Recent Articles:

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  Serious Games for Health and Medicine

  Sep 22, 2020

  Controlling the Sense of Embodiment for Virtual Avatar Applications: Methods and Empirical Study

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  Authors List:

  • Chang-Seop Kim  
  • Myeongul Jung  
  • So-Yeon Kim  
  • Kwanguk Kim  

  Abstract:

  Background: The sense of embodiment (SoE) is the feeling of one’s own body, and research on the SoE extends from the rubber hand illusion to the full-body ownership illusion with a virtual avatar. Objective: The key to utilizing a virtual avatar is understanding and controlling the SoE, and it can be extended to several medical applications. In this study, we aimed to clarify these aspects by considering the following three subcomponents of SoE: sense of agency, ownership, and self-location. Methods: We defined a human avatar (HA), point light avatar (PLA), and out-of-body point light avatar (OBPLA) and compared them in three user studies. In study 1, 28 participants were recruited and the three avatar conditions (HA, PLA, and OBPLA) were compared. In study 2, 29 new participants were recruited, and there were two avatar conditions (HA ad PLA) and two motion synchrony conditions (synchrony and asynchrony). In study 3, 29 other participants were recruited, and there were two avatar conditions (PLA and OBPLA) and two motion synchrony conditions (synchrony and asynchrony). Dependent measures included sense of agency, ownership, and self-location; emotional response; presence; and simulator sickness. Results: The findings of study 1 showed that the three avatar generation methodologies can control the sense of ownership and self-location in a stepwise manner while maintaining a high sense of agency. In studies 2 and 3, we found dependencies among the three subcomponents of SoE and observed that they affected users’ subjective experiences. Conclusions: Our findings may have implications for boosting the effects of virtual avatar applications in medical areas, by understanding and controlling the SoE with a full-body illusion.

  • JMIR Serious Games 2020;8(3):e21879

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  Game Design and Efficacy of Game...

  Sep 17, 2020

  Relationship Between Children’s Enjoyment, User Experience Satisfaction, and Learning in a Serious Video Game for Nutrition Education: Empirical Pilot Study

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  Authors List:

  • Ismael Edrein Espinosa-Curiel  
  • Edgar Efrén Pozas-Bogarin  
  • Juan Martínez-Miranda  
  • Humberto Pérez-Espinosa  

  Abstract:

  Background: The design and use of serious video games for children have increased in recent years. To maximize the effects of these games, it is essential to understand the children’s experiences through playing. Previous studies identified that enjoyment and user experience satisfaction of the players are principal factors that can influence the success of serious video games and the learning of their players. However, research about the relationship between enjoyment and user experience satisfaction with learning in children 8 to 10 years old is sparse. Objective: We examined the relationship of enjoyment and user experience satisfaction with the learning of children aged 8 to 10 years while playing a serious video game for health, FoodRateMaster. This serious video game teaches children about the characteristics of healthy and unhealthy foods and how to identify them in their environment. Methods: Children aged 8 to 10 years were recruited from a primary school in Mexico. Participants completed 12 individual gaming sessions with FoodRateMaster in 6 weeks. A food knowledge questionnaire was administered before and after game play to assess the players’ food knowledge. In addition, after the gaming sessions, the children’s enjoyment and user experience satisfaction were evaluated using the EGameFlow questionnaire and the Game User Experience Satisfaction Scale (GUESS) questionnaire. Results: We found significant positive associations for children’s (n=60) posttest knowledge with enjoyment (r₅₈=0.36, P=.005) and user experience satisfaction (r₅₈=0.27, P=.04). The children’s posttest knowledge scores were also positively correlated with challenge (r₅₈=0.38, P=.003), knowledge improvement (r₅₈=0.38, P=.003), and goal clarity (r₅₈=0.29, P=.02) EGameFlow subscales and with narrative (r₅₈=0.35, P=.006), creative freedom (r₅₈=0.26, P=.04), and visual esthetics (r₅₈=0.32, P=.01) GUESS subscales. Regression analysis indicated that the EGameFlow (F_7,52=2.74, P=.02, R²=0.27) and the GUESS (F_8,51=2.20, P=.04, R²=0.26) ratings significantly predicted the children’s posttest knowledge scores. EGameFlow challenge (β=0.40, t₅₂=2.17, P=.04) and knowledge improvement (β=0.29, t₅₂=2.06, P=.04) subscales significantly contributed to predicting children’s learning. None of the GUESS subscales significantly contributed to predicting children’s learning. Conclusions: The findings of this study suggest that both enjoyment and user experience satisfaction for children aged 8 to 10 years were positively correlated with their learning and that were significant predictors of it. Challenge, knowledge improvement, narrative, creative freedom, and visual esthetics subscales correlated positively with children’s learning. In addition, challenge and knowledge improvement contributed to predicting their learning. These results are relevant to consider during the design stages of serious games developed for young children’s learning purposes.

  • JMIR Serious Games 2020;8(3):e21813

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  Serious Games for Health and Medicine

  Sep 14, 2020

  Serious Game on a Smartphone for Adolescents Undergoing Hemodialysis: Development and Evaluation

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  Authors List:

  • Cristina Célia De Almeida Pereira Santana  
  • Ana Tereza Vaz De Souza Freitas  
  • Gilson Oliveira Barreto  
  • Igor Sousa De Avelar  
  • Renata Mazaro-Costa  
  • Gina Nolêto Bueno  
  • Diuly Caroline Ribeiro  
  • Gabriela Damasceno Silva  
  • Alessandra Vitorino Naghettini  

  Abstract:

  Background: Adolescents with chronic kidney disease have a hard time adhering to hemodialysis as a therapy, indicating a need to establish new alternatives for motivation and adherence to treatment. Objective: The objective of this study was to develop and evaluate a serious game to stimulate and motivate adolescents undergoing hemodialysis. Methods: We describe the technological production followed by a qualitative analysis. We invited 8 adolescents undergoing hemodialysis in the city Goiânia, located in the midwest of Brazil, to participate. The final convenience sample included 7 (87.5% of the target population) adolescents. The process was conducted in 3 phases: creation of a serious game, evaluation of its use, and observation of its motivating effect on behavioral modification with a focus on acquiring the necessary competence for self-care. Results: An app (Bim) in the modality of a serious game was developed to be used during hemodialysis; the player was encouraged to take care of a character with daily actions during his or her treatment. The game was made available to adolescents aged 10-14 years. Mobile devices were offered during the hemodialysis treatment for a period of 30-40 minutes, 3 times a week for 60 days. The usage definitions of the game were freely chosen by the participants. The qualitative evaluation of the use of the Bim app showed that it encompasses scenarios and activities that enable the exercise of daily actions for the treatment of patients. The behavioral evaluation showed that the Bim app worked as a motivating stimulus for behavioral adherence to hemodialysis requirements. Conclusions: The easy-to-access app interface showed good operability for its users. The description of the character and proposed activities contributed to motivation and ability to cope with hemodialysis care.

  • JMIR Serious Games 2020;8(3):e17979

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  Gamification

  Sep 8, 2020

  Effective Gamification of the Stop-Signal Task: Two Controlled Laboratory Experiments

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  Authors List:

  • Maximilian Achim Friehs  
  • Martin Dechant  
  • Sarah Vedress  
  • Christian Frings  
  • Regan Lee Mandryk  

  Abstract:

  Background: A lack of ability to inhibit prepotent responses, or more generally a lack of impulse control, is associated with several disorders such as attention-deficit/hyperactivity disorder and schizophrenia as well as general damage to the prefrontal cortex. A stop-signal task (SST) is a reliable and established measure of response inhibition. However, using the SST as an objective assessment in diagnostic or research-focused settings places significant stress on participants as the task itself requires concentration and cognitive effort and is not particularly engaging. This can lead to decreased motivation to follow task instructions and poor data quality, which can affect assessment efficacy and might increase drop-out rates. Gamification—the application of game-based elements in nongame settings—has shown to improve engaged attention to a cognitive task, thus increasing participant motivation and data quality. Objective: This study aims to design a gamified SST that improves participants’ engagement and validate this gamified SST against a standard SST. Methods: We described the design of our gamified SST and reported on 2 separate studies that aim to validate the gamified SST relative to a standard SST. In study 1, a within-subject design was used to compare the performance of the SST and a stop-signal game (SSG). In study 2, we added eye tracking to the procedure to determine if overt attention was affected and aimed to replicate the findings from study 1 in a between-subjects design. Furthermore, in both studies, flow and motivational experiences were measured. Results: In contrast, the behavioral performance was comparable between the tasks (P<.87; BF01=2.87), and the experience of flow and intrinsic motivation were rated higher in the SSG group, although this difference was not significant. Conclusions: Overall, our findings provide evidence that the gamification of SST is possible and that the SSG is enjoyed more. Thus, when participant engagement is critical, we recommend using the SSG instead of the SST.

  • JMIR Serious Games 2020;8(3):e17810

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  Quality of Games

  Sep 8, 2020

  Usability of Individualized Head-Related Transfer Functions in Virtual Reality: Empirical Study With Perceptual Attributes in Sagittal Plane Sound Localization

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  Authors List:

  • Claudia Jenny  
  • Christoph Reuter  

  Abstract:

  Background: In order to present virtual sound sources via headphones spatially, head-related transfer functions (HRTFs) can be applied to audio signals. In this so-called binaural virtual acoustics, the spatial perception may be degraded if the HRTFs deviate from the true HRTFs of the listener. Objective: In this study, participants wearing virtual reality (VR) headsets performed a listening test on the 3D audio perception of virtual audiovisual scenes, thus enabling us to investigate the necessity and influence of the individualization of HRTFs. Two hypotheses were investigated: first, general HRTFs lead to limitations of 3D audio perception in VR and second, the localization model for stationary localization errors is transferable to nonindividualized HRTFs in more complex environments such as VR. Methods: For the evaluation, 39 subjects rated individualized and nonindividualized HRTFs in an audiovisual virtual scene on the basis of 5 perceptual qualities: localizability, front-back position, externalization, tone color, and realism. The VR listening experiment consisted of 2 tests: in the first test, subjects evaluated their own and the general HRTF from the Massachusetts Institute of Technology Knowles Electronics Manikin for Acoustic Research database and in the second test, their own and 2 other nonindividualized HRTFs from the Acoustics Research Institute HRTF database. For the experiment, 2 subject-specific, nonindividualized HRTFs with a minimal and maximal localization error deviation were selected according to the localization model in sagittal planes. Results: With the Wilcoxon signed-rank test for the first test, analysis of variance for the second test, and a sample size of 78, the results were significant in all perceptual qualities, except for the front-back position between own and minimal deviant nonindividualized HRTF (P=.06). Conclusions: Both hypotheses have been accepted. Sounds filtered by individualized HRTFs are considered easier to localize, easier to externalize, more natural in timbre, and thus more realistic compared to sounds filtered by nonindividualized HRTFs.

  • JMIR Serious Games 2020;8(3):e17576

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  Games for Rehabilitation

  Sep 3, 2020

  Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study

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  Authors List:

  • Byron Lai  
  • Drew Davis  
  • Mai Narasaki-Jara  
  • Betsy Hopson  
  • Danielle Powell  
  • Marissa Gowey  
  • Brandon G Rocque  
  • James H Rimmer  

  Abstract:

  Background: Access to physical activity among youth with spina bifida (SB) is much lower than it is for children without disability. Enjoyable home-based exercise programs are greatly needed. Objective: Our objective is to examine the feasibility of a virtual reality (VR) active video gaming system (ie, bundle of consumer-available equipment) to meet US physical activity guidelines in two youth with SB. Methods: Two youth with SB—a 12-year-old female and a 13-year-old male; both full-time wheelchair users—participated in a brief, 4-week exercise program using a popular VR head-mounted display: Oculus Quest (Facebook Technologies). The system included a Polar H10 (Polar Canada) Bluetooth heart rate monitor, a no-cost mobile phone app (VR Health Exercise Tracker [Virtual Reality Institute of Health and Exercise]), and 13 games. The intervention protocol was conducted entirely in the homes of the participants due to the coronavirus disease 2019 (COVID-19) pandemic. The VR system was shipped to participants and they were instructed to do their best to complete 60 minutes of moderate-intensity VR exercise per day. Exercise duration, intensity, and calories expended were objectively monitored and recorded during exercise using the heart rate monitor and a mobile app. Fatigue and depression were measured via self-report questionnaires at pre- and postintervention. Participants underwent a semistructured interview with research staff at postintervention. Results: Across the intervention period, the total average minutes of all exercise performed each week for participants 1 and 2 were 281 (SD 93) and 262 (SD 55) minutes, respectively. The total average minutes of moderate-intensity exercise performed per week for participants 1 and 2 were 184 (SD 103) (184/281, 65.4%) and 215 (SD 90) (215/262, 82.1%) minutes, respectively. One participant had a reduction in their depression score, using the Quality of Life in Neurological Disorders (Neuro-QoL) test, from baseline to postintervention, but no other changes were observed for fatigue and depression scores. Participants reported that the amount of exercise they completed was far higher than what was objectively recorded, due to usability issues with the chest-worn heart rate monitor. Participants noted that they were motivated to exercise due to the enjoyment of the games and VR headset as well as support from a caregiver. Conclusions: This study demonstrated that two youth with SB who used wheelchairs could use a VR system to independently and safely achieve exercise guidelines at home. Study findings identified a promising protocol for promoting exercise in this population and this warrants further examination in future studies with larger samples.

  • JMIR Serious Games 2020;8(3):e20667

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  Games for Medical Education and Training

  Sep 2, 2020

  Biosensor Real-Time Affective Analytics in Virtual and Mixed Reality Medical Education Serious Games: Cohort Study

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  Authors List:

  • Panagiotis E Antoniou  
  • George Arfaras  
  • Niki Pandria  
  • Alkinoos Athanasiou  
  • George Ntakakis  
  • Emmanouil Babatsikos  
  • Vasilis Nigdelis  
  • Panagiotis Bamidis  

  Abstract:

  Background: The role of emotion is crucial to the learning process, as it is linked to motivation, interest, and attention. Affective states are expressed in the brain and in overall biological activity. Biosignals, like heart rate (HR), electrodermal activity (EDA), and electroencephalography (EEG) are physiological expressions affected by emotional state. Analyzing these biosignal recordings can point to a person’s emotional state. Contemporary medical education has progressed extensively towards diverse learning resources using virtual reality (VR) and mixed reality (MR) applications. Objective: This paper aims to study the efficacy of wearable biosensors for affect detection in a learning process involving a serious game in the Microsoft HoloLens VR/MR platform. Methods: A wearable array of sensors recording HR, EDA, and EEG signals was deployed during 2 educational activities conducted by 11 participants of diverse educational level (undergraduate, postgraduate, and specialist neurosurgeon doctors). The first scenario was a conventional virtual patient case used for establishing the personal biosignal baselines for the participant. The second was a case in a VR/MR environment regarding neuroanatomy. The affective measures that we recorded were EEG (theta/beta ratio and alpha rhythm), HR, and EDA. Results: Results were recorded and aggregated across all 3 groups. Average EEG ratios of the virtual patient (VP) versus the MR serious game cases were recorded at 3.49 (SD 0.82) versus 3.23 (SD 0.94) for students, 2.59 (SD 0.96) versus 2.90 (SD 1.78) for neurosurgeons, and 2.33 (SD 0.26) versus 2.56 (SD 0.62) for postgraduate medical students. Average alpha rhythm of the VP versus the MR serious game cases were recorded at 7.77 (SD 1.62) μV versus 8.42 (SD 2.56) μV for students, 7.03 (SD 2.19) μV versus 7.15 (SD 1.86) μV for neurosurgeons, and 11.84 (SD 6.15) μV versus 9.55 (SD 3.12) μV for postgraduate medical students. Average HR of the VP versus the MR serious game cases were recorded at 87 (SD 13) versus 86 (SD 12) bpm for students, 81 (SD 7) versus 83 (SD 7) bpm for neurosurgeons, and 81 (SD 7) versus 77 (SD 6) bpm for postgraduate medical students. Average EDA of the VP versus the MR serious game cases were recorded at 1.198 (SD 1.467) μS versus 4.097 (SD 2.79) μS for students, 1.890 (SD 2.269) μS versus 5.407 (SD 5.391) μS for neurosurgeons, and 0.739 (SD 0.509) μS versus 2.498 (SD 1.72) μS for postgraduate medical students. The variations of these metrics have been correlated with existing theoretical interpretations regarding educationally relevant affective analytics, such as engagement and educational focus. Conclusions: These results demonstrate that this novel sensor configuration can lead to credible affective state detection and can be used in platforms like intelligent tutoring systems for providing real-time, evidence-based, affective learning analytics using VR/MR-deployed medical education resources.

  • JMIR Serious Games 2020;8(3):e17823

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  Games for Rehabilitation

  Aug 25, 2020

  Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review

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  Authors List:

  • Bianca Steiner  
  • Lena Elgert  
  • Birgit Saalfeld  
  • Klaus-Hendrik Wolf  

  Abstract:

  Background: Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. Objective: This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. Methods: We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. Results: A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. Conclusions: There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics.

  • JMIR Serious Games 2020;8(3):e19914

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  Game Development

  Aug 25, 2020

  Virtual Reality–Based Executive Function Rehabilitation System for Children With Traumatic Brain Injury: Design and Usability Study

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  Authors List:

  • Jiabin Shen  
  • Henry Xiang  
  • John Luna  
  • Alice Grishchenko  
  • Jeremy Patterson  
  • Robert V Strouse  
  • Maxwell Roland  
  • Jennifer P Lundine  
  • Christine H Koterba  
  • Kimberly Lever  
  • Jonathan I Groner  
  • Yungui Huang  
  • En-Ju Deborah Lin  

  Abstract:

  Background: Traumatic brain injury (TBI) poses a significant threat to children’s health. Cognitive rehabilitation for pediatric TBI has the potential to improve the quality of life following the injury. Virtual reality (VR) can provide enriched cognitive training in a life-like but safe environment. However, existing VR applications for pediatric TBIs have primarily focused on physical rehabilitation. Objective: This study aims to design and develop an integrative hardware and software VR system to provide rehabilitation of executive functions (EF) for children with TBI, particularly in 3 core EF: inhibitory control, working memory, and cognitive flexibility. Methods: The VR training system was developed by an interdisciplinary team with expertise in best practices of VR design, developmental psychology, and pediatric TBI rehabilitation. Pilot usability testing of this novel system was conducted among 10 healthy children and 4 children with TBIs. Results: Our VR-based interactive cognitive training system was developed to provide assistive training on core EF following pediatric TBI. Pilot usability testing showed adequate user satisfaction ratings for both the hardware and software components of the VR system. Conclusions: This project designed and tested a novel VR-based system for executive function rehabilitation that is specifically adapted to children following TBI.

  • JMIR Serious Games 2020;8(3):e16947

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  Exergames, Active Games and...

  Aug 25, 2020

  Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study

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  Authors List:

  • Lucy McMichael  
  • Nuša Farič  
  • Katie Newby  
  • Henry W W Potts  
  • Adrian Hon  
  • Lee Smith  
  • Andrew Steptoe  
  • Abi Fisher  

  Abstract:

  Background: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity. Since parental support is a consistent determinant of physical activity in adolescents, it is crucial to gather the views of parents of adolescents about this type of intervention. Objective: This study aimed to interview parents of younger adolescents (13-17 years old) about physical activity, gaming, and VR as part of the larger vEngage study. Methods: Semistructured interviews were conducted with 18 parents of adolescents. Data were synthesized using framework analysis. Results: Parents believed that encouraging physical activity in adolescents was important, particularly for mental health. Most parents felt that their children were not active enough. Parents reported their adolescents regularly gamed, with mostly negative perceptions of gaming due to violent content and becoming addicted. Parents discussed an inability to relate to gaming due to “generational differences,” but an exception was exergaming, which they had played with their children in the past (eg, Wii Fit). Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. Conclusions: The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that addresses parental concerns, particularly around addiction, violence, and safety, without actively involving their participation. While parents would rather their children performed “real-world” physical activity, they believed the key to engagement was through technology. Overall, there was the perception that harnessing gaming and sedentary screen time for a positive purpose would be strongly supported.

  • JMIR Serious Games 2020;8(3):e14920

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  Games for Rehabilitation

  Aug 19, 2020

  Effects of Avatar Perspective on Joint Excursions Used to Play Virtual Dodgeball: Within-Subject Comparative Study

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  Authors List:

  • Susanne M van der Veen  
  • Alexander Stamenkovic  
  • Megan E Applegate  
  • Samuel T Leitkam  
  • Christopher R France  
  • James S Thomas  

  Abstract:

  Background: Visual representation of oneself is likely to affect movement patterns. Prior work in virtual dodgeball showed greater excursion of the ankles, knees, hips, spine, and shoulder occurs when presented in the first-person perspective compared to the third-person perspective. However, the mode of presentation differed between the two conditions such that a head-mounted display was used to present the avatar in the first-person perspective, but a 3D television (3DTV) display was used to present the avatar in the third-person. Thus, it is unknown whether changes in joint excursions are driven by the visual display (head-mounted display versus 3DTV) or avatar perspective during virtual gameplay. Objective: This study aimed to determine the influence of avatar perspective on joint excursion in healthy individuals playing virtual dodgeball using a head-mounted display. Methods: Participants (n=29, 15 male, 14 female) performed full-body movements to intercept launched virtual targets presented in a game of virtual dodgeball using a head-mounted display. Two avatar perspectives were compared during each session of gameplay. A first-person perspective was created by placing the center of the displayed content at the bridge of the participant’s nose, while a third-person perspective was created by placing the camera view at the participant’s eye level but set 1 m behind the participant avatar. During gameplay, virtual dodgeballs were launched at a consistent velocity of 30 m/s to one of nine locations determined by a combination of three different intended impact heights and three different directions (left, center, or right) based on subject anthropometrics. Joint kinematics and angular excursions of the ankles, knees, hips, lumbar spine, elbows, and shoulders were assessed. Results: The change in joint excursions from initial posture to the interception of the virtual dodgeball were averaged across trials. Separate repeated-measures ANOVAs revealed greater excursions of the ankle (P=.010), knee (P=.001), hip (P=.0014), spine (P=.001), and shoulder (P=.001) joints while playing virtual dodgeball in the first versus third-person perspective. Aligning with the expectations, there was a significant effect of impact height on joint excursions. Conclusions: As clinicians develop treatment strategies in virtual reality to shape motion in orthopedic populations, it is important to be aware that changes in avatar perspective can significantly influence motor behavior. These data are important for the development of virtual reality assessment and treatment tools that are becoming increasingly practical for home and clinic-based rehabilitation.

  • JMIR Serious Games 2020;8(3):e18888

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  Serious Games for Education

  Aug 19, 2020

  A Serious Game on the First-Aid Procedure in Choking Scenarios: Design and Evaluation Study

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  Authors List:

  • Imma Boada  
  • Antonio Rodriguez Benitez  
  • Santiago Thió-Henestrosa  
  • Josep Soler  

  Abstract:

  Background: Choking is one of the causes of unintentional injury death. Gaining the knowledge of the first-aid procedure that has to be applied in case of choking can increase the chances of survival of persons with choking. Serious games can be a good channel for educating people about choking scenarios and the actions to be taken to save the persons with choking. Objective: The objective of this study is to present and evaluate the effectiveness of a serious game designed to prevent choking and to promote the first-aid procedure that needs to be applied in case of choking. Methods: In this study, we present a serious game as a set of minigames that reproduces the main steps of the protocol for the first-aid performed in choking. In the proposed game, the player acquires the role of a helper who has to save the person in a choking emergency by applying the main steps of the protocol. Time and score restrictions are imposed to pass each minigame. To test this game, we performed a pilot study with 48 high school students. Different tests were performed to assess the students’ preferences and their knowledge on choking before and after playing the proposed game. The obtained results were analyzed using Mann-Whitney U test when a grade variable was involved and by using Fisher exact test when 2 categorical variables were involved. Results: The findings of our study showed that the players enjoyed the game. No statistical differences were detected when considering the gender of the player, their preferences for video games, or their previous experience in choking emergencies. By comparing the knowledge of these students before and after playing the game, we found that all the indicators of the knowledge about how to act in case of a choking emergency were improved through this serious game. Conclusions: The findings of our study show that the proposed game is a good strategy for promoting and teaching first-aid procedures in choking emergencies to nonexperts in this field.

  • JMIR Serious Games 2020;8(3):e16655

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