Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study

Abstract

BackgroundTraumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation.ObjectiveThe aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI.MethodsA total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered.ResultsThe effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points. However, depression scores increased significantly between baseline and after 8 weeks and between baseline and after 3 months in the rehabilitative gaming group. No differences were found in patients’ self-efficacy between the three measuring points in any of the groups. Participants did use the games (rehabilitation group: 93%, 27/29; entertainment group 100%, 29/29). Games were seen as a usable intervention (rehabilitation group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but they were more willing to use the game after the intervention period (76%, 16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment gaming group).ConclusionsWe did not find differences between the groups in improvement in the outcome measures. The improvements in test performance by all three groups may reflect rehearsal effects. Entertainment gaming had ...

The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis

“…In total, 27 RCTs were included in the current review [ 43 - 69 ]. Of those, 16 RCTs were included in the meta-analyses [ 45 - 52 , 54 , 59 - 65 ].…”

“…In 7 studies, the effect of computerized CBT games was compared with that of no intervention on the severity of depressive symptoms [ 59 - 65 ], and 4 of these studies assessed the effect of a computerized CBT game (SPARX) on the severity of depressive symptoms among patients with depression [ 59 , 60 , 64 ]. The first study found a statistically significant effect of the computerized CBT game over no intervention on the severity of depressive symptoms as measured using the Children’s Depression Rating Scale-Revised (CDRS-R; P =.001) but not the Reynolds Adolescent Depression Scale (RADS-2; P =.08) [ 59 ].…”

“…No statistically significant difference ( P =.25) in the severity of depressive symptoms was detected between the groups [ 63 ]. Välimäki et al [ 65 ] compared the effect of a computerized CBT game (CogniFit) with that of no intervention on the severity of depressive symptoms (measured using the Patient Health Questionnaire-9 [PHQ-9]) among patients with traumatic brain injury and found no statistically significant difference ( P =.76) between the groups. In the last study in this comparison, the effects of a computerized CBT game (ZeroPhobia) and no intervention on the severity of depressive symptoms (measured using the PHQ-9) among patients with acrophobia were investigated [ 61 ].…”

“…Välimäki et al [ 65 ] compared the effect of a computerized CBT game (CogniFit) with that of entertainment video games on the severity of depressive symptoms (measured using the PHQ-9) among patients with traumatic brain injury and found no statistically significant difference ( P =.36) between the groups. Another study compared the effect of a computerized CBT game (MindLight) with that of an entertainment video game (Triple Town) on the severity of depressive symptoms (Child Depression Inventory 2) among patients with autism spectrum disorder and anxiety [ 66 ].…”

The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis (Preprint)

“…In total, 27 RCTs were included in the current review . Of those, 16 RCTs were included in the meta-analyses [45][46][47][48][49][50][51][52]54,[59][60][61][62][63][64][65].…”