Serious Games For Healthcare Research Articles

Quality of experience assessment in virtual/augmented reality serious games for healthcare: A systematic literature review

Virtual reality (VR) gaming (VRG) captures, examines, analysis, and renders the game data virtually instead of the users’ devices over efficient networks. E.g., VR is crucial in visually guided surgery and manifold therapies. Video Quality Assessment (VQA) helps VRG software and devices execute high-quality inputs/outputs. This paper debates VRG processes, environments, VQA metrics, Quality of Experience (QoE), platforms, current methods, tools, use in medicine, existing operational gains/challenges, and highlights future directions.

Virtual reality and serious games in healthcare

This paper covers the uses and remedies of invented games and Virtual Reality (VR) in medical settings, such as exercise therapy for motor rehabilitation and exposure treatment for psychological fears and the alleviation of suffering. This paper examines the cutting-edge interactive gadgets seen in contemporary virtual reality and high-end gaming titles, including data gloves, haptic force feedback devices, and tracking devices based on sensors and cameras. Major ideas and breakthroughs in the discipline of gaming technology are examined, including adaptive games, flow theory, dynamic simulations, and potential uses in serious gaming and medicine. Examples of VR systems and game trials for stroke recovery are presented to illustrate the advantages and effects of these technologies over traditional clinical practices. The paper concludes by outlining potential future directions for the use of emerging gaming technologies in medical services, including augmented realities, the Wii-remote motion control system, and full-body motion capture and controller-free games, which were showcased at E3 2009. These technologies have significant potential for treating motor disorders, preventing obesity, and addressing other medical issues.

A Software Engineering Framework for Reusable Design of Personalized Serious Games for Health: Development Study.

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. 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. 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. 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. 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.

Who Engages and Why It Matters?

While the use and benefits of serious games in health care are increasingly recognized, the impact of individuals' game engagement remains understudied, limiting the potential for impact. This pilot study aims to describe game engagement and its associations with learning outcomes, sociodemographics, and health factors in women with advanced cancer receiving a 12-week self-advocacy serious game intervention. Game engagement was collected from study tablets and weekly self-reported surveys. Participants' game engagement was overall high but with large amounts of variation and did not differ by their sociodemographics and health factors. Participants with lower baseline symptom severity were more likely to repeat game scenarios, and those who engaged in all scenarios had higher connected strength post-intervention. Knowing what prevents patients with advanced cancer from engaging in the serious game enlightens ways to refine the gamified interventions. Future research is suggested to evaluate patients' engagement to deepen understanding of its impacts on learning outcomes.

Artificial Intelligence-Driven Serious Games in Health Care: Scoping Review.

Artificial intelligence (AI)-driven serious games have been used in health care to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state to plan on how to leverage them in the current and future health care needs. This study aimed to explore the features of AI-driven serious games in health care as reported by previous research. We conducted a scoping review to achieve the abovementioned objective. The most popular databases in the information technology and health fields (ie, MEDLINE, PsycInfo, Embase, CINAHL, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched using keywords related to serious games and AI. Two reviewers independently performed the study selection process. Three reviewers independently extracted data from the included studies. A narrative approach was used for data synthesis. The search process returned 1470 records. Of these 1470 records, 46 (31.29%) met all eligibility criteria. A total of 64 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games were used for rehabilitation in most of the studies. The most common genres of serious games were role-playing games, puzzle games, and platform games. Unity was the most prominent game engine used to develop serious games. PCs were the most common platform used to play serious games. The most common algorithm used in the included studies was support vector machine. The most common purposes of AI were the detection of disease and the evaluation of user performance. The size of the data set ranged from 36 to 795,600. The most common validation techniques used in the included studies were k-fold cross-validation and training-test split validation. Accuracy was the most commonly used metric for evaluating the performance of AI models. The last decade witnessed an increase in the development of AI-driven serious games for health care purposes, targeting various health conditions, and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. Although the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

Assessing HapHop-Physio: An Exer-Learning Game to Support Therapies for Children with Specific Learning Disorders

The HapHop-Physio exer-learning game is a cognitive rehabilitation solution for children with learning disorders to train memory and attention functions. Therefore, HapHop-Physio must be assessed as an appropriate tool developed to support the enhancement of essential cognitive skills. In this paper, we aim to establish the validity of HapHop-Physio in a healthcare setting with children receiving training with this tool. HapHop-Physio was developed through interaction between clinical experts, one graphic designer, and game developers. Following an assessment framework for serious games in healthcare, the game’s rationale, functionality, validity, and data safety are described. Particularly, the validity was assessed with experts through a case study conducted in three phases with 12 children diagnosed with Specific Learning Disorders. The baseline of the cognitive profile of the children was obtained and trained with HapHop-Physio. General trends and findings were obtained through an exploratory analysis of the gathered results from the phases. The validity aspects were achieved through continuous feedback from the experts, allowing to improve the game in five features: game structure, scoring system, avatars, login system, and clinicians’ dashboard. The application of the assessment framework in HapHop-Physio guarantees end users that the game is safe and effective enough to be used for supporting memory and attention training. One relevant finding from the case study was that cognitive performance improved in 11 out of 12 children at the end of the training. The positive outcomes of this assessment indicate the game’s appropriateness for a healthcare setting. However, the improvement in cognitive performance cannot be associated with HapHop-Physio in this case study. Consequently, it needs to be evaluated in a controlled experiment (including a control group) to ensure that it leads to cognitive rehabilitation in reality.

Application of Serious Games in Health Care: Scoping Review and Bibliometric Analysis.

BackgroundSerious games (SGs) as one kind of intervention that can improve the level of knowledge and change behavior to affect health outcomes has been increasingly applied in health care.ObjectiveAnalyze hotspots and trends of the application of SGs in health care and provide reference and direction for further research in the future.MethodsThe Web of Science (WoS) Core Collection database was used for extracting the literature on SGs in health care for the period from the database established to 11 October, 2021. Scoping review and bibliometric analysis were used to deeply analyze and visualize countries, categories of studies, annual study output, cited authors, cited journals, cited articles, and keywords of healthcare field.ResultsA total of 1,322 articles were retrieved, then every articles' title and abstract were read one by one, and 795 articles were included after screening with an exponential increase in publication volume. The United States of America made the greatest contribution to global publications regarding SGs in health care. From the total, 20.8% of articles fall under the category of health care sciences services. The target groups were mainly concentrated in children (18.0%), youth (13.8%), the elderly (10.9%), adolescents (9.1%), and adults (3.4%). Baranowski T (n = 103 citations) is the most influential author, followed by Kato PM (n = 73 citations) and Desmet A (n = 58 citations). The top three cited journals were “Plos One” (n = 268 citations), “Games for Health Journal” (n = 209 citations), and “Journal of Medical Internet Research” (n = 197 citations), and the top three cited articles were “A meta-analysis of serious digital games for healthy lifestyle promotion,” “A Systematic Review of Serious Games in Training Health Care Professionals,” and “Video game training enhances cognitive control in older adults.” More and more studies focus on specific age groups, such as children, adolescents, and the elderly. The research hotspots and trends included “rehabilitation,” “medical education,” and “design.”ConclusionsThe application of SGs in health care remains important areas for future research. “Rehabilitation,” “medical education,” and “design” reflected the latest research hotpots and future trends.

Architecting Intelligent Smart Serious Games for Healthcare Applications: A Technical Perspective.

The immune system of human beings plays a pivotal role in guarding against different types of diseases. During the COVID-19 pandemic, people with weak immune systems were more likely to die. Regular physical activities and healthy food intake can significantly improve the immune system; however, people with a sedentary lifestyle and a busy job schedule find it challenging and tedious to maintain regularity. Different approaches have been used over the years to engage people in various physical activities and improve their mental and physical health. The concept of employing serious games (games whose primary purpose is not fun or entertainment, but a serious goal) to effectuate better results has become one of the popular choices among healthcare professionals and research communities. Internet of things (IoT) has enabled digital transformation with smart cities, smart infrastructure, and the fourth industrial revolution. There have been some relevant studies on the encouragement of serious games in healthcare in the past few years. However, few research studies encourage IoT-enabled serious games played with IoT devices (sensors and actuators) by making the game experience more ubiquitous and pervasive. Consequently, the adaptation of the IoT in serious games for healthcare applications is a massive gap despite its growing need in an era significantly affected by COVID-19. This paper discusses the possibilities of integrating serious games with IoT and discusses the standard architecture, core technologies, and possible challenges. Finally, we present a prototype architecture and its various components and a qualitative analysis with recent studies.

Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING).

BackgroundIn health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so.ObjectiveThis study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions.MethodsWe used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field.ResultsOur results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions.ConclusionsConceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.

Social acceptance of serious games for physical and cognitive training in older adults residing in ambient assisted living environments

AimsAlthough ambient assisted living (AAL) environments and serious games for healthcare have been proposed as solutions to meet the changing demographics, the two approaches are rarely combined. We present the development and empirical evaluation of two serious games for healthcare in AAL. The first uses a cooking scenario for training of cognitive functioning. The latter uses a gardening scenario and motion capture for training agility and endurance. As the frequent lack of social acceptance is a major challenge in consumer health technology, we integrated methods of technology acceptance research by means of the UTAUT2-model and intention to use into the evaluation.Subject and methodsWe developed both games utilizing user-centered and participatory design methods ranging from low-fidelity paper prototypes to usability and acceptance evaluations of functional prototypes. In the final evaluation, each game prototype was evaluated by 64 participants form different age groups.ResultsThe results show that although performance decreases with age, the performance attained in the games is not decisive for social acceptance measured as intention to use. However, user diversity factors shape the evaluation of the games, and older people and people with low technical competence are in danger of being excluded from using serious games for healthcare.ConclusionExercise games, if designed right, can mitigate the negative effects of demographic change. Nevertheless, user diversity needs must be considered to ensure that the games are usable and used by a broad audience. The article concludes with guidelines and open research questions for the design of serious games in AAL environments.

Serious Motion-Based Exercise Games for Older Adults: Evaluation of Usability, Performance, and Pain Mitigation.

BackgroundMany societies are facing demographic changes that challenge the viability of health and welfare systems. Serious games for health care and ambient assisted living (AAL) offer health benefits and support for older adults and may mitigate some of the negative effects of the demographic shift.ObjectiveThis study aimed to examine the acceptance of serious games to promote physical health in AAL environments. Since AAL environments are designed specifically to support independent living in older adults, we studied the relationship among age and user diversity, performance in the game, and overall usability and acceptance evaluation.MethodsWe developed a motion-based serious exercise game for prototypical AAL environments. In two evaluations, outside (n=71) and within (n=64) the AAL environment, we investigated the influence of age, gender, self-efficacy in interacting with technology, need for achievement on performance, effect of the game, usability evaluation of the game, and overall acceptance.ResultsBoth games were evaluated as easy to use and fun to play. Both game interventions had a strong pain-mitigating effect in older adults (game 1: −55%, P=.002; game 2: −66%, P=.01).ConclusionsSerious exercise games outside and inside AAL environments can contribute to individuals’ health and well-being and to the stability of health care systems.

Artificial Intelligence in Health Care and Medicine: A Personalized Approach

Artificial Intelligence (AI) is becoming more and more ubiquitous, and AI also invades health care and related fields ever more. We believe this is a good thing. Inspired by work that we have done in various projects at the Alan Turing Institute Almere (ATIA), Delft University of Technology (TUD), Utrecht University (UU), and Vrije University (VU), we’ll review a number of applications of AI in health care and medicine, mainly from a personal viewpoint, expertise and interest. In many of the projects we have worked on there is a shared focus and interest in creating a more personalized approach to health care and medicine. It is this focus on a more personalized health care that we want to highlight in this paper. To this end, we review various examples of work to illustrate and argue that AI, and Social AI in particular, has great potential for improving healthcare and enabling a more personalized approach. We show techniques from Social AI can be effectively applied in developing Behavior Change Management systems, and illustrate its use in related work on data collection for Value-Based Health Care. In particular, we’ll discuss artificial emotions, serious games for healthcare, and artificial companions to assist with the care of patients in a hospital or home setting. These companions are able to monitor the behavior of patients, help them remind of taking medication, but also can have conversations with them giving them the feeling that they are cared for. We argue that these examples of Social AI techniques can be used to enable and improve personalized health care even in times where health care is economized upon like we face in The Netherlands. More generally, in this article we discuss various methods and techniques from AI to do this.

FASim: A 3D Serious Game for the First Aid Emergency

Background and Aim. This article aims to present FASim (First Aid Simulator), a 3D serious game for the first aid emergency. This game combines in a single framework the healthcare simulations with serious games and the functionalities of the multi agents systems (MAS). This work devoted to the basic steps in the development of our serious game FASim to learn the first aids and the signs of cardiac arrests which are the leading cause of premature death and the major cause of disability in the world. The practice of serious games in healthcare should be based on four main axes; firstly, the interaction between players is the key element of learning; secondly the adaptation of the game to the profiles of the players. So the game must be in relation with their abilities. Thirdly, the awareness and prevention are the important ingredients in healthcare to promoting the collective recognition of problems of giving the first step towards its resolution; finally, we need some intelligence to organize the first three axes to be able to make quick and accurate decisions. Results and Conclusion. The speed of intervention in the case of rapid cardiopulmonary resuscitation (CPR) increases the probability of survival after sudden cardiac arrest is still the key element to ensure success proven by QRISK method, which is a mathematical application to calculate the probability of having a heart attack. The number of staff must be very high preferences as a result we have created the collaboration to save the maximum life possible, and we implement an adaptive approach to improve the usability of the game. FASim focuses on the action of making quick and precise decisions, which must require a practical reasoning provided by the integration of the BDI (Belief Desire Intention) agent in the Non Players Character (NPCs). All our solutions are focus on the agent-based simulation, which is an excellent approach answer to all the criteria of medical emergencies.

A Serious Game for Clinical Assessment of Cognitive Status: Validation Study.

BackgroundWe propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening.ObjectiveThe objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations.MethodsWe carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM).ResultsAfter a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=–.339, P <.001) and MMSE (r=–.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments.ConclusionsThis research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making.

Making Games for Health Engaging: The Influence of Cognitive Skills.

Serious games for health care are on the rise. These games are thought to be effective because they can provide information in a context that is engaging. However, it is likely that game-based health training is most effective for a subset of people with specific skills, traits, and experiences. Understanding the factors associated with optimum game outcomes will help us better describe the learners for whom they are appropriate. Toward this end, the present study examined specific cognitive skills related to the achievement of flow state while playing a game for health. In total, 59 college students were recruited from undergraduate classes to play a game for health and were assessed on levels of mindfulness, cognitive flexibility, and flow state. The results suggest that the effect of cognitive flexibility on flow changes as a function of mindfulness. More specifically, the results suggest that there is a negative relationship between cognitive flexibility and flow in individuals low on mindfulness and a positive relationship between cognitive flexibility and flow in individuals high on mindfulness. Game designers wishing to create effective game-based treatment supplements may wish to implement cognitive flexibility and mindfulness training.

Educational Game Development Approach to a Particular Case: The Donor's Evaluation

BackgroundSerious games are a current trend nowadays. Almost every sector has used serious games in recent years for different educational purposes. The eLearning research team of the Complutense University of Madrid main focus of research is the development of low-cost serious games. During the past 10 years, we have been working with and developing serious games, paying special attention to those related to healthcare. MethodsFrom all these studies, a methodology was defined—the Educational Game Development Approach (EGDA)—to design, develop, and evaluate game-like simulations or serious games in healthcare. We present the application of the EGDA to a particular case, the development of a serious game representing the donor's evaluation in an intensive care unit from the point of view of a hospital coordinator following the EGDA methodology. In this simulation, we changed the strategy of selection of teaching cases by exponentially increasing the number of teaching cases. ResultsThis kind of educational content provides several benefits to students as they learn while playing; they receive immediate feedback of mistakes and correct moves and an objective assessment. These simulations allow the students to practice in a risk-free environment. Moreover, the addition of game elements increases engagement and promotes the retention of important information. ConclusionsA game-like simulation has been developed through the use of this methodology. This simulation represents a complex medical procedure.

Serious Games for Healthcare: Applications and Implications.

Serious Games for Healthcare: Applications and Implications.

Serious Games in Health Care: a Survey

to present an overview of existing serious games in healthcare designed for patients, and the evaluation of their effects. Such games, aiming to help patients better understand their condition or treatment, to foster healthy behaviors, or even to participate in therapies, are expected to grow in parallel with the importance of the videogaming industry. references were searched in Medline and through recursive browsing of their citations. 21 papers were identified and analyzed. Serious games are used to increase knowledge and control, foster preventive behaviors, or can be used in therapies. Their positive effects on improved patient understanding, adherence, and engagement, although documented mostly in preliminary studies, calls for the development and more thorough evaluation of these tools.