Neural Basis of Video Gaming: A Systematic Review

The tangled ways to classify games: A systematic review of how games are classified in psychological research

In the face of the rapid evolution of the gaming market and the puzzling overlap of genres, consistency in classification seems elusive. The purpose of the present review was to explore the classification of video game genres in the context of psychological research. The aim was to address the challenges associated with creating consistent and meaningful classifications of video game genres, considering the rapid evolution of the gaming market and recent tendency to create games that could be classified into multiple genres. We performed a search in four databases according to the PRISMA guidelines and reviewed 96 full-text papers (N = 49 909). Through our findings, we reveal how researchers strive to classify genres and the numerous complications that arise from this pursuit. In the face of these challenges, we propose alternative ways of classifying genres. Our first proposal is a new classification of video game genres based on our literature review. In our second proposal, we advocate a more detailed understanding by focusing on specific gaming mechanics, and thus we introduce the innovative concept of utilizing community-based tags, such as Steam tags, as an alternative to genres in psychological research.

Reduced reactivity to fear conditioning and pain tests in persons involved in violent video gaming is influenced by adverse childhood experiences

Video gaming, including violent video gaming, has become very common and lockdown measures of the COVID-19 pandemic even increased the prevalence rates. In this study, we examined if violent video gaming is associated with more adverse childhood experiences (ACE) and if it impairs pain processing and fear conditioning. We tested three groups of participants (violent video gamers, nonviolent video gamers, and non-gamers) and examined fear conditioning as well as pain perception during functional magnetic resonance imaging (fMRI). Violent video gamers displayed significantly higher pain thresholds as well as pain tolerance for electric stimulation, pressure pain stimulation, and cold pressor pain measurements than nonviolent video gamers and non-gamers. This relationship was moderated by adverse childhood experiences, especially physical neglect. Brain images acquired during the fear conditioning fMRI task showed that violent video gamers display significantly less differential brain activation to stimuli signaling pain versus no pain in the anterior cingulate cortex, the juxtapositional lobule cortex, and the paracingulate gyrus compared to non-gamers. There was also a significant negative correlation between adverse childhood experiences and activation in the precuneus and the intracalcarine cortex for signals of pain versus safety. The results of this study imply that violent video gaming is related to reduced processing of pain and signals of pain in a fear learning task, dependent of adverse childhood experiences. These mechanisms need to be examined in more detail and these data could be helpful in preventing the onset and adverse consequences of violent video gaming.

Large-scale network abnormality in behavioral addiction

BACKGROUND

Researchers have endeavored to ascertain the network dysfunction associated with behavioral addiction (BA) through the utilization of resting-state functional connectivity (rsFC). Nevertheless, the identification of aberrant patterns within large-scale networks pertaining to BA has proven to be challenging.

METHODS

Whole-brain seed-based rsFC studies comparing subjects with BA and healthy controls (HC) were collected from multiple databases. Multilevel kernel density analysis was employed to ascertain brain networks in which BA was linked to hyper-connectivity or hypo-connectivity with each prior network.

RESULTS

Fifty-six seed-based rsFC publications (1755 individuals with BA and 1828 HC) were included in the meta-analysis. The present study indicate that individuals with BAs exhibit (1) hypo-connectivity within the fronto-parietal network (FN) and hypo- and hyper-connectivity within the ventral attention network (VAN); (2) hypo-connectivity between the FN and regions of the VAN, hypo-connectivity between the VAN and regions of the FN and default mode network (DMN), hyper-connectivity between the DMN and regions of the FN; (3) hypo-connectivity between the reward system and regions of the sensorimotor network (SS), DMN and VAN; (4) hypo-connectivity between the FN and regions of the SS, hyper-connectivity between the VAN and regions of the SS.

CONCLUSIONS

These findings provide impetus for a conceptual framework positing a model of BA characterized by disconnected functional coordination among large-scale networks.

Videogame training increases clinical well-being, attention and hippocampal-prefrontal functional connectivity in patients with schizophrenia

Recent research shows that videogame training enhances neuronal plasticity and cognitive improvements in healthy individuals. As patients with schizophrenia exhibit reduced neuronal plasticity linked to cognitive deficits and symptoms, we investigated whether videogame-related cognitive improvements and plasticity changes extend to this population. In a training study, patients with schizophrenia and healthy controls were randomly assigned to 3D or 2D platformer videogame training or E-book reading (active control) for 8 weeks, 30 min daily. After training, both videogame conditions showed significant increases in sustained attention compared to the control condition, correlated with increased functional connectivity in a hippocampal-prefrontal network. Notably, patients trained with videogames mostly improved in negative symptoms, general psychopathology, and perceived mental health recovery. Videogames, incorporating initiative, goal setting and gratification, offer a training approach closer to real life than current psychiatric treatments. Our results provide initial evidence that they may represent a possible adjunct therapeutic intervention for complex mental disorders.

Event-related prefrontal activations during online video game playing are modulated by game mechanics, physiological arousal and the amount of daily playing

There is a trend to study human brain functions in ecological contexts and in relation to human factors. In this study, functional near-infrared spectroscopy (fNIRS) was used to record real-time prefrontal activities in 42 male university student habitual video game players when they played a round of multiplayer online battle arena game, League of Legends. A content-based event coding approach was used to analyze regional activations in relation to event type, physiological arousal indexed by heart rate (HR) change, and individual characteristics of the player. Game events Slay and Slain were found to be associated with similar HR and prefrontal responses before the event onset, but differential responses after the event onset. Ventrolateral prefrontal cortex (VLPFC) activation preceding the Slay onset correlated positively with HR change, whereas activations in dorsolateral prefrontal cortex (DLPFC) and rostral frontal pole area (FPAr) preceding the Slain onset were predicted by self-reported hours of weekly playing (HoWP). Together, these results provide empirical evidence to support the notion that event-related regional prefrontal activations during online video game playing are shaped by game mechanics, in-game dynamics of physiological arousal and individual characteristics the players.

Effects of Cognitively Stimulating Activities on the Cognitive Functioning of Older People with Mild Cognitive Impairment: A Meta-analysis

Background

The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings.

Objectives

This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, "In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?"

Methods

A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA on older people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot.

Results

This meta-analysis which compared studies that employed similar methodologies, found that CSA has a significant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMD of 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitive function was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran's Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment.

Conclusion

Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study's significant, large effect, and non-significant heterogeneity warrants caution.

High-skilled first-person shooting game players have specific frontal lobe activity: Power spectrum analysis in an electroencephalogram study

First-person shooting (FPS) games are among the most famous video games worldwide. However, cortical activities in environments related to real FPS games have not been studied. This study aimed to determine differences in cortical activity between low- and high-skilled FPS game players using 160-channel electroencephalography. Nine high-skilled FPS game players (official ranks: above the top 10%) and eight low-skilled FPS game players (official ranks: lower than the top 20%) were recruited for the experiment. The task was set for five different conditions using the AimLab program, which was used for the FPS game players' training. Additionally, we recorded the brain activity in the resting condition before and after the task, in which the participants closed their eyes and relaxed. The reaction time and accuracy (the number of hit-and-miss targets) were calculated to evaluate the task performance. The results showed that high-skilled FPS game players have fast reaction times and high accuracy during tasks. High-skilled FPS game players had higher cortical activity in the frontal cortex than low-skilled FPS game players during each task. In low-skilled players, cortical activity level and performance level were associated. These results suggest that high cortical activity levels were critical to achieving high performance in FPS games.

What is esports? A systematic scoping review and concept analysis of esports

This study conducted a systematic scoping review to collect definitions and explanations of esports and its related concepts in the existing literature. A thematic coding approach was used to screen possible disagreements and issues between the different characteristics of esports as presented in the existing definitions. Based on a critical discussion, the results of the coding were combined with the objective facts of the current esports industry and theories from similar fields to reconstruct the construction of an esports definition. In addition, the relationship between esports and its related concepts was discussed based on the proposed esports definition structure. The proposed esports criteria can help avoid misunderstandings and confusion in future studies regarding the research subjects related to esports and propose standardized usage of relevant terms in the field of esports research.

Association between gaming disorder and regional homogeneity in highly involved male adult gamers: A pilot resting-state fMRI study

BACKGROUND

Gaming behavior can induce cerebral changes that may be related to the neurobiological features of gaming disorder (GD). Additionally, individuals with higher levels of depression or impulsivity are more likely to experience GD. Therefore, the present pilot study explored potential neurobiological correlates of GD in the context of depression and impulsivity, after accounting for video gaming behavior.

METHODS

Using resting-state functional magnetic resonance imaging (fMRI), a cross-sectional study was conducted with 35 highly involved male adult gamers to examine potential associations between GD severity and regional homogeneity (ReHo) in the entire brain. A mediation model was used to test the role of ReHo in the possible links between depression/impulsivity and GD severity.

RESULTS

Individuals with greater GD severity showed increased ReHo in the right Heschl's gyrus and decreased ReHo in the right hippocampus (rHip). Furthermore, depression and impulsivity were negatively correlated with ReHo in the rHip, respectively. More importantly, ReHo in the rHip was found to mediate the associations between depression/impulsivity and GD.

CONCLUSIONS

These preliminary findings suggest that GD severity is related to ReHo in brain regions associated with learning/memory/mood and auditory function. Higher levels of depression or impulsivity may potentiate GD through the functional activity of the hippocampus. Our findings advance our understanding of the neurobiological differences behind GD symptoms in highly involved gamers.

Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis

BACKGROUND

Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field.

METHODS

In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane's tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool.

RESULTS

The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants' attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures.

CONCLUSIONS

Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children's functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.

A Literature Review on the Effects of Exergames on Executive Function in Youth

Exergames (video games that promote cognitive and physical activity simultaneously) benefit executive function in elderly populations. It has been suggested that exergames may induce larger effects than cognitive or exercise training alone, but few reviews have synthesized the causal factors of exergames on executive function from experimental research with youth. This review investigates (1) the various types of exergames and associated comparison conditions (2) the executive function outcome assessments commonly utilized in exergame research with youth (3) the efficacy of exergames by evaluating experimental studies that compared exergaming to cognitive, exercise, and passive control conditions inclusive of effect sizes and (4) the potential mechanisms underlying the changes in executive function induced from exergames. Eligible outcome data were available from 607 participants across ten studies, with the age of participants ranging from 4-21 (M age = 10.46 ). The findings indicate that exergames improve aspects of executive function from both acute and chronic studies. Despite the high variability of exergame contexts, dosage, populations, and outcome assessments, improvements in executive function comparing exergaming to passive control conditions were exhibited across all studies. While there is evidence of exergaming demonstrating advantages over passive control conditions, evidence is mixed when comparing exergaming to sedentary cognitive and exercise comparison conditions. Potential sources of these mixed results and future directions to address current gaps in the field are identified. As video game and technology use grows exponentially and concerns of childhood sedentary behavior and play deprivation increase, evidence-based practices that promote both physical and cognitive activity are needed.

Systematic Review of Gaming and Neuropsychological Assessment of Social Cognition

Playing video games is associated with cognitive changes and possibly psychosocial difficulties. Problematic gaming occurs upon the loss of control over videogame playing; gaming disorder is considered a behavioral addiction in the 11th version of the International Classification of Diseases. Models used to understand behavioral addictions include cognition as an essential factor in the development, maintenance, and relapse of addiction. Nevertheless, some aspects of cognition, such as social cognition, remain underexplored, despite evidence of alterations in cognitive and social function among patients with problematic gaming. This review aimed to describe the current understanding of social cognition in individuals exposed to videogames. We included all studies assessing social cognition in participants of any age with a wide range of exposure to video games (from simple use of video games (such as at least two exposures) to problematic gaming, defined according to the included study). This wide range of exposure allowed us to explore the whole process from repeated exposure to addiction. We included only studies that used neuropsychological tasks to assess social cognition. Patient-reported outcomes that could be biased by subjective self-report data were not included. The search was conducted from inception to January 2022 in three databases (PubMed, PsycINFO, and Web of Science). The systematic search identified 39 studies that assessed facial emotion processing, empathy, theory of mind, social decision-making, aggressive behavior, and moral competence. In general, results have been mixed, and a number of questions remain unanswered. Nevertheless, several studies showed cerebral changes when processing facial emotion that were linked with problematic gaming, while no link was obtained between nonproblematic gaming and empathy alterations. The influences of cooperation patterns, theory of mind, moral competence, and gaming frequency were highlighted. Finally, there was substantial heterogeneity in the population assessed and the methods used.

Neuroimaging correlates of internet gaming disorder: Can we achieve the promise of translating understandings of brain functioning into clinical advances?

Objectives

Here we aimed to consider the neural factors associated with internet gaming disorder (IGD), as well as the associations between these factors and existing treatments for the disorder.

Methods

A narrative review was conducted.

Results

Pharmacological as well as psychological treatments for IGD may be associated with specific changes in multiple brain areas and circuits. In particular, fronto-striatal and subcortical regions and pathways appear relevant to IGD and its treatment.

Conclusions

Neuroimaging holds promise for identifying specific mechanisms underlying IGD interventions. However, to date, firm conclusions are difficult to draw and more research examining neural mechanisms of empirically supported treatments for IGD is needed.

Biomarkers of professional cybersportsmen: Event related potentials and cognitive tests study

"Faster, higher, stronger" is the motto of any professional athlete. Does that apply to brain dynamics as well? In our paper, we performed a series of EEG experiments on Visually Evoked Potentials and a series of cognitive tests-reaction time and visual search, with professional eSport players in Counter-Strike: Global Offensive (CS:GO) and novices (control group) in order to find important differences between them. EEG data were studied in a temporal domain by Event-Related Potentials (ERPs) and in a frequency domain by Variational Mode Decomposition. The EEG analysis showed that the brain reaction of eSport players is faster (P300 latency is earlier on average by 20-70 ms, p < 0.005) and stronger (P300 peak amplitude is higher on average by 7-9 mkV, p < 0.01). Professional eSport players also exhibit stronger stimulus-locked alpha-band power. Besides, the Spearman correlation analysis showed a significant correlation between hours spend in CS:GO and mean amplitude of P200 and N200 for the professional players. The comparison of cognitive test results showed the superiority of the professional players to the novices in reaction time (faster) and choice reaction time-faster reaction, but similar correctness, while a significant difference in visual search skills was not detected. Thus, significant differences in EEG signals (in spectrograms and ERPs) and cognitive test results (reaction time) were detected between the professional players and the control group. Cognitive tests could be used to separate skilled players from novices, while EEG testing can help to understand the skilled player's level. The results can contribute to understanding the impact of eSport on a player's cognitive state and associating eSport with a real sport. Moreover, the presented results can be useful for evaluating eSport team members and making training plans.

Engaging learners with games-Insights from functional near-infrared spectroscopy

The use of game elements in learning tasks is thought to facilitate emotional and behavioral responses as well as learner engagement. So far, however, little is known about the underlying neural mechanisms of game-based learning. In the current study, we added game elements to a number line estimation task assessing fraction understanding and compared brain activation patterns to a non-game-based task version. Forty-one participants performed both task versions in counterbalanced order while frontal brain activation patterns were assessed using near-infrared spectroscopy (within-subject, cross-sectional study design). Additionally, heart rate, subjective user experience, and task performance were recorded. Task performance, mood, flow experience, as well as heart rate did not differ between task versions. However, the game-based task-version was rated as more attractive, stimulating and novel compared to the non-game-based task version. Additionally, completing the game-based task version was associated with stronger activation in frontal brain areas generally involved in emotional and reward processing as well as attentional processes. These results provide new neurofunctional evidence substantiating that game elements in learning tasks seem to facilitate learning through emotional and cognitive engagement.

Computational models of behavioral addictions: State of the art and future directions

Non-pharmacological behavioral addictions, such as pathological gambling, videogaming, social networking, or internet use, are becoming major public health concerns. It is not yet clear how behavioral addictions could share many major neurobiological and behavioral characteristics with substance use disorders, despite the absence of direct pharmacological influences. A deeper understanding of the neurocognitive mechanisms of addictive behavior is needed, and computational modeling could be one promising approach to explain intricately entwined cognitive and neural dynamics. This review describes computational models of addiction based on reinforcement learning algorithms, Bayesian inference, and biophysical neural simulations. We discuss whether computational frameworks originally conceived to explain maladaptive behavior in substance use disorders can be effectively extended to non-substance-related behavioral addictions. Moreover, we introduce recent studies on behavioral addictions that exemplify the possibility of such extension and propose future directions.

Potential Biological Markers and Treatment Implications for Binge Eating Disorder and Behavioral Addictions

The reward system is highly relevant to behavioral addictions such as gambling disorder (GD), internet gaming disorder (IGD), and food addiction/binge eating disorder (FA/BED). Among other brain regions, the ventral striatum (VS) has been implicated in reward processing. The main objective of the present state-of-the-art review was to explore in depth the specific role of the VS in GD, IGD and FA/BED, understanding it as a possible biomarker of these conditions. Studies analyzing brain changes following interventions for these disorders, and especially those that had explored possible treatment-related changes in VS, are discussed. More evidence is needed on how existing treatments (both pharmacological and psychobehavioral) for behavioral addictions affect the activation of the VS and related circuitry.

Health Implications of Virtual Architecture: An Interdisciplinary Exploration of the Transferability of Findings from Neuroarchitecture

Virtual architecture has been increasingly relied on to evaluate the health impacts of physical architecture. In this health research, exposure to virtual architecture has been used as a proxy for exposure to physical architecture. Despite the growing body of research on the health implications of physical architecture, there is a paucity of research examining the long-term health impacts of prolonged exposure to virtual architecture. In response, this paper considers: what can proxy studies, which use virtual architecture to assess the physiological response to physical architecture, tell us about the impact of extended exposure to virtual architecture on human health? The paper goes on to suggest that the applicability of these findings to virtual architecture may be limited by certain confounding variables when virtual architecture is experienced for a prolonged period of time. This paper explores the potential impact of two of these confounding variables: multisensory integration and gravitational perception. This paper advises that these confounding variables are unique to extended virtual architecture exposure and may not be captured by proxy studies that aim to capture the impact of physical architecture on human health through acute exposure to virtual architecture. While proxy studies may be suitable for measuring some aspects of the impact of both physical and virtual architecture on human health, this paper argues that they may be insufficient to fully capture the unintended consequences of extended exposure to virtual architecture on human health. Therefore, in the face of the increasing use of virtual architectural environments, the author calls for the establishment of a subfield of neuroarchitectural health research that empirically examines the physiological impacts of extended exposure to virtual architecture in its own right.

Association of Video Gaming With Cognitive Performance Among Children

IMPORTANCE

Although most research has linked video gaming to subsequent increases in aggressive behavior in children after accounting for prior aggression, findings have been divided with respect to video gaming's association with cognitive skills.

OBJECTIVE

To examine the association between video gaming and cognition in children using data from the Adolescent Brain Cognitive Development (ABCD) study.

DESIGN, SETTING, AND PARTICIPANTS

In this case-control study, cognitive performance and blood oxygen level-dependent (BOLD) signal were compared in video gamers (VGs) and non-video gamers (NVGs) during response inhibition and working memory using task-based functional magnetic resonance imaging (fMRI) in a large data set of 9- and 10-year-old children from the ABCD study, with good control of demographic, behavioral, and psychiatric confounding effects. A sample from the baseline assessment of the ABCD 2.0.1 release in 2019 was largely recruited across 21 sites in the US through public, private, and charter elementary schools using a population neuroscience approach to recruitment, aiming to mirror demographic variation in the US population. Children with valid neuroimaging and behavioral data were included. Some exclusions included common MRI contraindications, history of major neurologic disorders, and history of traumatic brain injury.

EXPOSURES

Participants completed a self-reported screen time survey including an item asking children to report the time specifically spent on video gaming. All fMRI tasks were performed by all participants.

MAIN OUTCOMES AND MEASURES

Video gaming time, cognitive performance, and BOLD signal assessed with n-back and stop signal tasks on fMRI. Collected data were analyzed between October 2019 and October 2020.

RESULTS

A total of 2217 children (mean [SD] age, 9.91 [0.62] years; 1399 [63.1%] female) participated in this study. The final sample used in the stop signal task analyses consisted of 1128 NVGs (0 gaming hours per week) and 679 VGs who played at least 21 hours per week. The final sample used in the n-back analyses consisted of 1278 NVGs who had never played video games (0 hours per week of gaming) and 800 VGs who played at least 21 hours per week. The VGs performed better on both fMRI tasks compared with the NVGs. Nonparametric analyses of fMRI data demonstrated a greater BOLD signal in VGs in the precuneus during inhibitory control. During working memory, a smaller BOLD signal was observed in VGs in parts of the occipital cortex and calcarine sulcus and a larger BOLD signal in the cingulate, middle, and frontal gyri and the precuneus.

CONCLUSIONS AND RELEVANCE

In this study, compared with NVGs, VGs were found to exhibit better cognitive performance involving response inhibition and working memory as well as altered BOLD signal in key regions of the cortex responsible for visual, attention, and memory processing. The findings are consistent with videogaming improving cognitive abilities that involve response inhibition and working memory and altering their underlying cortical pathways.

Increased Screen Time as a Cause of Declining Physical, Psychological Health, and Sleep Patterns: A Literary Review

Dependency on digital devices resulting in an ever-increasing daily screen time has subsequently also been the cause of several adverse effects on physical and mental or psychological health. Constant exposure to devices like smartphones, personal computers, and television can severely affect mental health- increase stress and anxiety, for example, and cause various sleep issues in both children as well as adults. Risk factors for obesity and cardiovascular disorders, including hypertension, poor regulation of stress, low HDL cholesterol, and insulin resistance are among the physical health repercussions we see. The psychological health effects comprise suicidal tendencies and symptoms of depression which are associated with digital device dependency, screen-time-induced poor sleep quality, and content-influenced negativity. Oftentimes it can cause the induction of a state of hyper-arousal, increase stress hormones, desynchronize the body clock or the circadian cycle, alter brain chemistry and create a drag on mental energy and development. With a focus on brain development in children and detrimental effects in both adults and children, this research article goes on to explore the various aspects of screen addiction and excessive screen exposure.

Do Individuals with Internet Gaming Disorder Share Personality Traits with Substance-Dependent Individuals?

(1) Background: Internet gaming disorder (IGD) shares many similarities with substance use disorder (SUD), contributing to its recognition as an addictive disorder. Nevertheless, no study has compared IGD to other addictive disorders in terms of personality traits established as highly co-occurring with SUDs. (2) Methods: We recruited a sample of gamers (massively multiplayer online role-playing games) (MMORPGs) via online in-game forums. We compared 83 individuals with IGD (MMORPG-IGD group) to 47 former heroin addicts under methadone maintenance treatment (MMT; MMT group) with regard to alexithymia, impulsivity, sensation seeking and aggressiveness assessed through self-administered scales, being TAS-20, BIS-10, Z-SSS and BDHI, respectively. (3) Results: Our results draw a relatively similar personality profile between groups but indicate that the subject traits are generally more pronounced in the MMT cohort. The overall lesser intensity of these traits in the MMORPG-IGD group might reflect the greater variability in the severity of the IGD. (4) Conclusions: IGD shares personality traits with MMT, and intensity may be influenced by the severity of the addiction or by certain direct environmental factors, and might also influence the propensity towards one behavior rather than another.

Neuroanatomical predictors of complex skill acquisition during video game training

It is known that the outcomes of complex video game (VG) skill acquisition are correlated with individual differences in demographic and behavioral variables, such as age, intelligence and visual attention. However, empirical studies of the relationship between neuroanatomical features and success in VG training have been few and far between. The present review summarizes existing literature on gray matter (GM) and white matter correlates of complex VG skill acquisition as well as explores its relationship with neuroplasticity. In particular, since age can be an important factor in the acquisition of new cognitive skills, we present studies that compare different age groups (young and old adults). Our review reveals that GM in subcortical brain areas predicts complex VG learning outcomes in young subjects, whereas in older subjects the same is true of cortical frontal areas. This may be linked to age-related compensatory mechanisms in the frontal areas, as proposed by The Scaffolding Theory of Aging and Cognition. In the case of plasticity, there is no such relationship – in the group of younger and older adults there are changes after training in both cortical and subcortical areas. We also summarize best practices in research on predictors of VG training performance and outline promising areas of research in the study of complex video game skill acquisition.

The impact of digital media on children's intelligence while controlling for genetic differences in cognition and socioeconomic background

Digital media defines modern childhood, but its cognitive effects are unclear and hotly debated. We believe that studies with genetic data could clarify causal claims and correct for the typically unaccounted role of genetic predispositions. Here, we estimated the impact of different types of screen time (watching, socializing, or gaming) on children’s intelligence while controlling for the confounding effects of genetic differences in cognition and socioeconomic status. We analyzed 9855 children from the USA who were part of the ABCD dataset with measures of intelligence at baseline (ages 9–10) and after two years. At baseline, time watching (r = − 0.12) and socializing (r = − 0.10) were negatively correlated with intelligence, while gaming did not correlate. After two years, gaming positively impacted intelligence (standardized β =  + 0.17), but socializing had no effect. This is consistent with cognitive benefits documented in experimental studies on video gaming. Unexpectedly, watching videos also benefited intelligence (standardized β =  + 0.12), contrary to prior research on the effect of watching TV. Although, in a posthoc analysis, this was not significant if parental education (instead of SES) was controlled for. Broadly, our results are in line with research on the malleability of cognitive abilities from environmental factors, such as cognitive training and the Flynn effect.

Moderating Effects of Depressive Symptoms and Self-Control Trait on the Association Between Problematic Internet Gaming and Time Spent

This study was performed to examine whether depressive symptoms (DPs) and low self-control (LSC) traits has modifying effects on the association of time spent on Internet gaming and problematic Internet game use (PIGU). Among 1,535 middle school students, 42.1 percent reported playing ≥1.5 hours of Internet games/day on average, and 10.0 percent were classified as PIGU. Stratified multiple logistic regression analysis showed gameplay of ≥1.5 hours/day led to more PIGU in the non-LSC traits group (higher DP group, p < 0.001; lower group, p = 0.019). In LSC trait group, in contrast, time spent on Internet gamine was not associated with PIGU regardless of the level of DP. Adolescents without LSC traits, to which most youths belong, might have higher possibility of PIGU if they do not limit their time spent on Internet gaming, regardless of whether they are depressed or not. In case of LSC trait, additional strategies would be needed. ClinicalTrials.gov identifier: NCT02415322.

Gamified Neurorehabilitation Strategies for Post-stroke Motor Recovery: Challenges and Advantages

Abstract

Purpose of Review

Stroke is the leading cause of permanent motor disability in the United States (US), but there has been little progress in developing novel, effective strategies for treating post-stroke motor deficits. The past decade has seen the rapid development of many promising, gamified neurorehabilitation technologies; however, clinical adoption remains limited. The purpose of this review is to evaluate the recent literature surrounding the adoption and use of gamification in neurorehabilitation after stroke.

Recent Findings

Gamification of neurorehabilitation protocols is both feasible and effective. Deployment strategies and scalability need to be addressed with more rigor. Relationship between engaged time on task and rehabilitation outcomes should be explored further as it may create benefits beyond repetitive movement.

Summary

As gamification becomes a more common and feasible way of delivering exercise-based therapies, additional benefits of gamification are emerging. In spite of this, questions still exist about scalability and widespread clinical adoption.

Impact on Executive Dysfunctions of Gamification and Nongamification in Playing Board Games in Children at Risk of Social Exclusion

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.

Sleep in Habitual Adult Video Gamers: A Systematic Review

Video gaming is a popular, globally recognized phenomenon, played recreationally or competitively as esports. Gaming is a typically sedentary nighttime activity; therefore, the potential to impact sleep and health is high. Furthermore, there are limited studies on adult gamers, who represent the majority demographic in esports. This review examines evidence describing sleep in habitual adult gamers to understand the associated risk for cardiometabolic disease or the benefits to gaming performance. Three electronic databases (PubMed, Scopus, ISI Web of Science) were searched for peer-reviewed articles published between January 2000 - April 2020. Twelve studies reporting on sleep in habitual adult gamers were included. A narrative synthesis was employed to report results, owing to high levels of heterogeneity across the included studies. Gamers with higher gaming addiction scores were more likely to have shorter, poorer quality sleep and greater daytime sleepiness and insomnia scores than gamers with lower gaming addiction scores and non-gamers. In addition, high-volume gamers were more likely to have worsened sleep quantity and quality, with delayed sleep timing and increased prevalence of insomnia. Despite limitations in the design of the included studies, excessive gaming is broadly associated with worsened sleep parameters. Noteworthy is the lack of studies investigating cardiometabolic health in gamers. Future work should explore the relative contribution and associated risk that various games, genres, and timing of gaming activities have on sleep, physical and mental health, particularly in vulnerable gaming cohorts engaged with contemporary forms of gaming and esports.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Subtyping treatment-seeking gaming disorder patients

BACKGROUND AND AIMS

Gaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach.

METHODS

The sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits.

RESULTS

Two GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles.

CONCLUSIONS

GD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients.

A Platform for Cognitive Monitoring of Neurosurgical Patients During Hospitalization

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.

Preliminary Evaluation of the Clinical Benefit of a Novel Visual Rehabilitation Program in Patients Implanted with Trifocal Diffractive Intraocular Lenses: A Blinded Randomized Placebo-Controlled Clinical Trial

The authors of this study evaluated the potential benefit on visual performance of a novel 3 week visual rehabilitation program based on the use of Gabor patches in patients undergoing bilateral cataract surgery with the implantation of two models of trifocal diffractive intraocular lens (IOL). A total of 30 patients were randomly assigned to two groups: a study group (15 patients) that used a videogame based on Gabor patches and a placebo group (15 patients) that used a videogame without specific stimuli for improving visual performance. No statistically significant differences between groups were found in distance, intermediate, and near post-training visual acuity (p ≥ 0.15). Significantly better distance contrast sensitivity (CS) was found for the spatial frequencies of 6 (p = 0.02) and 12 cpd (p = 0.01) in the study group. Likewise, significantly better values of near CS were found in the study group compared to the placebo group for the spatial frequency of 1.5 cpd (p = 0.02). In conclusion, a 3 week visual rehabilitation program based on the use of Gabor patches in the immediate postoperative period after the bilateral implantation of trifocal diffractive IOLs seems to be beneficial for improving both distance and near visual performance achieved with the implant.

Functional Connectivity Within the Fronto-Parietal Network Predicts Complex Task Performance: A fNIRS Study

Performance in complex tasks is essential for many high risk operators. The achievement of such tasks is supported by high-level cognitive functions arguably involving functional activity and connectivity in a large ensemble of brain areas that form the fronto-parietal network. Here we aimed at determining whether the functional connectivity at rest within this network could predict performance in a complex task: the Space Fortress video game. Functional Near Infrared Spectroscopy (fNIRS) data from 32 participants were recorded during a Resting-State period, the completion of a simple version of Space Fortress (monotask) and the original version (multitask). The intrinsic functional connectivity within the fronto-parietal network (i.e., during the Resting-State) was a significant predictor of performance at Space Fortress multitask but not at its monotask version. The same pattern was observed for the functional connectivity during the task. Our overall results suggest that Resting-State functional connectivity within the fronto-parietal network could be used as an intrinsic brain marker for performance prediction of a complex task achievement, but not for simple task performance.

Could virtual reality applications pose real risks to children and adolescents? A systematic review of ethical issues and concerns

Virtual reality technologies (VRTs) are high-tech human-computer interfaces used to develop digital content and can be applied to multiple different areas, often offering innovative solutions to existing problems. A wide range of digital games is being also developed with VRTs and together with their components, the games' structural elements are appealing to children and engaging them more in virtual worlds. Our research interest is directed towards children's development and the effects of VRTs within gaming environments. Contemporary psychology studies perceive human development as a holistic and lifelong process with important interrelationships between physical, mental, social and emotional aspects. For the objectives and scope of this work, we examine children development across three domains: physical, cognitive and psychosocial. In this context, the authors review the literature on the impact of VRTs on children, in terms of software and hardware. Since research requires an wide-ranging approach, we study the evidence reported on the brain and neural structure, knowledge, behaviour, pedagogy, academic performance, and wellness. Our main concern is to outline the emerging ethical issues and worries of parents, educators, ophthalmologists, neurologists, psychologists, paediatricians and all relevant scientists, as well as the industry's views and actions. The systematic review was performed on the databases Scopus, IEEE Xplore, PubMed, and Google Scholar from 2010 to 2020 and 85 studies were selected. The review concluded that findings remain contradictory especially for the psychosocial domain. Official recommendations from organizations and well-documented researches by academics on child well-being are reassuring if health and safety specifications and particularly the time limit are met. Research is still ongoing, constantly updated and consist of a priority for the scientific community given that technology evolves.

Evaluation of Participant Success in Gamified Drone Training Simulator Using Brain Signals and Key Logs

The risk of accidents while operating a drone is quite high. The most important solution is training for drone pilots. Drone pilot training can be done in both physical and virtual environments, but the probability of an accident is higher for pilot trainees, so the first method is to train in a virtual environment. The purpose of this study is to develop a new system to collect data on students’ educational development performance of students during the use of Gamified Drone Training Simulator and objectively analyze students’ development. A multimodal recording system that can collect simulator, keystroke, and brain activity data has been developed to analyze the cognitive and physical activities of participants trained in the gamified drone simulator. It was found that as the number of trials increased, participants became accustomed to the cognitive load of visual/auditory tasks and therefore the power in the alpha and beta bands decreased. It was observed that participants’ meditation and attention scores increased with the number of repetitions of the educational game. It can be concluded that the number of repetitions lowers stress and anxiety levels, increases attention, and thus enhances game performance.

Internet gaming disorder and its relationship with behavioral disorder and mother's parenting styles in primary school students according to gender in Iran

BACKGROUND

The problem of students' gaming addiction has been related to the individual student's characteristics and the influence of family environment. Researchers aimed to investigate if and how internet gaming disorder (IGD) of the elementary school boys and girls is related to behavioral disorder and their mother's parenting style in Iran.

METHODS

This is a descriptive correlational study, involving 657 fifth and sixth-grade elementary school students in 2019. Researchers used a multistage stratified random sampling of students, their parents and their teachers. Data were collected using internet gaming disorder questionnaire (IGD 20), Rutter teacher behavioral disorder questionnaire and Baumrind Parenting Styles questionnaire (PSI). Obtained data were analyzed using SPSS version16 for descriptive statistics and Pearson correlation coefficient test.

RESULTS

Findings showed that IGD prevalence was 5.9% among primary school students with significant relationship between IGD and behavioral disorder among all participants (r = 0.23, p = 0.04); although it was insignificant among boys (r = 0.13, p = 0.11). Also the relationship between IGD and mother's parenting style was significant in the total sample (r = 0.12, p = 0.03), in particular for girls and their mothers (r = 0.2, p = 0.001).

CONCLUSIONS

The results of this study indicate the importance of family and parental involvement in prevention and management of IGD chiefly among girls. Healthcare professionals will benefit from knowing the problematic consequences of online gaming among school-age children and try to promote safe and healthy online behavior supported by a supervised family environment.

Long-lasting connectivity changes induced by intensive first-person shooter gaming

Action videogames have been shown to induce modifications in perceptual and cognitive systems, as well as in brain structure and function. Nevertheless, whether such changes are correlated with brain functional connectivity modifications outlasting the training period is not known. Functional magnetic resonance imaging (fMRI) was used in order to quantify acute and long-lasting connectivity changes following a sustained gaming experience on a first-person shooter (FPS) game. Thirty-five healthy participants were assigned to either a gaming or a control group prior to the acquisition of resting state fMRI data and a comprehensive cognitive assessment at baseline (T0), post-gaming (T1) and at a 3 months' follow-up (T2). Seed-based resting-state functional connectivity (rs-FC) analysis revealed a significant greater connectivity between left thalamus and left parahippocampal gyrus in the gamer group, both at T1 and at T2. Furthermore, a positive increase in the rs-FC between the cerebellum, Heschl's gyrus and the middle frontal gyrus paralleled improvements of in-gaming performance. In addition, baseline rs-FC of left supramarginal gyrus, left middle frontal gyrus and right cerebellum were associated with individual changes in videogame performance. Finally, enhancement of perceptual and attentional measures was observed at both T1 and T2, which correlated with a pattern of rs-FC changes in bilateral occipito-temporal regions belonging to the visual and attention fMRI networks. The present findings increase knowledge on functional connectivity changes induced by action videogames, pointing to a greater and long-lasting synchronization between brain regions associated with spatial orientation, visual discrimination and motor learning even after a relatively short multi-day gaming exposure.

The Playing Brain. The Impact of Video Games on Cognition and Behavior in Pediatric Age at the Time of Lockdown: A Systematic Review

A growing number of children and adolescents play video games (VGs) for long amounts of time. The current outbreak of the Coronavirus pandemic has significantly reduced outdoor activities and direct interpersonal relationships. Therefore, a higher use of VGs can become the response to stress and fear of illness. VGs and their practical, academic, vocational and educational implications have become an issue of increasing interest for scholars, parents, teachers, pediatricians and youth public policy makers. The current systematic review aims to identify, in recent literature, the most relevant problems of the complex issue of playing VGs in children and adolescents in order to provide suggestions for the correct management of VG practice. The method used searches through standardized search operators using keywords related to video games and the link with cognition, cognitive control and behaviors adopted during the pandemic. Ninety-nine studies were reviewed and included, whereas twelve studies were excluded because they were educationally irrelevant. Any debate on the effectiveness of VGs cannot refer to a dichotomous approach, according to which VGs are rigidly 'good' or 'bad'. VGs should be approached in terms of complexity and differentiated by multiple dimensions interacting with each other.

Emotion-Driven Analysis and Control of Human-Robot Interactions in Collaborative Applications

The utilization of robotic systems has been increasing in the last decade. This increase has been derived by the evolvement in the computational capabilities, communication systems, and the information systems of the manufacturing systems which is reflected in the concept of Industry 4.0. Furthermore, the robotics systems are continuously required to address new challenges in the industrial and manufacturing domain, like keeping humans in the loop, among other challenges. Briefly, the keeping humans in the loop concept focuses on closing the gap between humans and machines by introducing a safe and trustworthy environment for the human workers to work side by side with robots and machines. It aims at increasing the engagement of the human as the automation level increases rather than replacing the human, which can be nearly impossible in some applications. Consequently, the collaborative robots (Cobots) have been created to allow physical interaction with the human worker. However, these cobots still lack of recognizing the human emotional state. In this regard, this paper presents an approach for adapting cobot parameters to the emotional state of the human worker. The approach utilizes the Electroencephalography (EEG) technology for digitizing and understanding the human emotional state. Afterwards, the parameters of the cobot are instantly adjusted to keep the human emotional state in a desirable range which increases the confidence and the trust between the human and the cobot. In addition, the paper includes a review on technologies and methods for emotional sensing and recognition. Finally, this approach is tested on an ABB YuMi cobot with commercially available EEG headset.

Breaking up prolonged sitting with a 6 min walk improves executive function in women and men esports players: a randomised trial

Objective

The effect of prolonged sitting on executive function and performance in competitive esports players are unknown. This study aimed to evaluate executive function following a 6 min bout of walking or rest during prolonged gaming in competitive esports players.

Methods

12 men and 9 women completed three separate 2-hour gaming session days assigned in randomised order consisting of a 6 min walk break, 6 min rest break and continuous before and after each session. Postintervention participant exit survey data were also collected.

Results

The walk condition produced a significantly faster mean solution time (7613.6±3060.5 min, p=0.02) and planning time (5369.0±2802.09, p=0.04) compared with the resting condition (9477±3547.4; 6924±3247.7) and continuous play (8200.0±3031.6; 5862.7±2860.7). The rest condition resulted in the slowest mean solution time (9477.0±3547.4) and planning time (6924.0±3247.7), with the continuous play resulting in a faster mean solution time (8200.1±3031.6) and planning time (5862.7±2860.7) than the rest condition. There was no impact on game performance in any of the conditions. However, over 70% of participants felt that the walk break improved esports performance.

Conclusions

Reducing sit time and breaking up prolonged sitting have acute and chronic health benefits. This study provides evidence that a 6 min walking break in the middle of 2 hours of gameplay allows gamers to have these health benefits while improving processing speed and executive function.

Trial registration number

NCT04674436.

What We Know About Massively Multiplayer Online Role-Playing Games

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines internet gaming disorder without differentiating games from their respective genres, such as first-person shooter versus real-time strategy versus online gaming. Our review of the literature on massively multiplayer online role-playing games (MMORPGs) suggests that MMORPGs are different from other games because they are the most addictive, and therefore deserve to be looked at separately. MMORPGs are internet platforms for online users to interact with each other in a virtual story line. The overview of the existing literature delineates the positive and negative aspects of MMORPGs and also the available evidence on neuroscientific and neuroanatomical correlates between internet gaming disorder and other addictions. Evidence shows that a player's characteristics and motivations can determine his or her risk of developing problematic play. Problematic MMORPG use may lead to mental disorders such as depression and addiction, and can negatively affect quality of life, and vice versa. Conversely, some players may benefit from being part of a social community and from using it as a learning platform or as a safe space to explore gender-identity issues. Brain circuitry and metabolism are changed through problematic MMORPG use, with the affected areas including the ventral striatum and left angular gyrus.

Sex difference in neural responses to gaming cues in Internet gaming disorder: Implications for why males are more vulnerable to cue-induced cravings than females

BACKGROUND

Although drug addiction studies have shown that females are more likely to become addicted and sensitive to drug cues, this feature seems reversed in Internet gaming disorder (IGD), of which males are more likely to be sufferers. Given the prevalence of IGD in the male population, the current study was set to examine the potential effect of sex on IGD's craving using a cue reactivity task.

METHODS

Sixty-five (32 males) IGD subjects underwent fMRI scanning during exposure to visual gaming cues and neutral cues. Brain responses to gaming cues relative to neutral cues were examined within two groups separately. In addition, Granger causal analysis (GCA) was conducted to investigate how the effective connectivity patterns were altered in male and female IGD subjects.

RESULTS

When facing gaming cues, lower regions of brain activation were observed in males compared to females, including the left anterior cingulate cortex (ACC), the superior frontal gyrus and the posterior cingulate cortex (PCC); GCA results, using the PCC as the ROI, showed higher middle temporal gyrus-PCC-right ACC/parahippocampal gyrus effective connectivity in males as compared with females, when exposed to gaming cues.

CONCLUSION

The results indicate that gaming cues could more severely disturb male IGD subjects' inhibition control function over game-elicited cravings compared to females, which might make it hard for males to control their game cravings and stop their gaming behaviors. This conclusion is valuable in understanding why males are more vulnerable to IGD than females.

Lenticular nucleus volume predicts performance in real-time strategy game: cross-sectional and training approach using voxel-based morphometry

It is unclear why some people learn faster than others. We performed two independent studies in which we investigated the neural basis of real-time strategy (RTS) gaming and neural predictors of RTS game skill acquisition. In the first (cross-sectional) study, we found that experts in the RTS game StarCraft® II (SC2) had a larger lenticular nucleus volume (LNV) than non-RTS players. We followed a cross-validation procedure where we used the volume of regions identified in the first study to predict the quality of learning a new, complex skill (SC2) in a sample of individuals who were naive to RTS games (a second (training) study). Our findings provide new insights into how the LNV, which is associated with motor as well as cognitive functions, can be utilized to predict successful skill learning and be applied to a much broader context than just video games, such as contributing to optimizing cognitive training interventions.

Structural brain differences associated with extensive massively-multiplayer video gaming

Video gaming can be associated with inter-individual differences in brain morphology. Much of this literature has focused on non-professional/occasional gamers who barely play, on the one extreme; or Internet Gaming Disorder (IGD) cases who typically play more than 5 h/day, on the other extreme. We sought to extend this literature and focus on extensive gamers, who play about 3 h/day, which is typically more than non-professional gamers, but less than IGD cases. Findings regarding this sector of gamers can inform research on risk factors or markers for IGD development, even before addiction symptoms emerge. We predicted that extensive gamers have smaller prefrontal regions that presumably reflect weaker inhibition abilities, and larger visuomotor regions that presumably reflect stronger motor skills in response to visual stimuli. We tested these assertions with a between-subject brain morphology comparison of 26 extensive League of Legends (LOL) and matched 26 non-gamers, using voxel based morphometry, deformation based morphometry, and cortical thickness and sulcus depth analyses. Findings largely supported our predictions by pointing to morphological alterations in extensive gamers in the bilateral ventromedial prefrontal cortex and left dorsolateral prefrontal cortex, as well is in the left superior parietal lobule. These findings suggest that extensive gamers, at least of Massive-Multiplayer battle arena games, present brain alterations that are consistent with presumed loss of control (as mediated by the prefrontal cortex), but also improved attention and visoumotor skills (as mediated by superior parietal lobule). Implications for research and practice are discussed.

Virtual reality rehabilitation in children with brain injury: a randomized controlled trial

AIM

To investigate the efficacy of a virtual reality rehabilitation system of wearable multi-inertial sensors to improve upper-limb function in children with brain injury.

METHOD

Eighty children (39 males, 41 females) with brain injury including cerebral palsy aged 3 to 16 years (mean age 5y 8mo, SD 2y 10mo) were assessed as part of a multicentre, single-blind, randomized controlled trial. The intervention group received a 30-minute virtual reality intervention and a 30-minute session of conventional occupational therapy while the control group received 60 minutes of conventional occupational therapy per session, with 20 sessions over 4 weeks. The virtual reality rehabilitation system consisted of games promoting wrist and forearm articular movements using wearable inertial sensors. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2), Upper Limb Physician's Rating Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and computerized three-dimensional motion analysis were performed.

RESULTS

Both groups (virtual reality, n=40; control, n=38) significantly improved after treatment compared to baseline; however, the virtual reality group showed more significant improvements in upper-limb dexterity functions (MA-2, virtual reality group: Δ=10.09±10.50; control: Δ=3.65±6.92), performance of activities of daily living, and forearm supination by kinematic analysis (p<0.05). In the virtual reality group, children with more severe motor impairment showed significant improvements compared to those with less severe impairment.

INTERPRETATION

The virtual reality rehabilitation system used in this study, which consists of wearable inertial sensors and offers intensive, interactive, and repetitive motor training, is effective in children with brain injury.

WHAT THIS PAPER ADDS

Both virtual reality rehabilitation and conventional occupational therapy were effective for upper-limb training. Virtual reality training was superior in improving dexterity, performance of activities of daily living, and active forearm supination motion. The effect of virtual reality training was significant in children with more severe motor impairments.

Stress-Reducing Effects of Playing a Casual Video Game among Undergraduate Students

To assess the potential effectiveness of playing a simple, casual video game (Flower) in reducing stress relative to participating in a mindfulness-meditation session (body scan) among undergraduate students. Eighty undergraduate student participants (mean age = 19.46 years, SD = 1.43; gender: 48 females, 29 males, 3 preferred not to answer) were assigned to one of two groups in alternating order: one who played Flower and the comparison group who participated in a body scan, each lasting 20 min. Psychological and physiological stress measurements were made before and after each intervention. Self-perceived psychological stress was measured using a modified version of the nine-item Psychological Stress Measure (PSM-9), and physiological stress (heart rate, systolic and diastolic blood pressure) was measured using an electronic blood-pressure cuff. The results were analyzed with a 2 (measurement: pre, post) × 2 (intervention: video game, mindfulness-meditation) mixed model analysis of variance (ANOVA) for each of the four outcome measures. There was a statistically significant reduction (pre- to post-intervention) across all outcome measures. Notably, there was a significant measurement × intervention interaction (p < .001) for the psychological stress measure; participants in the mindfulness-meditation group reported greater stress reduction after the intervention than participants in the video game group. Although these results suggest mindfulness-meditation provides a slight advantage for stress reduction than casual video games, the similarity in reduction across all physiological measures between the two interventions nevertheless suggests casual video games may also be an effective medium. This finding is especially promising given casual video games’ accessibility, ease of use, and popularity among students. These results may inform initiatives by colleges and universities to better support students during peak times of stress and especially during the current COVID-19 pandemic.

Effects of excessive violent video game playing on verbal memory: an event-related brain potentials study

The goal of the study was to investigate temporal dynamics of excessive violent game playing. We compared behavioral data and event-related potentials (ERPs) of excessive video game players (EVGPs, n = 21) and non-players (NPs, n = 21) using a classical learning, cued recall and recognition paradigm, featuring violent and non-violent words. During the recognition phase, EVGPs performed better for violent words, but worse for non-violent words compared to NPs. Also, EVGPs showed slower reaction times than NPs when responding to new violent words. We found significant group differences in parietal P300 and FN400 amplitudes. The EVGP group showed larger P300 amplitudes for violent words, and more negative FN400 amplitudes for new violent words compared to NPs. The results imply that EVGPs differ from NPs in their cognitive and ERP responses to violent and non-violent verbal stimuli. The cognitive processes of EVGPs are consistent with a model of attention and memory bias rather than with desensitization to violence.

Traces Of The Brain’s Learning Potential Present Within “Uneducational” Video Games

Video games, especially in mobile devices, have the reputation of being negative to the mass consumer. They are thought to be addictive, mind-numbing time waster. But is that really true? A study has been conducted to analyze video games design styles based on neuroaffective computational model using electroencephalogram (EEG). Although the objective is to classify abstract and realistic design styles, a different off-topic materials have been discovered. During the data collection, subjects completed an aptitude test using an online instrument provided by the Cambridge University’s Brain Lab. The EEG instruments recorded specific brain functions (cognitive, memory, verbal, creativity) separately. After classifying the data with emotional response, each brain functions give unique valence versus arousal scatter plot. What is interesting, however, is that when all of them plotted together in a single chart, they form a pattern similar to the data collected for playing video games. Could it possibly be that playing video games indeed stimulate specific brain functions? Or are these similarities in valence versus arousal plots just plain coincidences? A future research designed for brain function correlation using other model than emotions can confirm these findings. But for now, the consistency of these findings for all the subjects are hard to ignore.