Music Games: Potential Application and Considerations for Rhythmic Training

Exergames as an Effective Alternative to Real Environmental Tennis Training for Adolescents

(1) Background: The popularity of motion-sensing computer-based games, like virtual reality (VR) exergames, is increasing among adolescents. However, their efficacy compared to conventional physical training methods remains unclear. This study investigated whether VR exergames produce effects on reaction time (RT) comparable to traditional tennis training in school-aged adolescents. (2) Methods: In total, 130 adolescents (mean age: 15.6 ± 2.0 years; 67 boys: 15.5 ± 2.2 years; 63 girls: 15.7 ± 1.8 years) were recruited in schools and assigned to one of three groups: VR exergame (G1, n = 39), tennis training (G2, n = 25), or control (G3, n = 66). Participants' RTs were evaluated before and after the interventions. G1 engaged in VR exergames for 8 min, G2 underwent traditional tennis training for 30 min, and G3 did not participate in any physical activity. (3) Results: Our results indicated that in G3, girls exhibited slower RTs compared to boys (p < 0.0). No differences were observed in RTs when comparing G1 and G2. (4) Conclusions: Sex appeared to influence RT, with girls showing slower RTs than boys in G3. The findings suggest that VR exergames and traditional tennis training have similar impacts on RT. This indicates the potential of VR exergames as an alternative to conventional physical training for improving RT in adolescents.

Rhythmic musical activities may strengthen connectivity between brain networks associated with aging-related deficits in timing and executive functions

Brain aging and common conditions of aging (e.g., hypertension) affect networks important in organizing information, processing speed and action programming (i.e., executive functions). Declines in these networks may affect timing and could have an impact on the ability to perceive and perform musical rhythms. There is evidence that participation in rhythmic musical activities may help to maintain and even improve executive functioning (near transfer), perhaps due to similarities in brain regions underlying timing, musical rhythm perception and production, and executive functioning. Rhythmic musical activities may present as a novel and fun activity for older adults to stimulate interacting brain regions that deteriorate with aging. However, relatively little is known about neurobehavioral interactions between aging, timing, rhythm perception and production, and executive functioning. In this review, we account for these brain-behavior interactions to suggest that deeper knowledge of overlapping brain regions associated with timing, rhythm, and cognition may assist in designing more targeted preventive and rehabilitative interventions to reduce age-related cognitive decline and improve quality of life in populations with neurodegenerative disease. Further research is needed to elucidate the functional relationships between brain regions associated with aging, timing, rhythm perception and production, and executive functioning to direct design of targeted interventions.

Rhythmic serious games as an inclusive tool for music-based interventions

Technologies, such as mobile devices or sets of connected sensors, provide new and engaging opportunities to devise music-based interventions. Among the different technological options, serious games offer a valuable alternative. Serious games can engage multisensory processes, creating a rich, rewarding, and motivating rehabilitation setting. Moreover, they can be targeted to specific musical features, such as pitch production or synchronization to a beat. Because serious games are typically low cost and enjoy wide access, they are inclusive tools perfectly suited for remote at-home interventions using music in various patient populations and environments. The focus of this article is in particular on the use of rhythmic serious games for training auditory-motor synchronization. After reviewing the existing rhythmic games, initial evidence from a recent proof-of-concept study in Parkinson's disease is provided. It is shown that rhythmic video games using finger tapping can be used with success as an at-home protocol, and bring about beneficial effects on motor performance in patients. The use and benefits of rhythmic serious games can extend beyond the rehabilitation of patients with movement disorders, such as to neurodevelopmental disorders, including dyslexia and autism spectrum disorder.

At-Home Training With a Rhythmic Video Game for Improving Orofacial, Manual, and Gait Abilities in Parkinson’s Disease: A Pilot Study

Rhythm disorders are consistently reported in Parkinson’s disease (PD). They manifest across motor domains, such as in orofacial (oral diadochokinesis), manual (finger tapping), and gait tasks. It is still unclear, however, whether these disorders are domain- and task-specific, or result from impaired common mechanisms supporting rhythm processing (general dysrhythmia). We tested the possibility that an at-home intervention delivered via a rhythmic video game on tablet improves motor performance across motor domains in PD. Patients with PD (n = 12) played at home a rhythmic video game (Rhythm Workers) on tablet, in which they finger-tapped to the beat of music, for 6 weeks. A control group (n = 11) played an active non-rhythmic video game (Tetris). A third group (n = 10) did not receive any intervention. We measured rhythmic abilities in orofacial, manual and gait motor domains, as well as rhythm perception, before and after the intervention. Patients who performed the rhythmic training improved their orofacial and manual rhythmic performance. This beneficial effect was linked to improved rhythm perception only following the rhythmic training period. We did not observe any improvement in rhythmic abilities in the other two groups. In this pilot study, we demonstrated that at-home intervention with a rhythmic video game using finger tapping can have beneficial effects on motor performance across different motor domains (manual and orofacial). This finding provides evidence of a general dysrhythmia in PD and paves the way to technology-driven interventions aiming at alleviating rhythm-related motor deficits in PD.

Effects of music on ADHD symptomatology and potential application of music in video games: A systematic review (Preprint)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) has a considerable impact on an individual's daily life. Some difficulties with timing deficits may be associated with deficiencies in attention, reading, language skills, or executive function. Music therapy, either active (playing an instrument) or passive (listening to music) has demonstrated its efficacy in reducing symptomatology in many disorders. Video games may prove to be a useful assessment and treatment tool in compensating for the difficulties with multimodal treatment in ADHD.

OBJECTIVE

The aim of the study is to (1) analyze the evidence that music is beneficial in reducing the symptomatology of ADHD using systematic review and (2) propose the application of music in video games following music therapy strategies.

METHODS

Searches were conducted in PubMed, Embase, PsycINFO, Cochrane, and gray literature (Google Scholar and WorldCat). We used the following search syntax: ((music[Title/Abstract]) or (music therapy[Title/Abstract])) and (attention deficit disorder[MeSH or thesaurus term]).

RESULTS

Of the 70 records identified, 17 provided findings that music can be beneficial in various domains of ADHD. Active music therapy improves hemispheric synchrony, social skills, aggressivity, and impulsivity. Passive music therapy improves academic skills like arithmetic, drawing, and reading comprehension, as well as attention and disruptive behaviors. The effects depend on the music genre, tempo, or task difficulty. Music in video games was generally found to be beneficial for people with ADHD. Music improves immersion and flow while playing video games. Using rhythm may also improve timing skills and immersion in patients with ADHD. Regarding the proposed application of aspects of music to therapeutic video games for ADHD, some paradigms in timing and music therapy were considered in the proposed design of video games.

CONCLUSIONS

Improving ADHD treatment through the application of music in video games is proposed.

TRIAL REGISTRATION

PROSPERO CRD42021288226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288226.

Serious Video Games: Angels or Demons in Patients With Attention-Deficit Hyperactivity Disorder? A Quasi-Systematic Review

OBJECTIVE

To carry out a quasi-systematic review of the use of serious video games for health as a cognitive rehabilitative tool in patients diagnosed with attention-deficit hyperactivity disorder.

METHOD

A quasi-systematic review of serious video games used as an evaluative and rehabilitative tool in patients with ADHD was conducted. It included behavioral patterns in the use of video games and addiction problems in this population. For its elaboration the PRISMA GUIDES were followed. The search was carried out in three PubMed databases, MEDLINE, and PsycInfo using the keywords: [game OR serious game OR computer game) AND (psychotherapy OR rehabilitation OR intervention OR mental disorders) AND (adhd)], [(adhd) AND (Video game addiction)]. All articles written in English, Spanish, or Portuguese from January 1970 to June 2021 were included: those in which reference was made to the use of video games and/or new technologies as a therapeutic and evaluative tool in children and adults diagnosed with ADHD, as well as those that referred to behavioral and clinical patterns in the use of video games.

RESULTS

We found 605 articles of which 128 were reviewed (44 observational studies, 26 quasi-experimental studies, 26 experimental studies, 8 systematic reviews, 9 narrative texts, 6 case reports, 7 pilot studies, 8 systematic reviews, and 2 meta-analyses). Serious video games can be used to ameliorate ADHD symptoms while improving adherence to treatment. Some serious video games show high accuracy properties assessing ADHD features.

CONCLUSION

Serious video games for health are increasingly being used as a cognitive rehabilitation tool in patients with attention-deficit hyperactivity disorder (ADHD).

SYSTEMATIC REVIEW REGISTRATION

[www.crd.york.ac.uk/prospero], identifier [CRD42021247784].

Dynamic Systems Approach in Sensorimotor Synchronization: Adaptation to Tempo Step-Change

This paper presents a dynamic systems model of a sensorimotor synchronization (SMS) task. An SMS task typically gives temporally discrete human responses to some temporally discrete stimuli. Here, a dynamic systems modeling approach is applied after converting the discrete events to regularly sampled time signals. To collect data for model parameter fitting, a previously published pilot study was expanded. Three human participants took part in an experiment: to tap a finger on a keyboard, following a metronome which changed tempo in steps. System identification was used to estimate the transfer function that represented the relationship between the stimulus and the step response signals, assuming a separate linear, time-invariant system for each tempo step. Different versions of model complexity were investigated. As a minimum, a second-order linear system with delay, two poles, and one zero was needed to model the most important features of the tempo step response by humans, while an additional third pole could give a somewhat better fit to the response data. The modeling results revealed the behavior of the system in two distinct regimes: tempo steps below and above the conscious awareness of tempo change, i.e., around 12% of the base tempo. For the tempo steps above this value, model parameters were derived as linear functions of step size for the group of three participants. The results were interpreted in the light of known facts from other fields like SMS, psychoacoustics and behavioral neuroscience.

Synchronization to auditory and visual beats in Parkinson's disease

The ability to move in synchrony with a perceived regular beat in time is essential for humans to interact with environments in an anticipatory manner, and the basal ganglia have been shown to be preferentially involved in beat processing. Auditory beats are often adopted in assessing the sensorimotor deficiency of patients with Parkinson's disease (PD), which is characterized by basal ganglia dysfunction. Whereas beat synchronization has long been considered to be specific to the auditory modality, recent studies employing moving instead of static visual stimuli have shown comparable synchronization performances of auditory and visual beats. Here, we show that compared with control subjects, synchronization stability of PD patients significantly decreased for beats composed of visual contracting rings but not for beats consisting of auditory tones or static visual flashes. The results revealed specific impairment of visual beat synchronization in PD. Considering the common experience of visuomotor interactions in daily lives of PD patients, the present finding emphasizes the importance of evaluation of visuomotor timing deficiency in PD by employing moving visual stimuli that have ecological relevance.

Effects of interactive video-game-based exercise on balance in older adults with mild-to-moderate Parkinson's disease

BACKGROUND

This study aimed to evaluate the effectiveness of a customized interactive video game-based (IVGB) training on balance in older adults with mild-to-moderate Parkinson's disease (PD).

METHODS

In this 12-week crossover trial, PD patients ≥65 years of age were randomly divided into Group A (a 6-week intervention phase followed by a 6-week control phase) and Group B (a 6-week control phase followed by a 6-week intervention phase). Participants received IVGB exercise training during the intervention phase and no exercise during the control phase. Functional outcomes were measured using behavioral evaluation scales and questionnaires at baseline, week 6 and week 12.

RESULTS

Twenty-four PD patients were included in this study, and were evenly divided into two groups. After Bonferroni adjustment, the changes in Modified Falls Efficacy Scale (MFES) and two subscales of Multi-Directional Reach Test were significantly different between two groups in the first 6-week period. In addition, the changes in Berg Balance Scale, MFES, and two subscales of Maximum Step Length were significantly different between two groups in the second 6-week period. Compared to controls, 6-week IVGB exercise intervention significantly improved different but overlapping functional outcomes in two groups of PD patients.

CONCLUSIONS

The customized IVGB exercise training improves balance, postural stability and confidence in preventing falls in older adults with mild-to-moderate PD. However, this IVGB exercise doesn't have a significant impact on quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT03689764 . Registered 27 September 2018, retrospectively registered.

A Tablet-Based Assessment of Rhythmic Ability

The exponential rise in use of mobile consumer electronics has presented a great potential for research to be conducted remotely, with participants numbering several orders of magnitude greater than a typical research paradigm. Here, we attempt to demonstrate the validity and reliability of using a consumer game-engine to create software presented on a mobile tablet to assess sensorimotor synchronization, a proxy of rhythmic ability. Our goal was to ascertain whether previously observed research results can be replicated, rather than assess whether a mobile tablet achieves comparable performance to a desktop computer. To achieve this, younger (aged 18–35 years) and older (aged 60–80 years) adult musicians and non-musicians were recruited to play a custom-designed sensorimotor synchronization assessment on a mobile tablet in a controlled laboratory environment. To assess reliability, participants performed the assessment twice, separated by a week, and an intra-class correlation coefficient (ICC) was calculated. Results supported the validity of this approach to assessing rhythmic abilities by replicating previously observed results. Specifically, musicians performed better than non-musicians, and younger adults performed better than older adults. Participants also performed best when the tempo was in the range of previously-identified preferred tempos, when the stimuli included both audio and visual information, and when synchronizing on-beat compared to off-beat or continuation (self-paced) synchronization. Additionally, high ICC values (>0.75) suggested excellent test–retest reliability. Together, these results support the notion that consumer electronics running software built with a game engine may serve as a valuable resource for remote, mobile-based data collection of rhythmic abilities.

Interaction Modalities Used on Serious Games for Upper Limb Rehabilitation: A Systematic Review

This systematic review aims to analyze the state-of-the-art regarding interaction modalities used on serious games for upper limb rehabilitation. A systematic search was performed in IEEE Xplore and Web of Science databases. PRISMA and QualSyst protocols were used to filter and assess the articles. Articles must meet the following inclusion criteria: they must be written in English; be at least four pages in length; use or develop serious games; focus on upper limb rehabilitation; and be published between 2007 and 2017. Of 121 articles initially retrieved, 33 articles met the inclusion criteria. Three interaction modalities were found: vision systems (42.4%), complementary vision systems (30.3%), and no-vision systems (27.2%). Vision systems and no-vision systems obtained a similar mean QualSyst (86%) followed by complementary vision systems (85.7%). Almost half of the studies used vision systems as the interaction modality (42.4%) and used the Kinect sensor to collect the body movements (48.48%). The shoulder was the most treated body part in the studies (19%). A key limitation of vision systems and complementary vision systems is that their device performances might be affected by lighting conditions. A main limitation of the no-vision systems is that the range-of-motion in angles of the body movement might not be measured accurately. Due to a limited number of studies, fruitful areas for further research could be the following: serious games focused on finger rehabilitation and trauma injuries, game difficulty adaptation based on user's muscle strength and posture, and multisensor data fusion on interaction modalities.

How Rhythmic Skills Relate and Develop in School-Age Children

Rhythmic expertise can be considered a multidimensional skill set, with clusters of distinct rhythmic abilities evident in young adults. In this article, we explore relationships in school-age children (ages 5-8 years) among 4 rhythmic tasks hypothesized to reflect different clusters of skills, namely, drumming to an isochronous beat, remembering rhythmic patterns, drumming to the beat in music, and clapping in time with feedback. We find that drumming to an isochronous beat and remembering rhythmic patterns are not related. In addition, clapping in time with feedback correlates with performance on the other 3 rhythm tasks. This study contributes to the taxonomy of rhythmic skills in school-age children. It also supports the use of clapping in time training as a way to possibly affect a broad spectrum of rhythmic abilities that are linked to language and literacy processes.

Born to Speak and Sing: Musical Predictors of Language Development in Pre-schoolers

The relationship between musical and linguistic skills has received particular attention in infants and school-aged children. However, very little is known about pre-schoolers. This leaves a gap in our understanding of the concurrent development of these skills during development. Moreover, attention has been focused on the effects of formal musical training, while neglecting the influence of informal musical activities at home. To address these gaps, in Study 1, 3- and 4-year-old children (n = 40) performed novel musical tasks (perception and production) adapted for young children in order to examine the link between musical skills and the development of key language capacities, namely grammar and phonological awareness. In Study 2, we investigated the influence of informal musical experience at home on musical and linguistic skills of young pre-schoolers, using the same evaluation tools. We found systematic associations between distinct musical and linguistic skills. Rhythm perception and production were the best predictors of phonological awareness, while melody perception was the best predictor of grammar acquisition, a novel association not previously observed in developmental research. These associations could not be explained by variability in general cognitive functioning, such as verbal memory and non-verbal abilities. Thus, selective music-related auditory and motor skills are likely to underpin different aspects of language development and can be dissociated in pre-schoolers. We also found that informal musical experience at home contributes to the development of grammar. An effect of musical skills on both phonological awareness and language grammar is mediated by home musical experience. These findings pave the way for the development of dedicated musical activities for pre-schoolers to support specific areas of language development.

Cognition difference between players of different involvement toward the concrete design features in music games

When designing mobile games, how to understand preferences and cognition of players is a topic worth exploring. The main objectives of this paper are to obtain design features of music games on mobile devices, and explore players' perceptions toward music games. The results can serve as an orientation during decision-making in game design. Based on Miryoku Engineering and the Evaluation Grid Method, this study interviewed 22 frequent users to get concrete features of game design; Moreover, 210 subjects were divided into high, medium, and low involvement groups according to CIP measures, and then this study used Multiple Regression analysis to determine whether players with different levels of involvement had different perceptions of the design features of music games. The results found 44 concrete features and six original evaluations items of game design, and also discovered that there were perception differences in different involvement groups, and only two concrete design features significantly influenced all three groups: 'Extra games to earn more points after completing levels' and 'Playable without internet'.

Music and movement: Towards a translational approach

Rhythmic abilities are highly widespread in the general population. Most people can extract the regular beat of music, and align their movements with it. The aim of a translational approach for music and movement is to build on current fundamental research and theories of beat perception and synchronization to devise music-based interventions, which are informed by theory. To illustrate this approach, Parkinson's disease is taken as a model, with a focus on the positive effects of rhythmic auditory cueing on walking. In Parkinson's disease, a relation is found between the success of this music-based intervention and individual differences in rhythmic abilities. Patients with relatively spared rhythmic abilities are the most likely to benefit from cueing. Moreover, rhythmic auditory cueing can be optimized by using mobile technologies (tablets and smartphones), in the form of dedicated apps or serious games. A similar translational approach to the study of music, rhythm, and movement can be extended to remediation of cognitive, speech and language functions in other patient populations, such as children and adults with neurodevelopemental disorders.