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BackgroundThe objective of the present study was to assess whether computer game-based training in the home setting in the late phase after stroke could improve upper extremity motor function.MethodsTwelve subjects with prior stroke were recruited; 11 completed the study.DesignThe study had a single subject design; there was a baseline test (A1), a during intervention test (B) once a week, a post-test (A2) measured directly after the treatment phase, plus a follow-up (C) 16–18 weeks after the treatment phase. Information on motor function (Fugl-Meyer), grip force (GrippitR) and arm function in activity (ARAT, ABILHAND) was gathered at A1, A2 and C. During B, only Fugl-Meyer and ARAT were measured. The intervention comprised five weeks of game-based computer training in the home environment. All games were designed to be controlled by either the affected arm alone or by both arms. Conventional formulae were used to calculate the mean, median and standard deviations. Wilcoxon’s signed rank test was used for tests of dependent samples. Continuous data were analyzed by methods for repeated measures and ordinal data were analyzed by methods for ordered multinomial data using cumulative logistic models. A p-value of < 0.05 was considered statistically significant.ResultsSix females and five males, participated in the study with an average age of 58 years (range 26–66). FMA-UE A-D (motor function), ARAT, the maximal grip force and the mean grip force on the affected side show significant improvements at post-test and follow-up compared to baseline. No significant correlation was found between the amount of game time and changes in the outcomes investigated in this study.ConclusionThe results indicate that computer game-based training could be a promising approach to improve upper extremity function in the late phase after stroke, since in this study, changes were achieved in motor function and activity capacity.

In this article, the authors report on the construction and evaluation of a game-based driving simulator using a real car as a joystick. The simulator is constructed from off-the-shelf hardware and the simulation runs on open-source software. The feasibility of the simulator as a learning tool has been experimentally evaluated. Results are reported from an experimental study of games and traffic safety performed in an advanced gaming environment. During car simulator sessions, the authors collected data about different traffic safety variables, such as speed, headway distance, and lane change behavior, from 70 participants. The data were analyzed to investigate possible individual learning effects and differences between groupings of participants. The experiment shows clear, positive, individual learning effects for all traffic safety variables analyzed. The authors also made a qualitative analysis of the participants’ perception of the simulator as a learning tool. From the results, it is concluded that a game-based simulation can be used to enhance learning in driving education.

BackgroundThe aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score.MethodsAn experiment using a randomized controlled crossover design was conducted to compare immersion between two simulation training conditions for prehospital care: one basic and one contextualized. The Immersion Score Rating Instrument was used to compare the total immersion score for the whole scenario, the immersion score for individual mission phases, and to analyze differences in trigger occurrences. A paired t test was used to test for significance.ResultsThe comparison shows that the overall immersion score for the simulation was higher in the contextualized condition. The average immersion score was 2.17 (sd = 1.67) in the contextualized condition and −0.77 (sd = 2.01) in the basic condition (p < .001). The immersion score was significantly higher in the contextualized condition in five out of six mission phases. Events that might be disruptive for the simulation participants’ immersion, such as interventions of the instructor and illogical jumps in time or space, are present to a higher degree in the basic scenario condition; while events that signal enhanced immersion, such as natural interaction with the manikin, are more frequently observed in the contextualized condition.ConclusionsThe results suggest that contextualization of simulation training with respect to increased equipment and environmental fidelity as well as functional task alignment might affect immersion positively and thus contribute to an improved training experience.

This paper reviews empirically grounded research on practices in game development with the intent to give a comprehensive overview of contemporary development practices used in the video game industry. While there are many intangible elements that inform game development processes, this review specifically covers the more immediate practical challenges. The review covers a total of 48 papers published between 2006 and 2016, which were all subjected to thematic analysis by three reviewers. The results of the review show that an almost universal characteristic of game development is that it is almost impossible to accurately plan a development project in detail, largely due to the soft requirements inherent in game production which emerge mid-process during development projects, during when testing is coupled with continuous ideation and refinement. Practicing game developers have created their own frameworks that accommodate for this lack of planning. They include flat hierarchies, democratic decision-making, creative autonomy, and informal communication, which are designed to create an environment that maintains creativity and openness to product changes long into the production process. These frameworks vary significantly between studios and often between individual projects. This review also shows that the term ‘Agile’, while often used by both researchers and developers to characterize the process of game development, is not an apt descriptor of how game developers actually work. Agile is used as shorthand for unstructured and flexible development, rather than serving as a descriptor of a definable or unified work method. Finally, as companies develop more complicated hierarchies of stakeholders and staff, the desired flexibility and autonomy of game development becomes increasingly complicated to maintain, and often necessitates more formalized management processes and company structures. In these cases, inherent tensions of game development become more pronounced, and continuous creativity is hard to maintain due to a growing need to formalize processes.

BackgroundImmersion is important for simulation-based education; however, questionnaire-based instruments to measure immersion have some limitations. The aim of the present work is to develop a new instrument to measure immersion among participants in healthcare simulation scenarios.MethodsThe instrument was developed in four phases: trigger identification, content validity scores, inter-rater reliability analysis and comparison with an existing immersion measure instrument. A modified Delphi process was used to develop the instrument and to establish validity and reliability. The expert panel consisted of 10 researchers. All the researchers in the team had previous experience of simulation in the health and/or fire and rescue services as researchers and/or educators and simulation designers. To identify triggers, the panel members independently screened video recordings from simulation scenarios. Here, a trigger is an event in a simulation that is considered a sign of reduced or enhanced immersion among simulation participants.ResultsThe result consists of the Immersion Score Rating Instrument (ISRI). It contains 10 triggers, of which seven indicate reduced and three enhanced immersion. When using ISRI, a rater identifies trigger occurrences and assigns them strength between 1 and 3. The content validity analysis shows that all the 10 triggers meet an acceptable content validity index for items (I-CVI) standard. The inter-rater reliability (IRR) among raters was assessed using a two-way mixed, consistency, average-measures intra-class correlation (ICC). The ICC for the difference between weighted positive and negative triggers was 0.92, which indicates that the raters are in agreement. Comparison with results from an immersion questionnaire mirrors the ISRI results.ConclusionsIn conclusion, we present a novel and non-intrusive instrument for identifying and rating the level of immersion among participants in healthcare simulation scenarios.Electronic supplementary materialThe online version of this article (doi:10.1186/s41077-016-0018-x) contains supplementary material, which is available to authorized users.

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Game-based simulators, sometimes referred to as “lightweight” simulators, have benefits such as flexible technology and economic feasibility. In this article, we extend the notion of a game-based simulator by introducing multiple screen view and physical interaction. These features are expected to enhance immersion and fidelity. By utilizing these concepts we have constructed a training simulator for breathing apparatus entry. Game hardware and software have been used to produce the application. More important, the application itself is deliberately designed to be a game. Indeed, one important design goal is to create an entertaining and motivating experience combined with learning goals in order to create a serious game. The system has been evaluated in cooperation with the Swedish Rescue Services Agency to see which architectural features contribute to perceived fidelity. The modes of visualization and interaction as well as level design contribute to the usefulness of the system.