Game-based interventions for neuropsychological assessment, training and rehabilitation: Which game-elements to use? A systematic review

Ferreira-Brito, Filipa; Fialho, Mónica; Virgolino, Ana; Neves, Inês; Miranda, Ana Cristina; Sousa-Santos, Nuno; Caneiras, Cátia; Carriço, Luís; Verdelho, Ana; Santos, Osvaldo

doi:10.1016/j.jbi.2019.103287

Cited by 43 publications

(22 citation statements)

References 113 publications

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“…On the other hand, social-oriented features were underutilized, with only a few studies favoring competition (n=3/49, 6%) and social interaction (n=2/49, 4%). Similar findings have been reported in a recent review investigating game-based interventions for neuropsychological assessment, training, and rehabilitation [ 87 ]. This may be due to implementation complexity or the relative recency of the field.…”

Section: Discussionsupporting

confidence: 90%

The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis

Vermeir¹,

White²,

Johnson³

et al. 2020

JMIR Serious Games

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Background There has been a growing interest in the application of gamification (ie, the use of game elements) to computerized cognitive training. The introduction of targeted gamification features to such tasks may increase motivation and engagement as well as improve intervention effects. However, it is possible that game elements can also have adverse effects on cognitive training (eg, be a distraction), which can outweigh their potential motivational benefits. So far, little is known about the effectiveness of such applications. Objective This study aims to conduct a systematic review and meta-analysis to investigate the effect of gamification on process outcomes (eg, motivation) and on changes in the training domain (eg, cognition), as well as to explore the role of potential moderators. Methods We searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ProQuest Psychology, Web of Science, Scopus, PubMed, Science Direct, Excerpta Medica dataBASE, Institute of Electrical and Electronics Engineers Xplore, Association for Computing Machinery, and a range of gray-area literature databases. The searches included papers published between 2008 and 2018. Meta-analyses were performed using a random-effects model. Results The systematic review identified 49 studies, of which 9 randomized controlled trials were included in the meta-analysis. The results of the review indicated that research in this context is still developing and lacks well-controlled empirical studies. Gamification in cognitive training is applied to a large range of age groups and audiences and is mostly delivered at a research site through computers. Rewards and feedback continue to dominate the gamification landscape, whereas social-oriented features (eg, competition) are underused. The meta-analyses showed that gamified training tasks were more motivating/engaging (Hedges g=0.72) and more demanding/difficult (Hedges g=–0.52) than non- or less-gamified tasks, whereas no effects on the training domain were found. Furthermore, no variables moderated the impact of gamified training tasks. However, meta-analytic findings were limited due to a small number of studies. Conclusions Overall, this review provides an overview of the existing research in the domain and provides evidence for the effectiveness of gamification in improving motivation/engagement in the context of cognitive training. We discuss the shortcomings in the current literature and provide recommendations for future research.

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Section: Discussionsupporting

confidence: 90%

The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis

Vermeir¹,

White²,

Johnson³

et al. 2020

JMIR Serious Games

View full text Add to dashboard Cite

show abstract

“…Game-based training or intervention has been widely viewed as a means to promote adherence and cognitive capacity [ 35 , 36 ]. The use of various game elements such as points, difficulty levels, badges and storyline can enhance a patient’s intrinsic motivated behavior as it allows the patient to feel a sense of competence and accomplishment.…”

Section: Discussionmentioning

confidence: 99%

Gamification and Control of Nitinol Based Ankle Rehabilitation Robot

et al. 2021

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Conventional ankle rehabilitation exercises can be monotonous and repetitive. The use of robots and games can complement the existing practices, provide an engaging environment for the patient and alleviate the physiotherapist’s workload. This paper presents an ankle rehabilitation robot that uses two nitinol wire actuators and a Pong game to provide foot plantarflexion and dorsiflexion exercises. Nitinol is a type of smart material that has high volumetric mechanical energy density and can produce translational motion. A two-state discrete antagonistic control is proposed to manipulate the actuators. The system was tested on healthy participants and stroke patients. The results showed that the robot was safe and compliant. The robot did not forcefully plantarflex or dorsiflex the foot when the participant exerted opposing force. The actuators worked antagonistically to flex to the foot as intended, in sync with the up and down motions of the player’s bat in the game. These behaviors demonstrated the feasibility of a nitinol-based ankle rehabilitation robot and a simple and yet intuitive game in providing interactive rehabilitation exercise. The robot is expected to enhance the patient’s experience, participation and compliance to the rehabilitation routine and to quantitatively monitor the patient’s recovery progress.

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“…In NeuroVRehab.PT, we implemented two types of game elements: numeric (e.g., points, scores) and visual (e.g., messages, three-star classification) feedback elements and narrative contexts. Although the study of the motivational influences of different game elements is still in its infancy, preliminary studies suggest that immediate feedback elements are associated with high adherence rates during the initial phases of contact with the platform [59,60]. On the other hand, the storyline in which the main action unfolds is thought to be a crucial feature for long-term adherence [60] (see reference [59] for a description of the rationale underlying the selection of this game element).…”

Section: Discussionmentioning

confidence: 99%

“…Although the study of the motivational influences of different game elements is still in its infancy, preliminary studies suggest that immediate feedback elements are associated with high adherence rates during the initial phases of contact with the platform [59,60]. On the other hand, the storyline in which the main action unfolds is thought to be a crucial feature for long-term adherence [60] (see reference [59] for a description of the rationale underlying the selection of this game element). Although the conclusions that can be drawn from a single moment of contact with our platform are limited, the participants' statements that they had fun with and enjoyed using our platform is indicative that the implementation of these game-elements was successful, at least to some degree.…”

Section: Discussionmentioning

confidence: 99%

Photo-Realistic Interactive Virtual Environments for Neurorehabilitation in Mild Cognitive Impairment (NeuroVRehab.PT): A Participatory Design and Proof-of-Concept Study

Ferreira-Brito

Alves

Santos

et al. 2020

JCM

Self Cite

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Mild cognitive impairment (MCI) is characterized by cognitive, psychological, and functional impairments. Digital interventions typically focus on cognitive deficits, neglecting the difficulties that patients experience in instrumental activities of daily living (IADL). The global conjecture created by COVID-19 has highlighted the seminal importance of digital interventions for the provision of healthcare services. Here, we investigated the feasibility and rehabilitation potential of a new design approach for creating highly realistic interactive virtual environments for MCI patients’ neurorehabilitation. Through a participatory design protocol, a neurorehabilitation digital platform was developed using images captured from a Portuguese supermarket (NeuroVRehab.PT). NeuroVRehab.PT’s main features (e.g., medium-sized supermarket, the use of shopping lists) were established according to a shopping behavior questionnaire filled in by 110 older adults. Seven health professionals used the platform and assessed its rehabilitation potential, clinical applicability, and user experience. Interviews were conducted using the think-aloud method and semi-structured scripts, and four main themes were derived from an inductive semantic thematic analysis. Our findings support NeuroVRehab.PT as an ecologically valid instrument with clinical applicability in MCI neurorehabilitation. Our design approach, together with a comprehensive analysis of the patients’ past experiences with IADL, is a promising technique to develop effective digital interventions to promote real-world functioning.

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Game-based interventions for neuropsychological assessment, training and rehabilitation: Which game-elements to use? A systematic review

Cited by 43 publications

References 113 publications

The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis

The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis

Gamification and Control of Nitinol Based Ankle Rehabilitation Robot

Photo-Realistic Interactive Virtual Environments for Neurorehabilitation in Mild Cognitive Impairment (NeuroVRehab.PT): A Participatory Design and Proof-of-Concept Study

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