Serious Games for Learning Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis.

BACKGROUND: Learning disabilities are among the major cognitive impairments caused by aging. Among the interventions used to improve learning among older adults are serious games, which are participative electronic games designed for purposes other than entertainment. Although some systematic reviews have examined the effectiveness of serious games on learning, they are undermined by some limitations, such as focusing on older adults without cognitive impairments, focusing on particular types of serious games, and not considering the comparator type in the analysis. OBJECTIVE: This review aimed to evaluate the effectiveness of serious games on verbal and nonverbal learning among older adults with cognitive impairment. METHODS: Eight electronic databases were searched to retrieve studies relevant to this systematic review and meta-analysis. Furthermore, we went through the studies that cited the included studies and screened the reference lists of the included studies and relevant reviews. Two reviewers independently checked the eligibility of the identified studies, extracted data from the included studies, and appraised their risk of bias and the quality of the evidence. The results of the included studies were summarized using a narrative synthesis or meta-analysis, as appropriate. RESULTS: Of the 559 citations retrieved, 11 (2%) randomized controlled trials (RCTs) ultimately met all eligibility criteria for this review. A meta-analysis of 45% (5/11) of the RCTs revealed that serious games are effective in improving verbal learning among older adults with cognitive impairment in comparison with no or sham interventions (P=.04), and serious games do not have a different effect on verbal learning between patients with mild cognitive impairment and those with Alzheimer disease (P=.89). A meta-analysis of 18% (2/11) of the RCTs revealed that serious games are as effective as conventional exercises in promoting verbal learning (P=.98). We also found that serious games outperformed no or sham interventions (4/11, 36%; P=.03) and conventional cognitive training (2/11, 18%; P<.001) in enhancing nonverbal learning. CONCLUSIONS: Serious games have the potential to enhance verbal and nonverbal learning among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of evidence, the small sample size in most of the meta-analyzed studies (6/8, 75%), and the paucity of studies included in the meta-analyses. Thus, until further convincing proof of their effectiveness is offered, serious games should be used to supplement current interventions for verbal and nonverbal learning rather than replace them entirely. Further studies are needed to compare serious games with conventional cognitive training and conventional exercises, as well as different types of serious games, different platforms, different intervention periods, and different follow-up periods. TRIAL REGISTRATION: PROSPERO CRD42022348849; https://tinyurl.com/y6yewwfa.

Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review.

BACKGROUND: Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. OBJECTIVE: This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. METHODS: We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. RESULTS: Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). CONCLUSIONS: Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.

Parents of Children with Cleft Lip Exhibit Heightened Visual Attention to the Perioral Area.

Following high-quality surgical repair, children born with a cleft lip anomaly may still display lasting visual differences. We exposed control adults and parents of affected children to images of children with cleft deformity and compared their visual tracking patterns. The protocol investigated whether parental exposure to secondary cleft deformity heightens or diminishes visual attraction to this type of structural facial variation. Method: Twenty participants (10 control adults, 10 parents of affected children) assessed 40 colored images of children's faces while their eye movements were tracked. Twenty-four control images and 16 repaired cleft lip images were displayed to observers. Nine bilateral facial aesthetic zones were considered as regions of interest. Percentage of time visually fixating within each region, and statistical differences in fixation duration percentage between the two participant groups and across the bilateral regions of interest were analyzed. Results: While both groups of observers directed more visual attention to the nasal and oral regions of the cleft images than control images, parents of children with cleft lip spent significantly more time fixating on these areas (25% and 24% of the time, respectively) than did unaffected adults (14.6% and 19.3%; P < 0.001). Conclusions: These results demonstrate that parents of cleft lip children exhibit heightened attention to this type of facial difference relative to the naive observer. These findings highlight that observer profile can meaningfully influence the perception of a facial deformity. Awareness of this information may enhance communication between surgeon and parents of an affected child by providing added insight into parental perspective.

The performance of serious games for enhancing attention in cognitively impaired older adults.

Attention, which is the process of noticing the surrounding environment and processing information, is one of the cognitive functions that deteriorate gradually as people grow older. Games that are used for other than entertainment, such as improving attention, are often referred to as serious games. This study examined the effectiveness of serious games on attention among elderly individuals suffering from cognitive impairment. A systematic review and meta-analyses of randomized controlled trials were carried out. A total of 10 trials ultimately met all eligibility criteria of the 559 records retrieved. The synthesis of very low-quality evidence from three trials, as analyzed in a meta-study, indicated that serious games outperform no/passive interventions in enhancing attention in cognitively impaired older adults (P < 0.001). Additionally, findings from two other studies demonstrated that serious games are more effective than traditional cognitive training in boosting attention among cognitively impaired older adults. One study also concluded that serious games are better than traditional exercises in enhancing attention. Serious games can enhance attention in cognitively impaired older adults. However, given the low quality of the evidence, the limited number of participants in most studies, the absence of some comparative studies, and the dearth of studies included in the meta-analyses, the results remain inconclusive. Thus, until the aforementioned limitations are rectified in future research, serious games should serve as a supplement, rather than a replacement, to current interventions.

Contribution of Artificial Intelligence in Pregnancy: A Scoping Review.

For the past ten years, the healthcare sector and industry has witnessed a surge in Artificial Intelligence (AI) technologies being used in many different medical specialties. Recently, AI-driven technologies have been utilized in medical care for pregnancy. In this work, we present a scoping review that explores the features of AI-driven technologies used in caring for pregnant patients. This review was conducted using the Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews. Our analysis revealed that AI techniques were used in predicting pregnancy disorders such as preeclampsia and gestational diabetes, along with managing and treating ectopic pregnancies. We also found that AI technologies were used to assess risk factors and safety surveillance of pregnant women. We believe that AI-driven technologies have the potential to improve the healthcare provided to pregnant women.

Artificial Intelligence-Driven Serious Games in Health Care: Scoping Review.

BACKGROUND: Artificial intelligence (AI)-driven serious games have been used in health care to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state to plan on how to leverage them in the current and future health care needs. OBJECTIVE: This study aimed to explore the features of AI-driven serious games in health care as reported by previous research. METHODS: We conducted a scoping review to achieve the abovementioned objective. The most popular databases in the information technology and health fields (ie, MEDLINE, PsycInfo, Embase, CINAHL, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched using keywords related to serious games and AI. Two reviewers independently performed the study selection process. Three reviewers independently extracted data from the included studies. A narrative approach was used for data synthesis. RESULTS: The search process returned 1470 records. Of these 1470 records, 46 (31.29%) met all eligibility criteria. A total of 64 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games were used for rehabilitation in most of the studies. The most common genres of serious games were role-playing games, puzzle games, and platform games. Unity was the most prominent game engine used to develop serious games. PCs were the most common platform used to play serious games. The most common algorithm used in the included studies was support vector machine. The most common purposes of AI were the detection of disease and the evaluation of user performance. The size of the data set ranged from 36 to 795,600. The most common validation techniques used in the included studies were k-fold cross-validation and training-test split validation. Accuracy was the most commonly used metric for evaluating the performance of AI models. CONCLUSIONS: The last decade witnessed an increase in the development of AI-driven serious games for health care purposes, targeting various health conditions, and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. Although the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

Effectiveness of Serious Games for Language Processing Amongst Elderly Population with Cognitive Impairment: A Systematic Review and Meta-Analysis.

This article intended to carry out a systematic review on the effectiveness of serious games for language processing among older adults with cognitive impairment. Out of 548 retrieved records, six randomized controlled trials (RCTs) eventually met the eligibility criteria. A meta-analysis of four studies showed that serious games are more effective than no/passive interventions in enhancing language processing among older adults with cognitive impairment (p=0.008). Further, a statistically significant effect of serious games on language processing when compared with conventional cognitive activities and conventional exercises was reported in two RCTs. Other RCTs found that exergames are as effective as computerized cognitive training games in improving language processing. Serious games should be offered or used as complementary (i.e., not a substitute) to the current interventions. For there to be definitive conclusions about the efficacy of serious games on language processing more trials are needed.

Effectiveness of Serious Games for Visuospatial Abilities in Elderly Population with Cognitive Impairment: A Systematic Review and Meta-Analysis.

We explore the effectiveness of serious games for visuospatial abilities among older adults with cognitive impairment by conducting a systematic review. Out of 548 identified publications, seven randomized controlled trials (RCTs) were included in this review. According to a meta-analysis of four RCTs, there is no statistically significant difference (p=0.28) in visuospatial abilities between serious game and control groups. Further, the included RCTs noted no statistically significant difference in the visuospatial ability when comparing serious games to conventional exercise (one study) and other serious games (two studies). One RCT demonstrated a statistically significant effect of serious games on the visuospatial ability when compared with conventional cognitive training. This review could not prove the effectiveness of serious games in enhancing visuospatial abilities for older adults with cognitive impairment. Thus, serious games should not be offered or used for enhancing visuospatial abilities amongst the elderly population with cognitive impairment. More robust RCTs are needed to make firm conclusions on the efficacy of serious games.