Games for Health Journal

Particularly in the last 2 years, due to the new coronavirus pandemic, people with depression have increasingly sought human connection and relief from depressive symptoms through playing in the world of videogames, and a small yet growing portion of researchers have been investigating the therapeutic potential of that kind of interaction.

The objective of this review was to provide an exploration of the current panorama of scientific research with videogames used as therapeutic intervention tools for depression.

A systematic review was performed for that purpose, with a semantic field of 12 keywords around the terms “depression,” “mental health,” and “video games” narrowed down into a concise syntax—(games OR serious games) AND (depression) AND (treatment)—applied to relevant databases for health research; followed by the execution of a search and screening protocol based on one guiding question; and analysis of results based on four elaborative questions.

Twenty-six studies met the inclusion criteria and provided a set of both quantitative and qualitative data about demographics, kinds of therapeutic interventions, types of videogames used in the interventions, places, and forms of interaction.

Important gaps were found in the review, such as a lack of research aimed at the age group most affected by the disorder, who is also the largest consumer of games; and fresh opportunities to expand the understanding of the subject as well as guide developments of game-based therapeutic interventions.

With the elements of competition and reward, digital game-based learning is reportedly more effective than traditional instruction methods. Moreover, children with attention problems are reportedly often interested in internet games. We hypothesized that digital game-based learning can improve the effectiveness of educational opportunities in Russian immigrant children and could be more effective in children with attention-deficit/hyperactivity disorders (ADHD) compared with other children.

This study was designed as an 8-week crossover study that comprised 4 weeks of game rounds and 4 weeks of control rounds for two groups. Wise-Ax™ is a casual digital game for vocabulary education among Russian immigrant children. To develop the game, 1200 Korean words were selected from the word pool suggested by the Korean Government's Department of Education. A total of 26 students participated in the study. At 4 and 8 weeks, all students took the Korean language ability tests.

The study found that more than 80% of the children were satisfied with their digital game-based Korean education, which greatly improved their Korean language ability compared with the traditional teaching methods. Children with ADHD showed a greater increase in the Korean ability test compared with children without ADHD in the game round.

Wise-Ax could be an effective tool to help improve the Korean language ability of Russian immigrant children, especially those with ADHD.

The primary aim of this pilot study was to test the feasibility and acceptability of a prototype of a novel digital system enabling somatosensory training at home by means of a gamified mobile application in patients with chronic pain. The secondary aims were to test the effect size of the intervention on clinical outcomes to power a subsequent randomized controlled trial.

We conducted a pilot randomized controlled trial in patients with fibromyalgia. This was an 8-week crossover study, which included a 4-week somatosensory training phase (daily use with the novel digital system) and a 4-week control phase (no use of this new system) in a random order. Feasibility was tested by objectively measuring the adherence and retention rates. Acceptability and changes in pain and disability were measured through data from subjective questionnaires.

Thirty-five patients completed the study. The satisfaction questionnaire indicated high training enjoyment, ease of use for daily training and interest to continue to use the intervention after the study. The adherence (93%) and retention (94%) rates were high. The effect sizes were moderate for pain intensity (0.57).

The novel gamified technology for remotely delivered somatosensory training is feasible in a group of patients with fibromyalgia, and results in high engagement, satisfaction, and adherence. A subsequent clinical trial with the final version of the technology platform, including a longer training with more sensory training tasks and a bigger sample size is necessary.

Fibromyalgia is a complex pain syndrome with high personal and societal costs, with only few effective tools for treatment. Virtual reality (VR) may be an efficient pain management tool although the effectiveness in fibromyalgia patients is unclear.

This randomized crossover study set out to 1) investigate the effect of VR on cold pain threshold, -tolerance, and -intensity in fibromyalgia patients and in pain-free individuals and 2) explore the potential relationships between the effect of VR and pain catastrophizing.

Twenty-two female fibromyalgia patients and 22 sex- and age-matched pain-free individuals participated in two conditions (one with VR and one without VR) with foot immersion in 1°C–2°C cold water. The order of conditions was randomized and counterbalanced for each group. Conditions were separated by 20 minutes. Cold pain threshold, -tolerance, and -intensity were assessed during the conditions. Pain catastrophizing was assessed using the Pain Catastrophizing Scale.

VR induced moderate to large increases in cold pain threshold and pain tolerance compared with the control condition for both the fibromyalgia group and pain-free individuals (P < 0.03). Pain intensity was reduced after VR only in pain-free individuals (P < 0.003). Pain catastrophizing was not related to VR effect on pain threshold, -tolerance, or -intensity for any group.

VR had a significant effect on pain threshold and tolerance in fibromyalgia patients and pain-free individuals, which supports its ability to distract from pain. Future studies exploring the VR's potential as part of clinical pain management alone or in combination with other treatments are warranted.

ClinicalTrials.gov (NCT04294914).

This study examined the effects of motor-cognitive dual-task exergaming standing balance training on healthy older adults' static, dynamic, and walking balance.

Twenty-four adults older than 70 years (control group: n = 9, males = 6, balance training group: n = 15, males = 8) completed the experiment. Dual-tasking standing balance training comprised the accurate control of a ping-pong ball on a tray held with both hands, while standing on one leg (analog training) and three modules of Wii Fit™ exergaming (digital training). The duration of balance training was ∼15 minutes per day, 2 days per week for 8 weeks, in total 16 sessions. We measured one-leg standing time, functional reach distance, walking balance evaluated by the distance walked on a narrow beam (4-cm long, 4-cm wide, and 2-cm high) with single and dual tasking, habitual and maximal walking speed, and muscle strength of the hip extensor, hip abductor, hip adductor, knee extensor, and plantarflexor muscle groups in the right leg at baseline and after 8 weeks.

Control group decreased, but balance training group increased one-leg standing time. Only the balance training group improved functional reach distance and hip and knee extensor strength. There was no change in walking speed and walking balance in either group. In the balance training group, changes in maximal speed correlated with changes in dual-tasking walking balance and changes in one-leg standing time correlated with changes in single-tasking walking balance.

These results suggest that 16 sessions of motor-cognitive dual-task standing exergaming balance training substantially improved healthy older adults' static and dynamic balance and leg muscle strength but failed to improve walking speed and walking balance. Balance exercises specific to walking balance need to be included in balance training to improve walking balance.

Muscle strength and balance impairment change the control strategy and increase the probability of falling. This study aimed to investigate the effect of 6-week strength-balance training through virtual reality exergaming (VRE) on muscle strategy during the limits of stability (LOS) test, fear of falling, and quality of life (QOL) in osteoporotic women.

: Twenty volunteer postmenopausal women with osteoporosis were randomly allocated to the VRE (n = 10) and traditional training (TRT as control, n = 10) groups. The VRE and TRT strength-balance training was performed for 6 weeks and three sessions per week. Before and after exercise, the muscle activity (onset time, peak root means square [PRMS]) and hip/ankle activity ratio were assessed by the wireless electromyography system. The muscle activities of the dominant leg were recorded during LOS functional test. The fall efficacy scale and QOL were assessed. Paired t-test was used to compare results within groups, and an independent t-test was used to compare the percentage changes in parameters between the two groups.

The VRE improved the onset time and PRMS. The VRE significantly reduced the hip/ankle activity ratio in the LOS test's forward, backward, and right directions (P < 0.05). No significant change was seen in all directions of the LOS functional test in the TRT group (P > 0.05). VRE reduced the fall efficacy scale (P = 0.042). Both VRT and TRT improved the total QOL score (P = 0.010).

VRE was more effective in decreasing the onset time and hip/ankle ratio of muscle activation. The VRE is recommended to induce a better ability to reduce the fear of falling and control balance during functional activity in osteoporotic women.

Clinical Trial Registration number: IRCT20101017004952N9.

Pediatric hemiplegia is associated with wide-ranging deficits in arm and hand motor function, negatively impacting participation in daily occupations and quality of life. This study investigated whether performance measures generated during therapy videogame play by children with hemiplegia can be valid indicators of upper extremity motor function.

Ten children with hemiplegia used a custom therapy game system alternatively using their affected and non-affected hand to provide motion capture data that spans a wide range of motor function status. The children also completed a series of standardized outcome measure assessments with each hand, including the Quality of Upper Extremity Skills Test, the Jebsen Taylor Hand Function Test, and the Wolf Motor Function Test.

Statistical analysis using the nonparametric Spearman rank correlation revealed high and significant correlation between videogame-derived motion capture measures, characterizing the speed and smoothness of movements, and the standardized outcome measure assessments.

The results suggest that a low-cost motion capture system can be used to monitor a child's motor function status and progress during a therapy program.

The use of virtual reality (VR) as a non-pharmacologic method may enable children to tolerate invasive procedures in a hospital setting easily and feel less pain. This study aimed at determining the effect of using a VR headset during venipuncture on pain level, heart rate (HR), and oxygen saturation values in children aged 7–12 years old.

This was a randomized controlled experimental study. This study included 102 children (experimental group: 52; control group: 50) who visited a pediatric outpatient clinic of a university hospital in Turkey between May 2018 and May 2019. Data were collected using the Child and Family Information Form, State Anxiety Inventory for Children, Faces Pain Scale-Revised (FPS-R). Before venipuncture, state anxiety and pain scores of the children were evaluated. The children in the experimental group wore VR headsets during venipuncture. The children in the control group underwent standard venipuncture procedure. Pain scores were evaluated again in both groups after the venipuncture. Before, during, and after the venipuncture, pulse and oxygen saturation values were measured.

It was determined that post-procedure pain score was 1.46 ± 1.49 in the experimental group and 4.44 ± 2.26 in the control group. Post-venipuncture pain mean scores were significantly lower in the experimental group than those of the children in the control group (Z = −6.574; P = 0.001). Secondary outcomes: The mean HR during the procedure was significantly lower in the experimental group (99.27 ± 18.34/min) than in the control group (108.20 ± 21.42/min) (P = 0.026; t = −2.265). There was no statistically significant difference between the before and after the procedure difference of oxygen saturation values (Experimental group: −0.15 ± 1.54; Control Group: 0.04 ± 0.93) between groups (Z = −0.023; P = 0.982).

It was determined that post-venipuncture pain mean scores were significantly lower in the experimental group than in the control group. VR is effective to reduce the pain of children during venipuncture. VR headsets may be recognized as effective instruments to reduce the pain level of children in hospital settings. (Clinicaltrials.gov: NCT04950478)