Autism Spectrum Disorder (ASD) is characterized by social interaction difficulties and communication difficulties. Moreover, children with ASD often suffer from other co-morbidities, such as anxiety and depression. Finding appropriate treatment can be difficult as symptoms of ASD and co-morbidities often overlap. Due to these challenges, parents of children with ASD often suffer from higher levels of stress. This research aims to investigate the feasibility of empowering children with ASD and their parents through the use of a serious game to reduce stress and anxiety and a supporting parent application. The New Horizon game and the SpaceControl application were developed together with therapists and according to guidelines for e-health patient empowerment. The game incorporates two mini-games with relaxation techniques. The performance of the game was analyzed and usability studies with three families were conducted. Parents and children were asked to fill in the Spence's Children Anxiety Scale (SCAS) and Spence Children Anxiety Scale-Parents (SCAS-P) anxiety scale. The game shows potential for stress and anxiety reduction in children with ASD.Sensors 2020, 20, 966 2 of 41 language. ASD is a heterogeneous condition: the profile of each child or adult with ASD is unique [4]. An estimated 1 in 132 individuals suffers from ASD [5]. As a result of these challenges, related to social functioning and communication, people with ASD often suffer from other conditions, such as mood swings and anxiety. It is estimated that up to 72% of children with ASD suffer from co-morbidities [6], however, co-morbidity rates remain largely unknown for ASD, as co-morbid conditions can be difficult to diagnose [7][8][9][10]. Depression and anxiety are two of the most common ASD co-morbidities with rates around 40 to 50% [11].Due to communication difficulties, children with ASD are often unable to express themselves when stressed or frustrated. Combined with unique symptoms in every child and overlap in symptoms of co-morbidities, it is challenging to find the appropriate response. As a result, temper tantrums are common, which can be an important cause of parental stress [1]. Determining the correct diagnosis or finding appropriate treatment is difficult due to the challenges in communication and uniqueness in symptoms [7].Empowering both the children and their parents by raising awareness of the child's anxiety and stress can result in better management of the child's temper tantrums, which can result in a decrease in stress and anxiety. The term "patient empowerment" is used in many different settings and domains, but no general definition exists. The consensus is that patient empowerment is used to describe situations where patients and users are encouraged to take control of their health management [12]. In other words, patient empowerment is enabling patients to actively understand their health [13], but also the support to restore a sense of hope, respect, self-efficacy and the drive to face seemingly insurmountable challenges [14...

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Unilateral Spatial Neglect (USN) commonly results from a stroke or acquired brain injury. USN affects multiple modalities and results in failure to respond to stimuli on the contralesional side of space. Although USN is a heterogeneous syndrome, present-day therapy methods often fail to consider multiple modalities. Musical Neglect Therapy (MNT) is a therapy method that succeeds in incorporating multiple modalities by asking patients to make music. This research aimed to exploit the immersive and modifiable aspect of VR to translate MNT to a VR therapy tool. The tool was evaluated in a 2-week pilot study with four clinical users. These results are compared to a control group of four non-clinical users. Results indicated that patients responded to triggers in their entire environment and performance results could be clearly differentiated between clinical and non-clinical users. Moreover, patients increasingly corrected their head direction towards their neglected side. Patients stated that the use of VR increased their enjoyment of the therapy. This study contributes to the current research on rehabilitation for USN by proposing the first system to apply MNT in a VR environment. The tool shows promise as an addition to currently used rehabilitation methods. However, results are limited to a small sample size and performance metrics. Future work will focus on validating these results with a larger sample over a longer period. Moreover, future efforts should explore personalisation and gamification to tailor to the heterogeneity of the condition.

Gamification in healthcare has shown to increase user motivation and treatment adherence. Personalisation strategies have the potential to create sustainable health change and user motivation. In striving for personalisation, surveys are often used as an easy tool to collect information about the user. But lengthy surveys are often tedious and demotivating, provoking bad respondent behaviour which results in a loss of data quality. Gamified surveys can enhance respondent behaviour but are labour-intensive to develop. This study explores the effect of a re-usable mobile survey application, using personalised gamification, on user experience. In an A/B study setting with 28 participants, The Hexad Player Type Framework is used to determine the player type of the user and personalise the survey accordingly. Results have shown that the overall user experience of the gamified application is higher than the traditional survey and 37.5% of gamified users perceived the duration of the survey as shorter than the actual time, compared to 20% of the respondents of the traditional survey. No significant difference in data quality has been detected, as loss in data quality remained limited in both versions. Future work should explore the influence of more elaborate game elements in a larger population.

Background Despite effectiveness of action and coping planning in digital health interventions to promote physical activity (PA), attrition rates remain high. Indeed, support to make plans is often abstract and similar for each individual. Nevertheless, people are different, and context varies. Tailored support at the content level, involving suggestions of specific plans that are personalized to the individual, may reduce attrition and improve outcomes in digital health interventions. The aim of this study was to investigate whether user information relates toward specific action and coping plans using a clustering method. In doing so, we demonstrate how knowledge can be acquired in order to develop a knowledge-base, which might provide personalized suggestions in a later phase. Methods To establish proof-of-concept for this approach, data of 65 healthy adults, including 222 action plans and 204 coping plans, were used and were collected as part of the digital health intervention MyPlan 2.0 to promote PA. As a first step, clusters of action plans, clusters of coping plans and clusters of combinations of action plans and barriers of coping plans were identified using hierarchical clustering. As a second step, relations with user information (i.e. gender, motivational stage, ...) were examined using anova’s and chi2–tests. Results First, three clusters of action plans, eight clusters of coping plans and eight clusters of the combination of action and coping plans were identified. Second, relating these clusters to user information was possible for action plans: 1) Users with a higher BMI related more to outdoor leisure activities (F = 13.40, P < .001), 2) Women, users that didn’t perform PA regularly yet, or users with a job related more to household activities (X2 = 16.92, P < .001; X2 = 20.34, P < .001; X2 = 10.79, P = .004; respectively), 3) Younger users related more to active transport and different sports activities (F = 14.40, P < .001). However, relating clusters to user information proved difficult for the coping plans and combination of action and coping plans. Conclusions The approach used in this study might be a feasible approach to acquire input for a knowledge-base, however more data (i.e. contextual and dynamic user information) from possible end users should be acquired in future research. This might result in a first type of context-aware personalized suggestions on the content level. Trial registration The digital health intervention MyPlan 2.0 was preregistered as a clinical trial (ID:NCT03274271). Release date: 6-September-2017.

The global pandemic and the resulting lock-downs have indicated the importance of regular physical activity for both mental and physical wellness. Many mHealth applications to increase physical activity exist, they however continue to fail to achieve their objective. The need arises for a more theoretically-grounded approach that considers the dynamic nature of the individual. To create a system that is contextaware and personalised, an interdisciplinary approach is needed and regular input of stakeholders and end-users is of the essence. This expert knowledge is captured into an ontology, centred on the Health Action Process (HAPA) model for behaviour change. This paper describes the requirements for the design of such a mobile health Behaviour Change System for increased physical activity in adults and emphasises the need for personalisation on the level of the user, action and coping planning and motivational level.

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.

BACKGROUND The use of serious games in healthcare is on the rise, as they 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. Furthermore, no standardized approach exists on how serious games can be personalized as existing literature focuses on specific use cases and scenarios. Finally, the domain of serious game development fails to consider any transfer of domain knowledge, which means this labor-intensive process has to be repeated for each serious game. OBJECTIVE This paper proposes a framework that aims to streamline the multidisciplinary design process of personalized serious games in healthcare 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 healthcare. METHODS The proposed aims to answer three questions that need to be asked when designing serious games: (1) Why is the game personalized? (2) What parameters can be used for personalization? And (3) How is the personalization achieved? Respectively, the three involved stakeholders, namely, the domain expert, the (game) developer and the software engineer are each assigned a question and, following from this, their responsibilities regarding the design of the serious game. The (game) developer is responsible for all the game-related components; the domain expert is in charge of the modelling of the domain knowledge using simple or complex concepts, such as ontologies. Finally, the software engineer manages the personalization algorithms or models, integrated into the system. The framework is illustrated by developing and evaluating a proof of concept. RESULTS The proof of concept, a serious game for shoulder rehabilitation has been evaluated using simulations of heart rate and game scores, to assess how personalization is achieved. The simulations indicate the value of both online personalization, i.e. real-time personalization and offline personalization. The proof of concept illustrates how the interaction between the different components works and how the framework is used to simplify the design process. CONCLUSIONS The proposed framework for personalized serious games in healthcare identifies the responsibilities of the involved stakeholders in the design process, using three 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.