A systematic review of game technologies for pediatric patients

[EN] Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation.This work is supported by the Spanish Ministry of Economy and Competitiveness and the European Development Regional Fund (EDRF-FEDER) with Project TIN2014-60077-R.El Jurdi, S.; Montaner-Marco, J.; García Sanjuan, F.; Jaén Martínez, FJ.; Nácher-Soler, VE. (2018). A systematic review of game technologies for pediatric patients. Computers in Biology and Medicine. 97:89-112. https://doi.org/10.1016/j.compbiomed.2018.04.019S891129

Positively waiting: Technology as the preferred distractor in a pediatric outpatient setting

Visiting any pediatric outpatient clinic as a child may be considered a stressful and anxiety-inducing experience. The literature suggests that positive distractions, such as pet therapy and single-user electronic devices, may aid in reducing anxiety and maximizing patient satisfaction throughout the patient’s experience at a pediatric outpatient clinic. The aim of this pilot quality improvement project was to determine which positive distractions patients experienced and whether single-user electronic loaner devices should be provided to patients at pediatric outpatient facilities. A quantitative causal comparative approach was utilized in identifying patient exposure to key positive distraction techniques that may significantly decrease anxiety. The independent variable was the patient gender as reported by the caretaker. The term “caretaker” refers to the adult parent, guardian, relative, or friend accompanying the patient. The dependent variables were caretakers’ responses to interview questions regarding exposure to and interest in various positive distractors. Most patients reported more interactions with therapy dogs than either clowns or musicians, with none reporting magician interaction while waiting for their appointments. Many patients (71%) demonstrated interest in having access to single-user electronics during clinic appointment wait times. Male patients showed great interest (87%) in having access to single-user electronics. Findings suggest that pediatric healthcare facilities funding single-user electronics to reduce patient anxiety may increase patient satisfaction. Additionally, data suggest administrators may benefit by offering an array of positive distractions, with a particular focus on pet therapy programs. Child life specialists are particularly suited for overseeing the implementation of an efficient and effective program. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

Tangibot: A collaborative multiplayer game for pediatric patients

[EN] Background Previous research has studied the effects of games in pediatric wards, but none of it has focused on the impact of the hospital¿s school staff on the psychosocial state of the children nor on the gameplay itself. Objectives To present the Tangibot application and evaluate its impact on the children¿s psychosocial state in the short term and the impact of the teacher on their psychosocial state, communications and coordination during the activity. Methods A study was conducted in a hospital classroom with 20 participants, who participated twice in the game: one with the teacher playing along and another without her. An observational scale was used by two evaluators in order to assess the impact on the children. Results and conclusions The study revealed that the teacher has an impact on the children¿s communication and coordination procedures but has no impact on the psychosocial state of the participants. The teacher¿s impact was found to be positive about communications. Dialogue management significantly improves when the communication includes the teacher, which means speaking turns are observed more consistently. Information pooling also improves, and the participants ask the teacher more questions. Consensus is also reached more often and more easily, but this does not reflect on the performance, as the time management is evidently worse when the teacher is present, as is also the joint task orientation. On the other hand, it was found that the teacher does not have an impact on the psychosocial state of the participants during the game, and that it is the game itself which changes their state over time. In the case of affection, which reflects the participants¿ emotions of joy or boredom, their state improved significantly after a few minutes of play. The same thing occurred for physical activity, interest in the activity and interaction between peers, which increased in value in the first part of the game, although physical activity and interaction were reduced towards the end. No changes were found throughout the game in the number of complaints, nervousness or satisfied comments, which remained very low for all these aspects, showing that the game distracted them from their various symptoms. Based on these results, future work will explore the effects of gamification on the overall hospitalization perception, with special focus on the social opportunities during the hospital stay, to provide ways for the children to meet others during their treatment, to make the experience less painful and reduce their feelings of isolation. Some game strategies should also be evaluated to determine the ones that provide the best opportunities to improve the children¿s hospital experience.This work is funded by the European Development Regional Fund (EDRF-FEDER) and supported by Spanish MINECO with Project TIN2014-60077-R-AR. The work of Jorge Montaner is supported by a national grant from the Spanish Ministry for Education (FPU17/03333). Special thanks to the staff of La Fe Hospital in Valencia who have collaborated in the experiment.Montaner-Marco, J.; Carrión-Plaza, A.; García Sanjuan, F.; Jaén Martínez, FJ. (2019). Tangibot: A collaborative multiplayer game for pediatric patients. International Journal of Medical Informatics. 132. https://doi.org/10.1016/j.ijmedinf.2019.103982S13

Examination of The Applicability and Intensity of Nintendo Wiitm Exergaming For Children With Acute Lymphoblastic Leukemia: A Preliminary Study

Aims: Exploring the applicability and intensity of exergaming for children with cancer is essential. This study aimed to examine the applicability of Nintendo WiiTM exergames and determine the intensity of Physical Activity (PA) provided by these exergames for children with acute lymphoblastic leukemia. Methods: In this preliminary study, 31 children aged 6-14 years of both sexes were asked to play Wii exergames for a 60-minute research session. Using the Arabic video game applicability questionnaire, the children were instructedto score seven statements regarding usability, engagement, and enjoyment of exergames. In addition, heart rate (HR), predicted heart rate maximum (pred. HRmax), rating of perceived exertion (RPE), and oxygen saturation (SpO2) were measured at baseline and every 15 min during the session. Results: About 74.2%, 83.9%, and 93.6% of the children agreed that the games were usable, engaging, and enjoyable, respectively. Exergames were of moderate intensity as the children reached 59.22±8.40 % of age-predicted HRmax: the HR and its percentage of increase from the pred. HRmax (% pred. HRmax) was significantly higher in girls than in boys (P=0.01). The level of perceived exertion was moderate (5.74± 0.63). Conclusion: Implementation of Nintendo Wii exergames for 60 minutes was found to be applicable. In addition, it resulted in PA of moderate intensity

Social Robots in Hospitals: A Systematic Review

Hospital environments are facing new challenges this century. One of the most important is the quality of services to patients. Social robots are gaining prominence due to the advantages they offer; in particular, several of their main uses have proven beneficial during the pandemic. This study aims to shed light on the current status of the design of social robots and their interaction with patients. To this end, a systematic review was conducted using WoS and MEDLINE, and the results were exhaustive analyzed. The authors found that most of the initiatives and projects serve the el- derly and children, and specifically, that they helped these groups fight diseases such as dementia, autism spectrum disorder (ASD), cancer, and diabetes

Remote interspecies interactions: Improving humans and animals wellbeing through mobile playful spaces

[EN] Play is an essential activity for both humans and animals as it provides stimulation and favors cognitive, physical and social development. This paper proposes a novel pervasive playful environment that allows hospitalized children to participate in remote interspecies play with dogs in a dog daycare facility, while it also allows the dogs to play by themselves with the pervasive system. The aim of this playful interactive space is to help improving both children¿s and animal¿s wellbeing and their relationships by means of technologically mediated play, while creating a solid knowledge base to define the future of pervasive interactive environments for animals.This work is supported by the European Development Regional Fund (EDRF-FEDER), Spain and Spanish MINECO (TIN2014-60077-R). The work of Patricia Pons is supported by the Spanish MECD (FPU13/03831). Special thanks to the dogs and children who participated in our study, the dogs' owners and the children's families. The authors also gratefully acknowledge the teachers of the Unidad Pedagogica Hospitalaria La Fe and Oncologia Pediatrica La Fe and also Olga and Astrid from Buma's Doggy Daycare facility, for their invaluable support, collaboration and dedication.Pons Tomás, P.; Carrion-Plaza, A.; Jaén Martínez, FJ. (2019). Remote interspecies interactions: Improving humans and animals wellbeing through mobile playful spaces. Pervasive and Mobile Computing. 52:113-130. https://doi.org/10.1016/j.pmcj.2018.12.003S1131305

Gamification Strategies as Socialization Tools in the Context of Paediatric Hospitalization

[ES] En la presente tesis doctoral se aborda el problema de la socialización de los pacientes pediátricos en el contexto de su ingreso hospitalario, estudiando las posibilidades de mejorar este ámbito de la salud del paciente mediante diversas estrategias y herramientas tecnológicas teniendo en cuenta la problemática planteada y las dificultades propias del contexto. En primer lugar, se realizará una evaluación del estado del arte, así como una justificación de la problemática existente, planteando claramente los objetivos e hipótesis del presente trabajo, así como la metodología seguida. A continuación, se presentarán las diferentes herramientas implementadas y evaluadas, analizando los resultados obtenidos y situándolos en su contexto y marco tecnológico. Estas herramientas, que combinan actividades y aplicaciones presenciales, remotas o híbridas, implementan diferentes estrategias para poder valorar cuáles son las más adecuadas o que presentan un mayor impacto en el paciente. Tras esto, se propone un modelo de diseño basado en los resultados obtenidos en estudios anteriores, así como su posible aplicación en diferentes ámbitos, discutiendo el mismo y justificando las decisiones de diseño adoptadas. Finalmente, se establecerán las conclusiones obtenidas tras el análisis de los resultados y se plantearán cuáles son las posibles aplicaciones y trabajos futuros relacionados con el trabajo realizado en el marco de la tesis doctoral.[CA] Aquesta tesi doctoral aborda el problema de la socialització dels pacients pediàtrics durant la seua estada hospitalària, i s'estudien les possibilitats de millorar aquest àmbit de la salut del pacient mitjançant diverses estratègies i eines tecnològiques, considerant la problemàtica plantejada i les dificultats pròpies de l'entorn. En primer lloc, es realitzarà una avaluació de l'estat de l'art, així com una justificació de la problemàtica existent, i es plantejaran clarament els objectius i la hipòtesi del treball, així com la metodologia emprada. Seguidament, es presentaran les diferents eines implementades i avaluades, analitzant els resultats obtinguts i situant-los al seu context i marc tecnològic. Aquestes eines, que combinen activitats i aplicacions presencials, remotes o híbrides, implementen diferents estratègies per a poder valorar quines són les més adients, o les que presenten un major impacte en el pacient. A continuació, es proposa un model de disseny basat en els resultats obtinguts als estudis previs, així com la seua possible aplicació en diferents àmbits, discutint el model i justificant les decisions de disseny adoptades. Finalment, s'establiran les conclusions obtingudes després d'analitzar els resultats i es plantejaran les possibles aplicacions i treballs futurs relacionats amb els continguts desenvolupats durant la tesi doctoral.[EN] In this document, the problems for socialization for pediatric patients in the context of their hospital internment are considered, analyzing the possibilities of improving this aspect of the patient's health through the use of different strategies and technological tools considering the difficulties posed by the environment and the context. In the first place, an evaluation of the state of the literature and a justification of the existing problematic will be presented, clearly stating the objectives and hypothesis of this work, and also the methodology that has been followed. Afterwards, the different tools that have been implemented and evaluated will be described, analyzing the obtained results and placing them in their context and technological frame. These tools, that combine physically placed activities and applications with remote or hybrid ones, implement different strategies in order to be able to analyze which are the most convenient or the ones that show a higher benefit for the patient. In the following section, a design model, which is based on the results obtained in the previous studies, is proposed, with the justification of the design decisions made and a description of different applications and contexts in which the proposed model could be useful. Finally, the conclusions obtained after the analysis of the results will be presented, and a short discussion about possible applications and future related works will be done.Thanks to the Ministry for Education, that have funded my research through grant FPU17/03333Montaner Marco, J. (2023). Gamification Strategies as Socialization Tools in the Context of Paediatric Hospitalization [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/20155

O uso de jogos virtuais interativos para telereabilitação na paralisia cerebral

Dissertação de mestradoCom o advento tecnológico dos últimos anos, tem-se observado uma proliferação de jogos sérios com intuito terapêutico, a par do desenvolvimento de novas interfaces humanocomputador para aumentar a sua acessibilidade a qualquer pessoa. Dentro destes, jogos sérios ativos, que envolvem movimento do utilizador como forma de interação, baseados em visão computacional e sistemas de realidade virtual têm sido cada vez mais utilizados para reabilitação e promoção de habilidades funcionais em população pediátrica. De acordo com a literatura, estes jogos virtuais interativos têm os “ingredientes” necessários para aumentar a eficiência de um programa de reabilitação e potenciam a motivação e envolvimento das crianças com paralisia cerebral no processo de reabilitação. Crianças com paralisia cerebral necessitam de acompanhamento terapêutico ao longo de toda a sua vida, levando a uma sobrecarga cada vez maior nos sistemas de saúde e desmotivação com as tradicionais abordagens de reabilitação, tornando-se desta forma crucial a implementação de novas metodologias na intervenção do terapeuta ocupacional. Com este estudo pretende-se avaliar a eficácia de dois planos de jogo da plataforma web Timocco, na promoção de competências de movimento do membro superior em crianças com paralisia cerebral, quando realizados em formato de telereabilitação. Será igualmente avaliada a motivação dos participantes, bem como, a experiência de utilizador percecionada por eles e pelas suas famílias. Neste sentido, foi implementado um programa de reabilitação composto por dois planos de jogo da plataforma Timocco: o plano 1 designado de ‘atenção por favor mini’, e o plano 2 designado de ‘cruzamento da linha média’. Estes planos foram jogados consecutivamente, num período de cinco semanas, pelas 10 crianças com paralisia cerebral que constituem a amostra, em formato de telereabilitação. Foram analisadas estatisticamente, as diferenças no desempenho no jogo ‘banho de espuma’ no plano 1, e no jogo ‘cesto de frutas’ do plano 2, do início para o final da intervenção. O nível de motivação e experiência de utilizador obtidos respetivamente na subescala prazer/interesse do inventário de motivação intrínseca (IMI) e no questionário de usabilidade da telereabilitação foram analisados descritivamente. No plano 1, observou-se um aumento das pontuações totais, dos níveis jogados e diminuição do tempo médio de resposta ao longo das repetições do jogo 'banho de espuma', o que reflete um maior número de repetições de movimentos e movimento mais rápidos dos membros superiores. Observou-se igualmente aumento dos movimentos realizados com o membro superior mais afetado. No que respeita o plano 2, verificam-se igualmente evoluções na pontuação total. O tempo médio de resposta e número de níveis jogados manteve-se semelhante ao longo das repetições o que pode estar relacionado com o aumento da dificuldade e necessidade de maior precisão de movimento para completar este jogo. Os participantes mostraram um alto nível de motivação na utilização da plataforma Timocco, bem como, uma boa experiência de utilizador, refletida nas médias de classificação alta dos diferentes domínios da usabilidade avaliados. Esta investigação fornece evidências iniciais de que é viável o recurso a jogos virtuais interativos em casa, ministrados e supervisionados pela internet em formato de telereabilitação para intervenção com crianças com paralisia cerebral. De acordo com os resultados obtidos, a plataforma Timocco é uma alternativa válida para promover melhorias no movimento de membro superior.The technological advent of the last few years has been promoting a proliferation of serious games for therapeutic purposes, together with the development of new humancomputer interfaces to increase their accessibility to anyone. Within these, exergames, which involve user movement as a form of interaction, based on computer vision and virtual reality systems, have been increasingly used for rehabilitation and promotion of functional skills in the pediatric population. According to the literature, these virtual interactive games have the right “ingredients” to increase the efficiency of a rehabilitation program and enhance the motivation and involvement of children with cerebral palsy in the rehabilitation process. Children with cerebral palsy need therapeutic monitoring throughout their lives, leading to an increasing burden on health systems and lack of motivation with traditional rehabilitation approaches, thus making it crucial to implement new methodologies in the Occupational Therapist's intervention. The aim of the present study is to evaluate the effectiveness of Timocco’s web platform games plans, in promoting upper limb movement skills in children with cerebral palsy, in telerehabilitation context. Participants' motivation will also be assessed, as well as the user experience perceived by them and their families. In this sense, a rehabilitation program was implemented consisting of two Timocco’s game plans platform: plan 1 called ‘attention please mini’, and plan 2 called ‘crossing midline’. These plans were played consecutively over a period of five weeks by the 10 children with cerebral palsy who make up the sample, in telerehabilitation format. The performance differences in ‘bubble bath’ game in plan 1, and in ‘fruit basket’ game in plan 2 were analyzed statistically from the beginning to the end of the intervention. The level of motivation and user experience obtained respectively in the pleasure / interest subscale of the intrinsic motivation inventory (IMI) and in the tele-rehabilitation usability questionnaire (TUQ) were descriptively analyzed. In plan 1, there was an increase in total scores, levels played and a decrease in the average response time over the repetitions of the 'bubble bath' game, which reflects a greater number of repetitions of movements and faster movement of upper limbs. There was also an increase in movements performed with the most affected upper limb. Regarding plan 2, there were also developments in the total score. The average response time and number of levels played remained similar throughout the repetitions, which may be related to the increased difficulty and the need for greater precision of movement to complete this game. The participants showed a high level of motivation with Timocco platform, as well as a good user experience, reflected in the high-ranking averages of the different usability domains assessed. This investigation provides initial evidence that it is viable to use interactive virtual games at home, taught and supervised by the internet in a telerehabilitation format for intervention with children with cerebral palsy. According to the results obtained, the Timocco platform is a valid alternative to promote improvements in upper limb movement