Adaptive tele-therapies based on serious games for health for people with time-management and organisational problems: preliminary results

A meta-analysis on the effect of telemedicine on the management of attention deficit and hyperactivity disorder in children and adolescents

INTRODUCTION

This study aims to report the effect sizes of telemedicine treatments on the symptom domains of paediatric ADHD.

METHODS

In this systematic review and meta-analysis, electronic databases, i.e. PubMed, Scopus, Web of Science and Embase, were searched for articles published up to December 2020. The inclusion criteria were as follows: children or adolescents diagnosed for ADHD or other hyperkinetic disorders; randomized controlled trials (RCTs); efficacy established with parents and teachers or self-rating scales at least for one of the following domains: inattention, cognitive function, hyperactivity, hyperactivity/impulsivity or oppositional behaviours. The risk of bias was assessed using the Cochrane risk of bias tool for RCTs.

RESULTS

From 310 records reduced to 228 after removing duplicates, overall 12 studies were fulfilled our inclusion criteria. They consisted of 708 participants (358 with telemedicine intervention and 350 controls). The telemedicine interventions varied from computerized training programmes with phone calls to videoconferencing programmes, virtual reality classrooms or games. The most applicable method consisted of computerized training programmes with phone calls. Pooling results of all studies with available data on each subscale showed a significant effect of telemedicine on inattention/cognitive function (standardized mean difference (SMD) = 0.26, 95% CI: 0.16, 0.36), hyperactivity/impulsivity (SMD = 0.29, 95% CI: 0.06, 0.52), and oppositional behaviours (SMD = 0.72, 95% CI: 0.24, 1.20) subscales in ADHD. Almost all studies had an overall unclear risk of bias. The source of outcome assessment (parents, teachers or self-report questionnaire) was addressed as a potential confounding factor. In almost all symptom domains, the satisfaction from the treatment was higher in parents than in teachers.

CONCLUSIONS

The clinical effects of telemedicine on the treatment of ADHD showed a small effect size for inattention/cognitive function, hyperactivity/impulsivity and oppositional behaviours.

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].

Biofeedback Applied to Interactive Serious Games to Monitor Frailty in an Elderly Population

This article proposes an example of a multiplatform interactive serious game, which is an additional tool and assistant used in the rehabilitation of patients with musculoskeletal system problems. In medicine, any actions and procedures aimed at helping the rehabilitation of patients should entail the most comfortable, but at the same time, effective approach. Regardless of how these actions are orientated, whether for rehabilitation following surgery, fractures, any problems with the musculoskeletal system, or just support for the elderly, rehabilitation methods undoubtedly have good goals, although often the process itself can cause all kinds of discomfort and aversion among patients. This paper presents an interactive platform which enables a slightly different approach to be applied in terms of routine rehabilitation activities and this will help make the process more exciting. The main feature of the system is that it works in several ways: for normal everyday use at home, or for more in-depth observation of various biological parameters, such as heart rate, temperature, and so on. The basic component of the system is the real-time tracking system of the body position, which constitutes both a way to control the game (controller) and a means to analyze the player’s activity. As for the closer control of rehabilitation, the platform also provides the opportunity for medical personnel to monitor the player in real time, with all the data obtained from the game being used for subsequent analysis and comparison. Following several laboratory tests and feedback analysis, the progress indicators are quite encouraging in terms of greater patient interest in this kind of interaction, and effectiveness of the developed platform is also on average about 30–50% compared to conventional exercises, which makes it more attractive in terms of patient support.

What is the level of evidence for the use of currently available technologies in facilitating the self-management of difficulties associated with ADHD in children and young people? A systematic review

A number of technologies to help self-manage attention deficit hyperactivity disorder (ADHD) in children and young people (YP) have been developed. This review will assess the level of evidence for the use of such technologies. The review was undertaken in accordance with the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. 7545 studies were screened. Fourteen studies of technology that aim to self-manage difficulties associated with ADHD in children and YP were included. Primary outcome measures were measures that assessed difficulties related to ADHD. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, the Cochrane Library, ProQuest ASSIA, PsycINFO and Scopus. The methodological quality of the studies was assessed. This review highlights the potential for the use of technology in paediatric ADHD management. However, it also demonstrates that current research lacks robustness; using small sample sizes, non-validated outcome measures and little psychoeducation component. Future research is required to investigate the value of technology in supporting children and YP with ADHD and a focus psychoeducation is needed.

Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Background

The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called “Plan-It Commander”) as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD).

Objective

The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial.

Methods

Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up.

Results

After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported; P=.004) and on secondary outcomes of the social skill of responsibility (parent-reported; P=.04), and working memory (parent-reported; P=.02). Parents and teachers reported that total social skills improved over time within groups, whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups. Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study. Participants in group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time.

Conclusions

Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).

An iPad-Based Tool for Improving the Skills of Children with Attention Deficit Disorder

Attention Deficit Hyperactivity Disorder (ADHD), with a worldwide prevalence of 5.29%–7.1%, is one of the most common neurodevelopmental disorders among children and adolescents. Apart from typical symptoms like inattention, hyperactivity and impulsiveness, patients also evidence attention deficit problems with reading comprehension. This in turn causes poor school performance and widens the gap with peers without ADHD. This paper presents a novel and interactive tool based on Serious Games for Health, whose aim is not only to improve comprehension, but also hold the user’s attention. This tool is geared towards assessing reading quality and is intended for iPad devices. Preliminary results obtained from the experiment performed to evaluate the game are included in this report. A group of six typically developing children from Colegio Vizcaya aged between 8 and 12 took part in the evaluation of motivation, satisfaction and usability of the same therapy in the new media. Results obtained by participants playing the game were analysed together with questionnaires concerning the usability of the system. Game evaluation resulted in relatively good statistics-average score was 3 points out of 4 and average time for completing the exercise was 59 seconds. A SUS questionnaire with an average score of 92.75 out of 100 indicates that the game presented is user-friendly and an effective tool. Moreover, based on the feedback obtained from participants, the game had been improved and additional functionality introduced. Older participants completed the first game faster than the younger ones, but age was not influential in subsequent games.