JMIR Serious Games

This article (letter to the editor) discusses an overlooked, long-established technology within serious games research: the pinball machine. Pinball is a game that engages multiple cognitive processes, enhancing executive functions, as explored in the accompanying article. Its enduring presence in the gaming industry—spanning gameplay design, mechanics, electronics, and both kinetic and digital formats—raises important questions: Could pinball's unique format, rooted in both physical and digital realms, bridge the gap between traditional and modern approaches to serious gaming? Could it offer a more tangible, interactive experience as a promising therapeutic tool (or adjunct) compared to conventional serious games? Despite decades of studies examining the use of pinball machines as an intervention for individuals with various conditions, the role of pinball in serious game research remains underexplored. Why is this technology not more widely investigated, including its theoretical potential, even as it continues to evolve? Is pinball less adaptable or perhaps too costly compared to other technologies? While traditionally viewed as entertainment, the cognitive challenges pinball presents to players may provide an effective means to exercise executive function skills. To fully unlock its potential as a serious game, researchers must broaden their scope, integrating arcade technologies like the pinball machine into the increasingly digital-centric landscape of serious gaming.

We appreciate the insightful comments and reflections regarding our study on the impact of serious games on executive functions and their application in neurodiverse populations [1]. The suggestion to consider pinball machines as a tool within the serious games paradigm presents an interesting avenue for further exploration. At the time of our study, our focus was primarily on conventional and emerging digital technologies, such as virtual reality, mobile devices, and sensor-based interactions. However, we acknowledge that pinball, with its unique combination of physical and digital interactions, may offer valuable cognitive and therapeutic benefits, particularly in the context of executive function training. The references provided in the letter highlight historical and recent research supporting its potential applications in various populations, reinforcing the idea that this arcade technology could play a role in future serious game developments. Given the evidence presented on pinball’s ability to engage attention, impulse control, cognitive flexibility, and problem-solving skills, we recognize its potential as a tool to enhance executive function training. Future work in this area could explore the adaptation of pinball mechanics within digital serious games or investigate its direct application as a therapeutic tool in controlled settings. Additionally, we acknowledge that the development of assistive technologies for neurodiverse populations often encounters blind spots, where certain tools or approaches are overlooked. Our intention with the published article is to provide a roadmap for researchers, highlighting that there remains substantial work to be done in this area. By identifying these gaps, we aim to offer a starting point for ongoing and future investigations. Several studies have underscored the challenges and opportunities in designing technologies for neurodiverse users. For instance, Frauenberger et al. discuss the importance of involving neurodiverse children in the technology design process to ensure that their unique needs are met [2]. Similarly, Benton and Johnson highlight lessons from neurodiverse communities, emphasizing the necessity of tailored technological interventions [3]. These perspectives reinforce the need for comprehensive research and development efforts to address the diverse requirements of neurodiverse populations. We thank the authors of the letter for broadening the discussion on serious game technologies. Their insights open the door to new interdisciplinary research possibilities that could further enrich this field.

Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD.

Virtual reality (VR) active gaming is growing in popularity but little is known about physical activity during gameplay. Two popular VR games are Gorilla Tag and Beat Saber. Little is known about physical activity during these games in youth.

In collaboration with clinical domain experts, we developed a prototype of immersive virtual reality (VR) cognitive remediation for major depressive disorder (bWell-D). In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high noncompliance rates. Gamification may play a role in addressing this as it can boost adherence. However, careful consideration is required in its application to promote user motivation intrinsically.

The exponential growth of new technologies has meant that the educational field has had to update itself. From the educational point of view, there are some studies that have promoted the implementation of new technologies. These facts have raised the need to implement augmented reality in the university environment, especially among students of health sciences. The use of augmented reality can mean a new approach to teaching by teachers and better learning by students.

Physical activity (PA) is vital for physical and mental health, but many college students fail to meet recommended levels. AI-powered gamification interventions through mobile application (app) have the potential to improve PA levels among Chinese college students.

Retention capacities depend on the learning context. The optimal interval between two learning sessions to maintain the learner’s knowledge is often a subject of discussion, as well as the methodology used. Screen-based simulation could represent an easy alternative for re-training in neonatal resuscitation.

Proper donning and doffing of personal protection equipment (PPE) and hand hygiene in the correct spatial context of a health facility is important for the prevention and control of nosocomial infections. On-site training is difficult due to the potential infectious risks and shortages of PPE, whereas video-based training lacks immersion which is vital for the familiarization of the environment. Virtual reality (VR) training can support repeated practice of PPE donning and doffing in an immersive environment that simulates a realistic configuration of a health facility.

Pediatric patients undergoing surgery frequently experience significant anxiety, which can result in adverse effects such as prolonged sedation and behavioral changes associated with pharmacological interventions like oral midazolam. Video games offer a nonpharmacological distraction method that shows promise in alleviating procedural anxiety without significant side effects. However, the effectiveness of video games compared to midazolam in managing perioperative anxiety remains uncertain.

Cognitive bias modification (CBM) programs have shown promise in treating psychiatric conditions, but they can be perceived as boring and repetitive. Incorporating gamified designs and adaptive algorithms in CBM training may address this issue and enhance engagement and effectiveness.

Virtual reality (VR) is helpful for the management of stress and anxiety. However, current interventions have limitations related to location (ie, therapist’s office or hospitals) and content (ie, virtual experiences only for relaxation).