A Virtual Reality Serious Videogame Versus Online Chess Augmentation in Patients with Attention Deficit Hyperactivity Disorder: A Randomized Clinical Trial.

Objective: Serious videogames and virtual reality (VR) have gained increasing interest for treating attention deficit hyperactivity disorder (ADHD). "The Secret Trail of Moon" (TSTM) study is a clinical trial devoted to testing the efficacy of TSTM, a VR serious videogame developed to train in five major cognitive skills usually compromised in patients with ADHD. This study is a three-arm nonequality trial comparing TSTM to online chess training and a control group (CG). This study aims to demonstrate that augmentation with either TSTM or online chess is efficacious in clinically drug-stable patients with ADHD. Materials and Methods: This study is prospective, unicentric, and randomized with a CG. One hundred five patients with ADHD, ages 12-22 years old, and pharmacologically stable were enrolled. Patients were randomized into three groups: TSTM group, online chess group (therapeutic chess [TC]), and CG. Objective and subjective measures of the patient and parents are included. Patient visits differ for each group. TSTM group patients have 15 face-to-face visits: preinclusion visit, inclusion visit, 12 training visits, and final visit. TC and CG patients have 3 face-to-face visits (preinclusion, initial visit, and final visit) and 12 e-mail or phone communications during training (TC) or follow-up (CG group). This study was approved by the local Institutional Review Board (IRB). Results: Not applicable. This is a study protocol. Conclusion: This is the first study testing an augmentation strategy using either a serious videogame or chess in clinically drug-treated patients with ADHD. Using VR serious videogames present with several advantages over traditional videogames. Trial Registration: NCT04355065.

The Effect of Video-Based Games on Hand Functions and Cognitive Functions in Cerebral Palsy.

Objective: The purpose of this study is to investigate the effect of Leap Motion Based Exergame Therapy (LMBET) on upper limb gross grip strength (GGS), pinch forces, hand functions, gross motor function, and cognitive functions in patients with cerebral palsy (CP). Materials and Methods: Twenty patients with CP (11 hemiplegia and 9 diplegia) were included in the study. Structured Neurodevelopmental Therapy-based hand rehabilitation (SNDTBHR) (first treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks), and then LMBET (second treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks). GGS was evaluated by "dynamometer," pinch strengths were evaluated by "pinch meter," hand skills were evaluated by "Manual Ability Classification System (MACS)" and "Jebsen-Taylor Hand Function Test (JHFT)," the gross motor level was evaluated by "Gross Motor Function Classification System (GMFCS)," and cognitive functions were evaluated by "Wisconsin Card Sorting Test (WCST)." Results: Significant difference was found between LMBET and SNDTBHR on GGF, pinch forces, JHFT, and WCST in favor of LMBET (P < 0.017). There was no significant difference between both MACS and GMFCS measurements (P > 0.05). Conclusion: Positive effects of both SNDTBHR and LMBET have been found. However, measurements after LMBET are statistically more significant. Future research should take into account higher patient allocation. Including additional leap motion training to conventional physiotherapy is feasible and might be promising to train cognitive function in children with CP.

Videogame and Computer Intervention Effects on Older Adults' Mental Rotation Performance.

Objective: This article examined older adults' performance on two components of a mental rotation task (reaction time and rotation rate) in a home-based intervention study of videogame (Crazy Taxi [CT]) and computerized cognitive training (PositScience InSight). Materials and Methods: Participants were randomized to one of three groups: one group played an off-the-shelf videogame (i.e., CT), the second group engaged in a computerized training program focused on fast perceptual comparisons, visuospatial working memory, rapid scanning of a visual array and pattern recognition, visual discrimination, and selective and divided attention and processing speed (i.e., InSight), and the third (control) group received no training. Training in the two intervention conditions consisted of 60 training sessions of 1 hour each, which were completed in 3 months (5 hours a week). As part of a larger study, participants received mental rotation testing, which was administered immediately before (baseline), after (post-test), and 3 months after (follow-up) training. Results: Although the InSight group showed greater improvements in rotation rate at the immediate post-test, by the 3-month follow-up, the combined treatment groups (CT and InSight) had improved more than controls. Conclusion: The improvements in mental rotation performance found at 3-month follow-up add additional support to previous research, showing visuospatial benefits of both videogame play and cognitive training in older adults. Common elements of both interventions may include expansion of the attentional field of view and faster visual comparison efficiency.

The Effect of Expectations on Experiences and Engagement with an Applied Game for Mental Health.

Objective: Applied games are considered a promising approach to deliver mental health interventions. Nonspecific factors such as expectations and motivation may be crucial to optimize effectiveness yet have not been examined so far. The current study examined the effect of expectations for improvement on (1) experienced fun and positive affect, and (2) in-game play behaviors while playing MindLight, an applied game shown to reduce anxiety. The secondary aim was to examine the moderating role of symptom severity and motivation to change. Materials and Methods: Fifty-seven participants (47 females; 17-21 years old) preselected on anxiety symptoms viewed a trailer in which MindLight was promoted as either a mental health or an entertainment game. These trailers were used to induce different expectations in participants. Participants subsequently played the game for 60 minutes. Before playing, participants filled out questionnaires about their general anxiety symptoms, motivation to change, state anxiety, affect, and arousal. While playing, in-game behaviors and galvanic skin response (GSR) were recorded continuously. After playing, state anxiety, affect, and arousal were measured again as well as experienced fun. Results: Participants in both trailer conditions showed increases in state anxiety, arousal, and GSR. Expectations did not influence experienced fun and positive affect, nor in-game behaviors. In addition, no moderation effects of motivation to change and symptom severity were found. Conclusion: Experiences and engagement with MindLight were not influenced by expectations, motivation to change, and symptom severity. For future research, it is recommended to examine individual differences in these effects, and long-term and more distal outcomes and processes.

The Use of Gamification in Patients Undergoing Hip Arthroplasty: Scoping Review.

Objective: The use of gamification can promote health-related behavior. This article is the first attempt to provide a historical overview of the use of games in patients undergoing hip arthroplasty. Materials and Methods: We conducted a scoping review to map and characterize the games used for the person undergoing hip arthroplasty. To perform this review, the respective descriptors were identified using search syntax appropriate to each of the databases: MEDLINE_ (Medical Literature Analysis and Retrieval System Online), CINAHL_ (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, in the Psychology and Behavioral Sciences Collection, SCOPUS, SciELO (Scientific Electronic Library Online), and PEDRo (Physiotherapy Evidence Database). Results: An initial 968 articles were identified, of which 7 articles were included. The domains of the games under analysis essentially focus on aspects of rehabilitation (n = 5), or related (n = 2), and mostly exergames (n = 6). However, the instruments, characteristics, and procedures used to evaluate the games in the included studies have little depth and large variability. Conclusion: Few games exist that support people who have undergone hip arthroplasty. Most of the games under review were exergames to support rehabilitation. Consequently, we recommend developing another type of game with a focus on monitoring, counseling, and/or social support for selfmanagement training in persons undergoing hip arthroplasty.

Differences in Physical Activity During Walking and Two Pokémon Go Playing Styles.

Objective: Two self-selected playing styles of Pokémon Go (PG) have been observed: intermittent and continuous. However, it is unknown how playing style impacts volume and pattern of physical activity (PA) compared with a traditional walking bout. Materials and Methods: Twenty experienced PG players followed a 1.77 km walking loop during two randomly ordered, 30-minute walking conditions: PG and traditional walking. Objective measurement tools (pedometer, accelerometer, heart rate monitor, GPS watch) were used to measure steps, caloric expenditure, intensity, heart rate, and distance traveled, and direct observation was used to determine number of stops and playing style. Results: Most PG players used the intermittent playing style (60%). Traditional walking resulted in significantly greater PA than PG. There was a significant interaction between the PG playing style (continuous, intermittent) and condition (PG, traditional walking). There was no difference in PA variables between continuous and intermittent PG during traditional walking; however, total steps (3394.3 ± 255.8 vs. 2779.1 ± 317.5), aerobic steps (3314.3 ± 318.9 vs. 2387.5 ± 771.8), caloric expenditure (146.00 [130.0-201.3] vs. 110.0 [89.3-132.3 Kcals]), distance (2.4 [2.3-2.6] vs. 2.0 [1.8-2.1 km]), and moderate minutes (29.7 [27.5-29.8] vs. 25.8 [23.1-27.1]) were significantly greater, while sedentary minutes (0.2 [0-1.0] vs. 2.7 [1.7-4.3]) and number of stops (0 [0-0.8] vs. 4.5 [2.3-7.0]) were less, for continuous compared with intermittent PG. There was a main effect of condition on PA for intermittent PG players, but not continuous PG players. Conclusion: Continuous PG produced similar PA to traditional walking, while intermittent PG reduced PA, nevertheless PG may be a strategy for increasing PA participation.

A Videogame-Based Approach to Measuring Information Processing Speed in Multiple Sclerosis Patients.

Objective: Slowing information processing speed (IPS) is a biomarker of neuronal damage in patients with multiple sclerosis (pwMS). A focus on IPS might be the ideal solution in the perspective of promptly detecting cognitive changes over time. We developed a tablet-based home-made videogame to test the sensitivity of this device in measuring subclinical IPS in pwMS. Materials and Methods: Forty-three pwMS without cognitive impairment and 20 healthy controls (HCs) were administered the videogame task with a tablet. Response times (RTs) and accuracy were recorded. Results: PwMS (mean RTs = 505.5 ± 73.9 ms) were significantly slower than HCs (mean RTs = 462.3 ± 40.3 ms, P = 0.014) on the videogame task. A moderate but significant correlation (r = -0.35, P = 0.03) between mean RTs and the Symbol Digit Modalities Test was observed. Conclusion: Our videogame showed good sensitivity in measuring IPS in apparently cognitive normal pwMS. Computerized testing might be useful in screening initial cognitive dysfunction that should be monitored as a marker of underlying disease progression. IRB approval Number is 2332CESC.

Effects of Nintendo Ring Fit Adventure Exergame on Pain and Psychological Factors in Patients with Chronic Low Back Pain.

Objective: In recent years, there has been an increase in research on the therapeutic effects of exergaming, but there have been few studies on these types of interventions for chronic low back pain. In this study, we hypothesized that the Nintendo Ring Fit Adventure (RFA) exergame would be effective for patients with chronic low back pain, and we conducted a randomized prospective longitudinal study. Materials and Methods: Patients with chronic low back pain were included in this study. Twenty randomly selected patients (9 males and 11 females, mean age 49.3 years) were included in the RFA group, and RFA exergaming was performed once a week for 40 minutes for 8 weeks. Twenty patients (12 males and 8 females, mean age 55.60 years) served as the control group and received oral treatment for 8 weeks. Pain and psychological scores (pain self-efficacy, pain catastrophizing, and kinesiophobia) were measured and analyzed before and after 8 weeks of treatment in both groups. Results: In the RFA group, low back pain, buttock pain, and pain self-efficacy were significantly improved after 8 weeks of RFA exergaming, but there was no significant improvement in lower limb numbness, pain catastrophizing, or kinesiophobia. In the control group, no significant improvement was observed after 8 weeks of oral treatment. Conclusion: RFA exergaming increased pain self-efficacy and reduced pain in patients with chronic low back pain. Future treatment protocols should be developed to improve pain self-efficacy. Approval code: 2894, School of Medicine, Chiba University.

A novel "video-game" simulator for training fetoscopic laser coagulation of anastomoses in twin-to-twin transfusion syndrome.

 : We have developed a high-fidelity interactive "video-game" simulator in order to teach fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome This simulator may be used by teachers in order to provide metrics-based simulator education to multiple trainees, in both hands-on and distanced learning settings WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The use of simulation improves training of the fetoscopic laser techniques utilized in the treatment of twin-twin transfusion syndrome A number of mannequins have been developed to aid this education WHAT DOES THIS STUDY ADD?: Two new simulators are described for twin-twin transfusion syndrome training-silicone and digital The digital simulator is a novel digital video game virtual format This new format has enhanced interactivity and has the potential to enable distance learning.

Reality and Virtual: Hemodynamic Variables and Rating of Perceived Exertion Between Dance Sessions and Active Videogame Just Dance in Women.

Objective: To analyze the hemodynamic variables and the rating of perceived exertion (RPE) between an active videogame (AVG) session and a dance session. Materials and Methods: The sample consisted of 30 university women between 18 and 30 years of age, physically active and having some kind of experience with dancing. The volunteers participated in the two sessions held on different days, the first with an active dance videogame and the other with a dance instructor, both lasting 50 minutes, with a sequence of songs and moderate intensity. For the evaluation of the two sessions, heart rate (HR), blood pressure (BP), and RPE measurements were taken before and every 10 minutes, until the time for each modality (AVG or dance) was completed. The Shapiro-Wilk and Levene test were used for normal data. For the comparison of two sessions, the two-way ANOVA test was used for repeated measures, and were considered to have a significance level of P < 0.05. Results: There were significant differences in HR [F(6, 96) = 2.606, P = 0.02, η2 P = 0.140], from 10 to 50 minutes (P < 0.01), and diastolic BP [F(6, 84) = 1.858, P = 0.10, η2 P = 0.117], as well as, in the 20th minute (P = 0.02) between Just Dance 2016® and a dance session. All the variables analyzed showed an effect size as large in the classification of the degree of magnitude. Conclusion: There are similarities between the virtual and real dance sessions regarding hemodynamic variables and RPE. Thus, AVGs, especially Just Dance®, may be a favorable option for individuals who wish to exercise at home.

Effects of Interactive Videogames on Postural Control and Risk of Fall Outcomes in Frail and Pre-frail Older Adults: A Systematic Review and Meta-Analysis.

Background: Interactive videogames (IVGs) have been used to reduce risk of falls in the older adult and improve postural control (PC) outcomes. Objective: To systematically review trials that examine whether IVGs training is effective in improving PC and managing falls in frail and pre-frail older adults. Data Sources: Four databases were searched, Scopus, Web of science, PubMed, and MEDLINE, from January 2007 to March 2019. Eligibility Criteria: Frail and pre-frail older adults aged 65+. Interventions were any Nintendo® Wii™ training. The outcome measures were PC and risk of falls as measured by any validated outcome measure. Studies Appraisal Method: The PEDro (Physiotherapy Evidence Database) scale and Cochrane risk-of-bias tool were used by two independent authors. Results: Eleven papers were included, involving 388 participants, with a mean age of 79 ± 5.7 years. The mean duration of IVGs sessions was 8.8 ± 3.8 weeks, the mean total number of sessions was 20 ± 11.1 session, and the mean length of training was 44 ± 15.7 minutes. Meta-Analysis: IVGs achieved better results compared with traditional exercises and control on the Berg Balance Scale (mean difference [MD] 2.80; 95% confidence interval [CI] 1.21 to 4.39; P < 0.001; I2 = 16%), as well as in the short term on Timed Up and Go (MD -1.23; 95% CI -2.37 to -0.09; P = 0.03; I2 = 0%). Limitation: Definitive judgement could not be made due to the variability in training, training duration and outcomes measurement. Conclusion: IVGs is a promising modality that has a positive effect on PC but not on the outcome of falls, so it should be prescribed with caution among frail older adults. Systematic Review Registration: PROSPERO registration number: CRD42019129611.

Motivation in Team Exergames: Testing the Köhler Discrepancy Effect with a Software-Generated Partner During Plank Exercise.

Objective: The Köhler effect is a social-psychological group motivation gain phenomenon that has been successfully adapted to video-based exercise games (exergames) using human partners. This research then shifted to using software-generated partners (SGPs), providing greater flexibility and adaptability to manipulate the game environment to be most motivating for the user. However, recent SGP-based experiments have demonstrated a diminished motivation gain effect. Extending previous work with human-human partners, this experiment varied the perceived exercise ability of the SGP as a potential motivation gain effect moderator on the participant's exercise persistence. Materials and Methods: Male and female college students (n = 176; mean age, 21.5 years) completed two series of abdominal plank exercises using an exergame developed specifically for a previous Köhler study. Participants completed the exercises individually and, after a rest, were randomly assigned to complete the same exercises again alone or with one of three SGPs: low ability discrepancy partner (LP), moderate ability discrepancy partner (MP), and high ability discrepancy partner (HP). Results: A 2 (sex) × 4 (condition) analysis of covariance main effect for Condition was not significant after controlling for Block 1 times (P = 0.093). However, contrast estimates of plank persistence times between the MP condition and individual no-partner control were significant, P = 0.014, 95% confidence interval [4.34-37.68]. There were no other significant condition persistence differences. Conclusions: A moderate discrepancy between the participant and the superior nonhuman partner is more motivating in a conjunctive task paradigm than exercising alone or with an SGP that is low or high in ability discrepancy.

Defining Digital Game-Based Learning for Science, Technology, Engineering, and Mathematics: A New Perspective on Design and Developmental Research.

In the modern age, digital games are widely used as informal media for Science, Technology, Engineering, and Mathematics (STEM) education and medical therapy for game-based learning. Digital games provide learners with a graphical system of interaction that enhances scientific concepts within an enjoyable environment. The vastly increasing number of digital games produced in the market affects the quality of STEM digital games while requiring multidisciplinary expertise. This paper proposes a framework for STEM digital game-based learning encompassing input-process-output stages. Several studies from the early 2000s onward were reviewed to discuss and present a new perspective on a framework for the design and development of digital games, particularly for STEM. This proposed framework consists of digital game development as input, experience as a process, and constructs as output. This simple and precise framework will generate a universal product for various types of learners. It can thus be used as a guideline for game designers, developers, and experts to develop STEM digital games and achieve better learning outcomes.

Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study.

BACKGROUND: Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. OBJECTIVE: To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game-based digital therapeutic to assess cognition in multiple sclerosis. METHODS: A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. RESULTS: Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=-0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03). CONCLUSIONS: These findings suggest that EVO Monitor, an unsupervised, video game-based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618.

Reinforcing Value of a Moderately Physiologically Challenging Active Videogame Versus a Minimally Challenging Active Videogame.

Objective: This study assessed the oxygen consumption [VO2 mL/(kg·min)], liking, and relative reinforcing (motivating) value (RRV) of a moderately physiologically challenging exergame [Nintendo Wii-Sports Boxing (Boxing)] versus a minimally challenging exergame [Nintendo Wii Lego Star Wars (Lego)]. Materials and Methods: VO2 and liking were recorded in children(N = 28, 7.8 ± 1.3 years old) during three 10-minute conditions: recumbent resting (Resting), and playing Wii Boxing or Wii Lego. Resting was completed first, and the order of exergames was randomized. Next, children performed an operant button pressing task using a progressive fixed ratio to assess the RRV of the two videogame conditions. Children worked to earn up to 11 minutes for Boxing, Lego, or a combination of the two. The output maximum (Omax) performed to earn access to each game was the measure of RRV. Results: There was a significant (P ≤ 0.03 for all conditions) step-wise increase in VO2 from Resting [4.3 ± 1.2 mL/(kg·min)] to Lego [5.3 ± 0.5 mL/(kg·min)] and from Lego to Boxing [11.7 ± 4.2 mL/(kg·min)]. Liking was significantly greater for Boxing (P = 0.003) and Lego (P < 0.0001, 7.1 ± 2.9 cm; 7.1 ± 2.7 cm, respectively) versus Resting (4.6 ± 3.8 cm), with no significant difference between Boxing and Lego (P = 0.358). Lastly, Omax was significantly (P = 0.021) greater for Lego (257.7 ± 390.6 presses) than for Boxing (51.7 ± 131.0 presses). Conclusion: Oxygen consumption during Wii Boxing was significantly greater than during Wii Lego. Despite this greater physiological challenge, liking was similar for both Lego and Boxing. However, children were more motivated to play Lego than Boxing.

Physiological Responses of Exergaming Boxing in Adults: A Systematic Review and Meta-Analysis.

Objective: Studies investigating the effects of exergaming in available platforms are still limited. This review aims to systematically identify available studies on physiological intensities of exergaming boxing in able-bodied adults and recategorize them based on different platforms or environments. The meta-analysis further analyzes the physiological responses during exergaming boxing into a set of pooled data for any evidence of outliers, heterogeneity, or publication bias. Materials and Methods: A systematic search was conducted by using databases from Google Scholar, PubMed, and Web of Science. Population, intervention, comparison, and outcomes (PICO) and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used in the study selection process for the review. Results: From the 1534 articles examined, 16 articles were included for further analyses. Results indicated that exergaming boxing exhibits a wide range of metabolic equivalent of task (MET) values and intensity, from very light to vigorous, with elements of heterogeneity and bias detected. The Xbox® Kinect boxing platform produced higher MET (mean = 5.3) compared with the Nintendo® Wii™ boxing (mean = 3.8). Conclusion: The results of this review suggest that boxing exergames can produce intensity-adequate physical activity among younger adults that are beneficial for cardiometabolic improvements, regardless of platforms used. Exergaming boxing may be employed as an effective exercise tool to increase energy expenditure and physical activity level in young adults.

Effect of Wii-habilitation on spatiotemporal parameters and upper limb function post-burn in children.

BACKGROUND: Limb burns can cause different functional disorders that greatly impact one's quality of life. AIM: The purpose of the current study was to compare the effect of Nintendo Wii sports intervention, and traditional treatment methods on spatiotemporal parameters and upper limb function post-burn in children. METHODS: Thirty children their age ranging from 7-12 years, with dominant side upper limb burn participated in the study.Vicon3-D motion analysis system and Jebsen hand function test were used to evaluate spatiotemporal parameters (movement duration, peak velocity, and time to peak velocity percentage in three functional tasks) and upper limb function respectively. The children were randomly divided into study and control groups. The study group was rehabilitated with Wii training in addition to traditional therapy, while the control group rehabilitated only with the traditional therapy program. For the study group, the games selected were Wii Bowling, Baseball, and Tennis. Both groups were trained for 60 min daily, three times/week for six weeks. The outcomes were measured pre and post the treatment period. RESULTS: The whole-time duration and peak velocity improved significantly in the study group across the hand to head task (p = 0.001, p < 0.001, respectively), hand to mouth (p = 0.001), and hand to shoulder (p < 0.001, p = 0.0018, respectively) compared with the control group. The time to peak velocity percentage was enhanced significantly in the study group (p < 0.001) than the control group in all three-measured tasks. Moreover, the Jebsen hand function test improved significantly (p < 0.001) in the study group than in the control group. CONCLUSION: Wii-habilitation could be advised as an effective tool in the rehabilitation program of children with post-burn injuries.

The Effects of Physical Activity and Exergaming on Motor Skills and Executive Functions in Children with Autism Spectrum Disorder.

Objective: This study aims at investigating the effects of two types of interventions, Sports, Play and Active Recreation for Kids (SPARK) and exergaming (Kinect), on motor skills (MS) and executive functions (EF) in children with autism spectrum disorder (ASD). Materials and Methods: Sixty children, aged 6-10 years were randomly assigned to SPARK (n = 20), Kinect (n = 20), or a control group (n = 20). Children's MS and EF were assessed before and after the intervention. The SPARK and Kinect groups participated in an 8-week intervention; the control group received treatment as usual. Intention-to-treat repeated-measures ANOVA was used to examine the effects of the intervention. Results: For MS, a significant group X time interaction was observed for aiming and catching skills [F(2, 53) = 4.12, P < 0.05]; the SPARK group improved significantly from pre- to post-test compared with the other groups. For EF, a main effect of group was found for correct responses [F(2, 53) = 5.43, P < 0.01]. The Kinect group showed more correct responses than the SPARK and control groups. A main effect of time was significant for conceptual responses [F(1, 53) = 10.61, P < 0.01] and perseverative errors [F(1, 53) = 14.31, P < 0.01]. Conclusion: This study suggests that structured physical activity (PA) interventions that target specific MS improve motor function in children with ASD and exergaming could be effective for improving EF. Future research is needed to untangle the interaction between the type of exercise, traditional PA versus exergaming, and the dose associated with improvements in MS and EF in children with ASD.

Simulation Game Versus Multiple Choice Questionnaire to Assess the Clinical Competence of Medical Students: Prospective Sequential Trial.

BACKGROUND: The use of simulation games (SG) to assess the clinical competence of medical students has been poorly studied. OBJECTIVE: The objective of this study was to assess whether an SG better reflects the clinical competence of medical students than a multiple choice questionnaire (MCQ). METHODS: Fifth-year medical students in Paris (France) were included and individually evaluated on a case of pediatric asthma exacerbation using three successive modalities: high-fidelity simulation (HFS), considered the gold standard for the evaluation of clinical competence, the SG Effic'Asthme, and an MCQ designed for the study. The primary endpoint was the median kappa coefficient evaluating the correlation of the actions performed by the students between the SG and HFS modalities and the MCQ and HFS modalities. Student satisfaction was also evaluated. RESULTS: Forty-two students were included. The actions performed by the students were more reproducible between the SG and HFS modalities than between the MCQ and HFS modalities (P=.04). Students reported significantly higher satisfaction with the SG (P<.01) than with the MCQ modality. CONCLUSIONS: The SG Effic'Asthme better reflected the actions performed by medical students during an HFS session than an MCQ on the same asthma exacerbation case. Because SGs allow the assessment of more dimensions of clinical competence than MCQs, they are particularly appropriate for the assessment of medical students on situations involving symptom recognition, prioritization of decisions, and technical skills. TRIAL REGISTRATION: ClinicalTrials.gov NCT03884114; https://clinicaltrials.gov/ct2/show/NCT03884114.

Investigating the Feasibility of Exergame on Sleep and Emotion Among University Students.

Sleep deprivation and emotional problems such as stress, anxiety, and depression commonly occur in university students. Exercise is beneficial to ameliorate those problems; however, university students are not serious to take up physical activity. Commercially available exergame such as Xbox® 360 Kinect is one of the alternatives. This study aims at investigating the feasibility and the potential efficacy of using Xbox 360 Kinect game among health care undergraduate students. A pilot two-armed parallel randomized controlled trial was implemented. A total of 36 undergraduate students was recruited and randomly allocated into the intervention group (playing Xbox 360 Kinect) or the control group (continue with normal daily routine). The intervention group received 30 minutes of Xbox Kinect activity, three times per week for 6 weeks. Information on psychology (Depression, Anxiety, and Stress Scale-21) and sleep (Functional Outcome Sleep Questionnaire-30) status was collected at pre- and post-experiment. The researcher-developed feasibility questionnaire was given to the participants in the intervention group at post-experiment. Repeated-measures analysis of variance was used to investigate within-between group comparison, and significance value was set at p ≤ 0.05. The analysis found potential improvement on sleep (p = 0.039) and psychological health (p = 0.002-0.067). The intervention protocol is feasible and highly accepted by the participants. The required optimum amount of dosage, sample size, and the use of outcome measures are suggested from the findings. This pilot and feasibility study supports the use of Xbox 360 Kinect games in practice and to be implemented for future research.