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.

A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study

BACKGROUND

Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health.

OBJECTIVE

This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial.

METHODS

We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart.

RESULTS

We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings.

CONCLUSIONS

PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner.

Influence of Pokémon Go Playing Style on Physical Activity and Its Effect on Kinanthropometry Variables and Body Composition in Adolescents

BACKGROUND

Pokémon Go is a mobile app that offers both continuous and intermittent (gamified) gameplay, but no previous research in adolescents is known to have addressed changes in physical activity and body composition according to playing style. For this reason, the aims of the present investigation were (1) to establish the differences in the level of physical activity, and its influence on the kinanthropometric and body composition, of the adolescent population, considering their Pokémon Go playing style; and (2) to analyze whether the practice of previous physical activity has an influence on the effects of the use of Pokémon Go on the level of physical activity and changes in kinanthropometric and body composition variables.

METHODS

A total of 94 adolescents (50 males and 44 females; mean age: 13.66 [1.17] years-old; mean body mass index: 20.82 [4.03] kg/m2) whose physical activity level and body composition were measured, participated in the investigation. Two groups of adolescents completed a 10-week intervention using Pokémon Go continuously (n = 30) or intermittently (n = 31), while the control group (n = 33) did not use any after-school app. A one-way analysis of variance (ANOVA), a multivariate analysis of variance, and 2 repeated-measures ANOVA were performed to analyze the data.

RESULTS

Inactive adolescents in the continuous use group increased their physical activity between the pretest and posttest (P = .038), but this did not occur in the active group. Regarding body composition variables, the increase in body mass (P < .001) and body mass index (P = .006) in the control group was significantly higher than in the continuous use group of adolescents who were inactive, but not in the active group, while the decrease in fat mass (P < .001-.036) and sum of 3 skinfolds (P < .001-.003) was significantly higher in both Pokémon Go use groups as compared to the control group, regardless of the previous physical activity level.

CONCLUSIONS

The continuous style of play seems to be more effective in increasing physical activity in adolescents, but the changes in body composition and kinanthropometric variables occur similarly with continuous and intermittent gameplay. Therefore, the playful use of Pokémon Go can be used in educational and health fields to produce changes in body composition in this population.

Immersive Virtual Reality Reaction Time Test and Relationship with the Risk of Falling in Parkinson's Disease

Immersive virtual reality (IVR) uses customized and advanced software and hardware to create a digital 3D reality in which all of the user's senses are stimulated with computer-generated sensations and feedback. This technology is a promising tool that has already proven useful in Parkinson's disease (PD). The risk of falls is very high in people with PD, and reaction times and processing speed may be markers of postural instability and functionality, cognitive impairment and disease progression. An exploratory study was conducted to explore the feasibility of reaction time tests performed in IVR as predictors of falls. A total of 26 volunteers (79.2% male; 69.73 ± 6.32 years) diagnosed with PD (1.54 ± 0.90 H&Y stage; 26.92 ± 2.64 MMSE) took part in the study. IVR intervention was feasible, with no adverse effects (no Simulator Sickness Questionnaire symptoms). IVR reaction times were related (Spearman's rho) to functionality (timed up and go test (TUG) (rho = 0.537, p = 0.005); TUG-Cognitive (rho = 0.576, p = 0.020); cognitive impairment mini mental state exam (MMSE) (rho = -0.576, p = 0.002)) and the years of the patients (rho = 0.399, p = 0.043) but not with the first PD symptom or disease stage. IVR test is a complementary assessment tool that may contribute to preventing falls in the proposed sample. Additionally, based on the relationship between TUG and reaction times, a cut-off time is suggested that would be effective at predicting the risk of suffering a fall in PD patients using a simple and quick IVR test.

Habitual Videogame Playing Does Not Compromise Subjective Sleep Quality and Is Associated with Improved Daytime Functioning

Research on the effects of videogames (VGs) on health has produced mixed results. Here, we assess the relationships of VG playing with sleep; chronotype; sleepiness; and levels of depression, anxiety, and stress; and how they are modulated by the level of exposure to VGs. Four hundred-and two adult participants (age = 26.2 ± 7.84; 227 F) completed an online survey including questions on VG use and a set of standardized questionnaires. The sample was divided into three groups: habitual gamers (HGs, 42.2%), nonhabitual gamers (NHGs, 36.5%), and non-gamers (NGs, 21.3%). No between-group differences emerged in sleepiness (Epworth Sleepiness Scale) or Pittsburgh Sleep Quality Index measures except the sleep disturbances subscore, which was higher in NHGs. HGs showed delayed bed- and risetimes and higher eveningness (reduced Morningness-Eveningness Questionnaire). HGs and NHGs showed higher depression subscores (Depression Anxiety Stress Scale) but remained in the subclinical range. Moreover, hours/week of VG playing predicted delayed sleep timing, lower daytime dysfunction, and lower sleepiness. Our data suggest that VG playing does not necessarily compromise sleep quality and may even benefit daytime functioning, underlining the need to reconsider the relationships between VG use and health by taking into account possible modulating factors such as habitual VG exposure.

Nintendo® Wii Therapy Improves Upper Extremity Motor Function in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis

BACKGROUND

Nintendo^® Wii-based therapy (NWT) is a non-immersive virtual reality therapy used to recover upper extremity (UE) motor function in children with cerebral palsy (CP). We aimed primarily to elucidate the effectiveness of NWT in improving UE motor and functional impaired abilities in children with CP, compared to conventional therapy or no intervention. The secondary aim was to assess if NWT is more effective when used alone or combined with conventional therapy.

METHODS

A systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science, and CINHAL, ending in October 2021, in accordance with PRISMA guidelines. We included randomized controlled trials that compared NWT vs. conventional therapy or no intervention in terms of their impact on different UE impaired abilities (grip strength, tip grip strength, UE dissociated movements, functional capacity in daily living activities, gross and fine motor dexterity, and grasping ability) in children with CP. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI).

RESULTS

Nine studies (276 participants) were included. NWT is more effective than conventional therapy at improving grip strength (SMD = 0.5, 95% CI 0.08, 0.91), tip grip strength (SMD = 0.95, 95% CI 0.3, 1.61), and grasping ability (SMD = 0.72, 95%CI 0.14, 1.3). NWT is more effective than conventional therapy at improving functional capacity in daily living activities (SMD = 0.83, 95% CI 0.07, 1.56). For fine manual dexterity, NWT was better than no intervention (SMD = 3.12, 95% CI 1.5, 4.7).

CONCLUSIONS

Our results indicate that NWT is effective at improving various UE impaired motor skills in children with CP.

Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre−post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.

Interactive Videogame Improved Rehabilitation Motivation and Walking Speed in Chronic Stroke Patients: A Dual-Center Controlled Trial

Objective: This study aimed to evaluate the effectiveness of interactive video games (IVGs) in rehabilitation motivation and walking and balance abilities in chronic stroke patients. Materials and Methods: In this dual-center controlled trial, 24 chronic stroke patients from rehabilitation centers A and B were randomly assigned to an experimental (IVGs + traditional neurodevelopment treatment [TNT], n = 12) or a control group (walking training + TNT, n = 12). The patients in both the groups underwent TNT for 4 weeks (5 days/week) before undergoing either IVGs or walking training (4 weeks, 3 days/week) depending on the group. The primary and secondary outcomes were rehabilitation motivation and the Berg Balance Scale (BBS) score, Functional Reach Test (FRT) performance, and walking speed (WS), respectively. Results: The patients in both the groups showed significant increase in the BBS score, FRT performance, and WS; however, the experimental group showed more significant improvements in rehabilitation motivation (P = 0.02, η² = 0.415) and WS (P = 0.05, η² = 0.333) than the patients in the control group. Conclusion: This study suggests that the IVGs in combination with TNT provide effective rehabilitation motivation in chronic stroke patients. Clinical Trial Registration number: KCT0003408.

Internet gaming disorder: Its prevalence and associated gaming behavior, anxiety, and depression among high school male students, Dammam, Saudi Arabia

BACKGROUND:

Video games have become popular in the last few decades, resulting in an increase in reported negative consequences. This study aimed to assess the prevalence of internet gaming disorder (IGD), its association with gaming behavior, depression, and anxiety in male high school students.

MATERIALS AND METHODS:

This cross-sectional study involved male high school students in Dammam. Schools were selected using stratified random sampling, and data were collected using a self-administered questionnaire. Data analyzed using SPSS v23.0; the initial analysis included descriptive statistics. Continuous and ordinal variables were compared using t-test or Mann–Whitney U test, and ANOVA or Kruskal–Wallis test, as appropriate; Chi-square test was used for categorical variables. Spearman correlation coefficient was calculated to determine the correlation between IGD score and depression and anxiety scores.

RESULTS:

A total of 726 high school gamers were involved, 87% of whom were Saudi, with a mean age of 16.92 years and 45% were from public schools. The mean IGD score was 18.12, and the prevalence of IGD was 21.85%. Students who spent ≥4 h/day on weekdays or ≥6 h/day at weekends on videogames and gamers who spent ≥200 Saudi Riyals per month on gaming had significantly higher mean IGD scores (P < 0.001). Gamers who used PC/laptop for gaming had significantly higher IGD scores compared to those who used other devices (P = 0.002). Action, fight, open-world games, and games with violence were associated with significantly higher IGD scores. Among students with IGD, 21.7% had moderately severe/severe depression and 11.4% had severe anxiety.

CONCLUSION:

IGD is a concerning psychiatric disorder in male high school students. It is associated with certain gaming behavior and other mental problems. We recommend future larger-scale research that includes females as well.

Toxic behaviors in online multiplayer games: Prevalence, perception, risk factors of victimization, and psychological consequences

The rapid proliferation of online multiplayer games has opened a new avenue for aggressive behaviors such as hostile communication, sabotaging, and griefing. The present investigation explores the prevalence, perception, risk factors, and consequences of victimization in toxic behaviors. A total of 2097 Hungarian gamers (88.5% male, M_age = 26.2 years, SD = 6.8) completed an online questionnaire. Most (66%) were victims of such incidents in the past year, and gamers considered the problem of toxic behaviors as severe. Younger gamers who spent more time playing competitive videogames (especially multiplayer online battle arena and shooter games) were more likely to experience toxic behaviors from others. Repeatedly victimized gamers reported more symptoms of depression and problematic videogame use, while victim/perpetrators expressed higher anxiety and anger rumination. These results highlight the importance of cultivating prosocial group norms in gamers to improve safety of online multiplayer environments.

Effects of Exergaming in Patients with Cardiovascular Disease Compared to Conventional Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

Background: Exercise-based cardiac rehabilitation (CR) programs are used for improving prognosis and quality of life in patients with cardiovascular disease (CVD). Nonetheless, adherence to these programs is low, and exercise-based CR programs based on virtual reality (i.e., exergaming) have been proposed as an alternative to conventional CR programs. However, whether exergaming programs are superior to conventional CR programs in patients with CVD is not known. Objective: This systematic review with meta-analysis was conducted to explore whether exergaming enhances exercise capacity, quality of life, mental health, motivation, and exercise adherence to a greater extent than conventional CR programs in patients with CVD. Method: Electronic searches were carried out in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases up to June 2021. Meta-analyses were performed using robust variance estimation with small-sample corrections. The effect sizes were calculated as the mean differences (MD) or standardized mean differences (SMD) as appropriate. The SMD magnitude was classified as trivial (<0.20), small (0.20−0.49), medium (0.50−0.79), or large (≥0.80). Heterogeneity was interpreted based on the I2 statistics as low (25%), moderate (50%), or high (75%). Results: Pooled analyses showed no differences between exergaming and conventional CR programs for enhancing exercise capacity (i.e., distance covered in the six-minute walk test) (MD+ = 14.07 m (95% confidence interval (CI) −38.18 to 66.32 m); p = 0.426) and mental health (SMD+ = 0.17 (95% CI −0.36 to 0.70); p = 0.358). The results showed a small, statistically nonsignificant improvement in quality of life in favor of exergaming (SMD+ = 0.22 (95% CI = −0.37 to 0.81); p = 0.294). Moderate heterogeneity was found for exercise capacity (I2 = 53.7%), while no heterogeneity was found for quality of life (I2 = 3.3%) and mental health (I2 = 0.0%). Conclusions: Exergaming seems not to be superior to conventional CR programs for improving exercise capacity, quality of life, or mental health in patients with CVD.

Positive Youth Development and Internet Use in a Sample of Spanish Adolescents

During the COVID-19 pandemic, the use of Internet in the adolescent population has increased. A growing research interest has been developed about the consequences of Internet use for adolescent development. Despite most studies have examined the impact of Internet use on some indicators of psychological maladjustment, few studies have addressed the detrimental impact on the positive indicators of mental health. Positive youth development (PYD) represents a positive view of adolescent transition to adulthood which focuses on building the strengths that make young people more resistant to negative outcomes and more capable to choose a positive life direction. This study aimed to analyze the relationships between different aspects of Internet use and overall PYD in a sample of Spanish adolescents. To reach this aim, a sample of 1,038 adolescents (50.1% boys, M age = 14.19, SD = 1.38), enrolled in 14 high schools in the city of Huelva (Spain), filled in some self-report measures of PYD and Internet use and experience, such as the frequency of Internet use on weekdays or weekends, the different uses of Internet (i.e., social networks, playing online, reading, surfing or looking for information, playing or downloading music, and searching, selling, or buying products), and the subjective experience using the Internet (i.e., acknowledgment of spending too much time playing or in the networks, and being in a bad mood if they do not play or use the networks). Results of a hierarchical regression analysis showed that the more hours using Internet on weekdays, the less PYD. Moreover, the experience of feeling bad when not using the networks and spending too much time with online playing was related to lower PYD. However, the use of Internet for reading or looking for information had a positive association with PYD. These results suggest some implications for practice, such as the need to promote an adaptive Internet use, by providing a safe online context that encourages the acquisition of positive social values and life skills.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

SYSTEMATIC REVIEW REGISTRATION

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

Gaming Technology for Pediatric Neurorehabilitation: A Systematic Review

INTRODUCTION

The emergence of gaming technologies, such as videogames and virtual reality, provides a wide variety of possibilities in intensively and enjoyably performing rehabilitation for children with neurological disorders. Solid evidence-based results are however required to promote the use of different gaming technologies in pediatric neurorehabilitation, while simultaneously exploring new related directions concerning neuro-monitoring and rehabilitation in familiar settings.

AIM OF THE STUDY AND METHODS

In order to analyze the state of the art regarding the available gaming technologies for pediatric neurorehabilitation, Scopus and Pubmed Databases have been searched by following: PRISMA statements, PICOs classification, and PEDro scoring.

RESULTS

43 studies have been collected and classified as follows: 11 feasibility studies; six studies proposing home-system solutions; nine studies presenting gamified robotic devices; nine longitudinal intervention trials; and eight reviews. Most of them rely on feasibility or pilot trials characterized by small sample sizes and short durations; different methodologies, outcome assessments and terminologies are involved; the explored spectrum of neurological conditions turns out to be scanty, mainly including the most common and wider debilitating groups of conditions in pediatric neurology: cerebral palsy, brain injuries and autism.

CONCLUSION

Even though it highlights reduced possibilities of drawing evidence-based conclusions due to the above outlined biases, this systematic review raises awareness among pediatricians and other health professionals about gaming technologies. Such a review also points out a definite need of rigorous studies that clearly refer to the underlying neuroscientific principles.

Gender Differences in the Impact of COVID-19 Lockdown on Potentially Addictive Behaviors: An Emotion-Mediated Analysis

We study the impact of the spring 2020 lockdown in France on gender-related potentially addictive behaviors and associated negative emotions. We rely on an online survey we administered 1 week after the beginning of the lockdown, with responses collected within 2 weeks after the beginning of the lockdown (N = 1,087). We focus on potential addictions to non-creative activities as food consumption and smartphone usage (female-related), and videogame play (male-related). We find that women were about 1.6 times more likely than men to losing control of their usual diet and about 2.3 times more likely than men to increase smartphone usage, while no significant gender effect is detected as for increased videogame play. This is since the negative emotions driving the increase of female-related non-creative activities (sadness, discouragement, and nervousness) were themselves female-related, while the negative emotions driving the increase of male-related non-creative activities (boredom, emptiness, and stress) were shared by women too. Our study supports the intuition that the same negative emotion induced by COVID-19 side-effects could lead to different potentially addictive behaviors; this difference is explained by the interplay between different gender’s sensitivities to such emotion and different gender’s preferences for specific non-creative activities.

Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

Some Assembly Required: Player Mental Models of Videogame Avatars

In playing videogames, players often create avatars as extensions of agency into those spaces, where the player-avatar relationship (PAR) both shapes gameplay and is the product of gameplay experiences. Avatars are generally understood as singular bodies; however, we argue they are functional and phenomenological assemblages-networks of social and technological components that are internalized by players as networks of knowledge about the avatar. Different PARs are based on different internalizations (i.e., mental models) for what an avatar is and why it matters. Toward illuminating nuances in PARs, we examine the content and structure of players' internalizations of avatars as evidenced by descriptions of those digital bodies. Secondary analysis of N = 1,201 avatar descriptions parceled them by PAR type (avatars as asocial Objects, psychologically merged extensions of Me, hybrid me/other Symbiotes, and authentically social Other). Aggregated descriptions for each PAR type were subjected to semantic network analysis to identify patterns in salient avatar components, and then qualitatively compared across the four PARs. Results indicate component clusters that are universal to PARs (demographics and body features), common to three of four PARs (time, appearance, clothing, and player agency), and idiosyncratic to specific PARs (significance, character narratives, game dynamics, liminality, and gratifications). Findings signal the importance of theoretically engaging avatars as assemblages both (a) influenced by player-avatar sociality and (b) that contribute (in part and whole) to antecedents, processes, and effects of gameplay.

Design Bioethics: A Theoretical Framework and Argument for Innovation in Bioethics Research

Empirical research in bioethics has developed rapidly over the past decade, but has largely eschewed the use of technology-driven methodologies. We propose "design bioethics" as an area of conjoined theoretical and methodological innovation in the field, working across bioethics, health sciences and human-centred technological design. We demonstrate the potential of digital tools, particularly purpose-built digital games, to align with theoretical frameworks in bioethics for empirical research, integrating context, narrative and embodiment in moral decision-making. Purpose-built digital tools can engender situated engagement with bioethical questions; can achieve such engagement at scale; and can access groups traditionally under-represented in bioethics research and theory. If developed and used with appropriate rigor, tools motivated by "design bioethics" could offer unique insights into new and familiar normative and empirical issues in the field.

Online Videogames Use and Anxiety in Children during the COVID-19 Pandemic

Videogames use has constantly increased among children and adolescents, with uncertain consequences on their health. This study aimed to assess the prevalence of videogames use and addiction in a sample of Italian children during the COVID-19 pandemic and their association with anxiety symptoms. One hundred and sixty-two children (M/F:78/84; age range: 8–10 years; average age 9.4 ± 0.7 years) completed the Videogame Addiction Scale for Children (VASC), the Test of Anxiety and Depression (TAD) and the Children’s Anxiety Meter—State (CAM-S). Demographic variables and data on the access to electronic tools and games preferences were also collected. Overall, 96.3% of the study participants stated to have access to one or more device. They reported a low risk of videogame addiction (VASC score (mean ± SD): 46.7 ± 15.4), a moderate level of trait anxiety (TAD score (mean ± SD): 135 ± 16.8) and a low state anxiety (CAM-S score (mean ± SD): 2.2 ± 2.1). Males reported to spend more time on videogames, to perceive higher self-control and to be more influenced by reinforcement mechanisms; females described higher levels of trait anxiety. In the regression analysis, state anxiety was a predictor of videogame use and addiction (p = 0.01). Further research is needed to confirm these data and to maximize the developmentally positive effects of videogames and preventing the negative consequences.

Usability of affordable feedback-based technologies to improve mobility and physical activity in rehabilitation: a mixed methods study

PURPOSE

To explore physiotherapists' views on the usability of feedback-based technologies used in physical rehabilitation.

MATERIALS AND METHODS

A mixed methods study which was nested within a randomised controlled trial to investigate the effectiveness of affordable feedback-based technologies to improve mobility and physical activity within aged care and neurological rehabilitation. Technologies included virtual reality systems, handheld device apps and wearable devices. Physiotherapists (n = 11) who were involved in prescribing technologies during the trial rated the usability of 11 different devices using the System Usability Scale (SUS), then attended a focus group. Descriptive statistics and framework analysis were used for analysis.

RESULTS

Fitbit devices (mean 89.8, SD 9.3), Fysiogaming (mean 75.6, SD 15.3) and Xbox Kinect (mean 75.5, SD 11.2) rated in the acceptable range (>70) on the SUS. Three key factors on usability emerged from the focus groups: (1) Key device features relating to practicalities (ease of set up and use, reliability, safety) and therapeutic benefit (customisation, high active practice time, useful feedback) are important for usability; (2) Usability depends on the context of use; and (3) Usability can be enhanced with technical, clinical, environmental and financial support.

CONCLUSIONS

Health service managers and clinicians should consider key device features identified, contextual factors of their service, and supports available when selecting technologies for use in clinical practice. Further collaboration between clinicians, researchers and technology developers would benefit future technology development, particularly taking into consideration the identified key device features from this study.IMPLICATIONS FOR REHABILITATIONTechnology selection should be based on key device features relating to both practicalities and therapeutic benefit.Contextual factors and available supports should also be considered when selecting technologies.Key usability features identified in this study such as ease of set up, reliability and customisability should be considered in the design of future feedback-based technologies to optimise usability in physical rehabilitation.

A Review of Evidence on the Role of Digital Technology in Shaping Attention and Cognitive Control in Children

The role of digital technology in shaping attention and cognitive development has been at the centre of public discourse for decades. The current review presents findings from three main bodies of literature on the implications of technology use for attention and cognitive control: television, video games, and digital multitasking. The aim is to identify key lessons from prior research that are relevant for the current generation of digital users. In particular, the lack of scientific consensus on whether digital technologies are good or bad for children reflects that effects depend on users' characteristics, the form digital technologies take, the circumstances in which use occurs and the interaction between the three factors. Some features of digital media may be particularly problematic, but only for certain users and only in certain contexts. Similarly, individual differences mediate how, when and why individuals use technology, as well as how much benefit or harm can be derived from its use. The finding emerging from the review on the large degree of heterogeneity in associations is especially relevant due to the rapid development and diffusion of a large number of different digital technologies and contents, and the increasing variety of user experiences. We discuss the importance of leveraging existing knowledge and integrating past research findings into a broader organizing framework in order to guide emerging technology-based research and practice. We end with a discussion of some of the challenges and unaddressed issues in the literature and propose directions for future research.

"Looking Forward": a qualitative evaluation of a physical activity program for middle-aged and older adults with serious mental illness

OBJECTIVES

Older adults with serious mental illness (SMI) often have poor physical health in addition to serious mental health issues. Sustained engagement in a group physical activity program may provide necessary physical and mental health benefits. The purpose of this report is to describe participants' feedback about a video game-based group physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA). In particular, we wanted to understand what worked about the program, what was not ideal, and how it impacted their lives.

DESIGN

Semi-structured interviews were collected and analyzed with grounded theory methodology.

SETTING

Mental health facility.

PARTICIPANTS

Sixteen older adults with SMI.

MEASUREMENTS

Participants played an active video game for 50-minute sessions, three times a week for 10 weeks. Qualitative interviews were conducted with 16 participants upon completion of the program.

RESULTS

Participants expressed enthusiasm for the physical activity program, indicating it was an activity that they looked forward to doing. The results of the study provide insight into how the program may be implemented into practice at mental health facilities. Three implementation to practice categories were identified: (1) programmatic considerations, such as when to hold the groups and where; (2) the critical importance of staff involvement; and (3) harnessing patients' interest in the program.

CONCLUSION

Our results suggest that engagement in an intense video game-based group physical activity program has a positive impact on participants' overall health. The group atmosphere, staff involvement, availability of the program at a mental health facility, and health benefits were critical.

Effect of the Frustration of Psychological Needs on Addictive Behaviors in Mobile Videogamers-The Mediating Role of Use Expectancies and Time Spent Gaming

Casual videogames (CVGs), played on smartphones, are becoming increasingly popular, especially among females and adults. Whereas the addictive potential of online (computer) videogames is well-established, there is yet insufficient evidence for Internet gaming disorder (IGD) in mobile gamers and for the mediating role of some mechanisms involved. The aim of this study is to investigate the impact of the frustration of psychological needs on mobile videogamers’ addictive behavior as well as the role of cognitions (game-use expectancies) and behaviors (time spent playing) through a hypothesized serial mediation model, while controlling for important correlates, such as game genre, age, gender and payment during play. A total of 471 mobile game users (211 males) with an average age of 21.73 replied to an online survey containing sociodemographic and game variables, the Need Satisfaction and Frustration Scale (NSFS), the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) and a slightly modified version of the Internet Use Expectancies Scale (IUES). The results corroborate the negative effects of need frustration on IGD among mobile gamers and clarify the role of time spent playing and game-use expectancies in the development of IGD, highlighting the important role of cognitions in this relationship. We conclude that both the time spent playing and game-use expectancies should be important targets for clinical interventions, even though they are not included in the diagnostic criteria.

The relationship between maladaptive personality functioning and problematic technology use in adolescence: A cluster analysis approach

In the last two decades, scientific research has explored the problematic use of internet, videogames and mobile phones. However, there is still little consistent knowledge regarding the co-occurrence of problematic technology use and the role of maladaptive personality characteristics in adolescence. The present study aimed to investigate adolescents' styles of technology use with a cluster analysis approach focusing on personality functioning. The sample comprised 408 Italian adolescents (46.3% males) aged 11 to 18 years (M _age  = 13.80; SD = 2.08). Data were collected using the Internet Addiction Test, the Videogame Dependency Scale, the Test of Mobile-Phone Dependence Brief Form and the Personality Inventory for DSM5 Brief Form. Results provided a four-cluster solution based on the co-occurrence of problematic technology use. The four clusters were labeled as follows: cluster 1: "Above average internet and mobile-phone use"; cluster 2: "Below average technology use"; cluster 3: "Above average videogame use"; and cluster 4: "Problematic technology use." Analyses on demographic variables (e.g., gender and age) demonstrated significant differences between the four groups. Adolescents with high levels of problematic technology use reported greater overall personality dysfunction than the other three groups. This finding supported our hypothesis on maladaptive personality functioning in adolescents at risk for addiction. Finally, the Antagonism domain played a specific role in differentiating the severity of adolescents' involvement in technology use. Further studies are needed to confirm our findings and to plan preventive interventions as well as therapeutic treatments.

Is virtual reality beneficial for dual-task gait training in patients with Parkinson's disease? A systematic review

This systematic review examined the evidence about the effects of virtual reality (VR) on dual-task gait training in Parkinson's disease (PD).

Catching more than pocket monsters: Pokémon Go's social and psychological effects on players

The augmented reality mobile game Pokémon Go has reached unprecedented popularity since its release in 2016. The game has received intense media attention, but scientific inquiry into its popularity and the effects of play are in the early stages. Previous work has used secondary data or simple correlational analysis to draw early conclusions. A seven-day diary study was conducted to investigate potential health, psychological, and social outcomes of daily gameplay. Daily time spent playing Pokémon Go was related to higher scores of life satisfaction, vitality, and greater social interactions and conversation with both friends and strangers, but not with increased daily exercise. Increased total gameplay across the week was associated with increased interaction and conversations along with more exercise. Future directions for this unique type of game along with the need for theoretical development for unique style of games are discussed.

Positive Effects of Videogame Use on Visuospatial Competencies: The Impact of Visualization Style in Preadolescents and Adolescents

Use of videogames (VGs) is almost ubiquitous in preadolescents’ and adolescents’ everyday life. One of the most intriguing research topics about positive effects of VG use is about the domain of visuospatial competencies. Previous research show that training with videogames enables children and adolescents to improve their scores in visuospatial tests (such as mental rotation of shapes and cubes), and that such training could overcome gender differences in these domains. Our study aimed at (1) verifying the positive effects of videogame use in the visuospatial domain both for male and female adolescents and preadolescents and (2) verifying whether the visualization style (2D or isometric 3D) of the VG has an influence about the positive effects of gaming. Six measures of visuospatial competency were administered to 318 preadolescents (mean of age = 13.94 years, range 10–18) prior and after a 3-day training with 2D and 3D Tetris. Results indicate that (1) gaming on the whole has slight positive effects both for males and females in enhancing visuospatial competencies, at least in the short term, and (2) it seems that participants who used the videogame with 2D graphics obtained greater improvements in the mental rotation domain while the participants who used the videogame with 3D graphics obtained greater improvements in the spatial visualization domain. However, a general learning effect between T1 and T2 was measured, which was found regardless of Experimental condition, indicating that the effect of training with videogames can be less relevant than expected.

Moderating effect of social interaction on enjoyment and perception of physical activity in young adults with autism spectrum disorders

Background: Young adults with autism spectrum disorder (ASD) are at increased risk for a sedentary lifestyle and its associated health problems. In neurotypical (NT) individuals, social participation and enjoyment are related to physical activity engagement. Exergaming has been shown to increase energy expenditure compared to traditional video games and is an effective option for community-based recreation. Methods: We measured physiological and psychological responses of young adults with ASD to exergaming under varying conditions and sought to determine whether playing alone versus with a partner influenced physical activity level and/or experience in NT young adults (n = 18) and those with ASD (n = 18). Results: Both ASD and NT groups experienced high enjoyment and perceived exertion while exergaming. Perceived exertion was moderated by enjoyment when young adults with ASD played with a partner, reporting less effort despite actually expending more energy. Conclusion: Social interaction may lead to increased intensity and duration of physical activity for individuals with ASD. Exergaming is a socially acceptable and age-appropriate exercise modality for this group and likely represents a cost-effective and accessible way to incorporate physical activity and social interaction into their daily lives.

Games Used With Serious Purposes: A Systematic Review of Interventions in Patients With Cerebral Palsy

The purpose of the present systematic review was to examine extant research regarding the role of games used seriously in interventions with individuals with cerebral palsy. Therefore, PubMed, PsyINFO, Web of Science, Scopus, and IEEE databases were used. Search terms included: “serious games” OR “online games” OR “video games” OR “videogame” OR “game based” OR “game” AND “intervention” AND “cerebral palsy.” After the full reading and quality assessment of the papers, 16 studies met the inclusion criteria. The majority of the studies reported high levels of compliance, motivation, and engagement with game-based interventions both at home and at the clinical setting intervention. Regarding the effectiveness of the use of games, the results of the studies show both positive and negative results regarding their effectiveness. The efficacy was reported to motor function (i.e., improvements in the arm function, hand coordination, functional mobility, balance and gait function, postural control, upper-limbs function) and physical activity. Findings of this review suggest that games are used as a complement to conventional therapies and not as a substitute. Practitioners often struggle to get their patients to complete the assigned homework tasks, as patients display low motivation to engage in prescribed exercises. Data of this review indicates the use of games as tools suited to promote patients’ engagement in the therapy and potentiate therapeutic gains.

Technological Resources to Prevent Cyberbullying During Adolescence: The Cyberprogram 2.0 Program and the Cooperative Cybereduca 2.0 Videogame

Bullying and cyberbullying have serious consequences for all those involved, especially the victims, and its prevalence is high throughout all the years of schooling, which emphasizes the importance of prevention. This article describes an intervention proposal, made up of a program (Cyberprogram 2.0 Garaigordobil and Martínez-Valderrey, 2014a) and a videogame (Cooperative Cybereduca 2.0 Garaigordobil and Martínez-Valderrey, 2016b) which aims to prevent and reduce cyberbullying during adolescence and which has been validated experimentally. The proposal has four objectives: (1) To know what bullying and cyberbullying are, to reflect on the people involved in these situations; (2) to become aware of the harm caused by such behaviors and the severe consequences for all involved; (3) to learn guidelines to prevent and deal with these situations: know what to do when one suffers this kind of violence or when observing that someone else is suffering it; and (4) to foster the development of social and emotional factors that inhibit violent behavior (e.g., communication, ethical-moral values, empathy, cooperation…). The proposal is structured around 25 activities to fulfill these goals and it ends with the videogame. The activities are carried out in the classroom, and the online video is the last activity, which represents the end of the intervention program. The videogame (www.cybereduca.com) is a trivial pursuit game with questions and answers related to bullying/cyberbullying. This cybernetic trivial pursuit is organized around a fantasy story, a comic that guides the game. The videogame contains 120 questions about 5 topics: cyberphenomena, computer technology and safety, cybersexuality, consequences of bullying/cyberbullying, and coping with bullying/cyberbullying. To evaluate the effectiveness of the intervention, a quasi-experimental design, with repeated pretest-posttest measures and control groups, was used. During the pretest and posttest stages, 8 assessment instruments were administered. The experimental group randomly received the intervention proposal, which consisted of one weekly 1-h session during the entire school year. The results obtained with the analyses of variance of the data collected before and after the intervention in the experimental and control groups showed that the proposal significantly promoted the following aspects in the experimental group: (1) a decrease in face-to-face bullying and cyberbullying behaviors, in different types of school violence, premeditated and impulsive aggressiveness, and in the use of aggressive conflict-resolution strategies; and (2) an increase of positive social behaviors, self-esteem, cooperative conflict-resolution strategies, and the capacity for empathy. The results provide empirical evidence for the proposal. The importance of implementing programs to prevent bullying in all its forms, from the beginning of schooling and throughout formal education, is discussed.

Trial Implementation of a Telerehabilitation Exercise System in Residential Aged Care

The 2011 Productivity Commission report, Caring for Older Australians, observed that as the number of older Australians rises and the demand for aged care services increases, there will be a commensurate increase in demand for a well-trained aged care workforce. One of the significant issues impacting upon the ability of the aged services sector to respond to a growing number of older adults is to attract and retain sufficient numbers of staff. A number of factors are acknowledged to contribute to a failure of the aged care sector to attract and retain workers including: poor sector reputation, poor working conditions, including high client-staff ratios, a lack of career paths and professional development opportunities and low rates of remuneration. Poor perceptions about working in the aged care sector (e.g. that aged care nursing is less glamorous than nursing in the acute care sector) appear to develop early, with many nursing students indicating that they do not view aged care as an attractive career choice. Undergraduate nursing students have often found clinical placements in aged care unsatisfactory and unsettling, dissuading them from considering aged care as an employment option on graduation. In the following we describe one way we have attempted to address this issue by training undergraduate health sciences students (occupational therapy, nursing) to deliver a physical activity program to residents of an aged care facility using a novel telerehabilitation technology that enables remote prescription and monitoring of exercise programs. The main purpose of this quality assurance trial was to explore the feasibility and safety of supervised use of a novel telerehabilitation exercise system with older adults living in residential aged care. Four residents were recruited into the study and all displayed limitations in mobility, balance, strength and endurance. None had any had previous experience with computer games or interactive technologies. Resident diagnoses included multiple chronic health conditions and mild cognitive impairment. Over the six-week period, only one session was declined by a resident, providing an overall adherence rate of 98.5%. According to the resident's scores of perceived level of enjoyment, at the end of the first week the program was rated as always enjoyable by 75% of the residents. At the conclusion of the program, 100% responded as always enjoying the exercises and activities. Active sitting and standing time for residents across the program increased markedly. A novel finding from our study is that senior undergraduate students are capable of designing and delivering telerehabilitation programs to residents in aged care facilities. Whilst attention has been given to telesimulation in undergraduate preparation (where learners are off site and connected to simulated laboratory), our trial opens opportunities for a further paradigm shift towards teleplacement.

Cognitive Flexibility Training: A Large-Scale Multimodal Adaptive Active-Control Intervention Study in Healthy Older Adults

As aging is associated with cognitive decline, particularly in the executive functions, it is essential to effectively improve cognition in older adults. Online cognitive training is currently a popular, though controversial method. Although some changes seem possible in older adults through training, far transfer, and longitudinal maintenance are rarely seen. Based on previous literature we created a unique, state-of-the-art intervention study by incorporating frequent sessions and flexible, novel, adaptive training tasks, along with an active control group. We created a program called TAPASS (Training Project Amsterdam Seniors and Stroke), a randomized controlled trial. Healthy older adults (60–80 y.o.) were assigned to a frequent- (FS) or infrequent switching (IS) experimental condition or to the active control group and performed 58 half-hour sessions over the course of 12 weeks. Effects on executive functioning, processing- and psychomotor speed, planning, verbal long term memory, verbal fluency, and reasoning were measured on four time points before, during and after the training. Additionally, we examined the explorative question which individual aspects added to training benefit. Besides improvements on the training, we found significant time effects on multiple transfer tasks in all three groups that likely reflected retest effects. No training-specific improvements were detected, and we did not find evidence of additional benefits of individual characteristics. Judging from these results, the therapeutic value of using commercially available training games to train the aging brain is modest, though any apparent effects should be ascribed more to expectancy and motivation than to the elements in our training protocol. Our results emphasize the importance of using parallel tests as outcome measures for transfer and including both active and passive control conditions. Further investigation into different training methods is advised, including stimulating social interaction and the use of more variable, novel, group-based yet individual-adjusted exercises.

Pedestrian Inattention Blindness While Playing Pokémon Go as an Emerging Health-Risk Behavior: A Case Report

BACKGROUND

Cases of trauma resulting from the use of mobile phones while driving motor vehicles have become quite common in recent years. Road injuries incurred by people playing video games on mobile phones (or other media devices) while walking have also become a cause for concern. Pokémon Go has been the world's most popular game since it was launched in July 2016, with more than 15 million players trying to catch all Pokémon available in the game; however, the case detailed here is the first reported accident in the medical literature caused by a pedestrian distracted by the game while crossing a street.

OBJECTIVE

We aim to provide additional information on the innovative nature of distractions that generate risks in road-users, and to explore the underreporting of pedestrian-motor vehicle collisions due to mobile device usage.

METHODS

We included in this case report a 25-year-old male who suddenly crossed a road while playing Pokémon Go and was hit by a van, reporting several injuries and being assisted by the Emergency Medical Service of our hospital (Padova, Italy). The patient's history, the circumstances in which the collision happened, imaging data, and clinical course information were recorded per our hospital's privacy policy.

RESULTS

The patient hit by the van was playing Pokémon Go on his mobile phone while crossing a street, despite red traffic lights, which he did not notice due to of the distraction induced by the game.

CONCLUSIONS

Mobile videogames that imply movement (ie, walking, running, cycling) to play are an effective way to improve physical activity practice, especially in adolescents and young adults. Nevertheless, cases like the one presented here point out that these games could pose a significant risk to users who play while walking, cycling, or driving in unsafe areas such as city streets, because players become distracted and may ignore surrounding hazards. Comprehensive, multilevel interventions are needed to reduce accidents caused by distraction, and to stress findings on the positive and negative effects of video games, which are becoming a source of public health concern. Health care providers should be aware of their chief role in these possible prevention strategies, based on their direct interactions with road incident victims.

Videogames and Therapy: A Narrative Review of Recent Publication and Application to Treatment

Individuals who play videogames can interact with virtual worlds, resulting in emotional and intellectual connections that have therapeutic implications in the hands of a skilled and informed therapist. There is research available in the literature that suggests that videogames are a viable option in psychotherapy. The present article provides a review of the literature available in the use of videogames in treatment, discusses the importance of disseminating the findings in the literature, and discusses the integration of videogames in treatment.

Behavioral correlation with television watching and videogame playing among children in the United Arab Emirates

OBJECTIVE

Television viewing and videogame use (TV/VG) appear to be associated with some childhood behavioral problems. There are no studies addressing this problem in the United Arab Emirates.

METHODS

One hundred ninety-seven school children (mean age, 8.7 ± 2.1 years) were assessed. Child Behavior Checklist (CBCL) subscale scores and socio-demographic characteristics were compared between children who were involved with TV/VG more than 2 hours/day and those involved less than 2 hours/day (the recommended upper limit by The American Academy of Pediatrics).

RESULTS

Thirty-seven percent of children who were involved with TV/VG time of more than 2 hours/day scored significantly higher on CBCL syndrome scales of withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, internalizing problems, externalizing problems and the CBCL total scores compared with their counterparts. Moreover, these children were younger in birth order and had fewer siblings. After controlling for these confounders using logistic regression, we found that TV/VG time more than 2 hours/day was positively associated with withdrawn (p = 0.008), attention problem (p = 0.037), externalizing problems (p = 0.007), and CBCL total (p = 0.014).

CONCLUSION

Involvement with TV/VG for more than 2 hours/day is associated with more childhood behavioral problems. Counteracting negative effects of the over-involvement with TV/VG in children requires increased parental awareness.

Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists

Purpose: Our aim was to describe experiences of using Nintendo Wii Fit™ for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients' physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings.

Implications for Rehabilitation

Nintendo Wii Fit™ can be used as a fun and challenging way to perform balance exercises.

The competitive content embedded in the games triggers continued playing and exercising.

The positive effect on balance control can improve standing and walking in everyday activities.

A new adaptive videogame for training attention and executive functions: design principles and initial validation

A growing body of evidence suggests that action videogames could enhance a variety of cognitive skills and more specifically attention skills. The aim of this study was to develop a novel adaptive videogame to support the rehabilitation of the most common consequences of traumatic brain injury (TBI), that is the impairment of attention and executive functions. TBI patients can be affected by psychomotor slowness and by difficulties in dealing with distraction, maintain a cognitive set for a long time, processing different simultaneously presented stimuli, and planning purposeful behavior. Accordingly, we designed a videogame that was specifically conceived to activate those functions. Playing involves visuospatial planning and selective attention, active maintenance of the cognitive set representing the goal, and error monitoring. Moreover, different game trials require to alternate between two tasks (i.e., task switching) or to perform the two tasks simultaneously (i.e., divided attention/dual-tasking). The videogame is controlled by a multidimensional adaptive algorithm that calibrates task difficulty on-line based on a model of user performance that is updated on a trial-by-trial basis. We report simulations of user performance designed to test the adaptive game as well as a validation study with healthy participants engaged in a training protocol. The results confirmed the involvement of the cognitive abilities that the game is supposed to enhance and suggested that training improved attentional control during play.

Virtual environments for the transfer of navigation skills in the blind: a comparison of directed instruction vs. video game based learning approaches

For profoundly blind individuals, navigating in an unfamiliar building can represent a significant challenge. We investigated the use of an audio-based, virtual environment called Audio-based Environment Simulator (AbES) that can be explored for the purposes of learning the layout of an unfamiliar, complex indoor environment. Furthermore, we compared two modes of interaction with AbES. In one group, blind participants implicitly learned the layout of a target environment while playing an exploratory, goal-directed video game. By comparison, a second group was explicitly taught the same layout following a standard route and instructions provided by a sighted facilitator. As a control, a third group interacted with AbES while playing an exploratory, goal-directed video game however, the explored environment did not correspond to the target layout. Following interaction with AbES, a series of route navigation tasks were carried out in the virtual and physical building represented in the training environment to assess the transfer of acquired spatial information. We found that participants from both modes of interaction were able to transfer the spatial knowledge gained as indexed by their successful route navigation performance. This transfer was not apparent in the control participants. Most notably, the game-based learning strategy was also associated with enhanced performance when participants were required to find alternate routes and short cuts within the target building suggesting that a ludic-based training approach may provide for a more flexible mental representation of the environment. Furthermore, outcome comparisons between early and late blind individuals suggested that greater prior visual experience did not have a significant effect on overall navigation performance following training. Finally, performance did not appear to be associated with other factors of interest such as age, gender, and verbal memory recall. We conclude that the highly interactive and immersive exploration of the virtual environment greatly engages a blind user to develop skills akin to positive near transfer of learning. Learning through a game play strategy appears to confer certain behavioral advantages with respect to how spatial information is acquired and ultimately manipulated for navigation.

Gaming well: links between videogames and flourishing mental health

This paper is a review of the state of play of research linking videogaming and flourishing, and explores the role of videogames and technology to improve mental health and well-being. Its purpose is to develop understandings about the positive intersection of gaming and well-being, to document evidence regarding links between videogames and positive mental health, and to provide guidelines for use by other researchers as they design and use tools and games to improve mental health and well-being. Using Huppert's (Huppert and So, 2013) proposition that to flourish is more than the absence of mental disorder but rather a combination of feeling good and functioning effectively, resulting in high levels of mental well-being, and Seligman's (Seligman, 2011) PERMA theory of well-being, the paper identifies strengths in existing games that generate positive affect, positive functioning, and positive social functioning, contributing to, and supporting mental health and well-being.

Older adults' engagement with a video game training program

OBJECTIVES

The current study investigated older adults' level of engagement with a video game training program. Engagement was measured using the concept of Flow (Csikszentmihalyi, 1975).

METHODS

Forty-five older adults were randomized to receive practice with an action game (Medal of Honor), a puzzle-like game (Tetris), or a gold-standard Useful Field of View (UFOV) training program.

RESULTS

Both Medal of Honor and Tetris participants reported significantly higher Flow ratings at the conclusion, relative to the onset of training.

DISCUSSION

Participants are more engaged in games that can be adjusted to their skill levels and that provide incremental levels of difficulty. This finding was consistent with the Flow theory (Csikszentmihalyi, 1975).

Online games training aging brains: limited transfer to cognitive control functions

The prevalence of age-related cognitive decline will increase due to graying of the global population. The goal of the present study was to test whether playing online cognitive training games can improve cognitive control (CC) in healthy older adults. Fifty-four older adults (age 60–77) played five different cognitive training games online for 30 min a day over a period of seven weeks (game group). Another group of 20 older adults (age 61–73) instead answered quiz questions about documentaries online (documentary group). Transfer was assessed by means of a cognitive test battery administered before and after the intervention. The test battery included measures of working memory updating, set shifting, response inhibition, attention, and inductive reasoning. Compared with the documentary group, the game group showed larger improvement of inhibition (Stop-Signal task) and inductive reasoning (Raven-SPM), whereas the documentary group showed more improvement in selective attention (UFoV-3). These effects qualify as transfer effects, because response inhibition, inductive reasoning and selective attention were not targeted by the interventions. However, because seven other indicators of CC did not show benefits of game training and some of those that did suffered from potential baseline differences, the study as a whole provides only modest support for the potential of videogame training to improve CC in healthy older adults.

Virtual reality and interactive gaming technology for obese and diabetic children: is military medical technology applicable?

The Telemedicine and Advanced Technology Research Center has pursued a number of technologies that may have application to the problems of obesity and diabetes management in children. Children are getting fatter because of increased caloric intake and less physical activity. Furthermore, technology advances have failed to significantly improve metabolic control of type 1 diabetes. Behavioral strategies should target video games, mobile phones, and other popular items used by children and seen by them as necessities. Exergaming is considerably more active than traditional video gaming and can be equivalent to moderate-intensity exercise. Diabetes equipment such as continuous glucose monitors and insulin pumps lack integration and live connectivity and suffer from a poor user interface. In contrast, mobile phones offer wireless connectivity, an excellent voice-enabled interface, and cloud connectivity that could possibly serve as a motivational and compliance tool for diabetes patients through text messaging to the patient, parents, and physician. Mobile phones have the potential to motivate and educate obese children as well. Exergaming for obese children could also be integrated into award systems of game consoles and game play time. The key to successful implementation of these strategies depends on the ability to integrate and connect the various technologies.

Exergames for subsyndromal depression in older adults: a pilot study of a novel intervention

OBJECTIVES

Subsyndromal depression (SSD) is several times more common than major depression in older adults and is associated with significant negative health outcomes. Physical activity can improve depression, but adherence is often poor. The authors assessed the feasibility, acceptability, and short-term efficacy and safety of a novel intervention using exergames (entertaining video games that combine game play with exercise) for SSD in older adults.

METHODS

Community-dwelling older adults (N = 19, aged 63-94 years) with SSD participated in a 12-week pilot study (with follow-up at 20-24 weeks) of Nintendo's Wii sports, with three 35-minute sessions a week.

RESULTS

Eight-six percent of enrolled participants completed the 12-week intervention. There was a significant improvement in depressive symptoms, mental health-related quality of life (QoL), and cognitive performance but not physical health-related QoL. There were no major adverse events, and improvement in depression was maintained at follow-up.

CONCLUSIONS

The findings provide preliminary indication of the benefits of exergames in seniors with SSD. Randomized controlled trials of exergames for late-life SSD are warranted.

Enhancing Navigation Skills through Audio Gaming

We present the design, development and initial cognitive evaluation of an Audio-based Environment Simulator (AbES). This software allows a blind user to navigate through a virtual representation of a real space for the purposes of training orientation and mobility skills. Our findings indicate that users feel satisfied and self-confident when interacting with the audio-based interface, and the embedded sounds allow them to correctly orient themselves and navigate within the virtual world. Furthermore, users are able to transfer spatial information acquired through virtual interactions into real world navigation and problem solving tasks.