Stronger: A serious game framework for post-stroke rehabilitation

Different works in the educational field have proposed many applications for serious games (SGs) that have had immense positive impact and great success. Nevertheless, despite their potential, the application of SGs in education has been limited in terms of pedagogy. Several authors assert that this lack is because SG standards and guidelines have not been developed, and that there is an imbalance between the contribution from experts in education and game design specialists during the SG development. Specifically, methodologies that incorporate both game and pedagogical components in the requirements definition phase are necessary to develop serious games successfully. The definition of requirements must guide the development process. Many SG studies and projects indicates that games that are not well designed at the initial phase lose qualities and fail to fulfill pedagogical objectives. The goal of this study is to present a framework for a game design methodology that gives the gamer options for flexible participation in the game. We analyze the tasks associated with game design methodologies and serious educational games, especially those linked to gamers with non-standard cognitive abilities. Our approach identifies how educational innovation and the teaching-learning process contribute to game design. We propose an overall development focus based on a participatory, flexible, user-centered methodology adaptable to any type of gamer.

The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer’s disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician.

Serious Games (SGs) have been widely adopted in cultural settings and museums, especially the last five years. It is expected that SG can link directly the museum content with target user groups and can fulfill their educational needs. This paper aims to present a systematic mapping study on modern museum gaming technologies and applications. More specifically, focus is given on the use of Serious Games (SGs) by the visitors during exhibition navigation and exploration of museum's cultural and educational content. Major analysis criteria and review findings include game goals, purpose of use, scope, user acceptance and educational effectiveness. A pool of 48 quality literature publications were set under examination. It was found that most solutions were game-based than play-based and that both genres had educational benefits on offer. Also, the frequency of relevant publications per year was increasing from year 2009 up to 2015. Regarding scope, studied applications were split almost equally among education, culture and arts, while the overwhelming majority were targeted to the general public and not teachers, students or parents specifically. Those findings are of particular importance for museum curators, digital cultural content creators, pedagogical engineers and museum interface designers.

Alzheimer's disease and other related disorders (ADRD) represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments to assess the disease severity and progression, as well as to improve its treatment, stimulation, and rehabilitation. This is the underlying idea for the development of Serious Games (SG). These are digital applications specially adapted for purposes other than entertaining; such as rehabilitation, training and education. Recently, there has been an increase of interest in the use of SG targeting patients with ADRD. However, this field is completely uncharted, and the clinical, ethical, economic and research impact of the employment of SG in these target populations has never been systematically addressed. The aim of this paper is to systematically analyze the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of employing SG with patients with ADRD in order to provide practical recommendations for the development and use of SG in these populations. These analyses and recommendations were gathered, commented on and validated during a 2-round workshop in the context of the 2013 Clinical Trial of Alzheimer's Disease (CTAD) conference, and endorsed by stakeholders in the field. The results revealed that SG may offer very useful tools for professionals involved in the care of patients suffering from ADRD. However, more interdisciplinary work should be done in order to create SG specifically targeting these populations. Furthermore, in order to acquire more academic and professional credibility and acceptance, it will be necessary to invest more in research targeting efficacy and feasibility. Finally, the emerging ethical challenges should be considered a priority.

BackgroundThe use of serious games (SG) has received increasing attention in health care, and can be applied for both rehabilitation and evaluation of motor signs of several diseases, such as Parkinson’s disease (PD). However, the use of these instruments in clinical practice is poorly observed, since there is a scarcity of games that, during their development process, simultaneously address issues of usability and architectural design, contributing to the non-satisfaction of the actual needs of professionals and patients. Thus, this study aimed to present the architecture and usability evaluation at the design stage of a serious game, so-called RehaBEElitation, and assess the accessibility of the game.MethodsThe game was created by a multidisciplinary team with experience in game development and PD, taking into consideration design guidelines for the development of SG. The user must control the movements of a bee in a 3D environment. The game tasks were designed to mimic the following movements found in the gold-standard method tool—Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)—for the assessment of individuals with PD: hand opening and closing, hand extension and flexion, hand adduction and abduction, finger tapping, and forearm supination and pronation. The user interacts with the game using a wearable interface device that embeds inertial and tactile sensors. The architecture of RehaBEElitation was detailed using the business process model (BPM) notation and the usability of the architecture was evaluated using the Nielsen-Shneiderman heuristics. Game accessibility was evaluated by comparing the overall scores of each phase between 15 healthy participants and 15 PD patients. The PD group interacted with the game in both the ON and OFF states.ResultsThe system was modularized in order to implement parallel, simultaneous and independent programming at different levels, requiring less computational effort and enabling fluidity between the game and the control of the interface elements in real time. The developed architecture allows the inclusion of new elements for patient status monitoring, extending the functionality of the tool without changing its fundamental characteristics. The heuristic evaluation contemplated all the 14 heuristics proposed by Shneiderman, which enabled the implementation of improvements in the game. The evaluation of accessibility revealed no statistically significant differences (p < 0.05) between groups, except for the healthy group and the PD group in the OFF state of medication during Phase 3 of the game.ConclusionsThe proposed architecture was presented in order to facilitate the reproduction of the system and extend its application to other scenarios. In the same way, the heuristic evaluation performed can serve as a contribution to the advancement of the SG design for PD. The accessibility evaluation revealed that the game is accessible to individuals with PD.

ABSTRACTThe use of serious games (SGs) to provide intervention for various skills to children with autism spectrum disorder (ASD) has increased in the recent years. However, the potential of these games has not been utilized to provide learning of vocabulary to children with ASD. In designing games for children with ASD, there is a need to consider components specifically from the perspectives of ASD and the generic components that can support from the theoretical, content, and game design aspects. In the absence of any existing framework to design games for children with ASD, this article first introduces a framework named serious game design framework (SGDF), constructed to provide support throughout the design process. This framework was constructed based on the extensive review of the literature on ASD and existing SGDFs. The article then focuses on the design and development of a SG prototype based on SGDF. An experimental evaluation prototype was conducted to examine the effectiveness using the withdrawal design of single-subject research design (SSRD) in improving the receptive identification of vocabulary items among children with autism before and after using the prototype. The receptive identification of vocabulary items is measured in terms of the number of correct responses given and the number of attempts made to identify the correct response. The pre- and post-evaluations of the SG prototype show that learning of vocabulary items among children with ASD improved after using the game and they retained items at the end of weeks 1 and 2 following the withdrawal of intervention.

Recently, there has been growing interest in the use of Serious Games (SG), as they provide a more powerful means of knowledge transfer in almost every application domain especially in the crisis management field. With this increasing adoption of SG, designing novel techniques for learners’ assessment and evaluation has become of paramount importance to improve learning results and thus to maintain players’ motivation. This paper focuses on the learners’ assessment and evaluation in SG. After defining assessment and evaluation, we distinguish two main approaches: implicit and explicit. For each of these approaches, we present some techniques currently used in some existing games. Then we compare these different approaches and techniques. This synthesis is expected to help researchers and games creators working in this area and identifying benefits and limitations of these techniques in order to develop a new comprehensive technique that outperforms all existing ones.

In the context of Higher Education (HE) in general, and management education in particular, the use of Serious Games (SG) is spreading, and solutions are increasingly developing. Nevertheless, the implementation of this learning methodology deserves further study, in particular concerning pedagogical and psychological aspects such game performance and players’ metacognitive processes. This paper aims to study the relation among these two variables, based on the review of the results of MetaVals SG during the last 3 years. MetaVals is a collaborative, computer-based SG designed to facilitate collaboration and metacognitive awareness among HE students. It has been played by 250 students in 16 different experiences since its first version, in 2011. Overall results show a higher performance for collaborative than individual phases of the game, furthermore, students’ elicitation of their Level of Certainty (LC), although not significantly, could be related to a better performance. These results can be a basis for further studies focused on the implementation of collaborative GBL in formal and informal adult learning contexts. However, some challenges are also identified and discussed on the present version of MetaVals game, and solutions are proposed in order to continue with the design of SGs for wider application and learners’ needs in the current contexts.

Serious game for rehabilitation of the lower limb of hemiparetics patients after stroke

Serious Games (SG) have been conceptualized for various target groups (particularly stroke) in neurorehabilitation. SG claim to be effective at two levels: achieving the serious goal (effectiveness) and eliciting game experience (attractiveness). A systematic review of recent studies (4 RCT and 30 further studies) retrieved from four data bases (PubMed, Google scholar, IEEE, and ACM) was performed addressing two main issues: (1) applied game technologies and (2) the effectiveness and attractiveness of rehabilitation games. The study reveals heterogeneous features of the studies concerning game technology, target group, duration and volume of intervention, and outcome variables. The outcomes concerning functional improvement and attitude are sparsely documented and show a positive tendency. However, the evidence is not yet convincing. In the future, more studies with improved methods are needed to substantiate the evidence.

This study aimed to investigate the efficacy of traditional Chinese medicine (TCM) syndrome differentiation nursing in the rehabilitation of language function in stroke patients. This study compares the effects of TCM syndrome differentiation nursing and conventional rehabilitation nursing by assessing changes in language function using the Boston Diagnostic Aphasia Examination (BDAE) scores and clinical efficacy evaluation. This study is a retrospective study in which we reviewed cases of poststroke rehabilitation from 2020 to 2023. A total of 100 stroke patients were enrolled and divided into 2 groups: the TCM syndrome differentiation nursing group (n = 50) and the conventional rehabilitation nursing group (n = 50). TCM syndrome differentiation nursing was tailored based on individual patients' TCM diagnoses (e.g., Qi deficiency, blood stasis, or phlegm-dampness) and involved a combination of targeted nursing care, acupuncture, and herbal remedies. The conventional rehabilitation nursing group received standard poststroke rehabilitation therapies, including speech therapy and physical exercises. Both groups were assessed using BDAE scores and clinical efficacy evaluations at baseline and after 12 weeks of intervention. The TCM syndrome differentiation nursing group showed significantly greater improvements in BDAE scores compared with the conventional rehabilitation group (mean increase: 15.2 vs 8.6, P < .05). In addition, 72% of patients in the TCM group were classified as having "marked improvement" in clinical efficacy, compared with 48% in the conventional rehabilitation group (P < .05). The TCM group also reported fewer complications such as fatigue and stress compared with the conventional rehabilitation group (P < .05). TCM syndrome differentiation nursing significantly enhances language function recovery in stroke patients and serves as a valuable supplement to conventional rehabilitation methods. This study provides novel evidence supporting the integration of TCM-based interventions in stroke rehabilitation, offering a complementary approach to existing therapeutic strategies. Further research is needed to explore the long-term effects and underlying mechanisms of TCM syndrome differentiation nursing.

The use of serious games in cognitive rehabilitation would be invaluable to the rehabilitation process and provide advantages that may not be available in conventional rehabilitation. Although many recent game-based interventions for cognitive rehabilitation have been reported in the literature, not much knowledge is available on the best approach to develop usable games for individuals with cognitive disabilities. Therefore, Design Science approach was adopted to find a solution to this problem. This paper explores an existing Design Science framework and methodology, which are then combined and reduced into one single framework. This paper further examines how this framework can be used as a means to develop an artefact that can be used as a guideline in developing serious games for cognitive rehabilitation. The Design Science paradigm works well for the development of serious game for cognitive rehabilitation. This paper concludes with a discussion of the research contributions.

Use of Kinesio taping in lower-extremity rehabilitation of post-stroke patients: A systematic review and meta-analysis

Digital games cannot only be used for fun and entertainment. The term “serious games” (SG) denotes digital games serving serious purposes like education, training, advertising, research and health. Recently, a new generation of games has emerged involving whole-body movements. Compared to traditional interventions, these games may help elderly people to improve their health by enhancing physical fitness and coordinative abilities by combining increased motivation, game experience like fun and game flow and training. Serious games, particularly adventure and shooter games, already play an important role in health education, prevention and rehabilitation, e.g. to enhance health-related physical activity, improve sensory–motor coordination, prevent asthma, change nutrition behaviour and alleviate diabetes and prevent smoking or HIV. In this paper, the impact of SG on prevention and rehabilitation is discussed. Three criteria are applied. Beyond effectivity and efficiency, the additional benefits of serious games can be described and explained by different models including social, psychological, physiological and sensory–motor factors. The quality of study serves as a third criterion. Despite first promising results, there are only few high-quality studies. Adequate content, game interfaces, sustainability and appropriate settings are critical factors for the success of SG. In this regard, (sport) science can help to develop and evaluate SG and test appropriate settings that ensure sustainable use of serious games.

Ceftazidime-avibactam (CAZ-AVI) is a new cephalosporin/β-lactamase inhibitor combination that received clinical approval in China in 2019. This study aims to investigate the efficacy and safety of CAZ-AVI in the treatment of Klebsiella pneumoniae (KP) infection in a hospital, and differences in efficacy among various infection sites and between monotherapy and combination therapy, providing valuable insights for its further application. Patients who used CAZ-AVI between January 2019 and April 2023 were identified through the hospital information system. Demographic information, details of the infection site, KP strain's drug sensitivity report, treatment duration, combination therapies, adverse drug reactions (ADR), and 28-day survival were recorded. Clinical and microbiological efficacies were analyzed using SPSS 23.0 software to compare different infection sites and combination therapies. The overall effective clinical response (CR) rate of CAZ-AVI against KP infection was 62.13%, with a favorable microbial response (MR) rate was 65.68% and a 28-day survival rate was 63.91%. No significant difference occurred in effective CR and 28-day survival rate among different infection sites (P = 0.709 and 0.862, respectively). The favorable MR rate for abdominal infections was slightly lower than that for other sites of infection (P = 0.021). No significant differences in effective CR, favorable MR, and 28-day survival between monotherapy and combination therapy were present (P values were 0.649, 0.123, and 0.280, respectively). The incidence of ADR was 1.78%, including increased creatinine, elevated transaminase, hematuria, and thrombocytopenia. CAZ-AVI demonstrates good clinical efficacy and safety in the treatment of KP infections. The clinical efficacy of CAZ-AVI was similar across different infection sites, and combination therapy did not show an advantage over monotherapy. Further studies are warranted. It should be noted that CAZ-AVI may induce thrombocytopenia and hematuria.