Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework.

OBJECTIVE: This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies. METHODS: A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles. RESULTS: Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes. CONCLUSION: The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area. IMPACT: This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits.

The relationship between video games and social-emotional delay in Chinese rural preschoolers: A comparison of five types of media video games and social-emotional delay.

BACKGROUND: Recent studies have revealed a negative relationship between children's digital media use and social-emotional development. However, few studies distinguish between different digital devices and the different functions they provide that may lead to different outcomes. METHODS: This study explored the relationship between young children's time spent on various digital devices and their social-emotional delay based on a survey of 1182 preschoolers (3 to 6 years old) in rural China. Children's social-emotional delay was assessed through a validated screening tool (ASQ-SE II). RESULTS: Children's time spent on television, computers, tablets, or smartphones was not associated with their social-emotional delay. However, their risk of social-emotional delay increased as their time spent on game consoles increased. This relationship was reflected in five of the seven behavioural areas of children's social-emotional development (i.e., self-regulation, compliance, affect, social communications, and interactions with people). Moreover, it did not vary between children with different socioeconomic statuses. CONCLUSIONS: This study suggests a possible relationship between children's social-emotional delay and video games, which might need to be paid more attention to than other media types.

Playing three-dimensional video games boosts stereo vision.

Playing two-dimensional video games has been shown to result in improvements in a range of visual and cognitive tasks, and these improvements appear to generalize widely1,2,3,4,5,6. Here we report that young adults with healthy vision, surprisingly, showed a dramatic improvement in stereo vision after playing three-dimensional, but not two-dimensional, video games for a relatively short period of time. Intriguingly, neither group showed any significant improvement in binocular contrast sensitivity. This dissociation suggests that the visual enhancement was specific to genuine stereoscopic processing, not indirectly resulting from enhanced contrast processing, and required engaging in a disparity cue-rich three-dimensional environment.

Association between childhood trauma and Internet gaming disorder: a moderated mediation analysis with depression as a mediator and psychological resilience as a moderator.

BACKGROUND: The effect of childhood trauma on Internet gaming disorder remains unclear. In this study, we examined this association in Chinese students and explored the possible associated roles of psychological resilience and depression. METHODS: In total, 8,579 students from Hunan Province, China, provided information regarding their sociodemographic factors, history of childhood trauma, any symptoms of depression, psychological resilience, and characteristics of Internet gaming disorder for this cross-sectional study. The impact of childhood trauma on Internet gaming disorder, as well as the extent to which it was mediated by depression and moderated by psychological resilience was evaluated. RESULTS: The influence of childhood trauma on Internet gaming disorder was partially mediated by depression (B = 0.07, 95% CI [0.04, 0.05], p < 0.001), with psychological resilience acting as a mitigating factor (B = -0.002, 95% CI [13.74, 21.72], p < 0.001). Psychological resilience also moderated the association between childhood trauma and depression (B = - 0.003, 95% CI [22.17, 28.10], p < 0.001). Our moderated mediation model elucidated psychosocial mechanisms, revealing the underlying link between childhood trauma and Internet gaming disorder. It also demonstrated the partial mediating role of depression and modulating role of psychological resilience among Chinese students. CONCLUSIONS: Education and interventions, along with effective social support, should be provided to enhance students' psychological resilience and prevent childhood trauma and depression.

The nature and characteristics of problem gaming, with a focus on ICD-11 diagnoses.

PURPOSE OF REVIEW: This review describes the diagnoses related to problem gaming that are included in ICD-11, published by the WHO in 2022. It summarizes the recent literature on the prevalence of Gaming Disorder, its structure, antecedents and comorbidities, and explores whether the range of diagnoses currently available adequately covers the range of experiences seen with problem gaming. RECENT FINDINGS: Overall, between 3 and 6% of the population worldwide are reported to have a gaming disorder as defined by ICD-11 or DSM-5. However, most studies are constrained by methodological issues such as nonrepresentative samples and the use of brief questionnaires to determine prevalence. ICD-11 Gaming Disorder is a psychometrically sound diagnosis. There is no diagnosis that currently captures the experience of harm from gaming, where the requirements for the diagnosis of Gaming Disorder are not reached. SUMMARY: There is evidence in support of the proposed new entity of 'Harmful Gaming', which encompasses mental and physical harm/impairment due to a repeated pattern of gaming, but where requirements for the diagnosis of Gaming Disorder are not met. Such a diagnosis would complete the spectrum of diagnoses available for problem or unhealthy gaming, similar to those for unhealthy substance use, and would provide a framework for a public health approach to reducing the overall harm from unhealthy gaming.

Videogame training increases clinical well-being, attention and hippocampal-prefrontal functional connectivity in patients with schizophrenia.

Recent research shows that videogame training enhances neuronal plasticity and cognitive improvements in healthy individuals. As patients with schizophrenia exhibit reduced neuronal plasticity linked to cognitive deficits and symptoms, we investigated whether videogame-related cognitive improvements and plasticity changes extend to this population. In a training study, patients with schizophrenia and healthy controls were randomly assigned to 3D or 2D platformer videogame training or E-book reading (active control) for 8 weeks, 30 min daily. After training, both videogame conditions showed significant increases in sustained attention compared to the control condition, correlated with increased functional connectivity in a hippocampal-prefrontal network. Notably, patients trained with videogames mostly improved in negative symptoms, general psychopathology, and perceived mental health recovery. Videogames, incorporating initiative, goal setting and gratification, offer a training approach closer to real life than current psychiatric treatments. Our results provide initial evidence that they may represent a possible adjunct therapeutic intervention for complex mental disorders.

Integration of music-based game approaches with wearable devices for hand neurorehabilitation: a narrative review.

BACKGROUND: Restoring hand functionality is critical for fostering independence in individuals with neurological disorders. Various therapeutic approaches have emerged to address motor function restoration, with music-based therapies demonstrating notable advantages in enhancing neuroplasticity, an integral component of neurorehabilitation. Despite the positive effects observed, there remains a gap in the literature regarding implementing music treatments in neurorehabilitation, such as Neurologic Music Therapy (NMT), especially in conjunction with emerging fields like wearable devices and game-based therapies. METHODS: A literature search was conducted in various databases, including PubMed, Scopus, IEEE Xplore, and ACM Digital Library. The search was performed using a literature search methodology based on keywords. Information collected from the studies pertained to the approach used in music therapy, the design of the video games, and the types of wearable devices utilized. RESULTS: A total of 158 articles were found, including 39 from PubMed, 34 from IEEE Xplore, 48 from Scopus, 37 from ACM Digital Library, and 35 from other sources. Duplicate entries, of which there were 41, were eliminated. In the first screening phase, 152 papers were screened for title and abstract. Subsequently, 89 articles were removed if they contained at least one exclusion criterion. Sixteen studies were considered after 63 papers had their full texts verified. CONCLUSIONS: The convergence of NMT with emerging fields, such as gamification and wearable devices designed for hand functionality, not only expands therapeutic horizons but also lays the groundwork for innovative, personalized approaches to neurorehabilitation. However, challenges persist in effectively incorporating NMT into rehabilitation programs, potentially hindering its effectiveness.

Psychometric Properties of the Spanish Motives for Online Gaming Questionnaire in a Sample of College Students.

This study investigates the psychometric properties of the Spanish version of the Motives for Online Gaming Questionnaire (MOGQ). We explored the factor structure and construct validity of the MOGQ through its relationships with gaming disorder symptoms (IGD-20) and impulsivity traits. We also analyzed if sociodemographic variables and gaming habits were related to gaming motives. An online cross-sectional survey was completed by 845 college students. Structure validity was examined using a combination of exploratory and confirmatory factor analyses, which supported a bifactor model composed of a general motivation factor and six uncorrelated factors (a mixed factor composed of escape and coping, competition, recreation, skill, social, and fantasy). Omega-hierarchical and omega coefficients were used to determine reliability of the MOGQ. The scale presented acceptable reliability for the general factor (ωh = .79) and the specific factor scores (social ω = .79, escape/coping ω = .81, competition ω = .79, skill ω = .84, fantasy ω = .82, and recreation ω = .70). Positive associations were observed between the MOGQ and the IGD-20 symptoms, with escape/coping (r = .48) and fantasy (r =.40) showing the strongest ones. Null or low correlations were observed with impulsivity traits. Motives to play varied significantly across genders. These findings provide evidence that the Spanish version of the MOGQ is a reliable and valid tool to assess motives to play online games.

Physical activity, problematic gaming behavior, and quality of life prior and during the first 9 months of the COVID-19 pandemic: Findings from a longitudinal study among university students.

BACKGROUND: Generally, there is limited information on longitudinal trends and the interrelations between physical activity (PA), problematic gaming behavior (PGB), described as a dysfunctional pattern of videogame activities, and quality of life (QoL) based on data that include measurements from both pre- and postpandemic onset. This is also the case for university students. As society faced unprecedented restrictions during this period, these aspects may have developed unfavorably. OBJECTIVE: To examine PA, PGB, and QoL among Norwegian University students prior to and during the initial stages of the pandemic and assess their temporal interrelations. METHOD: The data are derived from the "Students' Psychological Health Over Time" study (SPOT). Linear mixed models were used to examine the development from January 2020 to November 2020 over three time points for the total sample and across gender. A traditional cross-lagged panel model analysis was used to estimate temporal associations. Age, gender, socioeconomic status, and partner status were included as covariates. FINDINGS: PA and QoL decreased linearly over time (Cohen's d = 0.12 and 0.35, respectively), while only male students reported a small reduction in PGB (Cohen's d = 0.03). PA levels decreased considerably more for male students than female students (Cohen's d = 0.17 and 0.09, respectively). There was a small reciprocal negative temporal association between PA and PGB (standardized ß = -0.04 and -0.05, respectively). All other temporal associations were not statistically significant in the adjusted analysis. CONCLUSION: The findings highlight gender-variant negative developments in PA and QoL and suggest a negative reciprocal interrelation between PA and PGB. The findings point to potential adverse health effects that should be taken into account when restrictive pandemic measures are considered.

Appetitive conditioning with pornographic stimuli elicits stronger activation in reward regions than monetary and gaming-related stimuli.

Appetitive conditioning plays an important role in the development and maintenance of pornography-use and gaming disorders. It is assumed that primary and secondary reinforcers are involved in these processes. Despite the common use of pornography and gaming in the general population appetitive conditioning processes in this context are still not well studied. This study aims to compare appetitive conditioning processes using primary (pornographic) and secondary (monetary and gaming-related) rewards as unconditioned stimuli (UCS) in the general population. Additionally, it investigates the conditioning processes with gaming-related stimuli as this type of UCS was not used in previous studies. Thirty-one subjects participated in a differential conditioning procedure in which four geometric symbols were paired with either pornographic, monetary, or gaming-related rewards or with nothing to become conditioned stimuli (CS + porn, CS + game, CS + money, and CS-) in an functional magnetic resonance imaging study. We observed elevated arousal and valence ratings as well as skin conductance responses for each CS+ condition compared to the CS-. On the neural level, we found activations during the presentation of the CS + porn in the bilateral nucleus accumbens, right medial orbitofrontal cortex, and the right ventral anterior cingulate cortex compared to the CS-, but no significant activations during CS + money and CS + game compared to the CS-. These results indicate that different processes emerge depending on whether primary and secondary rewards are presented separately or together in the same experimental paradigm. Additionally, monetary and gaming-related stimuli seem to have a lower appetitive value than pornographic rewards.

Network analysis of additional clinical features of (Internet) gaming disorder.

OBJECTIVES: There are dozens of screening instruments purporting to measure the (Internet) gaming disorder (IGD/GD). The two prominent diagnostic manuals, DSM-5 and ICD-11, list several additional diagnostic or clinical features and problems (e.g., neglect of sleep, neglect of daily duties, health deterioration) that should co-occur or be caused by the IGD/GD. It remains unclear how specific IGD/GD operationalizations (different screening scales) are related to these functional impairments. METHODS: To explore this, data on six measures of IGD/GD (IGDS9-SF, GDSS, GDT, GAMES test, two self-assessments) and 18 additional diagnostic features were collected from a sample of 1009 players who play digital games at least 13 h per week. A network approach was utilized to determine which operationalization is most strongly associated with functional impairment. RESULTS: In most of the networks, IGD/GD consistently emerged as the most central node. CONCLUSION: The similar centrality of IGD/GD, irrespective of its definition (DSM-5 or ICD-11) or operationalization, provides support for the valid comparison or synthesis of results from studies that used instruments coming from both DSM-5 and ICD-11 ontologies, but only if the goal is to evaluate IGD/GD relationships to other phenomena, not the relationships between the symptoms themselves.

Addressing the Association Between Action Video Game Playing Experience and Visual Search in Naturalistic Multisensory Scenes.

Prior studies investigating the effects of routine action video game play have demonstrated improvements in a variety of cognitive processes, including improvements in attentional tasks. However, there is little evidence indicating that the cognitive benefits of playing action video games generalize from simplified unisensory stimuli to multisensory scenes - a fundamental characteristic of natural, everyday life environments. The present study addressed if video game experience has an impact on crossmodal congruency effects when searching through such multisensory scenes. We compared the performance of action video game players (AVGPs) and non-video game players (NVGPs) on a visual search task for objects embedded in video clips of realistic scenes. We conducted two identical online experiments with gender-balanced samples, for a total of N = 130. Overall, the data replicated previous findings reporting search benefits when visual targets were accompanied by semantically congruent auditory events, compared to neutral or incongruent ones. However, according to the results, AVGPs did not consistently outperform NVGPs in the overall search task, nor did they use multisensory cues more efficiently than NVGPs. Exploratory analyses with self-reported gender as a variable revealed a potential difference in response strategy between experienced male and female AVGPs when dealing with crossmodal cues. These findings suggest that the generalization of the advantage of AVG experience to realistic, crossmodal situations should be made with caution and considering gender-related issues.

Effect of digital game intervention on cognitive functions in older adults: a multiple baseline single case experimental design study.

BACKGROUND: Residents in nursing homes are prone to cognitive decline affecting memory, visuospatial cognition, and executive functions. Cognitive decline can lead to dementia, necessitating prioritized intervention. METHODS: The current study aimed to investigate whether an intervention using a digital game was effective for preserving and improving the cognitive function of residents in nursing homes. An intervention study was conducted using a single-case AB design with multiple baselines. The participants in the study were five older adults aged 65 and over who do not play digital games regularly. The study ran for 15 weeks, including a baseline (phase A) and an intervention phase (phase B). Phase A had five baselines (5 to 9 weeks) with random participant assignment. In phase B, participants engaged in a digital game (Space Invaders) individually. Cognitive function was assessed as the outcome, measured using the Brain Assessment (performed on a tablet through the Internet) at 16 measurement points. Four of five participants (two female and two male) were included in the analysis, using visual inspection and Bayesian statistics with multi-level modeling. RESULTS: Visual inspection of the graphs revealed cognitive function score improvements after the intervention for most layers in terms of memory of numbers, memory of words, mental rotation test (visuospatial ability), and total scores in the Brain Assessment. These effects were also significant in the analysis by multi-level modeling. CONCLUSIONS: The results suggest that the use of digital games may be effective for preserving and improving cognitive function among residents of nursing home. TRIAL REGISTRATION: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000048677; public title: Effect of a Digital Game Intervention for Cognitive Functions in Older People; registration date: August 30, 2022).

A controversial issue in adolescents: Is the effect of digital games on creative personality traits positive or negative?

AIM: This study aimed to determine the effect of digital games on the creativity of adolescents. METHODS: This study was designed as a cross-sectional study using simple random sampling following the STROBE checklist. It was conducted with 384 adolescents between January and June 2022. Data were collected using the Digital Game Addiction Scale for Children and the Creative Personality Traits Scale. RESULTS: The adolescents were at risk for digital game addiction and had moderate creativity levels. The adolescents who had a male sex, had mothers who received primary education, started playing digital games before the age of 6 years, were using the internet for >5 h a day, had no activity other than playing digital games, and preferred action, adventure, and fighting games had higher digital game addiction levels than the other adolescents. In addition, the male adolescents had higher creativity levels than the female adolescents. There was a significant negative relationship between digital game addiction and creative personality traits among the adolescents. Digital game addiction had a negative effect on creativity. CONCLUSIONS: Adolescents are at risk for digital game addiction and have moderate creativity levels. Digital game addiction negatively affects the development of creative personality traits. Interventions should be planned to prevent digital game addiction among adolescents, and adolescents should be guided to increase awareness of the effects of digital games on their creativity.

An appraisal-based chain-of-emotion architecture for affective language model game agents.

The development of believable, natural, and interactive digital artificial agents is a field of growing interest. Theoretical uncertainties and technical barriers present considerable challenges to the field, particularly with regards to developing agents that effectively simulate human emotions. Large language models (LLMs) might address these issues by tapping common patterns in situational appraisal. In three empirical experiments, this study tests the capabilities of LLMs to solve emotional intelligence tasks and to simulate emotions. It presents and evaluates a new Chain-of-Emotion architecture for emotion simulation within video games, based on psychological appraisal research. Results show that it outperforms control LLM architectures on a range of user experience and content analysis metrics. This study therefore provides early evidence of how to construct and test affective agents based on cognitive processes represented in language models.

Examining how gamers connect with their avatars to assess their anxiety: A novel artificial intelligence approach.

Research has supported that a gamer's attachment to their avatar can offer significant insights about their mental health, including anxiety. To assess this hypothesis, longitudinal data from 565 adult and adolescent participants (Mage = 29.3 years, SD = 10.6) was analyzed at two points, six months apart. Respondents were assessed using the User-Avatar Bond (UAB) scale and the Depression Anxiety Stress Scale (DASS) to measure their connection with their avatar and their risk for anxiety. The records were processed using both untuned and tuned artificial intelligence [AI] classifiers to evaluate present and future anxiety. The findings indicated that AI models are capable of accurately and autonomously discerning cases of anxiety risk based on the gamers' self-reported UAB, age, and duration of gaming, both at present and after six months. Notably, random forest algorithms surpassed other AI models in effectiveness, with avatar compensation emerging as the most significant factor in model training for prospective anxiety. The implications for assessment, prevention, and clinical practice are discussed.

Gaming expertise induces meso­scale brain plasticity and efficiency mechanisms as revealed by whole-brain modeling.

Video games are a valuable tool for studying the effects of training and neural plasticity on the brain. However, the underlying mechanisms related to plasticity-associated brain structural changes and their impact on brain dynamics are unknown. Here, we used a semi-empirical whole-brain model to study structural neural plasticity mechanisms linked to video game expertise. We hypothesized that video game expertise is associated with neural plasticity-mediated changes in structural connectivity that manifest at the meso­scale level, resulting in a more segregated functional network topology. To test this hypothesis, we combined structural connectivity data of StarCraft II video game players (VGPs, n = 31) and non-players (NVGPs, n = 31), with generic fMRI data from the Human Connectome Project and computational models, to generate simulated fMRI recordings. Graph theory analysis on simulated data was performed during both resting-state conditions and external stimulation. VGPs' simulated functional connectivity was characterized by a meso­scale integration, with increased local connectivity in frontal, parietal, and occipital brain regions. The same analyses at the level of structural connectivity showed no differences between VGPs and NVGPs. Regions that increased their connectivity strength in VGPs are known to be involved in cognitive processes crucial for task performance such as attention, reasoning, and inference. In-silico stimulation suggested that differences in FC between VGPs and NVGPs emerge in noisy contexts, specifically when the noisy level of stimulation is increased. This indicates that the connectomes of VGPs may facilitate the filtering of noise from stimuli. These structural alterations drive the meso­scale functional changes observed in individuals with gaming expertise. Overall, our work sheds light on the mechanisms underlying structural neural plasticity triggered by video game experiences.

Enhancing ESG learning outcomes through gamification: An experimental study.

This study investigates the effectiveness of gamification in enhancing learning outcomes in Environmental, Social, and Governance (ESG) education. Employing a cluster randomized experiment, the research involved 22 classes from four universities, divided into gamified and traditional teaching groups. The gamified group engaged with ESG concepts through interactive, game-like elements, while the control group followed standard educational practices. The study aimed to determine whether gamification could improve ESG course effectiveness and enhance Psychological Ownership and Perceived Importance, thereby influencing learning outcomes. Data collected through post-experiment surveys were analyzed using multiple linear regression and Structural Equation Modeling (SEM). Results indicated that students in the gamified group performed significantly better in ESG exams compared to the control group, demonstrating the effectiveness of gamification in enhancing academic achievement. The SEM analysis further revealed that gamification positively impacted Psychological Ownership and Perceived Importance, which in turn significantly improved academic performance. These findings suggest that incorporating gamification in ESG education can effectively engage students and deepen their understanding of complex sustainability issues. This study contributes to the field by highlighting the potential of gamification as a transformative tool in higher education, particularly in teaching abstract and multifaceted subjects like ESG.