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Ferreira-Brito F, Alves S, Guerreiro T, Santos O, Caneiras C, Carriço L, Verdelho A. Digital health and patient adherence: A qualitative study in older adults. Digit Health 2024; 10:20552076231223805. [PMID: 38222080 PMCID: PMC10787534 DOI: 10.1177/20552076231223805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Computer confidence and computer self-efficacy can impact an individual's perceived ease of use and usefulness of technology, ultimately determining adherence to digital healthcare services. However, few studies focus on assessing the impact of non-clinical factors on the efficacy and adherence to digital healthcare platforms. Objective We aimed to analyse the role of non-clinical factors (i.e. computer confidence and computer self-efficacy) in the interaction experience (IX) and the feasibility of a digital neuropsychological platform called NeuroVRehab.PT in a group of older adults with varying levels of computer confidence. Methods Eight older adults (70.63 ± 6.1 years) evaluated the platform, and data was collected using the Think-Aloud method and a semi-structured interview. Sessions were audio-recorded and analysed through an inductive-deductive informed Thematic Analysis protocol. This study was conducted according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Results Three main themes were identified (Interaction Experience, Digital Literacy, and Attitudes toward NeuroVRehab.PT). Computer anxiety and fear of making errors were not uncommon, even among older adults who perceive themselves as confident in technology use, and negatively impacted IX. Moreover, some game elements (e.g. three-star system, progression bar) were not intuitive to all participants, leading to misleading interpretations. On the other hand, human support and the platform's realism seemed to impact participants' IX positively. Conclusions This study shed light on the barriers raised by non-clinical factors in adopting and using digital healthcare services by older adults. Furthermore, a critical analysis of the platform's features that promote user adoption is done, and suggestions for overcoming limitations are presented.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Sérgio Alves
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Osvaldo Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Unbreakable Idea Research, Painho, Portugal
| | - Cátia Caneiras
- Laboratório de Investigação em Microbiologia na Saúde Ambiental (EnviHealthMicro Lab), Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Healthcare Department, Nippon Gases Portugal, Lisboa, Portugal
| | - Luís Carriço
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Aneni K, Chen CH, Meyer J, Cho YT, Lipton ZC, Kher S, Jiao MG, Gomati de la Vega I, Umutoni FA, McDougal RA, Fiellin LE. Identifying Game-Based Digital Biomarkers of Cognitive Risk for Adolescent Substance Misuse: Protocol for a Proof-of-Concept Study. JMIR Res Protoc 2023; 12:e46990. [PMID: 37995115 DOI: 10.2196/46990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Adolescents at risk for substance misuse are rarely identified early due to existing barriers to screening that include the lack of time and privacy in clinic settings. Games can be used for screening and thus mitigate these barriers. Performance in a game is influenced by cognitive processes such as working memory and inhibitory control. Deficits in these cognitive processes can increase the risk of substance use. Further, substance misuse affects these cognitive processes and may influence game performance, captured by in-game metrics such as reaction time or time for task completion. Digital biomarkers are measures generated from digital tools that explain underlying health processes and can be used to predict, identify, and monitor health outcomes. As such, in-game performance metrics may represent digital biomarkers of cognitive processes that can offer an objective method for assessing underlying risk for substance misuse. OBJECTIVE This is a protocol for a proof-of-concept study to investigate the utility of in-game performance metrics as digital biomarkers of cognitive processes implicated in the development of substance misuse. METHODS This study has 2 aims. In aim 1, using previously collected data from 166 adolescents aged 11-14 years, we extracted in-game performance metrics from a video game and are using machine learning methods to determine whether these metrics predict substance misuse. The extraction of in-game performance metrics was guided by literature review of in-game performance metrics and gameplay guidebooks provided by the game developers. In aim 2, using data from a new sample of 30 adolescents playing the same video game, we will test if metrics identified in aim 1 correlate with cognitive processes. Our hypothesis is that in-game performance metrics that are predictive of substance misuse in aim 1 will correlate with poor cognitive function in our second sample. RESULTS This study was funded by National Institute on Drug Abuse through the Center for Technology and Behavioral Health Pilot Core in May 2022. To date, we have extracted 285 in-game performance metrics. We obtained institutional review board approval on October 11, 2022. Data collection for aim 2 is ongoing and projected to end in February 2024. Currently, we have enrolled 12 participants. Data analysis for aim 2 will begin once data collection is completed. The results from both aims will be reported in a subsequent publication, expected to be published in late 2024. CONCLUSIONS Screening adolescents for substance use is not consistently done due to barriers that include the lack of time. Using games that provide an objective measure to identify adolescents at risk for substance misuse can increase screening rates, early identification, and intervention. The results will inform the utility of in-game performance metrics as digital biomarkers for identifying adolescents at high risk for substance misuse. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46990.
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Affiliation(s)
- Kammarauche Aneni
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Ching-Hua Chen
- Center for Computational Health, IBM Research, Yorktown Heights, NY, United States
| | - Jenny Meyer
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Fairfield University, Fairfield, CT, United States
| | - Youngsun T Cho
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Zachary Chase Lipton
- Machine Learning Department, School of Computer Science, Carnegie Mellon University, Pittsburg, PA, United States
| | | | - Megan G Jiao
- McGovern Medical School, UTHealth Houston, Houston, TX, United States
| | | | | | - Robert A McDougal
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- Yale School of Public Health, New Haven, CT, United States
| | - Lynn E Fiellin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Yale School of Public Health, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
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3
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Bos E, Preller KH, Kaur G, Malhotra P, Kharawala S, Motti D. Challenges With the Use of Digital Sham: Systematic Review and Recommendations. J Med Internet Res 2023; 25:e44764. [PMID: 37874638 PMCID: PMC10630857 DOI: 10.2196/44764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Digital therapeutics (DTx) are software-based products that prevent, manage, or treat a medical condition and are delivered through a smartphone app, web application, or wearable device. Clinical trials assessing DTx pose challenges, foremost among which is designing appropriate digital shams (or digital placebos), which should ideally mimic DTx (in terms of design, components, and duration of treatment) while omitting the active principle or component. OBJECTIVE The objective of our review was to understand how digital shams are being used in clinical research on DTx in neuroscience, which is the most common therapy area for DTx. METHODS We conducted a systematic literature review of DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) with a focus on controlled clinical trials involving digital shams. Studies were identified from trial registries (ClinicalTrials.gov, the European Union Clinical Trials Register, and Trial Trove) and through structured searches in MEDLINE and Embase (both via the Embase website) and were limited to articles in English published from 2010 onward. These were supplemented by keyword-based searches in PubMed, Google, and Google Scholar and bibliographic searches. Studies assessing DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) were included. Details related to the publication, DTx, comparator, patient population, and outcomes were extracted and analyzed. RESULTS Our search criteria identified 461 neuroscience studies involving 213 unique DTx. Most DTx were extended reality based (86/213, 40.4%) or mobile device based (56/213, 26.3%); 313 were comparative, of which 68 (21.7%) used shams. The most common therapeutic areas assessed in these studies were stroke (42/213, 19.7%), depression (32/213, 15%), and anxiety (24/213, 11.3%). The most common treatments were cognitive behavioral therapy or behavioral therapy (67/213, 32.4%), physical rehabilitation (60/213, 28.2%), and cognitive training (41/213, 19.2%). We identified the following important issues related to the use of digital shams in neuroscience: shams were not validated before use in studies, they varied widely in design (from being nearly identical to the DTx to using different software programs altogether), and the level of patient engagement or satisfaction with the sham and the impact of the sham on study outcomes were infrequently reported. CONCLUSIONS Digital shams are critical for the clinical development of DTx in neuroscience. Given the importance of sham controls in evaluating DTx efficacy, we provide recommendations on the key information that should be reported in a well-designed DTx trial and propose an algorithm to allow the correct interpretation of DTx study results. Sham-controlled studies should be routinely used in DTx trials-in early-phase studies-to help identify DTx active components and-in late-phase studies-to confirm the efficacy of DTx. The use of shams early in development will ensure that the appropriate sham control is used in later confirmatory trials.
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Affiliation(s)
- Ernst Bos
- F Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Gavneet Kaur
- Bridge Medical Consulting Limited, London, United Kingdom
| | - Pooja Malhotra
- Bridge Medical Consulting Limited, London, United Kingdom
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Fernandez MA, Rebon-Ortiz F, Saura-Carrasco M, Climent G, Diaz-Orueta U. Ice Cream: new virtual reality tool for the assessment of executive functions in children and adolescents: a normative study. Front Psychol 2023; 14:1196964. [PMID: 37809320 PMCID: PMC10556863 DOI: 10.3389/fpsyg.2023.1196964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
This study focuses on the obtention of normative data for participants between 8 and 16 years old who were administered the Ice Cream test, a virtual reality tool designed to evaluate executive functions. The normative sample comprised n = 821 participants (49% female), with an age range of 8 to 16 years old, recruited across nine different testing sites in Spain. Experienced evaluators in psychological assessment, recruited and trained by the developer of the test, administered the test to the recruited sample. An empirical analysis of Ice Cream identified three factors, namely planning, learning and flexibility. Descriptive normative groups by age and gender were initially provided. A homoscedasticity analysis by gender showed no statistically significant differences between male and female participants. Cluster analysis by age suggested the creation of different age groups, respectively, 8 to 11 and 12 to 16 in Planning and Flexibility, and 8 to 9 and 10 to 16 in Learning, and subsequently, descriptive data for the established age groups per factor are shown. A confirmatory factor analysis showed the suitability of the 3 factors established as measured of three differentiated executive functions. Complementary data on the validity and reliability, and internal consistency of the scales are provided. Obtained normative data are relevant for evaluating executive functions in children and adolescents in a more ecological way. Further studies are needed to determine sensitivity and specificity of Ice Cream VR test to measure executive functions in different clinical populations.
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Affiliation(s)
| | | | | | - Gema Climent
- Giunti-Nesplora SL., Donostia-San Sebastian, Spain
| | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
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5
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Cheng HL, Lin CH, Tseng SH, Peng CW, Lai CH. Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined with Visual Feedback Training in Improving Neuroplasticity and Lower Limb Function after Chronic Stroke: A Pilot Study. BIOLOGY 2023; 12:biology12040515. [PMID: 37106715 PMCID: PMC10135922 DOI: 10.3390/biology12040515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
After a stroke, sustained gait impairment can restrict participation in the activities listed in the International Classification of Functioning, Disability, and Health model and cause poor quality of life. The present study investigated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and visual feedback training (VF) training in improving lower limb motor performance, gait, and corticospinal excitability in patients with chronic stroke. Thirty patients were randomized into three groups that received either rTMS or sham stimulation over the contralesional leg region accompanied by VF training groups in addition to the conventional rehabilitation group. All participants underwent intervention sessions three times per week for four weeks. Outcome measures included the motor-evoked potential (MEP) of the anterior tibialis muscle, Berg Balance Scale (BBS) scores, Timed Up and Go (TUG) test scores, and Fugl–Meyer Assessment of Lower Extremity scores. After the intervention, the rTMS and VF group had significantly improved in MEP latency (p = 0.011), TUG scores (p = 0.008), and BBS scores (p = 0.011). The sham rTMS and VF group had improved MEP latency (p = 0.027). The rTMS and VF training may enhance the cortical excitability and walking ability of individuals with chronic stroke. The potential benefits encourage a larger trial to determine the efficacy in stroke patients.
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Affiliation(s)
- Hsien-Lin Cheng
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Chueh-Ho Lin
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Sung-Hui Tseng
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-2-2737-2181 (ext. 3243)
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6
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Aneni K, Gomati de la Vega I, Jiao MG, Funaro MC, Fiellin LE. Evaluating the validity of game-based assessments measuring cognitive function among children and adolescents: A systematic review and meta-analysis. PROGRESS IN BRAIN RESEARCH 2023; 279:1-36. [PMID: 37661161 DOI: 10.1016/bs.pbr.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Games offer advantages over traditional methods of assessing cognitive function among children and adolescents. However, the validity of game-based assessments has not been systematically evaluated. We conducted a systematic review and meta-analysis to assess the validity of game-based assessments measuring cognitive function among children and adolescents. We systematically searched several databases using pre-defined inclusion criteria. For papers that met the criteria, we extracted and analyzed the cognitive functions measured by each study, the correlation coefficients between game-based and traditional assessments, and factors that could influence the validity of game-based assessments. Our review identified 19 articles featuring 20 studies, 18 games, and 378 unique correlations between game-based and traditional assessments of cognitive function. Game-based assessments yielded significant correlations (n=282, 75%) with traditional assessments, over half of which were in the low to medium range in strength (r=0.3-0.69, n=227, 80%). Factors related to the child, such as age, gender, and prior gaming experience, may influence the validity of game-based assessments by modifying performance on game-based assessments. In addition, we found that game-based assessments that measured cognitive functions across more than one neurocognitive domain and used a prediction model for scoring were more likely to yield significant correlations. In contrast, including a narrative storyline in a game-based assessment was less likely to yield significant correlations. Most studies were of good quality, although the lack of sample size justification was a limiting factor. Further research is needed to elucidate the influence of identified factors on the validity of game-based assessment to justify the wide adoption of game-based assessments of cognitive function among children and adolescents.
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Affiliation(s)
- Kammarauche Aneni
- Yale Child Study Center, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | | | - Megan G Jiao
- McGovern Medical School, Houston, TX, United States
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States
| | - Lynn E Fiellin
- Yale Child Study Center, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States; Yale School of Public Health, New Haven, CT, United States.
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Vita-Barrull N, Guzmán N, Estrada-Plana V, March-Llanes J, Mayoral M, Moya-Higueras J. Impact on Executive Dysfunctions of Gamification and Nongamification in Playing Board Games in Children at Risk of Social Exclusion. Games Health J 2021; 11:46-57. [PMID: 34962161 DOI: 10.1089/g4h.2021.0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Modern board and card game-based cognitive interventions and gamification practices showed effectiveness in boosting executive functions and decreasing behavioral problems in children. However, the combination of both game-based methods has not been tested. Therefore, the main aim of this study was to test the effectiveness of gamification in modern board and card game-based cognitive interventions in Spanish schoolchildren at risk of social exclusion. Materials and Methods: In this multicenter single-blind study with a quasi-experimental design, 176 schoolers (6-13 years old) were assigned to a gamified group (with a narrative context and a rewarding system) and 107 to a nongamified group (with no narrative context or rewarding system). The interventions were implemented in regular classes. Behavioral executive dysfunction was assessed using the Behavior Rating Inventory of Executive Function, Second Revision (BRIEF-2) (Teacher form), pre- and postintervention. Results: We found significant time effects in all BRIEF-2 domains with small and medium effect sizes (d = -0.35 to d = -0.62). The nongamified group showed significantly higher decreases in all measures than those who used gamification. Conclusions: It is possible that playing for the joy of playing in the nongamified group was enough motivation to focus on the task, while adding gamification elements did not favor greater effectiveness of the program.
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Affiliation(s)
- Nuria Vita-Barrull
- Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain
| | - Núria Guzmán
- Atención, Familia, Infancia y Mayores (AFIM21), Almería, Spain
| | - Verónica Estrada-Plana
- Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain
| | - Jaume March-Llanes
- Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain
| | - Maria Mayoral
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Jorge Moya-Higueras
- Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Lleida, Spain.,Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
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Ashmaig O, Hamilton LS, Modur P, Buchanan RJ, Preston AR, Watrous AJ. A Platform for Cognitive Monitoring of Neurosurgical Patients During Hospitalization. Front Hum Neurosci 2021; 15:726998. [PMID: 34880738 PMCID: PMC8645698 DOI: 10.3389/fnhum.2021.726998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
Intracranial recordings in epilepsy patients are increasingly utilized to gain insight into the electrophysiological mechanisms of human cognition. There are currently several practical limitations to conducting research with these patients, including patient and researcher availability and the cognitive abilities of patients, which limit the amount of task-related data that can be collected. Prior studies have synchronized clinical audio, video, and neural recordings to understand naturalistic behaviors, but these recordings are centered on the patient to understand their seizure semiology and thus do not capture and synchronize audiovisual stimuli experienced by patients. Here, we describe a platform for cognitive monitoring of neurosurgical patients during their hospitalization that benefits both patients and researchers. We provide the full specifications for this system and describe some example use cases in perception, memory, and sleep research. We provide results obtained from a patient passively watching TV as proof-of-principle for the naturalistic study of cognition. Our system opens up new avenues to collect more data per patient using real-world behaviors, affording new possibilities to conduct longitudinal studies of the electrophysiological basis of human cognition under naturalistic conditions.
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Affiliation(s)
- Omer Ashmaig
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Center for Learning and Memory, The University of Texas at Austin, Austin, TX, United States
| | - Liberty S. Hamilton
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, United States
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, The University of Texas at Austin, Austin, TX, United States
| | - Pradeep Modur
- Seton Brain and Spine Institute, Division of Neurosurgery, Austin, TX, United States
| | - Robert J. Buchanan
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Seton Brain and Spine Institute, Division of Neurosurgery, Austin, TX, United States
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Alison R. Preston
- Center for Learning and Memory, The University of Texas at Austin, Austin, TX, United States
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, United States
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, United States
| | - Andrew J. Watrous
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Center for Learning and Memory, The University of Texas at Austin, Austin, TX, United States
- Institute for Neuroscience, The University of Texas at Austin, Austin, TX, United States
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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Gielis K, Vanden Abeele ME, De Croon R, Dierick P, Ferreira-Brito F, Van Assche L, Verbert K, Tournoy J, Vanden Abeele V. Dissecting Digital Card Games to Yield Digital Biomarkers for the Assessment of Mild Cognitive Impairment: Methodological Approach and Exploratory Study. JMIR Serious Games 2021; 9:e18359. [PMID: 34734825 PMCID: PMC8603181 DOI: 10.2196/18359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 01/28/2021] [Accepted: 08/11/2021] [Indexed: 01/19/2023] Open
Abstract
Background Mild cognitive impairment (MCI), the intermediate cognitive status between normal cognitive decline and pathological decline, is an important clinical construct for signaling possible prodromes of dementia. However, this condition is underdiagnosed. To assist monitoring and screening, digital biomarkers derived from commercial off-the-shelf video games may be of interest. These games maintain player engagement over a longer period of time and support longitudinal measurements of cognitive performance. Objective This paper aims to explore how the player actions of Klondike Solitaire relate to cognitive functions and to what extent the digital biomarkers derived from these player actions are indicative of MCI. Methods First, 11 experts in the domain of cognitive impairments were asked to correlate 21 player actions to 11 cognitive functions. Expert agreement was verified through intraclass correlation, based on a 2-way, fully crossed design with type consistency. On the basis of these player actions, 23 potential digital biomarkers of performance for Klondike Solitaire were defined. Next, 23 healthy participants and 23 participants living with MCI were asked to play 3 rounds of Klondike Solitaire, which took 17 minutes on average to complete. A generalized linear mixed model analysis was conducted to explore the differences in digital biomarkers between the healthy participants and those living with MCI, while controlling for age, tablet experience, and Klondike Solitaire experience. Results All intraclass correlations for player actions and cognitive functions scored higher than 0.75, indicating good to excellent reliability. Furthermore, all player actions had, according to the experts, at least one cognitive function that was on average moderately to strongly correlated to a cognitive function. Of the 23 potential digital biomarkers, 12 (52%) were revealed by the generalized linear mixed model analysis to have sizeable effects and significance levels. The analysis indicates sensitivity of the derived digital biomarkers to MCI. Conclusions Commercial off-the-shelf games such as digital card games show potential as a complementary tool for screening and monitoring cognition. Trial Registration ClinicalTrials.gov NCT02971124; https://clinicaltrials.gov/ct2/show/NCT02971124
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Affiliation(s)
- Karsten Gielis
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Robin De Croon
- Department of Computer Science, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul Dierick
- Department of Gerontopsychiatry, University Psychiatric Center, Duffel, Belgium
| | - Filipa Ferreira-Brito
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Lies Van Assche
- Section of Geriatric Psychiatry, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Psychiatry, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katrien Verbert
- Department of Computer Science, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Gerontology and Geriatrics, Katholieke Universiteit Leuven, Leuven, Belgium
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Hau CT, Gouwanda D, Gopalai AA, Low CY, Hanapiah FA. Gamification and Control of Nitinol Based Ankle Rehabilitation Robot. Biomimetics (Basel) 2021; 6:biomimetics6030053. [PMID: 34562877 PMCID: PMC8482156 DOI: 10.3390/biomimetics6030053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Conventional ankle rehabilitation exercises can be monotonous and repetitive. The use of robots and games can complement the existing practices, provide an engaging environment for the patient and alleviate the physiotherapist’s workload. This paper presents an ankle rehabilitation robot that uses two nitinol wire actuators and a Pong game to provide foot plantarflexion and dorsiflexion exercises. Nitinol is a type of smart material that has high volumetric mechanical energy density and can produce translational motion. A two-state discrete antagonistic control is proposed to manipulate the actuators. The system was tested on healthy participants and stroke patients. The results showed that the robot was safe and compliant. The robot did not forcefully plantarflex or dorsiflex the foot when the participant exerted opposing force. The actuators worked antagonistically to flex to the foot as intended, in sync with the up and down motions of the player’s bat in the game. These behaviors demonstrated the feasibility of a nitinol-based ankle rehabilitation robot and a simple and yet intuitive game in providing interactive rehabilitation exercise. The robot is expected to enhance the patient’s experience, participation and compliance to the rehabilitation routine and to quantitatively monitor the patient’s recovery progress.
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Affiliation(s)
- Chong Tune Hau
- School of Engineering, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia; (C.T.H.); (A.A.G.)
| | - Darwin Gouwanda
- School of Engineering, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia; (C.T.H.); (A.A.G.)
- Correspondence:
| | - Alpha A. Gopalai
- School of Engineering, Monash University Malaysia, Bandar Sunway 47500, Selangor, Malaysia; (C.T.H.); (A.A.G.)
| | - Cheng Yee Low
- Faculty of Mechanical and Manufacturing Engineering, Universiti Tun Hussein Onn Malaysia, Parit Raja, Batu Pahat 86400, Johor, Malaysia;
| | - Fazah A. Hanapiah
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia;
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11
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Ferreira-Brito F, Ribeiro F, Aguiar de Sousa D, Costa J, Caneiras C, Carriço L, Verdelho A. Are Video Games Effective to Promote Cognition and Everyday Functional Capacity in Mild Cognitive Impairment/Dementia Patients? A Meta-Analysis of Randomized Controlled Trials. J Alzheimers Dis 2021; 84:329-341. [PMID: 34542073 DOI: 10.3233/jad-210545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) and dementia are associated with increased age. MCI is a clinical entity described as a transitional state between normal cognition and dementia. Video games (VGs) can potentially promote cognition and functional capacity since multiple cognitive domains are recruited during gameplay. However, there is still a lack of consensus regarding the efficacy of VGs as therapeutic tools, particularly in neurodegenerative diseases. OBJECTIVE We aimed to analyze the impact of VGs on cognition and functional capacity outcomes in MCI/dementia patients. METHODS We conducted a systematic review and meta-analysis study (PROSPERO [CRD42021229445]). PubMed, Web of Science, Epistemonikos, CENTRAL, and EBSCO electronic databases were searched for RCT (2000-2021) that analyzed the impact of VGs on cognitive and functional capacity outcomes in MCI/dementia patients. RESULTS Nine studies were included (n = 409 participants), and Risk of Bias (RoB2) and quality of evidence (GRADE) were assessed. Data regarding attention, memory/learning, visual working memory, executive functions, general cognition, functional capacity, quality of life were identified, and pooled analyses were conducted. An effect favoring VGs interventions was observed on Mini-Mental State Examination (MMSE) score (MD = 1.64, 95%CI 0.60 to 2.69). CONCLUSION Although promising, the effects observed should be interpreted with caution since serious methodological shortcomings were identified in the studies included. Nonetheless, the effect observed is higher than the minimum clinically important difference (1.4 points) established to MMSE. Future studies on the current topic urge. Recommendations for the design and conduction of cognitive RCT studies are presented.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Ribeiro
- Center for Interdisciplinary Research in Health, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Diana Aguiar de Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisboa, Lisbon, Portugal
| | - João Costa
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro Colaborador Português da Rede Cochrane Iberoamericana, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cátia Caneiras
- Laboratório de Investigação em Microbiologia na Saúde Ambiental (EnviHealthMicro Lab), Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Healthcare Department, Nippon Gases Portugal, Vila Franca de Xira, Portugal
| | - Luís Carriço
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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12
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al‐Qallawi S, Raghavan M. A review of online reactions to game‐based assessment mobile applications. INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT 2021. [DOI: 10.1111/ijsa.12346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Sherif al‐Qallawi
- School of Psychology Florida Institute of Technology Melbourne Florida USA
| | - Mukhunth Raghavan
- Department of Psychology University of South Florida Tampa Florida USA
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13
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Ferreira-Brito F, Alves S, Santos O, Guerreiro T, Caneiras C, Carriço L, Verdelho A. Photo-Realistic Interactive Virtual Environments for Neurorehabilitation in Mild Cognitive Impairment (NeuroVRehab.PT): A Participatory Design and Proof-of-Concept Study. J Clin Med 2020; 9:jcm9123821. [PMID: 33255869 PMCID: PMC7760013 DOI: 10.3390/jcm9123821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Mild cognitive impairment (MCI) is characterized by cognitive, psychological, and functional impairments. Digital interventions typically focus on cognitive deficits, neglecting the difficulties that patients experience in instrumental activities of daily living (IADL). The global conjecture created by COVID-19 has highlighted the seminal importance of digital interventions for the provision of healthcare services. Here, we investigated the feasibility and rehabilitation potential of a new design approach for creating highly realistic interactive virtual environments for MCI patients’ neurorehabilitation. Through a participatory design protocol, a neurorehabilitation digital platform was developed using images captured from a Portuguese supermarket (NeuroVRehab.PT). NeuroVRehab.PT’s main features (e.g., medium-sized supermarket, the use of shopping lists) were established according to a shopping behavior questionnaire filled in by 110 older adults. Seven health professionals used the platform and assessed its rehabilitation potential, clinical applicability, and user experience. Interviews were conducted using the think-aloud method and semi-structured scripts, and four main themes were derived from an inductive semantic thematic analysis. Our findings support NeuroVRehab.PT as an ecologically valid instrument with clinical applicability in MCI neurorehabilitation. Our design approach, together with a comprehensive analysis of the patients’ past experiences with IADL, is a promising technique to develop effective digital interventions to promote real-world functioning.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (O.S.); (A.V.)
- Correspondence:
| | - Sérgio Alves
- LASIGE, Faculdade de Ciências Universidade de Lisboa, 1749-016 Lisboa, Portugal; (S.A.); (T.G.); (L.C.)
| | - Osvaldo Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (O.S.); (A.V.)
- Unbreakable Idea Research, Lda, 2550-426 Painho, Portugal
| | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências Universidade de Lisboa, 1749-016 Lisboa, Portugal; (S.A.); (T.G.); (L.C.)
| | - Cátia Caneiras
- Laboratório de Investigação em Microbiologia na Saúde Ambiental (EnviHealthMicro Lab), Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
- Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal
| | - Luís Carriço
- LASIGE, Faculdade de Ciências Universidade de Lisboa, 1749-016 Lisboa, Portugal; (S.A.); (T.G.); (L.C.)
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal; (O.S.); (A.V.)
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
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14
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Wang G, Zhao M, Yang F, Cheng LJ, Lau Y. Game-based brain training for improving cognitive function in community-dwelling older adults: A systematic review and meta-regression. Arch Gerontol Geriatr 2020; 92:104260. [PMID: 32980574 DOI: 10.1016/j.archger.2020.104260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given that increasing aging is associated with a natural decline in cognitive function, identifying effective interventions that can help to prevent cognitive decline in older adults is a research priority. OBJECTIVE To synthesize the best evidence to assess the effectiveness of game-based brain training in improving cognitive function and to evaluate the preferred design features of the intervention. METHODS Twelve databases, trial registries, and gray literature resources were systematically searched for in randomized controlled trials. Meta-analysis and random-effects meta-regression were conducted using Comprehensive Meta-analysis Software 3.0. Overall effect was measured using Hedges's g and determined using Z-statistics. Cochran's Q test and I2 were used to investigate heterogeneity. The Grading of Recommendation, Assessment, Development, and Evaluation system was used to assess overall quality of evidence. RESULTS Fifteen trials among 759 older adults were conducted. Meta-analysis revealed that game-based brain training significantly improved processing speed (g = 0.23), selective attention (g = 0.40), and short-term memory (g = 0.35) versus a control group. Our subgroup analyses emphasized that non-time pressure games, multiplayer, computer platform, provider support, sessions ≤ 3 times per week for ≤ 60 min. each comprised a preferable design. Meta-regression identified game design (β = 0.211, p = 0.008) that had statistically significant effects on processing speed. Egger's regression asymmetry test (p = 0.293) suggested no publication bias. CONCLUSIONS Game-based brain training can be considered a supplementary intervention for improving cognitive functions in community-dwelling older adults. Future trials should use well-designed trials with large sample sizes.
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Affiliation(s)
| | - Menglu Zhao
- Bachelor of Science, School of Nursing, Qingdao University, China.
| | - Fuguo Yang
- School of Nursing, Qingdao University, China.
| | - Ling Jie Cheng
- Nursing Research Unit, Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore.
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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15
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Vermeir JF, White MJ, Johnson D, Crombez G, Van Ryckeghem DML. The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis. JMIR Serious Games 2020; 8:e18644. [PMID: 32773374 PMCID: PMC7445616 DOI: 10.2196/18644] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background There has been a growing interest in the application of gamification (ie, the use of game elements) to computerized cognitive training. The introduction of targeted gamification features to such tasks may increase motivation and engagement as well as improve intervention effects. However, it is possible that game elements can also have adverse effects on cognitive training (eg, be a distraction), which can outweigh their potential motivational benefits. So far, little is known about the effectiveness of such applications. Objective This study aims to conduct a systematic review and meta-analysis to investigate the effect of gamification on process outcomes (eg, motivation) and on changes in the training domain (eg, cognition), as well as to explore the role of potential moderators. Methods We searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ProQuest Psychology, Web of Science, Scopus, PubMed, Science Direct, Excerpta Medica dataBASE, Institute of Electrical and Electronics Engineers Xplore, Association for Computing Machinery, and a range of gray-area literature databases. The searches included papers published between 2008 and 2018. Meta-analyses were performed using a random-effects model. Results The systematic review identified 49 studies, of which 9 randomized controlled trials were included in the meta-analysis. The results of the review indicated that research in this context is still developing and lacks well-controlled empirical studies. Gamification in cognitive training is applied to a large range of age groups and audiences and is mostly delivered at a research site through computers. Rewards and feedback continue to dominate the gamification landscape, whereas social-oriented features (eg, competition) are underused. The meta-analyses showed that gamified training tasks were more motivating/engaging (Hedges g=0.72) and more demanding/difficult (Hedges g=–0.52) than non- or less-gamified tasks, whereas no effects on the training domain were found. Furthermore, no variables moderated the impact of gamified training tasks. However, meta-analytic findings were limited due to a small number of studies. Conclusions Overall, this review provides an overview of the existing research in the domain and provides evidence for the effectiveness of gamification in improving motivation/engagement in the context of cognitive training. We discuss the shortcomings in the current literature and provide recommendations for future research.
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Affiliation(s)
- Julie F Vermeir
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Melanie J White
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Daniel Johnson
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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16
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Oliveira J, Gamito P, Lopes B, Silva AR, Galhordas J, Pereira E, Ramos E, Silva AP, Jorge Á, Fantasia A. Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke. Disabil Rehabil Assist Technol 2020; 17:298-303. [PMID: 32255695 DOI: 10.1080/17483107.2020.1749891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. Materials and Methods: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). Results: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. Conclusions: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.Implications for rehabilitationVirtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.
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Affiliation(s)
- Jorge Oliveira
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal.,HEI-Lab, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - Pedro Gamito
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal.,HEI-Lab, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - Beatriz Lopes
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - Ana Rute Silva
- EPCV, Universidade Lusófona de Humanidades e Tecnologias (ULHT), Lisbon, Portugal
| | - João Galhordas
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Eduarda Pereira
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Elisabete Ramos
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Ana Paula Silva
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - Áurea Jorge
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
| | - António Fantasia
- Serviço de Psicologia, Centro de Medicina de Reabilitação de Alcoitão (CMRA), Alcabideche, Portugal
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17
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Oldrati V, Corti C, Poggi G, Borgatti R, Urgesi C, Bardoni A. Effectiveness of Computerized Cognitive Training Programs (CCTP) with Game-like Features in Children with or without Neuropsychological Disorders: a Meta-Analytic Investigation. Neuropsychol Rev 2020; 30:126-141. [PMID: 32112369 DOI: 10.1007/s11065-020-09429-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/13/2020] [Indexed: 12/18/2022]
Abstract
Computerized cognitive training programs (CCTP) are based on the assumption that cognitive abilities may be boosted by repetitively performing challenging tasks. The integration of game-like features in these programs, associated with the goal of amusing or rewarding participants, may contribute to generate cognitive benefits. Indeed, reinforcement contingencies have been reported to produce positive effects on performance and motivation, especially in children. This meta-analysis was aimed at providing a quantitative summary of the effectiveness of CCTP with game-like features in school-aged children with typical and atypical development. A total of 24 studies, with the cognitive and behavioral outcome data of 1547 participants, were selected for inclusion in the meta-analysis. Subgroup analyses were performed to identify the sources of the observed methodological heterogeneity. A robust variance estimation model, after removal of study outliers, yielded a small-to-moderate significant effect size. Final results pointed out smaller but more precise estimate effect sizes according to methodological aspects related to cognitive domain of outcomes, standardization of measures and type of control applied. Alongside supporting the use of CCTP for rehabilitating cognitive functions, the present results shed light on how different methodological choices are able to shape research findings in the field of children's cognitive rehabilitation.
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Affiliation(s)
- Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Geraldina Poggi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Renato Borgatti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
- Scientific Institute, IRCCS E. Medea, San Vito al Tagliamento, Pordenone, Italy
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