The Wii-Volution in Rehabilitation, A Legacy Interrupted.

The field of Artificial Intelligence (AI) has gained increased attention since the release of ChatGPT in late 2022. Following the popularity and wide application, several generative AI (GAI or GenAI) tools have been released, with capabilities of generating novel content such as text, images, audio, and video. Previous research has noted both opportunities and limitations with GAI for various fields. One field with high potential impact is the game industry and the subfield of serious games, where the purpose of the game extends that of pure entertainment. GAI could play an important role for design and development of serious games, where design teams are typically smaller (compared with big commercial games), and competences in game mechanics, graphics and other game resources can be limited. This paper explores the opportunities and limitations of GAI tools to support development of serious games. This is done through the development of a serious game, based on the author’s PhD thesis, where various GAI tools are used to generate game content such as in-game dialogue, graphics, and audio. Development of the game artefact, which is named ‘Computer Programming in Schools’, follows the process of a design science research (DSR) project where emphasis is placed on the design in one iteration of development. The author’s experiences of utilizing GAI tools during the development of the game were recorded in a researcher diary, together with screenshots and images from the game. In this paper, these experiences are discussed and compared to related research in order to seek the most salient opportunities and limitations for GAI to support design and development of serious games. The paper provides several hands-on examples of design and development of a serious game with GAI tools and concludes with a set of recommendations for the future use of GAI in game development.

Despite the growing popularity and widespread use of serious games, the development of effective serious games is difficult, requiring an appropriate balance between game design and instructional design. Although there are fundamental differences between games developed purely for entertainment compared to those developed for “serious” purposes, there are currently no standard development tools specifically intended for serious game design and development available that encourage developers to follow a set of best practices. Rather, developers of serious games often rely on existing game engines and frameworks that are specific to entertainment-based game development. Given the availability of a large number of game engines and frameworks, deciding on which one to use to develop a serious game may be difficult, yet the choice of engine or framework can play a significant role in the development process. In this paper we present the results of a literature review that examined the frameworks and game engines that are used to develop serious games. We provide a list of the most commonly used frameworks and game engines and summarize their features. Knowledge of the frameworks and game engines that are most popular and details regarding why they are popular may prove to be useful to serious games developers seeking such tools. The chapter ends with a brief discussion regarding a framework that is currently being developed specifically for the development of serious games. Through consultation with the potential users of the framework (serious games developers), the framework aims to strike a balance between ease of use and functionality, while providing the user with the necessary options and tools to ideally develop effective serious games.

With the drop in the price of Brain-Computer Interface (BCI) devices, which have been widely used in the medical sector, the development of serious BCI-based games has been accelerated. However, developers involved with the development of these games have found it difficult to acquire brain- and brain-wave-related knowledge. This paper defines templates that are necessary for developing BCI contents and proposes a method for developing BCI contents; the definition of the knowledge is based on templates. We present an example of a BCI-based game that has been developed using the proposed method. Since technical knowledge required for the development of serious games has been defined on the basis of templates, a developer can concentrate on the task of developing games.

To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.

Nowadays the development of serious games for rehabilitation therapy is gaining popularity thanks to the motivational advantages of this type of computer software. Consequently, the need for a process framework for the development of this category of software applications has become more evident. The final goal is to guarantee that these software products are developed and validated following a systematic and coherent approach that supports the development of reliable serious games. In this work we introduce a design proposal for a methodological framework for the development of serious games for motor rehabilitation therapy.

In this work, we present a case study, examining the design, development, and evaluation of an Augmented Reality serious game for cognitive screening (namely Smartkuber), which aims to provide reliable and motivating cognitive screening for the elderly. This case study can be of interest for the game designers and researchers, allowing them to build on previous experiences and lessons learned. Smartkuber’s development process took place in four stages: (1) analysing the state of the art and defining characteristics, (2) setting up and examining the interaction method, (3) adding and evaluating the game content, and (4) evaluating cognitive screening performance and future direction. The “lessons learned” around the design and development of serious games for cognitive screening are discussed, with focus on Augmented Reality, interaction, test validity, and game motivation aspects.

Serious games are developed with the purpose of bestowing a benefit on the user. That benefit could be related to the user's health, education, safety or efficiency. We propose that the mechanism that the game employs to achieve such a benefit should be identified as the key to the development of a successful serious game. We introduce a paradigm for the design and development of serious games as benefit delivery systems. We suggest that the paradigm can apply to all applications and genres of serious game. Three serious games for health are employed as case studies of developing a serious game as a benefit delivery system. Recommendations are then made for the adoption of the paradigm for serious gaming in general.

Serious game development for rehabilitation therapy is becoming increasingly popular because of the motivational advantages that these types of applications provide. Consequently, the need for a common process framework for this category of software development has become increasingly evident. The goal is to guarantee that products are developed and validated by following a coherent and systematic method that leads to high-quality serious games. This paper introduces a new process framework for the development of serious games for motor rehabilitation therapy. We introduce the new model and demonstrate its application for the development of a serious game for the improvement of the balance and postural control of adults with cerebral palsy. The development of this application has been facilitated by two technological transfer contracts and is being exploited by two different organizations. According to clinical measurements, patients using the application improved from high fall risk to moderate fall risk. We believe that our development strategy can be useful not only for motor rehabilitation therapy, but also for the development of serious games in many other rehabilitation areas.

To assess development of reaching and head stability in infants at very high risk (VHR-infants) of cerebral palsy (CP) who did and did not develop CP. This explorative longitudinal study assessed the kinematics of reaching and head sway in sitting in 37 VHR-infants (18 CP) one to four times between 4.7 months and 22.6 months corrected age. Developmental trajectories were calculated using linear mixed effect models. Motor function was evaluated with the Infant Motor Profile (IMP) around 13 months corrected age. Throughout infancy, VHR-infants with CP had a worse reaching quality than infants without CP, reflected for example by more movement units (factor 1.52, 95% CI 1.16-1.99) and smaller transport movement units (factor 1.86, 95% CI 1.20-2.90). Total head sway of infants with and without CP was similar, but infants with CP used more head movement units to achieve stability. The rate of developmental change in infants with and without CP was similar. Around 13 months, head control and reaching quality were interrelated; both were associated with IMP-scores. Infants with CP showed a worse kinematic reaching quality and head stability throughout infancy from early age onwards than VHR-infants without CP, implying that kinematically they do not grow into a deficit, but exhibit deficits from early infancy on. Reaching quality improves throughout infancy in all infants at high risk (VHR-infants). Infants with cerebral palsy (CP) show a worse reaching quality than VHR-infants without CP. Infants with CP achieve head stability differently from infants without CP. Infants with CP exhibit kinematic reaching problems from early age onwards.

BackgroundSerious video games have now been used and assessed in clinical protocols, with several studies reporting patient improvement and engagement with this type of therapy. Even though some literature reviews have approached this topic from a game perspective and presented a broad overview of the types of video games that have been used in this context, there is still a need to better understand how different game characteristics and development strategies might impact and relate to clinical outcomes.ObjectiveThis review assessed the relationship between the characteristics of serious games (SGs) and their relationship with the clinical outcomes of studies that use this type of therapy in motor impairment rehabilitation of patients with stroke, multiple sclerosis, or cerebral palsy. The purpose was to take a closer look at video game design features described in the literature (game genre [GG], game nature [GN], and game development strategy [GDS]) and assess how they may contribute toward improving health outcomes. Additionally, this review attempted to bring together medical and game development perspectives to facilitate communication between clinicians and game developers, therefore easing the process of choosing the video games to be used for physical rehabilitation.MethodsWe analyzed the main features of SG design to obtain significant clinical outcomes when applied to physical rehabilitation of patients recovering from motor impairments resulting from stroke, multiple sclerosis, and cerebral palsy. We implemented a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) database-adjusted electronic search strategy for the PubMed, IEEE Xplore, and Cochrane databases.ResultsWe screened 623 related papers from 2010-2021 and identified 12 that presented results compatible with our inclusion criteria. A total of 512 participants with stroke (8 studies, 417 participants), cerebral palsy (1 study, 8 participants), and multiple sclerosis (2 studies, 46 participants) were included; 1 study targeting the elderly (41 participants) was also included. All studies assessed motor, sensory, and functional functions, while some also measured general health outcomes. Interventions with games were used for upper-limb motor rehabilitation. Of the 12 studies, 8 presented significant improvements in at least one clinical measurement, of which 6 presented games from the casual GG, 1 combined the casual, simulation, and exergaming GGs, and 2 combined the sports and simulation GGs.ConclusionsOf the possible combinations of game design features (GG, GN, and GDS) described, custom-made casual games that resort to the first-person perspective, do not feature a visible player character, are played in single-player mode, and use nonimmersive virtual reality attain the best results in terms of positive clinical outcomes. In addition, the use of custom-made games versus commercial off-the-shelf games tends to give better clinical results, although the latter are perceived as more motivating and engaging.

This paper introduces the SHARE-IT project, which leverages serious games paradigm to motivate and engage children with autism diagnosis in interactive activities, based on the state-of-the-art autism intervention practices. The aim of SHARE-IT is to formulate, in partnership with schools, parents and industry, the requirements for a robust, intelligent and authorable environment for supporting children in exploring, practicing and acquiring social interaction skills. SHARE-IT focuses on two key challenges: (i) developing robust system architecture and implementation, able to support both continuing development of a serious game for children with autism and its real world use; and (ii) selecting appropriate technologies and techniques to allow for (a) multi-device and operating system deployment, (b) the development of an intelligent serious game for supporting social interaction while (c) allowing the flexibility for the environment to be authored by lay persons. SHARE-IT’s architecture is presented and several considerations of importance to enabling the engineering of an intelligent and authorable serious game are discussed. Examples of technologies developed to date are given throughout and a discussion of future challenges offered.

AimThis paper describes the steps of a protocol for developing and assessing a non-pharmacological intervention, specifically a Serious Game, with the goal of improving eight cognitive skills in adults with Intellectual Disabilities. Serious games that focus on one deficit and/or are restricted to one disorder have been developed to improve the cognitive skills of people with Intellectual Disabilities. There is a lack of a single tool that targets various cognitive skills as well as a broader spectrum of disorders.PurposeThe presentation of the protocol which describes the steps of developing a new Serious Game that will be evaluated in a randomised control trial intervention.Participants and MethodsThe protocol is divided into three stages: identification of cognitive deficits and development of the Serious Game, randomised control trial intervention- follow up assessment, and evaluation of the Serious Game by trainers and caregivers. The participants of the intervention are adults with Intellectual Disabilities.ResultsThe protocol’s results are expected to cover the development of a new Serious Game for specific cognitive functions of a mixed group of adults with Intellectual Disabilities, evaluating the structure and content of the game through neuropsychological assessments for participants and specific questionnaires for trainers and caregivers, evaluating the improvement of specific cognitive abilities in participants in the intervention; and measuring the possible improvement of the quality of life and social interaction of people with Intellectual Disabilities.ConclusionThis is the first study to develop a protocol and implement and assess this new Serious Game. This Serious Game is expected to assist people with Intellectual Disabilities in cognitive and social aspects.

Objective: To describe the development and evaluation of a nurse-patient interactive serious game in improving nurses' self-efficacy and performances in teaching the correct inhaler technique. Materials and Methods: The technology, pedagogy, and content knowledge (TPACK) framework was applied to guide the development of the serious game. The learning effectiveness of the serious game was evaluated through a randomized controlled trial that involved 46 registered nurses. Participants in the experimental group were asked to teach the inhaler technique to a standardized patient using the serious game as a teaching tool, whereas participants in the control group were asked to provide their own usual teaching to a standardized patient without the serious game. The performances of both groups were assessed based on their feedback to a standardized patient who made several errors while demonstrating the inhaler technique. Self-efficacy levels of teaching the inhaler technique were examined before and after the intervention. Results: A significantly higher number of participants from the experimental group obtained perfect performance scores than those in the control group (65.21% vs. 21.74%, χ2 = 15.18, P < 0.01). The posttest self-efficacy mean scores for the experimental group improved significantly (P < 0.001) after the intervention, and significantly higher (P < 0.05) compared to the posttest mean scores of the control group. Conclusion: The study provided evidence on the effectiveness of a serious game in improving the self-efficacy and immediate postintervention performances of nurses teaching the inhaler technique. This game provides a practical and accessible learning tool to help nurses ensure effective patient education.

Some activities related to the maintenance of power distribution networks can be performed without interrupting the flow of energy on the line. This kind of activity, referred to as "live line maintenance", imposes risks which have to be taken into account, especially those which may affect human lives. Thus, the training process is crucial to the safety of electricians and to the success of maintenance operations. In order to address these issues, a virtual environment can be used as a mechanism for improving knowledge acquisition and retention, enhancing the quality of the learning process during training. This paper discusses the development of a serious game for training of live line maintenance activities. Aspects of the developed software, its characteristics and functional model, in addition to the interactive devices adopted and technical strategies are presented. The goal is to describe an unprecedented platform which uses devices such as the Nintendo Wii Remote and 3D TV sets to provide a novel model of interaction and navigation. These models are based on some principles of pervasive computing.

To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP. CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), andwiththe most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males). Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01). Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed. Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.