Serious Games to Improve Attention in Boys and Girls with Attention Deficit Hyperactivity Disorder (ADHD): A Pilot Study

Background: The objective of this study was to test a treatment program in Serious Games (SG) format to improve attention in children from Catalonia, Spain, with Attention Deficit Hyperactivity Disorder (ADHD). The activities adapted to the SG format consisted of (1) stimulus selection, (2) mark equal drawings, (3) eight differences, (4) hidden figures, (5) compare texts, (6) compare measures and shapes, (7) put model keys, (8) labyrinths and (9) memorization of drawings. Method: A pretest-posttest design was used with a cohort of 30 children between 8 and 10 years old diagnosed with ADHD, with 20% girls (n = 6) and 80% boys (n = 24) with a mean age of 9.4 years (SD = 0.63; range of 8 to 10 years). Four schools and a clinical center from Catalonia, Spain participated in the sample composition. Half of the sample participated in an attention improvement program for nine sessions of 30-45 minutes each in Serious Games format. They were presented with a series of game challenges with various virtual scenarios through a monitor. The other half did the same attention improvement program in pencil and paper format. Results: The children in the Serious Games group progressed and improved more during treatment, as shown by the average number of errors of commission (p =.02) than those in the pencil and paper group. Both groups also improved in the total score and concentration scale of the D2 test (p < .001). Conclusions: Attentional training through programs in Serious Games format seems to have a more significant effect on commission errors than attentional training in pencil and paper format.

Antecedentes: El objetivo del presente estudio ha sido poner a prueba un programa de tratamiento en formato Serious Games (SG) para mejorar la atención en niños de Cataluña, España, con Trastorno por Déficit de Atención/Hiperactividad (TDAH). Las actividades adaptadas al formato SG consistieron en (1) selección de estímulos, (2) marcar dibujos iguales, (3) ocho diferencias, (4) figuras ocultas, (5) comparar textos, (6) comparar medidas y formas, (7) poner llaves modelo, (8) laberintos y (9) memorización de dibujos. Método: Se utilizó un diseño pretest-postest con una cohorte de 30 niños entre 8 y 10 años con diagnóstico de TDAH, con un 20% de niñas (n = 6) y un 80% de niños (n = 24) con una edad media de 9.4 años (DE = 0.63; rango de 8 a 10 años). La mitad de la muestra participó en un programa de mejora de la atención durante 9 sesiones de entre 30-45 minutos cada una en formato de Serious Games. Se les presentó una serie de desafios de juego con varios escenarios virtuales a través de un monitor. La otra mitad de la muestra hizo el mismo programa de mejora de la atención, pero en formato lápiz y papel. Resultados: Los niños del grupo de Serious Games progresaron y mejoraron más durante el tratamiento, como lo demuestra el promedio de errores de comisión (p = .02), en comparación con los niños del grupo de lápiz y papel. Ambos grupos también mejoraron en la puntuación total y en la escala de concentración de la prueba D2 (ambos p < .001). Conclusiones: El entrenamiento atencional a través de programas en formato Serious Games parece tener un mayor efecto que el entrenamiento atencional en formato lápiz y papel sobre los errores de comisión.

Differences in augmented reality games performance between individuals with down syndrome and individuals with typical development

Introduction: Down syndrome is the most common genetic cause of intellectual disability, and the use of augmented reality can be improving the cognitive, motor, and literacy skills of this population Objective: to compare statistical differences in learning between individuals with Down syndrome and individuals with typical development using augmented reality games.Methods: we compared the reaction time before and after the virtual reality tasks, in addition to the performance in these tasks, which consisted of correctly identifying numbers and letters in 46 people with Down syndrome and 46 controls with typical development.Results: our results indicate that the total points for the typical development group were higher (M = 13.0 and 11.9) when compared to the Down syndrome group (M = 6.6 and 4.6) for letters of the alphabet and numbers, respectively. Furthermore, the results indicated that participants in both groups were more accurate in identifying alphabetic symbols when compared to numerical symbols, and both groups were sensitive to the number of symbols presented in each phase. The down syndrome group had a lower performance when compared to the typical development group.Conclusion: despite the need for further studies, our results support the outcome that there is clinical utility of an intervention based on virtual reality tasks for people with Down syndrome. In conclusion, the use of this technology to improve the reaction time of this population is considered useful

Introdução: a síndrome de Down é uma das principais doenças genéticas que causam deficiência intelectual, e o uso da realidade aumentada pode aumentar as habilidades cognitivas, motoras e de aprendizado dessa população. Objetivo: comparar diferenças estatísticas na aprendizagem entre indivíduos com síndrome de Down e indivíduos com desenvolvimento típico usando jogos de realidade aumentada.Métodos: comparamos o tempo de reação antes e depois das tarefas de realidade virtual, além do desempenho nessas tarefas, que consistiam em identificar corretamente números e letras em 46 pessoas com síndrome de Down e 46 controles com desenvolvimento típico.Resultados: nossos resultados indicam que o total de pontos para o grupo de desenvolvimento típico foi maior (M = 13,0 e 11,9) quando comparado ao grupo com síndrome de Down (M = 6,6 e 4,6) para letras do alfabeto e números, respectivamente. Além disso, os resultados indicaram que os participantes de ambos os grupos foram mais precisos na identificação de símbolos alfabéticos quando comparados aos símbolos numéricos, e ambos os grupos foram sensíveis ao número de símbolos apresentados em cada fase. O grupo com síndrome de Down teve desempenho inferior quando comparado ao grupo de desenvolvimento típico.Conclusão: apesar da necessidade de mais estudos, nossos resultados suportam a utilidade clínica de uma intervenção baseada em tarefas de realidade virtual para pessoas com síndrome de Down. Em conclusão, considera-se útil o uso dessa tecnologia para melhorar o tempo de reação dessa população

Evaluation of the effect of serious game teaching method in the cultivation of clinical reasoning and reflection ability of pediatric practice nurses / 中国实用护理杂志

Objective:To develop serious games for pediatrics and to explore the effect of cultivating the clinical reasoning and reflection ability of pediatric trainee nurses.Methods:This was a non-randomized controlled trial study. The convenience sampling method was used to select 88 pediatric trainee nurses in the Second Xiangya Hospital of Central South University from April 2021 to January 2022. They were divided into the control group and the experimental group with 44 cases in each group by the method of random sampling. The control group was given clinical practice teaching in pediatrics according to the practice syllabus. Based on the teaching events of Gagne, the teaching links of serious games were designed, and teaching was carried out to the experimental group. The clinical reasoning and reflection ability, learning satisfaction and self-confidence of the two groups of pediatric trainee nurses before and after teaching were evaluated by the Self-Assessment of Clinical Reasoning and Reflection, Student Learning Satisfaction and Self-Confidence Scale, and examination scores of the two groups of pediatric trainee nurses were evaluated.Results:There was no significant difference in the clinical reasoning and reflection ability, learning satisfaction and self-confidence before teaching between the two groups( P>0.05). The total score of clinical reasoning and reflection evaluation after teaching was (101.13±6.69) points in the experimental group, which was higher than that in the control group (94.57 ± 8.86) points, the difference was statistically significant ( t=-3.92, P<0.05). The learning satisfaction and self-confidence scores after teaching were (20.82 ± 2.16), (33.20 ± 1.47) points in the experimental group, which were higher than those in the control group (19.52 ± 2.30), (31.89 ± 2.44) points, the differences were statistically significant ( t=-2.33, -3.07, both P<0.05). The scores on the theory and skill examination in the experimental group were also better than those in the control group, the differences were statistically significant ( t values were -2.59--2.14, all P<0.05). Conclusions:The serious game teaching method can effectively improve the clinical reasoning and reflection ability, practical learning satisfaction, self-confidence, and graduation performance of pediatric nursing interns, which can provide a reference for the reform of pediatric nursing practice teaching.

Diseño de juegos serios: Análisis de metodologías / Designing serious games: Analysis of methodologies

Resumen En la actualidad las Tecnologías de la Información y la Comunicación (TIC) se han convertido en un aliado estratégico para potenciar procesos formativos innovadores, en este sentido, los juegos serios constituyen piezas de software que utilizan técnicas de entretenimiento para adquirir habilidades específicas orientadas al aprendizaje. El diseño de estas piezas de software requiere consideraciones especiales, por ejemplo, la intención pedagógica, definición de objetivos pedagógicos y lúdicos, usuarios finales, tipo de retroalimentación, análisis de experiencias de usuario, validación de objetivos. Estas consideraciones se aplicaron en esta revisión sistemática de literatura como criterios para analizar y comparar nueve metodologías utilizadas para diseñar juegos serios. Los principales resultados muestran la importancia de incorporar la elicitación y especificación de requerimientos, así como la asignación de roles involucrados en la producción del juego y la relevancia de incorporar elementos de definición pedagógica. El aporte de esta investigación ayuda a evaluar la eficiencia y la experiencia del usuario en cuanto a la interacción con el juego y, facilita la elaboración de un registro cuantitativo del aprendizaje basado en juegos para conocer el proceso y su calidad por parte del usuario. En conclusión, las metodologías analizadas aportan información sobre las consideraciones a la hora de proponer una metodología para el diseño de un juego serio.

Abstract Nowadays, Information and Communication Technologies (ICT) have become a strategic ally to enhance innovative training processes. In this context, serious games are software pieces that use entertainment techniques to acquire specific skills oriented towards learning. The design of these software pieces require special considerations, such as: pedagogical intention, pedagogical and ludic objectives definition, end users, roles identification, feedback type, user experiences analysis, objectives validation. These considerations are used to analyze and compare nine different methodologies to design serious games. The main results of the analysis show the importance of incorporating the requirements elicitation and specification, as well as the roles assignment involved in the game production and also the relevance of incorporating pedagogical definition elements. The contribution of this investigation helps to assess the efficiency, the learning and the users experience in regards to the interaction with the game, and facilitates the development of a quantitative record of the learning to know the process and its quality by the user. In conclusion, the methodologies analyzed provide information on aspects to consider when proposing a methodology to design a serious game.

Simulação virtual por meio de um serious game sobre segurança do paciente: um estudo experimenta / Virtual simulation through a serious game about patient safety: an experimental study

Introdução: A segurança do paciente tem ganhado destaque e amplo debate no processo de formação dos estudantes da área da saúde, assim como na enfermagem. O uso de tecnologia digital educacional, como o serious game, pode ser utilizado como estratégia em atividades de simulação virtual que, por sua vez, estão sendo integradas aos currículos de saúde, com o intuito de permitir que os estudantes possam desenvolver novas habilidades e competências em um ambiente seguro. Objetivos: Avaliar a aprendizagem cognitiva de estudantes de enfermagem no uso da simulação virtual por meio de um serious game sobre segurança do paciente em um curso de difusão online. Método: Trata-se de um estudo metodológico e exploratório descritivo, de abordagem quantitativa e intervenção experimental com pré e pós-teste. Para o desenvolvimento do curso utilizou-se referencial teórico-metodológico do design instrucional contextualizado e a aprendizagem significativa. O conteúdo do curso foi avaliado por expertises da área da enfermagem e a análise dos dados realizou-se por meio de estatística descritiva simples. O curso de difusão extracurricular online foi ofertado através de um ambiente virtual de aprendizagem aos participantes, com o tema "Assistência de Enfermagem e segurança do paciente", seguindo os preceitos éticos em pesquisa, e estes foram randomizados e divididos em grupo experimental NR1 e grupo controle NR2. Para a randomização utilizou-se o software R, versão 4.0.0. A comparação entre grupos quanto à mudança na taxa de acerto do pré e pós-teste foi feita através do teste t-Student e regressão linear intragrupos. Para todas as comparações adotou-se um nível de significância de 5%. Cabe ressaltar que a intervenção realizada com o grupo NR1 seguiu os preceitos da realização de atividades de simulação com prebriefing e debriefing online. Resultado: A validação do conteúdo do curso de difusão foi realizada por seis expertises, que avaliaram como pertinentes os objetivos, estrutura, apresentação e relevância. Participaram no estudo um total 59 estudantes do curso de Bacharelado em Enfermagem e Bacharelado e Licenciatura em Enfermagem, divididos no grupo NR1 (n=29) e grupo NR2 (n=30). Comparando-se os resultados obtidos no pré e pós-teste no curso de difusão online com associação do uso da simulação virtual através do serious game, a aplicação do teste t-Student para as amostras evidenciou que a aprendizagem cognitiva do pós-teste do NR1 do grupo experimental (p<0,001) obteve aumento após a intervenção quando comparado ao NR2 grupo controle (p<0,001), porém nenhuma diferença de significância estatística foi encontrada entre os grupos experimental e controle em relação às médias da pontuação após o pós-teste. No entanto, a aprendizagem cognitiva na comparação antes-depois intragrupos apresentou aumento de conhecimento nos dois grupos. Ao final, os estudantes avaliaram como excelente a proposta do curso e o grupo experimental avaliou o serious game como uma ferramenta interativa e lúdica para aprendizagem, assim como a experiência do debriefing via online foi avaliada também como positiva. Conclusão: Este estudo forneceu evidências sobre o potencial do uso de serious game em estratégias de simulação virtual, o qual demonstrou a viabilidade do desenvolvimento de um curso de difusão extracurricular para o ensino de segurança do paciente a estudantes de enfermagem. Apesar do uso do serious game não ter evidenciado impacto estatisticamente significativo na aprendizagem cognitiva, a proposta foi bem avaliada pelos estudantes e o debriefing online obteve avaliações positivas pelo conforto e pela construção do conhecimento de forma reflexiva, diante da praticidade e flexibilidade da realização da simulação virtual de forma síncrona, com vista a contribuir para o desenvolvimento de uma aprendizagem ativa e desenvolvimento de competências para a segurança do paciente.

Introduction: Patient safety has gained prominence and wide debate in the process of training students in the health area, as well as in nursing. The use of educational digital technology, such as the serious game, can be used as a strategy in virtual simulation activities that, in turn, are being integrated into the health curricula, to allow students to develop new skills and competencies in a safe environment. Objectives: To evaluate the cognitive learning of nursing students in the use of virtual simulation through a serious game about patient safety in an online diffusion course. Method: This is a methodological and descriptive study, with a quantitative approach and experimental intervention with pre and posttest. For the development of the course, the theoretical-methodological framework of contextualized instructional design and meaningful learning was used. The course content was evaluated by nursing experts and data analysis was performed using simple descriptive statistics. The online extracurricular diffusion course was offered through a virtual learning environment for participants, with the theme "Nursing care and patient safety", following ethical research principles, and these were randomized and divided into an NR1 experimental group and an NR2 control group. For randomization, software R, version 4.0.0 was used. The comparison between groups regarding the change in the hit rate of the pre and post-test was made using the t-Student test and intragroup linear regression. For all comparisons, a significance level of 5% was adopted. It is noteworthy that the intervention carried out with the NR1 group followed the precepts of conducting simulation activities with pre-briefing and online debriefing. Result: A validation of the course content was carried out by six experts, who assessed the objectives, structure, presentation, and relevance as pertinent. A total of 59 students from the Bachelor of Nursing course and Bachelor and Associate Degree of Nursing course participated in the study, divided into the NR1 group (n=29) and the NR2 group (n=30). Comparing the results obtained in the pre and post-test in the online diffusion course with the association of the use of virtual simulation through the serious game, the application of the t-Student test for the samples showed that the cognitive learning of the post-test of the NR1 experimental group (p<0.001) increased after the intervention when compared to the NR2 control group (p<0.001), but no difference in statistical significance was found between the experimental and control groups about to the mean scores after the post-test. However, cognitive learning in the comparison before-after intra-groups showed an increase in knowledge in both groups. In the end, the students evaluated the course proposal as excellent and the experimental group evaluated the serious game as an interactive and playful tool for learning, as well as the experience of debriefing online was also evaluated as positive. Conclusion: This study provided evidence on the potential of using a serious game in virtual simulation strategies, which demonstrated the feasibility of developing an extracurricular diffusion course for teaching patient safety to nursing students. Although the use of the serious game did not show a statistically significant impact, the proposal was well evaluated by the students and the online debriefing obtained positive evaluations for the comfort and for the cognitive learning in a reflexive way, given the practicality and flexibility of carrying out the virtual simulation in a way synchronous, to contribute to the development of active learning and the development of skills for patient safety.

Desarrollo de competencias digitales en el profesorado a través de juegos serios: un estudio de caso aplicado en la Universidad de Costa Rica (UCR) / Development of digital competencies in teachers through serious games: a case study applied at Universidad de Costa Rica (UCR)

Resumen El presente artículo de investigación científica reúne resultados de un estudio de caso sobre la integración de juegos serios en actividades formativas del personal docente en la adquisición de competencias digitales. Este estudio analiza el grado de aceptación por parte de docentes hacia las Tecnologías de la Información y de la Comunicación (TIC) implicadas, en particular los juegos serios, y evaluar dichas competencias; asimismo, describe la aplicación de una metodología propia utilizada para la organización de la experiencia con el personal docente de la Sede del Atlántico-Universidad de Costa Rica (UCR), trabajando con AstroCódigo (juego serio) con la intención de aproximar a cincuenta y seis docentes participantes al uso de videojuegos en procesos formativos y a la resolución de problemas de manera algorítmica; para valorar la opinión del personal docente y directivo, se utilizó la aplicación de entrevistas, observación participante, encuestas y grupos focales. Los resultados permiten percibir que el profesorado acepta los juegos serios y registra un cambio de opinión respecto a las variables que influyen para su adopción en su quehacer docente. Se concluye que la experiencia dio cuenta de la motivación y del interés de seguir participando en instancias de capacitación para fomentar la generación de competencias digitales por parte del personal académico. Se resalta la anuencia de las autoridades encargadas de la gestión universitaria en brindar apoyo a futuros proyectos y actividades vinculadas con la formación del profesorado en tecnologías digitales a través de juegos serios.

Abstract The following scientific investigation article gathers the results of a case study about the integration of serious games in formative activities for faculty to acquire digital competencies. The study analyzing the level of acceptance among faculty towards Information and Communication Technologies (ICT) involved, particularly serious games, and assessing the competencies: it also describes the application of a methodology used to organize the experience of the faculty of the Atlantic Branch of the University of Costa Rica (UCR), using AstroCódigo (serious game) to approach 56 participating teachers to the use of video games in formative processes and problem-solving using algorithms. Interviews, participants' observations, surveys and focus groups were used to assess the opinion of faculty and directors. Results revealed that faculty accepts serious games and registers a change of opinion regarding the variables that influence their adoption in their teaching. In conclusion, the experience revealed motivation and the interest of participating in training activities to develop digital competencies on behalf of the academic staff. It is important to highlight the willingness of the university management authorities to support future projects and activities related to faculty professional development in digital technologies through serious games.

De la lucha al testimonio. Las representaciones audiovisuales e interactivas del cáncer en los videojuegos / From fight to testimony. Audiovisual and interactive representations of cancer in video games / Da luta ao testemunho. Representações audiovisuais e interativas do câncer em videogames

Esta investigación explora la intersección entre el cáncer -una de las principales causas de mortalidad de las sociedades contemporáneas- y uno de los medios más significativos de la cultura popular en el siglo XXI: los videojuegos. El análisis de contenido de los mensajes ha comprendido ocho videojuegos que, durante los últimos 15 años, revelan un planteamiento narrativo en torno a la afección, pacientes, tratamientos y desenlace de la enfermedad. Los resultados señalan una construcción en la que perviven sus rasgos más populares dirigidos al empoderamiento social frente a la enfermedad a través del recurso a la ciencia, el respaldo social o las convicciones espirituales.(AU)

This article analyzes the intersection between cancer - one of the leading causes of death in contemporary society - and one of the most important forms of media in twentieth-century popular culture: video games. An analysis was conducted of messages conveyed by eight videogames launched in the last 15 years with narratives on the disease, patients, and cancer treatment and outcomes. The findings point to a narrative construction that depicts the most common features of the disease, focusing on social empowerment through the use of science, social support, and spiritual convictions.(AU)

Neste artigo analisamos a interseção entre o câncer - uma das principais causas de mortalidade nas sociedades contemporâneas - e uma das mídias mais significativas da cultura popular no século 21: os videogames. A análise de conteúdo das mensagens foi composta por oito videogames que, nos últimos 15 anos, revelam uma abordagem narrativa em torno da condição dos pacientes, dos tratamentos e do desfecho da doença. Os resultados apontam para uma construção em que permanecem seus traços mais populares, voltados para o empoderamento social frente à doença, por meio do uso da ciência, apoio social ou das convicções espirituais.(AU)

Exploring the Impact of Serious Games for Cognitive Functions through the Humphrey Fellowship Programme

The use of serious games as digital medicine started in recent years as the United States Food and Drug Administration granted Class 1 or 2 device clearance to serious games or game-like technologies. This encouraging trend motivates interdisciplinary cooperation between experts in the medical sciences and the game industry because the Northern American pharmaceutical revenues have exceeded USD1 trillion globally since 2014. The potential of this lucrative business opportunity may attract fund providers and venture capitalists to support game-related research and development projects. The author elaborates his activities and experiences in the United States in FY2017/2018 as a Humphrey fellow from Malaysia. Specifically, the research and development trend of serious games for cognitive function in the academic and the game industry has positive impact on how medical doctors and practitioners in low- and middle-income countries may use or develop games as digital medicine.

Missão kid: um exergame de apoio ao combate a obesidade infantil / Missão kid: a support exergame to combat childhood obesity

OBJETIVO: Apresentar uma abordagem tecnológica em saúde, baseada em um aplicativo para dispositivos móveis, um jogo sério, de apoio ao combate da obesidade infantil, através da motivação para a prática de exercícios físicos e adoção de hábitos saudáveis. MÉTODO: Apoiado pelo design de interação participativo e centrado no usuário e em conceitos e métodos das áreas de Jogos Sérios, mHealth, Inteligência artificial e saúde coletiva foi desenvolvido um sistema web (de acompanhamento) e um jogo mobile, voltado para a promoção da saúde de crianças, fundamentalmente as com sobrepeso e obesidade. RESULTADOS: Testes preliminares apresentam indícios positivos da internalização dos conceitos de estilo de vida ativo e alimentação saudável pelas crianças. Também foi avaliada a eficácia da estratégia de validação automática dos exercícios praticados pelos usuários no contexto do jogo, mostrando um resultado semelhante. CONCLUSÃO: O projeto apresenta uma abordagem tecnológica em saúde com resultados preliminares positivos, há ainda estudos e mandamento quanto às estratégias de adesão utilizadas bem como quanto a validação dos exercícios.

OBJECTIVE: To present a technological approach in health, based on an application for mobile devices, a serious game, to support coping the childhood obesity through motivation for physical exercise and healthy habits. METHOD: Backed by the participatory interaction design and user-centered design besides other concepts and methods in the areas of Serious Games, mHealth, artificial intelligence and collective health, it was developed a mobile game and a web system (for monitoring), focused on health promotion about overweight and obesity. RESULTS: Preliminary tests show positive evidences of internalisation of active lifestyle concepts and healthy eating for children. Also the effectiveness of the strategy of automatic exercise validation was evaluated, showing a similar result. CONCLUSION: The project presents a technological approach in health (mHealth) with positive preliminary results. There are still ongoing studies as accession strategies used as well as the validation exercise.