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In this chapter, we present a state-of-the-art report on serious games dealing with e-health in a broad sense, including medicine, nursing, health care, and physical exercise. The games have been classified according to their main purpose (entertainment, teaching, or health), stages of the disease being treated and the type of users of the system (...
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... this paper, we survey the serious games that are related to health and classify them with respect to different aspects. Not only games that have been described and evaluated in peer-reviewed publications are presented in this article but the scope of the survey also includes: 1) the commercial games (consoles and PCs) 2) online games 3) games and application on mobile platforms 4) games running on specialized platforms in clinics, hospitals and patients homes. We begin with reviews of important concepts: section 1.1 provides an introduc- tion of serious games, and section 1.2 describes health. Section 1.3 describes the intersection of the two fields, and provides a review on previous surveys. Section 2 details the different ways in which serious games in health can be classified, while section 3 contains a comprehensive list of games. A summary of their main characteristics, a comparison table, graphs and a discussion of the results is present in section 4. Finally, section 5 concludes the paper. Today, the term serious game is becoming more and more popular even though there is currently no single definition of the concept. Serious games are defined in contraposition to entertainment games. They inherit gameplay characteristics from entertainment games, but the main focus may be learning or training, and the lessons learnt are expected to be used in real-life work environments. Serious games are present in many areas of knowledge, including defense, manufacturing, education and medicine, among others. According to Navarro[38], serious games is an emerging technology growing in importance for specialized training, taking advantage of 3D games and game engines in order to improve the realistic experience of users. We propose the char- acterization of serious games by using the following main components: rules and gameplay, challenges, interaction modes and goals. The gameplay is the pattern defined through the game rules which connects the player and the game. The goals may be explicit (stated as game objectives) or implicit. Implicit goals may include increasing skills and abilities, gaining knowledge or acquiring experience (Fig. 1). The World Health Organization (WHO) [1] defined health in its broader sense as ”a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Other definitions simply require being free from illness or injury [57]. If we use the stricter definition, we may only consider games dealing with the different phases of illness development, both doctor training and patient familiariza- tion with his illness. However, the use of the WHO definition allows us to consider a third variety of games which has had a big success recently: games dealing with healthy habits such as exercise (including dancing and fitness games), so we shall use this broader definition in this paper. In Maslow’s hierachy of needs [33] , health is represented in the second lowest level, after basic needs required for life are fulfilled. Health is then a very basic need, and maintaining health should therefore be a priority. Additionally, the desirable human characteristics located in higher levels of Maslow’s pyramid which are needed for a functioning, peaceful society are negatively impacted by lack of health in the population. From the reasons stated above, Healthcare is one of the main issues that affects people the most in every stage of life (from infancy to old age). Many re- searches [29] [20] have shown the need of highly trained and educated health care professionals to avoid medical errors, and the use of serious games in health can provide an additional mean to increase interest in training, education and evaluation of their performance, as we will see in the next section. Repetitive tasks are needed in many cases to treat patients, but patient boredom has a negative impact on the patient’s willingness to continue the treatment. The use of tailored games to replace these tasks therefore has good results. Additionally, since the recent explosion of videogames, which now are used in two thirds of households by people of all ages [40], patients can feel more at ease and enjoy their treatment performing an activity they like. Since 2002 [42] many serious games in the field of e-health have been developed, dealing with a wide variety of aspects of surgeon training, radiology operation, Car- diopulmonary Resuscitation (CPR) and patient care, among others. Games aimed at patients have also been developed. The previous surveys of serious games are described next; Ricardo and Rafael [32] present the state of adaptivity in general games and simulations focusing on the purposes, targets, and methods from both academia and industry. N.A. Bartolome et.al. [7] present a systematic review of 21 serious games for health and education described at scientific papers written in English from 2003 to 2011 and projects from the 7 th Framework Program. Pamela M. Kato [27] summarize the scientific literature of commercially available and tailor-made games used for education and training with patients and medical students and doctors. The classification is based on diseases. Paula et al. [41] propose a classification designed to properly distinguish and compare eight Serious Games for Rehabilitation systems with respect to their fundamental characteristics. They also describe a particular Serious Game for Rehabilitation, RehaCom, as a case study. Carolyn et al. [59] explore the use of games for children with long term treatment regimes, where motivation for compli- ance is a key factor in the success of the treatment. There are many interesting criteria to classify serious games in health. In this section, we describe these criteria in detail (Fig. 2). There are three main purposes in serious games for health: • The main purpose is entertainment but there is a need to move some parts of the body so the wellness is gotten as a bonus, such as dance dance revolution (DDR) [60] which is the pioneering series of the rhythm and dance genre in video games. The exercise (commercial) games became famous since Wii [39] was released by Nintendo on November 19, 2006. The motion controlled over the avatar by various accessories inspired people to exercise with the video games. • The main goal is Health but the game is used as a tool to pass on knowledge and / or skills. To use the capability of the game engine, various serious health contents are conveyed to players; for example Fatworld [49], Re-Mission [53], Air Medic Sky 1 [54] and many other games shown in section 3 (Review Studies). • Serious use in health and medical purpose but with a need to simulate the situa- tion to avoid / concern risk, safety, budget, etc. Most of the games in this category are simulation games with use in health and medical field such as Virtual Dental Implant Training Simulation Program [9] [16], EMSAVE (”Emergency Medical Services for the disAbled” Virtual Environment) [55] [22], Olive: 3D Hospital Training [48] [44], ...
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Background
While serious games seem to be supportive in healthcare education, none of them had been designed to develop competence in diagnosis and treatment planning of oral lesions. Therefore, this research aimed to develop an online simulation-based serious game for training diagnosis and treatment planning of oral lesions (SimOL) and to evaluat...
Citations
... Serious Games have been around for decades effectuating numerous objectives such as education, healthcare, defense, training, and many more [2][3][4][5][6]. Distinctively for healthcare, they are categorized into health monitoring, anomaly detection, therapy, education, and rehabilitation [7]. Even though its serious gaming domain is booming, it is still not as extensive as needed, noting its wide range of benefits highlighted throughout this paper which can potentially elevate the level of training in medicine. ...
... Regardless, they have a multitude of current applications; surgical procedures such as knee replacements and blood management, odontology for dentistry risk management, nursing training for patient pain regulation, cardiology for stroke rehabilitation assistance, first aid training, and the list goes on [3][4][5][6]8]. There currently exists games including EMSAVE, OLIVE, PULSE!!, VIRTUAL PAIN MANAGER, and VIR-TUAL ECG, that target, respectively, urgent medical procedures for the disabled, hospital training, clinical skills enhancement with patients of trauma [7], patient pain regulation for nurses, and ECG recordings precision for cardiology professionals [8]. ...
Background
Cancer patients are often treated with radiation, therefore increasing their exposure to high energy emissions. In such cases, medical errors may be threatening or fatal, inducing the need to innovate new methods for maximum reduction of irreversible events. Training is an efficient and methodical tool to subject professionals to the real world and heavily educate them on how to perform with minimal errors. An evolving technique for this is Serious Gaming that can fulfill this purpose, especially with the rise of COVID-19 and the shift to the online world, by realistic and visual simulations built to present engaging scenarios. This paper presents the first Serious Game for Lung Cancer Radiotherapy training that embodies Biomedical Engineering principles and clinical experience to create a realistic and precise platform for coherent training.
Methods
To develop the game, thorough 3D modeling, animation, and gaming fundamentals were utilized to represent the whole clinical process of treatment, along with the scores and progress of every player. The model’s goal is to output coherency and organization for students’ ease of use and progress tracking, and to provide a beneficial educational experience supplementary to the users’ training. It aims to also expand their knowledge and use of skills in critical cases where they must perform crucial decision-making and procedures on patients of different cases.
Results
At the end of this research, one of the accomplished goals consists of building a realistic model of the different equipment and tools accompanied with the radiotherapy process received by the patient on Maya 2018, including the true beam table, gantry, X-ray tube, CT Scanner, and so on. The serious game itself was then implemented on Unity Scenes with the built models to create a gamified authentic environment that incorporates the 5 main series of steps; Screening, Contouring, External Beam Planning, Plan Evaluation, Treatment, to simulate the practical workflow of an actual Oncology treatment delivery for lung cancer patients.
Conclusion
This serious game provides an educational and empirical space for training and practice that can be used by students, trainees, and professionals to expand their knowledge and skills in the aim of reducing potential errors.
... Dance combines physical activity, social and emotional engagement, and cognitive stimulation all programmed to maintain synaptic connections and plasticity [12]. Serious games (SG) can be used in this context to improve cognitive functions in efficient way [13][14][15][16]. Exergames can have a particular positive impact on cognitive functions, such as attention and memory [17] [18] and visuospatial abilities [19]. ...
The care of elderly people with neurodegenerative diseases leading to cognitive disorders and dementia represents a major health issue. In this context, serious games (SGs) can improve cognitive functions efficiently. Exergames can boost cognitive functions such as attention and memory. In this population, negative feelings can be exacerbated by inadapted technological design. The aim of this study is to design and evaluate an adapted exergame named Escapad for older adults suffering from Mild Cognitive Impairment (MCI). As part of preliminary study, two versions of Escapad were used with both therapists and MCI patients, who rated version 2 as more adaptable. Hence, we have implemented Escapad to stimulate several cognitive domains in elderly people with MCI who have a depressive tendency. Our results showed a significant improvement in visuospatial abilities/executive functions (p=0.033), temporo-spatial orientation (p=0.048) and a significant reduction in depression (p=0.033). Technical aspects and game use are discussed in this paper.
... In the mental health domain, serious games have a significant positive impact on the effectiveness of certain therapies, as they are able to harness the appealing aesthetics, engaging interactions, and instantaneous feedback of video games for the benefit of individuals (Kato, 2010;Wattanasoontorn et al., 2014). Due to their ability to add interest to activities that may otherwise be boring or repetitive, serious games have the potential to overcome the engagement issues that conventional e-Health apps face. ...
Virtual and augmented reality have been used to diagnose and treat several mental health disorders for decades. Technological advances in these fields have facilitated the availability of commercial solutions for end customers and practitioners. However, there are still some barriers and limitations that prevent these technologies from being widely used by professionals on a daily basis. In addition, the COVID-19 pandemic has exposed a variety of new scenarios in which these technologies could play an essential role, like providing remote treatment. Disorders that traditionally had received less attention are also getting in the spotlight, such as depression or obsessive-compulsive disorder. Improvements in equipment and hardware, like Mixed Reality Head Mounted Displays, could help open new opportunities in the mental health field. Extended reality (XR) is an umbrella term meant to comprise Virtual reality (VR), mixed reality (MR), and augmented reality (AR). While XR applications are eminently visual, other senses are being explored in literature around multisensory interactions, such as auditory, olfactory, or haptic feedback. Applying such stimuli within XR experiences around mental disorders is still under-explored and could greatly enrich the therapeutic experience. This manuscript reviews recent research regarding the use of XR for mental health scenarios, highlighting trends, and potential applications as well as areas for improvement. It also discusses future challenges and research areas in upcoming topics such as the use of wearables, multisensory, and multimodal interaction. The main goal of this paper is to unpack how these technologies could be applied to XR scenarios for mental health to exploit their full potential and follow the path of other health technologies by promoting personalized medicine.
... Virtual environments allow infinite potential for scientific exploration, offering scenarios that are simply impossible in reality. Vivid examples can be found in many domains, such as science and engineering discovery (Barab et al., 2009;Mott et al., 2006;Sandford et al., 2006), military training (Smith, 2009;Zielke et al., 2009) and healthcare training (Hoffman, 2006;Wattanasoontorn et al., 2012). A comprehensive review of the current development as well as social and technical barriers to its mass implementation is documented in (Freitas, 2010;Sandford et al., 2006;Ulicsak, 2010). ...
Recent years have witnessed a growing interest in interactive narrative-based serious games for education and training. A key challenge posed by educational serious games is the balance of fun and learning, so that players are motivated enough to unfold the narrative stories on their own pace while getting sufficient learning materials across. In this chapter, various design strategies that aim to tackle this challenge are presented through the development of Sustain City, an educational serious game system that engages students, particularly prospective and beginning science and engineering students, in a series of engineering design. Besides narrative-learning synthesis, supplementing the player's actions with feedback, and the development of a sufficient guidance system, the chapter also discusses the integration of rigorous assessment and personalized scaffolding. The evaluation of Sustain City deployment confirms the values of the serious games in promoting students' interests and learning in science, technology, engineering, and mathematics (STEM) fields.
... Since their inception, serious games have been used in military, training, health care, and education (De Gloria, Bellotti, and Berta, 2014;Wattanasoontorn, García-Hernández, and Sbert, 2012). In the militia, there are tactical operations where the use of foreign languages is required for better communication with native speakers, like in rescue operations. ...
When new educational games are developed for teaching languages, a set of ideas or intuitions about how students can gain more knowledge are used; however, few of them are based on a solid theory or substantiated with linguistic research. This chapter presents a brief review about second language acquisition theories; describes the importance of recovering, maintaining, and transmitting indigenous languages; and analyzes efforts made for enhancing bilingual education. Serious games are presented as an alternative for learning indigenous languages, and guidelines to develop serious games implementing second language acquisition theories are proposed. Finally, a discussion about challenges and future trends in recovering, maintaining, and transmitting indigenous languages is presented.
... Telecommunications (Almeida et al., 2011); General businesses (Donovan & Lead, 2012;Kapp, 2013;Uskov & Sekar, 2014;Boller & Kapp, 2017); Healthcare (Wattanasoontorn, Hernández, & Sbert, 2014); ...
Serious Games have been used in professional training to increase employee engagement and improve training initiatives. This review intends to identify the application of Serious Games in professional training and how these games have been developed, evaluated, and adapted to relate to the learning outcomes. It aims to map the use of Serious Games in professional training, verifying which forms of adaptation are used, learning outcomes, and models and frameworks of Serious Games that include game elements. Different learning outcomes associated with Serious Games were identified, in the general context and professional training, with knowledge acquisition being the most investigated result and questionnaires the most used type of assessment. It was found that several technologies are used in the adaptation of Serious Games. This literature review highlighted gaps in Serious Games research, especially in adaptive games applied in the context of professional training, such as the absence of frameworks for adaptive Serious Games and the lack of a framework for Serious Games that relates game elements to learning outcomes.
... contexts: Military(Hays, 2005;Greitzer, Kuchar, & Huston, 2007;Engberg-Pedersen, 2017);Telecommunications(Almeida et al, 2011); General businesses(Donovan & Lead, 2012;Kapp, 2013;Uskov & Sekar, 2014;Boller & Kapp, 2017); Healthcare(Wattanasoontorn, Hernández, & Sbert, 2014); Manufacturing companies(Riedel, Feng, Hauge, Hansen, & Tasuya, 2015); ...
Serious Games have been used in professional training to increase employee engagement and improve the results of training initiatives in this context. This work intends to investigate the influence of game elements, in adaptable Serious Games, according to the users' interactions, in the increase of engagement in the game itself and, as the main objective, in the learning outcomes and the transfer of the acquired knowledge and practised skills to activities in the daily work. Using the Design Science Research methodology, this study is intended to develop a framework for the development and evaluation of Serious Games to improve the user experience, the learning outcomes, the transfer of knowledge to work situations, and the application of skills practised in the game in real professional scenarios.
... Interaction modules allow trainees to simulate history taking, mostly through constrained input-e.g. lists of questions and answers prepared for a specific case [11,[20][21][22][23][24][25]. Other methods for processing user input use rules, ontologies and knowledge bases [26,27], statistical language models [28], machine-learning classifiers [29], crowd-sourcing data [22] and preliminary neural approaches [30,31]. ...
Simulated consultations through virtual patients allow medical students to practice history-taking skills. Ideally, applications should provide interactions in natural language and be multi-case, multi-specialty. Nevertheless, few systems handle or are tested on a large variety of cases. We present a virtual patient dialogue system in which a medical trainer types new cases and these are processed without human intervention. To develop it, we designed a patient record model, a knowledge model for the history-taking task, and a termino-ontological model for term variation and out-of-vocabulary words. We evaluated whether this system provided quality dialogue across medical specialities (n = 18), and with unseen cases (n = 29) compared to the cases used for development (n = 6). Medical evaluators (students, residents, practitioners, and researchers) conducted simulated history-taking with the system and assessed its performance through Likert-scale questionnaires. We analysed interaction logs and evaluated system correctness. The mean user evaluation score for the 29 unseen cases was 4.06 out of 5 (very good). The evaluation of correctness determined that, on average, 74.3% (sd = 9.5) of replies were correct, 14.9% (sd = 6.3) incorrect, and in 10.7% the system behaved cautiously by deferring a reply. In the user evaluation, all aspects scored higher in the 29 unseen cases than in the 6 seen cases. Although such a multi-case system has its limits, the evaluation showed that creating it is feasible; that it performs adequately; and that it is judged usable. We discuss some lessons learned and pivotal design choices affecting its performance and the end-users, who are primarily medical students.
... Serious gaming is a well-known product category in the field of Human-Computer Interaction that explicitly intends to improve the knowledge and skills of its users (Michael & Chen, 2005). Researchers have studied serious games that help users learn math (Mayo, 2009), monitor their heart disease (Wattanasoontorn et al., 2014), and understand cultural differences (Zielke et al., 2009), among many other things. ...
This paper introduces a framework for impact-centered design that maps the direct and indirect psychological, social, and behavioral effects resulting from human-product interactions, as well as the strategic pathways that designers utilize to achieve these effects. The framework was created through a series of expert workshops in which 186 design cases were analyzed. The framework includes three basic levels. At the base, user-product interaction evokes three types of direct product experience: aesthetic experience, experience of meaning, and emotional experience. The second level describes more indirect and long-term types of impact: on behaviors, attitudes, (general) experiences, and users’ and stakeholders’ knowledge. The third and final level represents the general quality of life and society. This paper details the characteristics of and theoretical models underlying the various impact areas, provides illustrative student design cases, and describes how the impact areas relate to each other and how design can influence them. Design research can help increase the designer’s influence by contributing theoretical models that explain the various relationships in the impact areas. We propose a three-part classification of these models to get an overview of the current state of knowledge of each impact area, and to discuss the different ways in which models can guide designers. In the discussion, we offer four action points to help set a concerted agenda for impact-centered design research.
... About non-patient-oriented games, these serious games could be used for health and wellness, professional training, and non-professional training. About patientoriented games, these serious games could be designed for health monitoring, clinical detection, treatment, rehabilitation, and self-care education [130]. Each serious game has five main components: rules (gameplay), challenge, interaction, and goal (explicit: game objectives and implicit: skills, knowledge, experiences) [130]. ...
... About patientoriented games, these serious games could be designed for health monitoring, clinical detection, treatment, rehabilitation, and self-care education [130]. Each serious game has five main components: rules (gameplay), challenge, interaction, and goal (explicit: game objectives and implicit: skills, knowledge, experiences) [130]. Many review studies have been done for the topics of treatment and rehabilitation serious games, and they mostly concluded that serious games were shown positive effects on chronic, stroke, and traumatic diseases [90][91][92]. ...
Facial disorders negatively affect professional, social, and personal lives of involved patients.Thus, recovery of facial mimics into normal and symmetrical conditions allows these patients to improve their life qualities. Functional rehabilitation of facial disorders is an important clinical step to improve qualities of surgical interventions and drug therapies. However, facialmimic rehabilitation currently remains a major scientific, technological, and clinical challenge.Especially, conventional rehabilitation processes lack of quantitative and objective biofeedbacks. Moreover, rehabilitation exercises just included long-term and repetitive actions. This makes patients less ambitious for completing their training programs. Besides, numerous modeling methods, interaction devices, and system architectures have been successfully employed in clinical applications, but they have not been successfully applied for facial mimic rehabilitation. Consequently, this thesis was conducted to complement these drawbacks by designing a clinical decision-support system for facial mimic rehabilitation. Especially, patientspecific models and serious games were integrated with the system for providing quantitative and objective bio-feedbacks and training motivations. The thesis has six main contributions: (1) a novel real-time subject-specific head generation & animation systems, (2) a novel head-to-skull prediction process, (3) a muscle-oriented patientspecific facial paralysis grading system, (4) a novel serious game system for facial mimic rehabilitation, (5) a novel clinical decision-support system for facial mimic rehabilitation, and (6) a reference guide for developing real-time soft-tissues simulation systems. This thesis opens new avenues for new research areas relating to automatic generation of patient specific head from visual sensor and internal structures using statistical shape modeling and real-time modeling and simulation for facial mimic rehabilitation.
