Development and Evaluation of Maze-Like Puzzle Games to Assess Cognitive and Motor Function in Aging and Neurodegenerative Diseases

Nef, Tobias; Chesham, Alvin; Schütz, Narayan; Botros, Angela; Vanbellingen, Tim; Burgunder, Jean‐Marc; Müllner, Julia; Müri, René M.; Urwyler, Prabitha

doi:10.3389/fnagi.2020.00087

Cited by 22 publications

(12 citation statements)

References 84 publications

(114 reference statements)

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“…Mobile platforms (smartphones and tablets) are being used for cognitive assessment of older adults, improving repeated and continuous assessment [ 115 ]. Additionally, cognitive assessment through serious video game playing has been tested in multiple populations, including children and adolescents [ 116 ], adults and older adults [ 117 , 118 ] and as possible tools for cognitive screening in neurodegenerative diseases [ 119 ]. The potentiality of exergames that promote physical activity with and without combined cognitive training for cognitive decline prevention and neurorehabilitation remain to be further explored [ 120 ], particularly in older adults.…”

Section: Monitoring Cognitive Performance and Brain Functionmentioning

confidence: 99%

Wearable Devices for Physical Activity and Healthcare Monitoring in Elderly People: A Critical Review

et al. 2021

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The availability of wearable devices (WDs) to collect biometric information and their use during activities of daily living is significantly increasing in the general population. These small electronic devices, which record fitness and health-related outcomes, have been broadly utilized in industries such as medicine, healthcare, and fitness. Since they are simple to use and progressively cheaper, they have also been used for numerous research purposes. However, despite their increasing popularity, most of these WDs do not accurately measure the proclaimed outcomes. In fact, research is equivocal about whether they are valid and reliable methods to specifically evaluate physical activity and health-related outcomes in older adults, since they are mostly designed and produced considering younger subjects’ physical and mental characteristics. Additionally, their constant evolution through continuous upgrades and redesigned versions, suggests the need for constant up-to-date reviews and research. Accordingly, this article aims to scrutinize the state-of-the-art scientific evidence about the usefulness of WDs, specifically on older adults, to monitor physical activity and health-related outcomes. This critical review not only aims to inform older consumers but also aid researchers in study design when selecting physical activity and healthcare monitoring devices for elderly people.

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Section: Monitoring Cognitive Performance and Brain Functionmentioning

confidence: 99%

Wearable Devices for Physical Activity and Healthcare Monitoring in Elderly People: A Critical Review

et al. 2021

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“…Visual search also plays a key role in solving specific computerized cognitive trainings such as puzzle games [11]. Puzzle games have been used as training tools in health sciences [12][13][14], and recent research suggests their potential as digital markers of cognitive and motor dysfunctions [15,16]. Well-known puzzle games are tile-matching match-three (TMM3) [17] and flow free [18].…”

Section: Puzzle Games As a Tool For Investigating Visual Searchmentioning

confidence: 99%

Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults

Krebs¹,

Falkner²,

Niklaus³

et al. 2021

JMIR Serious Games

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Background Recent studies suggest that computerized puzzle games are enjoyable, easy to play, and engage attentional, visuospatial, and executive functions. They may help mediate impairments seen in cognitive decline in addition to being an assessment tool. Eye tracking provides a quantitative and qualitative analysis of gaze, which is highly useful in understanding visual search behavior. Objective The goal of the research was to test the feasibility of eye tracking during a puzzle game and develop adjunct markers for cognitive performance using eye-tracking metrics. Methods A desktop version of the Match-3 puzzle game with 15 difficulty levels was developed using Unity 3D (Unity Technologies). The goal of the Match-3 puzzle was to find configurations (target patterns) that could be turned into a row of 3 identical game objects (tiles) by swapping 2 adjacent tiles. Difficulty levels were created by manipulating the puzzle board size (all combinations of width and height from 4 to 8) and the number of unique tiles on the puzzle board (from 4 to 8). Each level consisted of 4 boards (ie, target patterns to match) with one target pattern each. In this study, the desktop version was presented on a laptop computer setup with eye tracking. Healthy older subjects were recruited to play a full set of 15 puzzle levels. A paper-pencil–based assessment battery was administered prior to the Match-3 game. The gaze behavior of all participants was recorded during the game. Correlation analyses were performed on eye-tracking data correcting for age to examine if gaze behavior pertains to target patterns and distractor patterns and changes with puzzle board size (set size). Additionally, correlations between cognitive performance and eye movement metrics were calculated. Results A total of 13 healthy older subjects (mean age 70.67 [SD 4.75] years; range 63 to 80 years) participated in this study. In total, 3 training and 12 test levels were played by the participants. Eye tracking recorded 672 fixations in total, 525 fixations on distractor patterns and 99 fixations on target patterns. Significant correlations were found between executive functions (Trail Making Test B) and number of fixations on distractor patterns (P=.01) and average fixations (P=.005). Conclusions Overall, this study shows that eye tracking in puzzle games can act as a supplemental source of data for cognitive performance. The relationship between a paper-pencil test for executive functions and fixations confirms that both are related to the same cognitive processes. Therefore, eye movement metrics might be used as an adjunct marker for cognitive abilities like executive functions. However, further research is needed to evaluate the potential of the various eye movement metrics in combination with puzzle games as visual search and attentional marker.

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“…These games are sometimes so well designed that one loses track of time. Serious games, robotics, virtual/augmented reality, have found their way into neurorehabilitation [18][19][20][21], and theory of flow experience emerged in recent neurorehabilitation studies [22,23]. Indeed, serious exergames may have an explicit educational and/or therapeutic purpose and are often designed in such a way that they may also improve cognitive or physical capabilities [22,24].…”

Section: Introductionmentioning

confidence: 99%

Getting into a “Flow” state: a systematic review of flow experience in neurological diseases

Ottiger

Wegen

Keller

et al. 2021

J NeuroEngineering Rehabil

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Background Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological diseases engage in exercises using robotics, virtual/augmented reality, or serious games on tablets/computer. When developing new therapy games, measuring flow experience can indicate whether the game motivates one to train. The purpose of this study was to identify and systematically review current literature on flow experience assessed in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson’s disease. Additionally, we critically appraised, compared and summarized the measurement properties of self-reported flow questionnaires used in neurorehabilitation setting. Design A systematic review using PRISMA and COSMIN guidelines. Methods MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, SCOPUS were searched. Inclusion criteria were (1) peer-reviewed studies that (2) focused on the investigation of flow experience in (3) patients with neurological diseases (i.e., stroke, traumatic brain injury, multiple sclerosis and/or Parkinson’s disease). A qualitative data synthesis was performed to present the measurement properties of the used flow questionnaires. Results Ten studies out of 911 records met the inclusion criteria. Seven studies measured flow in the context of serious games in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson’s disease. Three studies assessed flow in other activities than gaming (song-writing intervention and activities of daily living). Six different flow questionnaires were used, all of which were originally validated in healthy people. None of the studies presented psychometric data in their respective research population. Conclusion The present review indicates that flow experience is increasingly measured in the physical/cognitive rehabilitation setting in patients with neurological diseases. However, psychometric properties of used flow questionnaires are lacking. For exergame developers working in the field of physical/cognitive rehabilitation in patients with neurological diseases, a valid flow questionnaire can help to further optimize the content of the games so that optimal engagement can occur during the gameplay. Whether flow experiences can ultimately have positive effects on physical/cognitive parameters needs further study.

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Development and Evaluation of Maze-Like Puzzle Games to Assess Cognitive and Motor Function in Aging and Neurodegenerative Diseases

Cited by 22 publications

References 84 publications

Wearable Devices for Physical Activity and Healthcare Monitoring in Elderly People: A Critical Review

Wearable Devices for Physical Activity and Healthcare Monitoring in Elderly People: A Critical Review

Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults

Getting into a “Flow” state: a systematic review of flow experience in neurological diseases

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