Effectiveness of a Fire Disaster PFA Simulation Game: A Single-Blinded Trial

OBJECTIVE

As societies become more complex, disasters are increasing in frequency and magnitude. To respond to the psychological problems that may arise in such situations, it is necessary to develop the psychological first aid (PFA) training program that is more engaging for disaster relief workers and less limited in time and space. This study aimed to investigate the effectiveness of a web-based PFA simulation game for disaster relief workers to provide to fire disaster victims.

METHODS

This was a non-randomized controlled experimental study with 30 participants in the experimental and control groups. The experimental group learned through the web-based PFA simulation game developed in this study, and the control group was provided with written educational materials regarding general disaster. The effects of time between groups and interaction between groups were tested.

RESULTS

Compared to the control group, the experimental group showed significant effects on core competencies in disaster response, self-efficacy, and problem-solving process, and the persistence of the effects was also significantly different.

CONCLUSION

The web-based PFA simulation game was found to be effective in improving core competencies in disaster response, self-efficacy, and problem-solving process of disaster relief workers. These results suggest that simulation games can be an effective learning method for learning PFA for disaster relief workers. Since it is difficult to learn through direct participation in disaster situations, a web-based simulation game may be a more effective way to improve and maintain the competence of PFA.

A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study

Background

Cognitive stimulation of older people helps prevent, and even treat, age-related diseases, such as mild cognitive impairment. Playing games reduces the probability of experiencing this pathology, which is related to the loss of the ability to carry out some instrumental activities of daily living.

Objective

This work describes the design and development of a serious game for the cognitive stimulation of older people, with exercises related to the daily life task of shopping. A pilot study for its preliminary usability validation is also presented.

Methods

The designed serious game includes 4 exercises consisting of shopping in a hypermarket, ordering products, making payments, and organizing the purchase, thus dealing with the most frequent cognitive problems of older people associated with episodic declarative memory, naming, calculation, and organization, respectively.

Results

A total of 19 older people participated in the pilot study for the usability validation of the serious game. They indicated that they like the aesthetic and interesting topic of the game. They reported that it provides a high level of entertainment and could be useful in daily life for mental stimulation. The participants found the serious game to be intuitive, but the ease of use and readability of the instructions could be improved.

Conclusions

This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation to prevent or treat mild cognitive impairment, although a long-term intervention study should be performed as future work. Its ecological validity design, with everyday tasks, adaptable levels of difficulty, and motivational mechanisms, is a differentiating factor compared to similar serious games.

Promoting teachers' wellbeing through a serious game intervention: a qualitative exploration of teachers' experiences

Introduction

Teachers' wellbeing plays a critical role in their overall job satisfaction, motivation, and effectiveness in building supporting learning environments. In today's dynamic educational settings, where teachers often face numerous challenges and stressors, their wellbeing becomes increasingly vital. Consequently, there is an urgent need to innovate and develop targeted training interventions that can support specifically the wellbeing of educators.

Methods

This study sought to provide an overview of the "Online Wellbeing Course - OWC," a serious game developed to enhance teachers' wellbeing, and to investigate the participants' feedback after being engaged in the OWC, utilizing a qualitative approach through focus group discussions. A total of 189 in-service teachers took part in the study. To qualitatively explore their experiences with the OWC, participants were involved in focus groups and asked to provide feedback about how and to what extent the course was beneficial for their wellbeing.

Results

Teachers reported enhancements in areas such as emotional competence, self-care strategies, social awareness, relationship skills, decision-making, and school climate.

Discussion

These outcomes suggested the potential of serious games as an innovative training approach for supporting teachers' wellbeing, offering valuable insights for researchers, policymakers, and educators.

A Serious Game ("Fight With Virus") for Preventing COVID-19 Health Rumors: Development and Experimental Study

BACKGROUND

Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors.

OBJECTIVE

This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders.

METHODS

This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named "Fight With Virus" as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved.

RESULTS

We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games.

CONCLUSIONS

Compared to traditional media, serious games can effectively improve midelders'/elders' cognitive abilities while they face a health rumor. The gameplay effect is related to the individual's age and educational background, while income and gender have no impact.

Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: A Prospective Open-Label Study

The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.

A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study

BACKGROUND

Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored.

OBJECTIVE

This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents.

METHODS

We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Māori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children's Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4.

RESULTS

Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI -0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI -2.71 to 4.31; P=.64) for GHSQ; -1.09 (95% CI -2.83 to 0.66; P=.21) for FS; and -3.42 (95% CI -6.84 to -0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful.

CONCLUSIONS

The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31588.

The Effects of Serious Games on Cardiopulmonary Resuscitation Training and Education: Systematic Review With Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Serious games have emerged as an innovative educational strategy with the potential to significantly enhance the quality and effectiveness of cardiopulmonary resuscitation (CPR) training. Despite their promise, there remains a degree of controversy when comparing the advantages of serious games with traditional CPR training methods. This study seeks to provide a comprehensive assessment of the impact of serious games on CPR training and education by systematically analyzing the results of previous research.

OBJECTIVE

This study aimed to assess the effect of serious games on CPR training and education by summarizing and pooling the results of previous studies.

METHODS

We conducted a thorough and systematic search across 9 prominent web-based databases, encompassing the period from the inception of these databases until April 1, 2023. The databases included in our search were PubMed, Cochrane Library, Wiley Online Library, EBSCO (PsycInfo), SpringerLink, Chinese Biology Medicine Disc, Vip Journal Integration Platform, Wanfang Database, and Chinese National Knowledge Infrastructure. The studies selected adhered to the following criteria: (1) being a randomized controlled trial comparing serious games and traditional methods for CPR training; (2) having participants aged 12 years or older in CPR; (3) having an experimental group using serious games and a control group using nongame methods for CPR instruction; and (4) having outcomes including theoretical and skill assessments, compression depth, and rate. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. Data analysis was performed using RevMan (version 5.3; Cochrane Training), and mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables.

RESULTS

A total of 9 articles were included, involving 791 study participants, of whom 395 in the experimental group taught CPR training using serious games and 396 in the control group taught CPR training using traditional methods. The results of our meta-analysis indicate that the use of serious games in CPR training yields outcomes that are comparable in effectiveness to traditional training methods across several key areas. Specifically, serious games demonstrated equivalence to traditional formats in theory assessment (SMD -0.22, 95% CI - 0.96 to 0.51; P=.55), skill assessment (SMD -0.49, 95% CI -1.52 to 0.55; P=.36), compression depth (MD -3.17, 95% CI -0.18 to 6.53; P=.06), and compression rate (MD -0.20, 95% CI -7.29 to 6.89; P=.96).

CONCLUSIONS

In summary, serious games offer a viable and effective CPR education approach, yielding results comparable to traditional formats. This modality is a valuable addition to CPR training methodologies. However, caution is warranted in interpreting these findings due to limited controlled trials, small sample sizes, and low-quality meta-analyzed evidence.

An Augmented Reality Serious Game for Children's Optical Science Education: Randomized Controlled Trial

Background

Knowledge construction in the context of children's science education is an important part of fostering the development of early scientific literacy. Nevertheless, children sometimes struggle to comprehend scientific knowledge due to the presence of abstract notions.

Objective

This study aimed to evaluate the efficacy of augmented reality (AR) games as a teaching tool for enhancing children's understanding of optical science education.

Methods

A total of 36 healthy Chinese children aged 6-8 years were included in this study. The children were randomly divided into an intervention group (n=18, 50%) and a control group (n=18, 50%). The intervention group received 20 minutes of AR science education using 3 game-based learning modules, whereas the control group was asked to learn the same knowledge for 20 minutes with a non-AR science learning app. Predict observe explain tests for 3 topics (animal vision, light transmission, and color-light mixing) were conducted for all participants before and after the experiment. Additionally, the Intrinsic Motivation Inventory, which measures levels of interest-enjoyment, perceived competence, effort-importance, and tension-pressure, was conducted for children after the experiment.

Results

There was a statistically significant difference in light transmission (z=-2.696; P=.008), color-light mixing (z=-2.508; P=.01), and total predict observe explain test scores (z=2.458; P=.01) between the 2 groups. There were also variations between the groups in terms of levels of interest-enjoyment (z=-2.440; P=.02) and perceived competence (z=-2.170; P=.03) as measured by the Intrinsic Motivation Inventory.

Conclusions

The randomized controlled trial confirmed that the AR-based science education game we designed can correct children's misconceptions about science and enhance the effectiveness of science education.

Health Care Professional-Supported Co-Design of a Mime Therapy-Based Serious Game for Facial Rehabilitation

This research letter presents the co-design process for RG4Face, a mime therapy-based serious game that uses computer vision for human facial movement recognition and estimation to help health care professionals and patients in the facial rehabilitation process.

The Development of Response and Interference Inhibition in Children: Evidence from Serious Game Training

A serious game titled "Crossing the Jungle" was developed in this study to train children's inhibition skills using the Stroop task. The effects of inhibitory control on children were tested by a pre-test, post-test, and one-month follow-up test. In the control groups, children were asked to play a commercial game instead. In experiment 1, 48 participants chose either the training or control game voluntarily, whereas, in experiment 2, 44 participants were randomly assigned to either group. In both experiments, children exposed to the serious game demonstrated training effects from the Stroop spatial task and near-transfer effects from the Flanker task. However, transferring effects were not produced by the Go/No-go task. As a result, although the serious game "Crossing the Jungle" does not improve response inhibition, children aged 9 to 12 who play it may benefit from improved interference inhibition abilities. This provides evidence for the mutual independence of interference inhibition and response inhibition in children at this stage.

A Serious Game to Train Rhythmic Abilities in Children With Dyslexia: Feasibility and Usability Study

BACKGROUND

Rhythm perception and production are related to phonological awareness and reading performance, and rhythmic deficits have been reported in dyslexia. In addition, rhythm-based interventions can improve cognitive function, and there is consistent evidence suggesting that they are an efficient tool for training reading skills in dyslexia.

OBJECTIVE

This paper describes a rhythmic training protocol for children with dyslexia provided through a serious game (SG) called Mila-Learn and the methodology used to test its usability.

METHODS

We computed Mila-Learn, an SG that makes training remotely accessible and consistently reproducible and follows an educative agenda using Unity (Unity Technologies). The SG's development was informed by 2 studies conducted during the French COVID-19 lockdowns. Study 1 was a feasibility study evaluating the autonomous use of Mila-Learn with 2500 children with reading deficits. Data were analyzed from a subsample of 525 children who spontaneously played at least 15 (median 42) games. Study 2, following the same real-life setting as study 1, evaluated the usability of an enhanced version of Mila-Learn over 6 months in a sample of 3337 children. The analysis was carried out in 98 children with available diagnoses.

RESULTS

Benefiting from study 1 feedback, we improved Mila-Learn to enhance motivation and learning by adding specific features, including customization, storylines, humor, and increasing difficulty. Linear mixed models showed that performance improved over time. The scores were better for older children (P<.001), children with attention-deficit/hyperactivity disorder (P<.001), and children with dyslexia (P<.001). Performance improved significantly faster in children with attention-deficit/hyperactivity disorder (β=.06; t3754=3.91; P<.001) and slower in children with dyslexia (β=-.06; t3816=-5.08; P<.001).

CONCLUSIONS

Given these encouraging results, future work will focus on the clinical evaluation of Mila-Learn through a large double-blind randomized controlled trial comparing Mila-Learn and a placebo game.

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Effects of a Preventive Mental Health Curriculum Embedded Into a Scholarly Gaming Course on Adolescent Self-Esteem: Prospective Matched Pairs Experiment

Background

Positive self-esteem predicts happiness and well-being and serves as a protective factor for favorable mental health. Scholarly gaming within the school setting may serve as a channel to deliver a mental health curriculum designed to improve self-esteem.

Objective

This study aims to evaluate the impact of a scholarly gaming curriculum with and without an embedded preventive mental health curriculum, Mental Health Moments (MHM), on adolescents' self-esteem.

Methods

The scholarly gaming curriculum and MHM were developed by 3 educators and a school-based health intervention expert. The scholarly gaming curriculum aligned with academic guidelines from the International Society for Technology Education, teaching technology-based career skills and video game business development. The curriculum consisted of 40 lessons, delivered over 14 weeks for a minimum of 120 minutes per week. A total of 83 schools with previous gaming engagement were invited to participate and 34 agreed. Schools were allocated to +MHM or -MHM arms through a matched pairs experimental design. The -MHM group received the scholarly gaming curriculum alone, whereas the +MHM group received the scholarly gaming curriculum plus MHM embedded into 27 lessons. MHM integrated concepts from the PERMA framework in positive psychology as well as the Collaborative for Academic, Social, and Emotional Learning (CASEL) standards in education, which emphasize self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Participants in the study were students at schools offering scholarly gaming curricula and were enrolled at recruitment sites. Participants completed a baseline and postintervention survey quantifying self-esteem with the Rosenberg Self-Esteem Scale (score range 0-30). A score <15 characterizes low self-esteem. Participants who completed both baseline and postintervention surveys were included in the analysis.

Results

Of the 471 participants included in the analysis, 235 received the -MHM intervention, and 236 received the +MHM intervention. Around 74.9% (n=353) of participants were in high school, and most (n=429, 91.1%) reported this was their first year participating in scholarly gaming. Most participants were male (n=387, 82.2%). Only 58% (n=273) reported their race as White. The average self-esteem score at baseline was 17.9 (SD 5.1). Low self-esteem was reported in 22.1% (n=104) of participants. About 57.7% (n=60) of participants with low self-esteem at baseline rated themselves within the average level of self-esteem post intervention. When looking at the two groups, self-esteem scores improved by 8.3% among the +MHM group compared to no change among the -MHM group (P=.002). Subgroup analyses revealed that improvements in self-esteem attributed to the +MHM intervention differed by race, gender, and sexual orientation.

Conclusions

Adolescents enrolled in a scholarly gaming curriculum with +MHM had improved self-esteem, shifting some participants from abnormally low self-esteem scores into normal ranges. Adolescent advocates, including health care providers, need to be aware of nontraditional educational instruction to improve students' well-being.

Educator's blueprint: A how-to guide for creating analog serious games for learning in medical education

Serious games are an emerging tool for teaching and learning within medical education. These games can be used to facilitate learning or to demonstrate complex concepts in short bursts of interactive learning. This educator's blueprint will provide 10 strategies for creating a serious game, focusing on card and board games. These strategies include creating a project charter; determining the nature of the game; establishing game mechanics; selecting the best medium; prototyping and playtesting; reviewing sensitivity to equity, diversity, and inclusion; reviewing and refining content; funding game development, manufacture, and distribution; marketing and publicizing the game; and future-proofing the game. This blueprint hopes to help aspiring serious game designers and educators to conceptualize the steps for successfully creating a new serious game for medical education.

[Welcoming learners, a DEPHI on the DMU!]

The reception of learner-caregivers is a challenge for the care sectors in the context of clinical training, moreover in view of the current situation in connection with the health of our hospitals. Remember that internship periods represent 50 % of apprenticeship time in training institutes. So how does a Medical-University Department of Hematology and Immunology try to implement a policy of welcoming and supporting trainees, taking into account their level of training and promoting interest and emulation for future professionals health?

Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study

BACKGROUND

Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence.

OBJECTIVE

This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs.

METHODS

We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework.

RESULTS

The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient's characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model.

CONCLUSIONS

The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary.

Usability of ENTRUST as an Assessment Tool for Entrustable Professional Activities (EPAs): A Mixed Methods Analysis

OBJECTIVE

As the American Board of Surgery transitions to a competency-based model of surgical education centered upon entrustable professional activities (EPAs), there is a growing need for objective tools to determine readiness for entrustment. This study evaluates the usability of ENTRUST, an innovative virtual patient simulation platform to assess surgical trainees' decision-making skills in preoperative, intra-operative, and post-operative settings.

DESIGN

This is a mixed-methods analysis of the usability of the ENTRUST platform. Quantitative data was collected using the system usability scale (SUS) and Likert responses. Analysis was performed with descriptive statistics, bivariate analysis, and multivariable linear regression. Qualitative analysis of open-ended responses was performed using the Nielsen-Shneiderman Heuristics framework.

SETTING

This study was conducted at an academic institution in a proctored exam setting.

PARTICIPANTS

The analysis includes n = 47 (PGY 1-5) surgical residents who completed an online usability survey following the ENTRUST Inguinal Hernia EPA Assessment.

RESULTS

The ENTRUST platform had a median SUS score of 82.5. On bivariate and multivariate analyses, there were no significant differences between usability based on demographic characteristics (all p > 0.05), and SUS score was independent of ENTRUST performance (r = 0.198, p = 0.18). Most participants agreed that the clinical workup of the patient was engaging (91.5%) and felt realistic (85.1%). The most frequent heuristics represented in the qualitative analysis included feedback, visibility, match, and control. Additional themes of educational value, enjoyment, and ease-of-use highlighted participants' perspectives on the usability of ENTRUST.

CONCLUSIONS

ENTRUST demonstrates high usability in this population. Usability was independent of ENTRUST score performance and there were no differences in usability identified in this analysis based on demographic subgroups. Qualitative analysis highlighted the acceptability of ENTRUST and will inform ongoing development of the platform. The ENTRUST platform holds potential as a tool for the assessment of EPAs in surgical residency programs.

A Video Game for Entrepreneurship Learning in Ecuador: Development Study

BACKGROUND

Games have been a part of human life since ancient times and are taught to children and adults who want to simultaneously have fun and learn. Nevertheless, in the third decade of this century, technology invites us to consider using video games to learn topics such as entrepreneurship. However, developing a serious game (SG) is difficult because everyone who forms part of the game development team requires adequate learning resources to acquire the necessary information and improve their game development skills.

OBJECTIVE

This work aimed to detail the experience gained in developing ATIC (Aprende, Trabaja, Innova, Conquista [learn, work, innovate, conquer]), an SG proposed for teaching and learning entrepreneurship.

METHODS

To develop a videogame, first, we established a game development team formed by professors, professionals, and students who have different roles in this project. Scrum was adopted as a project management method. To create concept art for the video game, designers collected ideas from various games, known as "getting references." In contrast, narratology considers the life of a recent university graduate immersed in real life, considering locations, characteristics, and representative characters from an essential city of Ecuador.

RESULTS

In a Unity 3D video game in ATIC, the life of a university student who graduates and ventures into a world full of opportunities, barriers, and risks, where the player needs to make decisions, is simulated. The art of this video game, including sounds and music, is based on the landscape and characteristics of and characters from Cuenca, Ecuador. The game aims to teach entrepreneurs the mechanisms and processes to form their businesses. Thus, we developed the following elements of an SG: (1) world, (2) objects, (3) agents, and (4) events.

CONCLUSIONS

The narrative, mechanics, and art of video games are relevant. However, project management tools such as leaderboards and appointments are crucial to influencing individuals' decision to continue to play, or not play, an SG. Developing a serious video game is not an easy task. It was essential to consider many factors, such as the video game audience, needs of learning, context, similarities with the real world, narrative, game mechanics, game art, and game sounds. However, overall, the primary purpose of a serious video game is to transmit knowledge in a fun way and to give adequate and timely feedback to the gamer. Finally, nothing is possible if the members of game development team are not satisfied with the project and not clear about their roles.

Effect of Voice and Articulation Parameters of a Home-Based Serious Game for Speech Therapy in Children With Articulation Disorder: Prospective Single-Arm Clinical Trial

BACKGROUND

Articulation disorder decreases the clarity of language and causes a decrease in children's learning and social ability. The demand for non-face-to-face treatment is increasing owing to the limited number of therapists and geographical or economic constraints. Non-face-to-face speech therapy programs using serious games have been proposed as an alternative.

OBJECTIVE

The aim of this study is to investigate the efficacy of home therapy on logopedic and phoniatric abilities in children with articulation disorder using the Smart Speech game interface.

METHODS

This study is a prospective single-arm clinical trial. Children with articulation disorders, whose Urimal Test of Articulation and Phonology (U-TAP) was -2 SDs or less and the Receptive and Expressive Vocabulary Test score was -1 SD or more, were enrolled. A preliminary evaluation (E0) was conducted to check whether the children had articulation disorders, and for the next 4 weeks, they lived their usual lifestyle without other treatments. Prior to the beginning of the training, a pre-evaluation (E1) was performed, and the children trained at home for ≥30 minutes per day, ≥5 times a week, over 4 weeks (a total of 20 sessions). The Smart Speech program comprised oral exercise training, breathing training, and speech training; the difficulty and type of the training were configured differently according to the participants' articulation error, exercise, and vocal ability. After the training, postevaluation (E2) was performed using the same method. Finally, 8 weeks later, postevaluation (E3) was performed as a follow-up. A voice evaluation included parameters such as maximum phonation time (MPT), fundamental frequency (F0), jitter, peak air pressure (relative average perturbation), pitch, intensity, and voice onset time. Articulation parameters included a percentage of correct consonants (PCC; U-TAP word-unit PCC, U-TAP sentence-unit PCC, and three-position articulation test) and alternate motion evaluation (diadochokinesis, DDK). Data obtained during each evaluation (E1-E2-E3) were compared.

RESULTS

A total of 13 children with articulation disorders aged 4-10 years were enrolled in the study. In voice parameters, MPT, jitter, and pitch showed significant changes in repeated-measures ANOVA. However, only MPT showed significant changes during E1-E2 (P=.007) and E1-E3 (P=.004) in post hoc tests. Other voice parameters did not show significant changes. In articulation parameters, U-TAP, three-position articulation test (TA), and DDK showed significant changes in repeated-measures ANOVA. In post hoc tests, U-TAP (word, sentence) and TA showed significant changes during E1-E2 (P=.003, .04, and .01) and E1-E3 (P=.001, .03, and .003), and DDK showed significant changes during E1-E2 only (P=.03).

CONCLUSIONS

Home-based serious games can be considered an alternative treatment method to improve language function.

TRIAL REGISTRATION

Clinical Research Information Service KCT0006448; https://cris.nih.go.kr/cris/search/detailSearch.do/20119.

Serious Game for Fine Motor Control Rehabilitation for Children With Epileptic Encephalopathy: Development and Usability Study

BACKGROUND

Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living.

OBJECTIVE

This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE.

METHODS

The participants were 4 children with EE (male: n=2, 50%; female: n=2, 50%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction.

RESULTS

The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist's evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value.

CONCLUSIONS

The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology.

Comparing the Outcomes of Virtual Reality-Based Serious Gaming and Lecture-Based Training for Advanced Life Support Training: Randomized Controlled Trial

BACKGROUND

Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)-based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training.

OBJECTIVE

The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training.

METHODS

Participants were students from Acibadem Mehmet Ali Aydinlar University's Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups' performances in this study.

RESULTS

The improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game-based training instead of classroom lectures.

CONCLUSIONS

Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups' total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910.

Effects of Serious Games for Patients With Chronic Obstructive Pulmonary Disease: Systematic Literature Review

BACKGROUND

The use of serious games for rehabilitation has been an emerging intervention in health care fields, referred to as an entertaining and positive activity. Although related studies have been conducted on patients with chronic obstructive pulmonary disease (COPD), a more comprehensive study that summarizes and evaluates its effects in this area is needed.

OBJECTIVE

This review aimed to systematically evaluate the effects of serious games in promoting rehabilitation and related outcome measures of serious game-based engagement in patients with COPD.

METHODS

This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Searches were performed in the following databases: PubMed, Scopus, Embase (via Ovid), CINAHL, Science Direct, and China Biology Medicine disc. Only quantitative studies were included in this review, and the methodological quality and bias of the included studies were evaluated using related tools. Several outcomes, including clinical outcomes and serious game-based engagement outcomes, were ultimately collected in this review. The results were summarized and evaluated using descriptive methods due to significant heterogeneity.

RESULTS

In total, 11 studies were included. Serious games played a potentially positive effect on pulmonary function and exercise capacity. However, no consistent findings were reported on dyspnea and psychological status. Additionally, serious game engagement showed favorable findings on adherence, enjoyment, and acceptability. Furthermore, no serious adverse effects were identified in all included studies.

CONCLUSIONS

This review preliminarily indicated the potential benefits of serious games in promoting rehabilitation for patients with COPD, despite the limited quality of the included studies. More studies with high methodological quality are needed to further explore the effects of serious games in this field.

Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study

BACKGROUND

Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation.

OBJECTIVE

This study aimed to compare the effects of VR games on chronic low back pain.

METHODS

This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P≤.05.

RESULTS

The study comprised a sample of 40 patients with low back pain; 12 (40%) were female and 28 (60%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were -.60 (P=.76), -2.30 (P<.001), and -1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects.

CONCLUSIONS

VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups.

TRIAL REGISTRATION

Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916.

The Effectiveness of Video-Based Game Exercise Therapy Applications in Pes Planus Rehabilitation: Protocol for a Randomized Controlled Trial

BACKGROUND

Pes planus is one of the most common foot deformities. Although there are many studies on the effectiveness of various exercise methods in pes planus rehabilitation, the number of studies on video-based game exercise therapy applications is very limited.

OBJECTIVE

This study aims to evaluate the effectiveness of 2 video-based game exercise therapies and structured exercise practices in pes planus rehabilitation.

METHODS

This study is a 3-arm, parallel-group, single-blinded randomized controlled trial. The study will include 69 patients with flexible pes planus aged between 18 and 25 years who attend the orthopedics and traumatology clinic and meet the inclusion criteria. The primary outcomes are measures of navicular drop and pedobarographic analysis before and after the intervention, and the secondary outcomes include balance, femoral anteversion, and lower extremity muscle strength. Participants will be evaluated with a navicular drop test for medial longitudinal arch height, a pedobarographic analysis system for plantar pressure analysis, a Craig test for femoral anteversion, the Becure Balance System for balance measurement, and a myometer device for lower extremity muscle strength measurement. Participants will be randomly assigned to a structured exercise group, an exergame group, or a serious game group according to their order of arrival. The structured exercise group will use a short foot exercise, a towel-picking exercise, and various walking and balance exercises. Patients in the serious play group will play the lower extremity games in the Becure Balance System. Patients in the exergame group will play balance games on the Nintendo Wii game console. All participants will participate in 18 exercise sessions (3 days a week for 6 weeks). After the treatment, the initial measurements will be repeated.

RESULTS

The study started in January 2023. It is expected to be completed in June 2024.

CONCLUSIONS

This study will be the first randomized controlled study to evaluate the effectiveness of 2 different video-based game exercise therapy applications in pes planus rehabilitation. Through this study, the use of video-based game exercise therapy in pes planus rehabilitation, together with the developing technology, will be a guide. In addition, a new exercise protocol, including serious game exercises, will be added to the literature. In the future, it is expected that our study on the development of different game systems, especially for the ankle, will provide pioneering feedback.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05679219; https://clinicaltrials.gov/study/NCT05679219.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51772.

MedSMA℞T Adventures in PharmaCity Game: Youth Experiences and Recommendation for Use in Opioid Safety Education

Adolescents are often excluded from the creation of opioid safety interventions; therefore, it is crucial to design evidence-based interventions tailored for and with youth. Video games are ubiquitous and approachable to adolescents making them an accessible educational modality. MedSMA℞T: Adventures in PharmaCity is a serious game that educates adolescents and their families on the safe, appropriate, and responsible use of opioid prescriptions. The first objective of the study was to elucidate adolescents' experiences and perceptions of the game. The second objective was to elicit their recommendations for use and suggestions for improvement. Adolescents were recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Recruitment occurred between April 2021 and October 2021. Eligible adolescents played the game and completed a follow-up virtual semi-structured interview with a study team member. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. A thematic content analysis was performed. A total of seventy-two adolescents participated. Analysis yielded four themes: prior gaming experience, educational salience, game design impressions, and recommendations for improvement. Most adolescents approached MedSMA℞T with prior gaming experience. The youth correctly identified the game's intended objective: the promotion of opioid medication safety. Adolescents had overarchingly positive impressions of the game's levels, characters, and graphics. Study participants suggested expanded game levels, improved controls, and more instructions for gameplay. In summary, adolescents had favorable experiences using the MedSMA℞T game which allude to the wide-spread acceptability of this intervention among young people.

The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review

BACKGROUND

AIDS, which is caused by HIV, has long been one of the most significant global public health issues. Since the beginning of the HIV epidemic, various types of nonelectronic communication tools have been commonly used in HIV/AIDS prevention and care, but studies that apply the potential of electronic games are still limited.

OBJECTIVE

We aimed to identify, compare, and describe serious games and gamified systems currently used in HIV/AIDS prevention and care that were studied over a specific period of time.

METHODS

A scoping review was conducted into serious games and gamified systems used in HIV prevention and care in various well-known digital libraries from January 2010 to July 2021.

RESULTS

After identifying research papers and completing the article selection process, 49 of the 496 publications met the inclusion criteria and were examined. A total of 32 articles described 22 different serious games, while 17 articles described 13 gamified systems for HIV prevention and care.

CONCLUSIONS

Most of the studies described in the publications were conducted in the United States, while only a few studies were performed in sub-Saharan African countries, which have the highest global HIV/AIDS infection rates. Regarding the development platform, the vast majority of HIV/AIDS gaming systems were typically deployed on mobile devices. This study demonstrates the effectiveness of using serious games and gamified systems. Both can improve the efficacy of HIV/AIDS prevention strategies, particularly those that encourage behavior change.

A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study

BACKGROUND

Heart rate variability biofeedback (HRVB) is an established intervention for increasing heart rate variability (HRV) in the clinical context. Using this technique, participants become aware of their HRV through real-time feedback and can self-regulate it.

OBJECTIVE

The aim of this study was 2-fold: first, to develop a serious game that applies the HRVB technique to teach participants to self-regulate HRV and, second, to test the app with participants in a pilot study.

METHODS

An HRVB app called the FitLab Game was developed for this study. To play the game, users must move the main character up and down the screen, avoiding collisions with obstacles. The wavelength that users must follow to avoid these obstacles is based on the user's basal heart rate and changes in instantaneous heart rate. To test the FitLab Game, a total of 16 participants (mean age 23, SD 0.69 years) were divided into a control group (n=8) and an experimental group (n=8). A 2 × 2 factorial design was used in each session. Participants in the experimental condition were trained in breathing techniques.

RESULTS

Changes in the frequency and time domain parameters of HRV and the game's performance features were evaluated. Significant changes in the average RR intervals and root mean square of differences between adjacent RR intervals (RMSSD) were found between the groups (P=.02 and P=.04, respectively). Regarding performance, both groups showed a tendency to increase the evaluated outcomes from baseline to the test condition.

CONCLUSIONS

The results may indicate that playing different levels leads to an improvement in the game's final score by repeated training. The tendency of changes in HRV may reflect a higher activation of the mental system of attention and control in the experimental group versus the control group. In this context, learning simple, voluntary strategies through a serious game can aid the improvement of self-control and arousal management. The FitLab Game appears to be a promising serious game owing to its ease of use, high engagement, and enjoyability provided by the instantaneous feedback.

Looking fear in the eye: Gamified virtual reality exposure towards spiders for children using attention based feedback

Many children around the globe suffer from spider phobia. Virtual reality exposure therapy is an effective phobia treatment, but so far predominantly tailored for adults. A gamified approach utilizing gaze interaction would allow for a more child-friendly and engaging experience, and provide the possibility to foster working mechanisms of exposure therapy. We developed an application in which children make spiders change in positively connoted ways (e.g., make them dance or shrink) if sufficient visual attention towards them is captured via eye tracking. Thereby, motivation for and positive affects during exposure towards spiders are aspired. In this pilot study on 21 children without (n = 11) and with fear of spiders (n = 10), we examined positive and negative affect during exposure to a virtual spider and to different gaze-related transformations of the spider within a quasi-experimental design. Within a one-group design, we additionally examined fear of spiders in spider fearful children before and one week after the intervention. We found that significantly more positive than negative affect was induced by the spiders' transformations in children without and with fear of spiders. Fear of spiders was furthermore significantly reduced in spider-fearful children, showing large effect sizes (d > .80). Findings indicate eligibility for future clinical use and evaluation in children with spider phobia.

The person-centred care game: a reflective tool for learning person-centred care in higher education

Person-centred care (PCC) is being implemented within many health care systems and educational institutions are important enablers of learning PCC. Teachers in higher education are responsible for helping students develop the ability to reflect. One approach is with serious games, which allow students to reflect on realistic situations and shape their skills with virtual patients. This paper describes the development of a serious game, the person-centred care game - (PCC game), which was designed to promote learning of PCC by reflection. We demonstrated how this PCC game could be used to induce PCC knowledge and skills by student reflection in an academic course on PCC.

The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial

BACKGROUND

With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs.

OBJECTIVE

This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population.

METHODS

In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion.

RESULTS

A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups.

CONCLUSIONS

Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.

Pharmacists' perspectives on MedSMA℞T: A serious game to educate youth about opioid safety

BACKGROUND

Adolescent opioid misuse has been recognized as a dire public health issue. Despite efforts to address the opioid epidemic in the United States, opioid-related morbidity and mortality have continued to rise. Few interventions have been tailored to prevent adolescent opioid misuse. MedSMA℞T: Adventures in PharmaCity (MedSMA℞T), is a serious game that educates the end-user by challenging them to make applicable decisions in a low-stakes environment.

OBJECTIVE

The study aimed to characterize pharmacists' perspectives on using MedSMA℞T to educate adolescents and families about opioid medication safety.

METHODS

Pharmacists were recruited from the Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin. Consented pharmacists played the MedSMA℞T game for 30 minutes while a research team member observed via Zoom. Virtual semi-structured interviews (45 minutes) were recorded and transcribed verbatim. Two members of the research team independently coded each transcript using NVivo software to conduct inductive thematic analyses. Bi-weekly meetings were held to discuss and refine codes as well as the master codebook, and identify prevalent themes (intercoder reliability, kappa = 0.91).

RESULTS

Twenty-two pharmacists were interviewed between August and November 2021. Four themes were identified: game content and design, patient education, implementation barriers, and implementation facilitators. Most pharmacists perceived MedSMA℞T to be an effective resource for opioid safety education. Pharmacists reported that age-appropriate language was used in combination with realistic scenarios and relatable characters. Pharmacists also highlighted the value of interactive gameplay to engage the player to actively learn and recall educational content.

CONCLUSIONS

Pharmacists play an integral role as medication experts and contributed valuable insights into using and incorporating the MedSMA℞T game into various pharmacy practice settings. Future work is necessary to understand parents' and adolescents' perceptions of using MedSMA℞T as an opioid safety education tool in pharmacies.

Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention

BACKGROUND

After the COVID-19 pandemic, society has become more aware of the importance of some basic hygienic habits to avoid exposure to pathogens transmitted via hands. Given that a high frequency of touching mucous membranes can lead to a high risk of infection, it is essential to establish strategies to reduce this behavior as a preventive measure against contagion. This risk can be extrapolated to a multitude of health scenarios and transmission of many infectious diseases. #RedPingüiNO was designed as an intervention to prevent the transmission of SARS-CoV-2 and other pathogens through the reduction of facial self-touches by thoughtfully engaging participants in a serious game.

OBJECTIVE

Facial self-touches should be understood as behaviors of limited control and awareness, used to regulate situations of cognitive and emotional demands, or as part of nonverbal communication. The objective of this study was to ensure that participants become aware of and reduce these behaviors through a game of self-perception.

METHODS

The quasi-experimental intervention was applied to 103 healthy university students selected by convenience sampling and put into practice for 2 weeks, with 1 control group (n=24, 23.3%) and 2 experimental groups (experimental group with no additional social reinforcement interventions: n=36, 35%; experimental group with additional social reinforcement interventions: n=43, 41.7%). The objective was to improve knowledge and perception and reduce facial self-touches to prevent exposure to pathogens transmitted via hands not only in health multihazard scenarios but also in ordinary circumstances. The ad hoc instrument used to analyze the experience consisted of 43 items and was valid and reliable for the purpose of this study. The items were divided into 5 blocks extracted from the theoretical framework: sociological issues (1-5); hygiene habits (6-13); risk awareness (14-19); strategies for not touching the face (20-26); and questions after the intervention (27-42), designed as a postintervention tool assessing the game experience. Validation of the content was achieved through assessment by 12 expert referees. External validation was performed using a test-retest procedure, and reliability was verified using the Spearman correlation.

RESULTS

The results of the ad hoc questionnaire, which were analyzed using the Wilcoxon signed-rank test and McNemar index to identify significant differences between test and retest for a 95% CI, showed that facial self-touches were reduced (item 20, P<.001; item 26, P=.04), and awareness of this spontaneous behavior and its triggers increased (item 15; P=.007). The results were reinforced by qualitative findings from the daily logs.

CONCLUSIONS

The intervention exhibited a greater effect from sharing the game, with interactions between people; however, in both cases, it was helpful in reducing facial self-touches. In summary, this game is suitable for reducing facial self-touches, and owing to its free availability and design, it can be adapted to various contexts.

Feasibility of a serious game system including a tangible object for post stroke upper limb rehabilitation: a pilot randomized clinical study

Introduction

Serious games can be used to provide intensive rehabilitation through attractive exercises as part of post-stroke rehabilitation. However, currently available commercial and serious games systems primarily train shoulder and elbow movements. These games lack the grasping and displacement components that are essential to improve upper limb function. For this reason, we developed a tabletop device that encompassed a serious game with a tangible object to rehabilitate combined reaching and displacement movements: the Ergotact system.

Objectives

The aim of this pilot study was to assess the feasibility and the short-term effects of a training program using the Ergotact prototype in individuals with chronic stroke.

Methods

Participants were assigned to one of two groups: a serious game training group (Ergotact) or a control training group (Self).

Results

Twenty-eight individuals were included. Upper limb function increased after the Ergotact training program, although not statistically significantly, and the program did not induce pain or fatigue, demonstrating its safety.

Conclusion

The Ergotact system for upper limb rehabilitation was well accepted and induced participant satisfaction. It complies with current recommendations for people with stroke to autonomously perform intensive active exercises in a fun context, in addition to conventional rehabilitation sessions with therapists.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT03166020?term=NCT03166020&draw=2&rank=1, identifier NCT03166020.

A feature and conjunction visual search immersive virtual reality serious game for measuring spatial and distractor inhibition attention using response time and action kinematics

BACKGROUND

Treisman (1980) proposed that visual-spatial attention to targets presented with distractors involves parallel and serial cognition. When the target is different from distractors by a single feature, the number of distractors does not influence search speed (parallel). However, when the target is different from the distractor by a conjunction of features, increased numbers of distractors increase task difficulty (serial). Here, we developed a serious game in immersive virtual reality (IVR) for evaluating spatial and distractor inhibition attention.

METHODS

We tested 60 healthy participants. They performed the serious game in which they had to find a target mole wearing a red miner's helmet. In the single feature parallel conditions, the distractor moles wore blue (miner's or horned) helmets, and in the conjunction feature serial conditions, the distractor moles wore blue miner's helmets or red horned helmets. There were 11-17-23 distractors. Responses were made with the dominant hand by hitting the target with a virtual hammer. We measured mean response time (RT), mean velocity (MV) and coefficient of variance of speed (CV).

RESULTS

Participants were significantly slower (RT and MV) and showed greater CV when responding to targets in conjunction compared to single feature search tasks. Further, participants were slower (RT and MV) and showed greater CV when the number of distractors increased. A significant interaction between search tasks and distractors showed that RT and CV only increased with distractor number for the conjunction search tasks. MV decreased with distractor number for both single and conjunction tasks, with a stronger decrease for conjunction relative to single feature search.

CONCLUSION

The results replicated previous findings, providing support for the use of immersive virtual reality technology for the simultaneous evaluation of spatial and distractor inhibition attention using complex 3D objects.

A Serious Game for the Assessment of Visuomotor Adaptation Capabilities during Locomotion Tasks Employing an Embodied Avatar in Virtual Reality

The study of visuomotor adaptation (VMA) capabilities has been encompassed in various experimental protocols aimed at investigating human motor control strategies and/or cognitive functions. VMA-oriented frameworks can have clinical applications, primarily in the investigation and assessment of neuromotor impairments caused by conditions such as Parkinson's disease or post-stroke, which affect the lives of tens of thousands of people worldwide. Therefore, they can enhance the understanding of the specific mechanisms of such neuromotor disorders, thus being a potential biomarker for recovery, with the aim of being integrated with conventional rehabilitative programs. Virtual Reality (VR) can be entailed in a framework targeting VMA since it allows the development of visual perturbations in a more customizable and realistic way. Moreover, as has been demonstrated in previous works, a serious game (SG) can further increase engagement thanks to the use of full-body embodied avatars. Most studies implementing VMA frameworks have focused on upper limb tasks and have utilized a cursor as visual feedback for the user. Hence, there is a paucity in the literature about VMA-oriented frameworks targeting locomotion tasks. In this article, the authors present the design, development, and testing of an SG-based framework that addresses VMA in a locomotion activity by controlling a full-body moving avatar in a custom VR environment. This workflow includes a set of metrics to quantitatively assess the participants' performance. Thirteen healthy children were recruited to evaluate the framework. Several quantitative comparisons and analyses were run to validate the different types of introduced visuomotor perturbations and to evaluate the ability of the proposed metrics to describe the difficulty caused by such perturbations. During the experimental sessions, it emerged that the system is safe, easy to use, and practical in a clinical setting. Despite the limited sample size, which represents the main limitation of the study and can be compensated for with future recruitment, the authors claim the potential of this framework as a useful instrument for quantitatively assessing either motor or cognitive impairments. The proposed feature-based approach gives several objective parameters as additional biomarkers that can integrate the conventional clinical scores. Future studies might investigate the relation between the proposed biomarkers and the clinical scores for specific disorders such as Parkinson's disease and cerebral palsy.

Development and evaluation of a virtual reality training for emergency treatment of shortness of breath based on frameworks for serious games

Background

Virtual reality (VR) can offer an innovative approach to providing training in emergency situations, especially in times of COVID-19. There is no risk of infection, and the procedure is scalable and resource-efficient. Nevertheless, the challenges and problems that can arise in the development of VR training are often unclear or underestimated. As an example, we present the evaluation of the feasibility of development of a VR training session for the treatment of dyspnoea. This is based on frameworks for serious games, and provides lessons learned. We evaluate the VR training session with respect to usability, satisfaction, as well as perceived effectiveness and workload of participants.

Methods

The VR training was developed using the established framework (Steps 1-4) for serious games of Verschueren et al. and Nicholson's RECIPE elements for meaningful gamification. Primary validation (Step 4) was performed at the University of Bern, Switzerland, in a pilot study without control group, with a convenience sample of medical students (n=16) and established measurement tools.

Results

The theoretical frameworks permitted guided development of the VR training session. Validation gave a median System Usability Scale of 80 (IQR 77.5-85); for the User Satisfaction Evaluation Questionnaire, the median score was 27 (IQR 26-28). After the VR training, there was a significant gain in the participants' confidence in treating a dyspnoeic patient (median pre-training 2 (IQR 2-3) vs. post-training 3 (IQR 3-3), p=0.016).Lessons learned include the need for involving medical experts, medical educators and technical experts at an equivalent level during the entire development process. Peer-teaching guidance for VR training was feasible.

Conclusion

The proposed frameworks can be valuable tools to guide the development and validation of scientifically founded VR training. The new VR training session is easy and satisfying to use and is effective - and is almost without motion sickness.

Quantification and Rehabilitation of Unilateral Spatial Neglect in Immersive Virtual Reality: A Validation Study in Healthy Subjects

Unilateral spatial neglect is a common sensorimotor disorder following the occurrence of a stroke, for which prismatic adaptation is a promising rehabilitation method. However, the use of prisms for rehabilitation often requires the use of specific equipment that may not be available in clinics. To address this limitation, we developed a new software package that allows for the quantification and rehabilitation of unilateral spatial neglect using immersive virtual reality. In this study, we compared the effects of virtual and real prisms in healthy subjects and evaluated the performance of our virtual reality tool (HTC Vive) against a validated motion capture tool. Ten healthy subjects were randomly exposed to virtual and real prisms, and measurements were taken before and after exposure. Our findings indicate that virtual prisms are at least as effective as real prisms in inducing aftereffects (4.39° ± 2.91° with the virtual prisms compared to 4.30° ± 3.49° with the real prisms), but that these effects were not sustained beyond 2 h regardless of exposure modality. The virtual measurements obtained with our software showed excellent metrological qualities (ICC = 0.95, error = 0.52° ± 1.18°), demonstrating its validity and reliability for quantifying deviation during pointing movements. Overall, our results suggest that our virtual reality software (Virtualis, Montpellier, France) could provide an easy and reliable means of quantifying and rehabilitating spatial neglect. Further validation of these results is required in individuals with unilateral spatial neglect.

NeuroSuitUp: System Architecture and Validation of a Motor Rehabilitation Wearable Robotics and Serious Game Platform

BACKGROUND

This article presents the system architecture and validation of the NeuroSuitUp body-machine interface (BMI). The platform consists of wearable robotics jacket and gloves in combination with a serious game application for self-paced neurorehabilitation in spinal cord injury and chronic stroke.

METHODS

The wearable robotics implement a sensor layer, to approximate kinematic chain segment orientation, and an actuation layer. Sensors consist of commercial magnetic, angular rate and gravity (MARG), surface electromyography (sEMG), and flex sensors, while actuation is achieved through electrical muscle stimulation (EMS) and pneumatic actuators. On-board electronics connect to a Robot Operating System environment-based parser/controller and to a Unity-based live avatar representation game. BMI subsystems validation was performed using exercises through a Stereoscopic camera Computer Vision approach for the jacket and through multiple grip activities for the glove. Ten healthy subjects participated in system validation trials, performing three arm and three hand exercises (each 10 motor task trials) and completing user experience questionnaires.

RESULTS

Acceptable correlation was observed in 23/30 arm exercises performed with the jacket. No significant differences in glove sensor data during actuation state were observed. No difficulty to use, discomfort, or negative robotics perception were reported.

CONCLUSIONS

Subsequent design improvements will implement additional absolute orientation sensors, MARG/EMG based biofeedback to the game, improved immersion through Augmented Reality and improvements towards system robustness.

Children and Young People's Involvement in Designing Applied Games: Scoping Review

BACKGROUND

User involvement is widely accepted as key for designing effective applied games for health. This especially holds true for children and young people as target audiences, whose abilities, needs, and preferences can diverge substantially from those of adult designers and players. Nevertheless, there is little shared knowledge about how concretely children and young people have been involved in the design of applied games, let alone consensus guidance on how to do so effectively.

OBJECTIVE

The aim of this scoping review was to describe which user involvement methods have been used in the design of applied games with children and young people, how these methods were implemented, and in what roles children and young people were involved as well as what factors affected their involvement.

METHODS

We conducted a systematic literature search and selection across the ACM Digital Library, IEEE Xplore, Scopus, and Web of Science databases using State of the Art through Systematic Review software for screening, selection, and data extraction. We then conducted a qualitative content analysis on the extracted data using NVivo.

RESULTS

We retrieved 1085 records, of which 47 (4.33%) met the eligibility criteria. The chief involvement methods were participatory design (20/47, 43%) and co-design (16/47, 37%), spanning a wide range of 45 concrete activities with paper prototyping, group discussions, and playtesting being the most frequent. In only half of the studies (24/47, 51%), children and young people participated as true design partners. Our qualitative content analysis suggested 5 factors that affect their successful involvement: comprehension, cohesion, confidence, accessibility, and time constraints.

CONCLUSIONS

Co-design, participatory design, and similar high-level labels that are currently used in the field gloss over very uneven degrees of participation in design and a wide variety of implementations that greatly affect actual user involvement. This field would benefit from more careful consideration and documentation of the reason of user involvement. Future research should explore concrete activities and configurations that can address the common challenges of involving children and young people, such as comprehension, cohesion, confidence, and accessibility.

Evaluating the Utility of a Psychoeducational Serious Game (SPARX) in Protecting Inuit Youth From Depression: Pilot Randomized Controlled Trial

BACKGROUND

Inuit youth in Northern Canada show considerable resilience in the face of extreme adversities. However, they also experience significant mental health needs and some of the highest adolescent suicide rates in the world. Disproportionate rates of truancy, depression, and suicide among Inuit adolescents have captured the attention of all levels of government and the country. Inuit communities have expressed an urgent imperative to create, or adapt, and then evaluate prevention and intervention tools for mental health. These tools should build upon existing strengths, be culturally appropriate for Inuit communities, and be accessible and sustainable in Northern contexts, where mental health resources are often scarce.

OBJECTIVE

This pilot study assesses the utility, for Inuit youth in Canada, of a psychoeducational e-intervention designed to teach cognitive behavioral therapy strategies and techniques. This serious game, SPARX, had previously demonstrated effectiveness in addressing depression with Māori youth in New Zealand.

METHODS

The Nunavut Territorial Department of Health sponsored this study, and a team of Nunavut-based community mental health staff facilitated youth's participation in an entirely remotely administered pilot trial using a modified randomized control approach with 24 youths aged 13-18 across 11 communities in Nunavut. These youth had been identified by the community facilitators as exhibiting low mood, negative affect, depressive presentations, or significant levels of stress. Entire communities, instead of individual youth, were randomly assigned to an intervention group or a waitlist control group.

RESULTS

Mixed models (multilevel regression) revealed that participating youth felt less hopeless (P=.02) and engaged in less self-blame (P=.03), rumination (P=.04), and catastrophizing (P=.03) following the SPARX intervention. However, participants did not show a decrease in depressive symptoms or an increase in formal resilience indicators.

CONCLUSIONS

Preliminary results suggest that SPARX may be a good first step for supporting Inuit youth with skill development to regulate their emotions, challenge maladaptive thoughts, and provide behavioral management techniques such as deep breathing. However, it will be imperative to work with youth and communities to design, develop, and test an Inuit version of the SPARX program, tailored to fit the interests of Inuit youth and Elders in Canada and to increase engagement and effectiveness of the program.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05702086; https://www.clinicaltrials.gov/ct2/show/NCT05702086.

The Good Talk! A Serious Game to Boost People's Competence to Have Open Conversations About COVID-19: Protocol for a Randomized Controlled Trial

BACKGROUND

Vaccine hesitancy is one of the many factors impeding efforts to control the COVID-19 pandemic. Exacerbated by the COVID-19 infodemic, misinformation has undermined public trust in vaccination, led to greater polarization, and resulted in a high social cost where close social relationships have experienced conflict or disagreements about the public health response.

OBJECTIVE

The purpose of this paper is to describe the theory behind the development of a digital behavioral science intervention-The Good Talk!-designed to target vaccine-hesitant individuals through their close contacts (eg, family, friends, and colleagues) and to describe the methodology of a research study to evaluate its efficacy.

METHODS

The Good Talk! uses an educational serious game approach to boost the skills and competences of vaccine advocates to have open conversations about COVID-19 with their close contacts who are vaccine hesitant. The game teaches vaccine advocates evidence-based open conversation skills to help them speak with individuals who have opposing points of view or who may ascribe to nonscientifically supported beliefs while retaining trust, identifying common ground, and fostering acceptance and respect of divergent views. The game is currently under development and will be available on the web, free to access for participants worldwide, and accompanied by a promotional campaign to recruit participants through social media channels. This protocol describes the methodology for a randomized controlled trial that will compare participants who play The Good Talk! game with a control group that plays the widely known noneducational game Tetris. The study will evaluate a participant's open conversation skills, self-efficacy, and behavioral intentions to have an open conversation with a vaccine-hesitant individual both before and after game play.

RESULTS

Recruitment will commence in early 2023 and will cease once 450 participants complete the study (225 per group). The primary outcome is improvement in open conversation skills. Secondary outcomes are self-efficacy and behavioral intentions to have an open conversation with a vaccine-hesitant individual. Exploratory analyses will examine the effect of the game on implementation intentions as well as potential covariates or subgroup differences based on sociodemographic information or previous experiences with COVID-19 vaccination conversations.

CONCLUSIONS

The outcome of the project is to promote more open conversations regarding COVID-19 vaccination. We hope that our approach will encourage more governments and public health experts to engage in their mission to reach their citizens directly with digital health solutions and to consider such interventions as an important tool in infodemic management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40753.

TAG-ME again: A serious game for measuring working memory

BrainTagger (demo version: researcher-demo.braintagger.com) is a suite of Target Acquisition Games for Measurement and Evaluation (TAG-ME). Here we introduce TAG-ME Again, a serious game modeled after the well-established N-Back task, to assess working memory ability across three difficulty levels corresponding to 1-, 2-, and 3-back conditions. We also report on two experiments aimed at assessing convergent validity with the N-Back task. Experiment 1 examined correlations with N-Back task performance in a sample of adults (n = 31, 18-54 years old) across three measures: reaction time; accuracy; a combined RT/accuracy metric. Significant correlations between game and task were found, with the strongest relationship being for the most difficult version of the task (3-Back). In Experiment 2 (n = 66 university students, 18-22 years old), we minimized differences between the task and the game by equating stimulus-response mappings and spatial processing demands. Significant correlations were found between game and task for both the 2-Back and 3-Back levels. We conclude that TAG-ME Again is a gamified task that has convergent validity with the N-Back Task.

Games in Times of a Pandemic: Structured Overview of COVID-19 Serious Games

BACKGROUND

The COVID-19 pandemic introduced an urgent need for effective strategies to disseminate crucial knowledge and improve people's subjective well-being. Complementing more conventional approaches to knowledge dissemination, game-based interventions were developed to create awareness and educate people about the pandemic, hoping to change their attitudes and behavior.

OBJECTIVE

This study provided an overview and analysis of digital and analog game-based interventions in the context of the COVID-19 pandemic. As major pandemics and other large-scale disruptive events are expected to increase in frequency in the coming decades, this analysis aimed to inform the design, uptake, and effects of similar future interventions.

METHODS

From November 2021 to April 2022, Scopus, Google, and YouTube were searched for articles and videos describing COVID-19-themed game-based interventions. Information regarding authorship, year of development or launch, country of origin, license, deployment, genre or type, target audience, player interaction, in-game goal, and intended transfer effects was extracted. Information regarding intervention effectiveness was retrieved where possible.

RESULTS

A diverse assortment of 23 analog and 43 digital serious games was identified, approximately one-third of them (25/66, 38%) through scientific articles. Most of these games were developed by research institutions in 2020 (13/66, 20%) and originated in Europe and North America (38/66, 58%). A limited number (20/66, 30%) were tested on relatively small samples, using a diversity of research methods to assess the potential changes in participants' knowledge, attitudes, and behaviors as well as their gameplay experience. Although most of the evaluated games (11/20, 55%) effectively engaged and motivated the players, increased awareness, and improved their understanding of COVID-19-related issues, the games' success in influencing people's behavior was often unclear or limited.

CONCLUSIONS

To increase the impact of similar future interventions aimed at disseminating knowledge and influencing people's attitudes and behaviors during a large-scale crisis, some considerations are suggested. On the basis of the study results and informed by existing game theories, recommendations are made in relation to game development, deployment, and distribution; game users, design, and use; game design terminology; and effectiveness testing for serious games.

A Software Engineering Framework for Reusable Design of Personalized Serious Games for Health: Development Study

BACKGROUND

The use of serious games in health care is on the rise, as these games motivate treatment adherence, reduce treatment costs, and educate patients and families. However, current serious games fail to offer personalized interventions, ignoring the need to abandon the one-size-fits-all approach. Moreover, these games, with a primary objective other than pure entertainment, are costly and complex to develop and require the constant involvement of a multidisciplinary team. No standardized approach exists on how serious games can be personalized, as existing literature focuses on specific use cases and scenarios. The serious game development domain fails to consider any transfer of domain knowledge, which means this labor-intensive process must be repeated for each serious game.

OBJECTIVE

We proposed a software engineering framework that aims to streamline the multidisciplinary design process of personalized serious games in health care and facilitates the reuse of domain knowledge and personalization algorithms. By focusing on the transfer of knowledge to new serious games by reusing components and personalization algorithms, the comparison and evaluation of different personalization strategies can be simplified and expedited. In doing so, the first steps are taken in advancing the state of the art of knowledge regarding personalized serious games in health care.

METHODS

The proposed framework aimed to answer 3 questions that need to be asked when designing personalized serious games: Why is the game personalized? What parameters can be used for personalization? and How is the personalization achieved? The 3 involved stakeholders, namely, the domain expert, the (game) developer, and the software engineer, were each assigned a question and then assigned responsibilities regarding the design of the personalized serious game. The (game) developer was responsible for all the game-related components; the domain expert was in charge of the modeling of the domain knowledge using simple or complex concepts (eg, ontologies); and the software engineer managed the personalization algorithms or models integrated into the system. The framework acted as an intermediate step between game conceptualization and implementation; it was illustrated by developing and evaluating a proof of concept.

RESULTS

The proof of concept, a serious game for shoulder rehabilitation, was evaluated using simulations of heart rate and game scores to assess how personalization was achieved and whether the framework responded as expected. The simulations indicated the value of both real-time and offline personalization. The proof of concept illustrated how the interaction between different components worked and how the framework was used to simplify the design process.

CONCLUSIONS

The proposed framework for personalized serious games in health care identifies the responsibilities of the involved stakeholders in the design process, using 3 key questions for personalization. The framework focuses on the transferability of knowledge and reusability of personalization algorithms to simplify the design process of personalized serious games.

The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games

Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.

The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study

PURPOSE

To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD).

MATERIALS AND METHODS

Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA.

RESULTS

Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise.

CONCLUSIONS

The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings.

TRIAL REGISTRATION

The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315)Implications for rehabilitationThe VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate.Supervision of exergaming by health professionals is essential for successful implementation.The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises.

The Influence of Mobile Device Type on Camera-Based Monitoring of Neck Movements for Cervical Rehabilitation

We developed a mobile application for cervical rehabilitation that uses a non-invasive camera-based head-tracker sensor for monitoring neck movements. The intended user population should be able to use the mobile application in their own mobile device, but mobile devices have different camera sensors and screen dimensions that could affect the user performance and neck movement monitoring. In this work, we studied the influence of mobile devices type on camera-based monitoring of neck movements for rehabilitation purposes. We conducted an experiment to test whether the characteristics of a mobile device affect neck movements when using the mobile application with the head-tracker. The experiment consisted of the use of our application, containing an exergame, in three mobile devices. We used wireless inertial sensors to measure the real-time neck movements performed while using the different devices. The results showed that the effect of device type on neck movements was not statistically significant. We included the sex factor in the analysis, but there was no statistically significant interaction between sex and device variables. Our mobile application proved to be device-agnostic. This will allow intended users to use the mHealth application regardless of the type of device. Thus, future work can continue with the clinical evaluation of the developed application to analyse the hypothesis that the use of the exergame will improve therapeutic adherence in cervical rehabilitation.

IAmHero: Preliminary Findings of an Experimental Study to Evaluate the Statistical Significance of an Intervention for ADHD Conducted through the Use of Serious Games in Virtual Reality

The use of new technologies, such as virtual reality (VR), represents a promising strategy in the rehabilitation of subjects with attention-deficit/hyperactivity disorder (ADHD). We present the results obtained by administering the IAmHero tool through VR to a cohort of subjects with ADHD between 5 and 12 years of age. The trial time was approximately 6 months. In order to assess the beneficial effects of the treatment, standardised tests assessing both ADHD symptoms and executive functions (e.g., Conners-3 scales) were administered both before and at the end of the sessions. Improvements were observed at the end of treatment in both ADHD symptoms (especially in the hyperactivity/impulsivity domain) and executive functions. One of the strengths of the VR approach is related above all to the acceptability of this tool and its flexibility. Unfortunately, to date, there are still few studies on this topic; therefore, future studies are essential to expand our knowledge on the utility and benefits of these technologies in the rehabilitation field.

Effects of the Uncertainty of Interpersonal Communications on Behavioral Responses of the Participants in an Immersive Virtual Reality Experience: A Usability Study

Two common difficulties which people face in their daily lives are managing effective communication with others and dealing with what makes them feel uncertain. Past research highlights that the result of not being able to handle these difficulties influences people's performance in the task at hand substantially, especially in the context of a social environment such as a workplace. Perceived uncertainty of information is a key influential factor in this regard, with effects on the quality of the information transfer between sender and receiver. Uncertainty of information can be induced into the communication system in three ways: when there is any kind of information deficit that makes the target message unclear for the receiver, when there are some requested changes that could not be predicted by the receiver, and when the content of the message is so interconnected and complex that it limits understanding. Since uncertainty is an inseparable feature of our lives, studying the effects that different levels of it have on individuals and how individuals nevertheless accomplish the tasks of daily living is of high importance. Modern technologies such as immersive virtual reality (VR) have been successful in providing effective platforms to support human behavioral and social well-being studies. In this paper, we suggest the design, development, and evaluation of an immersive VR serious game platform to study behavioral responses to the uncertain features of interpersonal communications. In addition, we report the result of a within-subject user study with 17 participants aged between 20 and 35 and their behavioral responses to two levels of uncertainty with subjective and objective measures. The results convey that the application successfully and meaningfully measured some behavioral responses related to exposure to different levels of uncertainty and overall, the participants were satisfied with the experience.

Game-based learning in medical education

At present, medical education is rapidly evolving. Game-based learning (GBL) has been gradually used for education, and several innovations have emerged. The emergence of serious games and gamification provides alternative approaches for educators to improve the medical teaching process. Both serious games and gamification exert their education-promoting function by providing the possibility of combining learning activities such as feedback, testing, and spaced repetition with active participation and autonomy as well as positive experiences for students. Developing effective GBL modalities has the potential to bring immersive experiences for medical students and improve their study outcomes. Herein, we reviewed recent studies employing GBL in medical education, including serious games and gamification teaching. Furthermore, we also discussed the effectiveness and limitations of GBL to suggest future directions for the development and application of GBL in medical education.