSyS and Madeira ITI, Pólo Científico e Tecnológico da Madeira, Caminho da Penteada, 9020-105 Funchal, Portugal
| | - Rúben Ornelas
- ITI-LARSyS and Madeira ITI, Pólo Científico e Tecnológico da Madeira, Caminho da Penteada, 9020-105 Funchal, Portugal
| | - Mónica S. Cameirão
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Campus Universitário da Penteada, 9020-105 Funchal, Portugal
- ITI-LARSyS and Madeira ITI, Pólo Científico e Tecnológico da Madeira, Caminho da Penteada, 9020-105 Funchal, Portugal
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Aminov A, Rogers JM, Middleton S, Caeyenberghs K, Wilson PH. What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes. J Neuroeng Rehabil 2018; 15:29. [PMID: 29587853 PMCID: PMC5870176 DOI: 10.1186/s12984-018-0370-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/11/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects. METHODS Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge's g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/Function, Activity, and Participation levels of the International Classification of Functioning. RESULTS Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33-0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28-0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34-0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28-0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury. CONCLUSION VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.
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Affiliation(s)
- Anna Aminov
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Jeffrey M Rogers
- South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Sandy Middleton
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Karen Caeyenberghs
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Disability and Development Research (CeDDR), Australian Catholic University, Melbourne, VIC, Australia
| | - Peter H Wilson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia.
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia.
- Centre for Disability and Development Research (CeDDR), Australian Catholic University, Melbourne, VIC, Australia.
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Wilson PH, Smits-Engelsman B, Caeyenberghs K, Steenbergen B, Sugden D, Clark J, Mumford N, Blank R. Cognitive and neuroimaging findings in developmental coordination disorder: new insights from a systematic review of recent research. Dev Med Child Neurol 2017; 59:1117-1129. [PMID: 28872667 DOI: 10.1111/dmcn.13530] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Abstract
AIM To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account. METHOD A systematic review of the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included. RESULTS Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving prefrontal, parietal, and cerebellar regions in children with DCD than those in comparison groups. Data from diffusion-weighted magnetic resonance imaging suggested reduced white matter organization involving sensorimotor structures and altered structural connectivity across the whole brain network. INTERPRETATION Taken together, results support the hypothesis that children with DCD show differences in brain structure and function compared with typically developing children. Behaviourally, these differences may affect anticipatory planning and reduce automatization of movement skill, prompting greater reliance on slower feedback-based control and compensatory strategies. Implications for future research, theory development, and clinical practice are discussed.
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Affiliation(s)
- Peter H Wilson
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.,Centre for Disability and Development Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Bouwien Smits-Engelsman
- Department of Health and Rehabilitation Services, University of Cape Town, Cape Town, South Africa
| | - Karen Caeyenberghs
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.,Centre for Disability and Development Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Bert Steenbergen
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Victoria, Australia.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - David Sugden
- School of Special Needs Education, University of Leeds, Leeds, UK
| | - Jane Clark
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Nick Mumford
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Rainer Blank
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Child Centre, Maulbronn, Germany
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Kashuk S, Williams J, Thorpe G, Wilson P, Egan G. Diminished motor imagery capability in adults with motor impairment: An fMRI mental rotation study. Behav Brain Res 2017; 334:86-96. [DOI: 10.1016/j.bbr.2017.06.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 06/18/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
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Wilson PH, Adams ILJ, Caeyenberghs K, Thomas P, Smits-Engelsman B, Steenbergen B. Motor imagery training enhances motor skill in children with DCD: A replication study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 57:54-62. [PMID: 27388492 DOI: 10.1016/j.ridd.2016.06.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Children with impaired motor coordination (or DCD) have difficulty using motor imagery. We have suggested that this difficulty is explained by the internal modeling deficit (IMD) hypothesis of DCD. Our previous training study lent support for this hypothesis by showing that a computerized imagery training protocol (involving action observation, and mental- and overt-rehearsal) was equally effective to perceptual-motor therapy (PMT) in promoting motor skill acquisition. AIMS The study presented here was designed to replicate and extend this finding, targeting a select group of children with moderate-to-severe DCD. METHODS AND PROCEDURES All 36 children with DCD who participated were referred to the study and scored below the 10th percentile for their age on the Movement Assessment Battery for Children (MABC). Using a randomized control trial, the referred children were assigned randomly to one of three groups using a blocked procedure: imagery training, perceptual-motor training (PMT), and wait-list control. Motor proficiency was measured using the MABC, pre and post-training. Individual training consisted of 60-min sessions, conducted once a week for 5 weeks. RESULTS Results showed that the imagery protocol was equally effective as PMT in promoting motor skill acquisition, with moderate-to-large effect sizes. Individual differences showed that the majority of children in the two intervention groups improved their motor performance significantly. CONCLUSIONS Overall, these results further support the use of motor imagery protocols in the treatment of DCD, and tentative support for the IMD hypothesis. Developmental and dose issues in the implementation of imagery-based intervention are discussed.
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Affiliation(s)
- Peter H Wilson
- School of Psychology, Australian Catholic University, Melbourne, Australia; Centre for Disability and Development Research (CeDDR), Australian Catholic University, Australia.
| | - Imke L J Adams
- Behavioural Science Institute, Radboud University Nijmegen, 6500 HE Nijmegen, The Netherlands
| | - Karen Caeyenberghs
- School of Psychology, Australian Catholic University, Melbourne, Australia; Centre for Disability and Development Research (CeDDR), Australian Catholic University, Australia
| | - Patrick Thomas
- School of Education, Griffith University, Brisbane, Australia
| | - Bouwien Smits-Engelsman
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Bert Steenbergen
- School of Psychology, Australian Catholic University, Melbourne, Australia; Centre for Disability and Development Research (CeDDR), Australian Catholic University, Australia; Behavioural Science Institute, Radboud University Nijmegen, 6500 HE Nijmegen, The Netherlands
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Gomez A, Piazza M, Jobert A, Dehaene-Lambertz G, Huron C. Numerical abilities of school-age children with Developmental Coordination Disorder (DCD): A behavioral and eye-tracking study. Hum Mov Sci 2016; 55:315-326. [PMID: 27592037 DOI: 10.1016/j.humov.2016.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 01/29/2023]
Abstract
Developmental Coordination Disorder (DCD) is a disorder of motor coordination which interferes with academic achievement. Difficulties in mathematics have been reported. Performance in the number line task is very sensitive to atypical development of numerical cognition. We used a position-to-number task in which twenty 7-to-10years old children with DCD and 20 age-matched typically developing (TD) children had to estimate the number that corresponded to a hatch mark placed on a 0-100 number line. Eye movements were recorded. Children with DCD were less accurate and slower to respond than their peers. However, they were able to map numbers onto space linearly and used anchoring strategies as control. We suggest that the shift to a linear trend reflects the ability of DCD children to use efficient strategies to solve the task despite a possibly more imprecise underlying numerical acuity.
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Affiliation(s)
- Alice Gomez
- Cognitive Neuroimaging Unit, CEA DRF/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France
| | - Manuela Piazza
- Cognitive Neuroimaging Unit, CEA DRF/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France
| | - Antoinette Jobert
- Cognitive Neuroimaging Unit, CEA DRF/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France
| | - Ghislaine Dehaene-Lambertz
- Cognitive Neuroimaging Unit, CEA DRF/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France
| | - Caroline Huron
- Cognitive Neuroimaging Unit, CEA DRF/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France.
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