Which game narratives do adolescents of different gameplay and sociodemographic backgrounds prefer? a mixed-methods analysis

OBJECTIVE: The aim of this study was to investigate which narrative elements of digital game narratives are preferred by the general adolescent population, and to examine associations with gender, socioeconomic status (SES), and gameplay frequency. Further, the study aims to discuss how results can be translated to serious digital games. MATERIALS AND METHODS: Adolescents were recruited through school to complete a survey on narrative preferences in digital games. The survey included questions on sociodemographic information, frequency of gameplay, and an open-ended question on what could be an appealing narrative for them. Data were analyzed in a mixed-methods approach, using thematic analysis and chi-square analyses to determine narrative preferences and the associations between game narrative elements and player characteristics (gender, SES, and frequency of gameplay). RESULTS: The sample consisted of 446 adolescents (12-15 years old) who described 30 narrative subthemes. Preferences included human characters as protagonists; nonhuman characters only as antagonists; realistic settings, such as public places or cities; and a strong conflict surrounding crime, catastrophe, or war. Girls more often than boys defined characters by their age, included avatars, located the narrative in private places, developed profession-related skills, and included a positive atmosphere. Adolescents of nonacademic education more often than adolescents of academic education defined characters by criminal actions. Infrequent players more often included human characters defined by their age than frequent players. After performing a Bonferroni correction, narrative preferences for several gender differences remained. CONCLUSION: Different narrative elements related to subgroups of adolescents by gender, SES, and frequency of gameplay. Customization of narratives in serious digital health games should be warranted for boys and girls; yet, further research is needed to specify how to address girls in particular

Designing video games for older adults and caregivers

Providing care for older adults is a challenging task, particularly when close family members are involved: instead of spending quality time with the other person, caregiving relationships often focus on daily needs of the older adult, leaving little room for persons to communicate outside the caregiving context. In this paper, we examine the design of interactive technologies to support caregiving relationships through play. We present an exploratory study where ten caregiving dyads played cooperative motion-based video games, and follow up with two case studies to analyze how video game play affects older adults and family caregivers. Our results show that playing games generally represents an enjoyable activity for older adults and caregivers that can be integrated into the caregiving context. Based on our findings, we highlight design opportunities, and outline core challenges that need to be addressed to design accessible games that provide positive shared experiences for a wide range of caregiving dyads

Attuning a mobile simulation game for school children using a design-based research approach

We report on a design-based research study that was conducted over nine months. It chronicles the development and implementation of HeartRun, a cardiopulmonary resuscitation (CPR) training approach for school children. Comparable to an unexpected emergency, HeartRun consists of authentic activities involving different roles, game tasks, locations and physical objects to support process-oriented learning for first responders. It aims to enhance the psychological preparedness of the rescuer and thus promotes a more prompt and appropriate response. In this paper, we describe a cycle of three design-based research (DBR) studies in which HeartRun was explored with school children. In order to better understand how to design mobile game environments that support dimensions of seamless learning, we analysed children and their knowledge-building practices while learning with HeartRun. The mobile game has evolved significantly from its initial conception through an iterative process of (re) designing and testing the synchronization between physical and digital worlds, learner collaboration and ubiquitous knowledge access, i.e. dimensions of mobile seamless learning activities. Based on our experiences, we conclude by discussing challenges and shortcomings of mobile game-based learning environments.This research was financed by the European Regional Development Fund (ERDF), regions of the Euregio Meuse-Rhine and the participating institutions under the INTERREG IVa programme (EMR.INT4-1.2.-2011-04/070, http://www.emurgency.eu)

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

HabitApp: New Play Technologies in Pediatric Cancer to Improve the Psychosocial State of Patients and Caregivers

[EN] Childhood cancer involves long periods of hospitalization that trigger emotions such as fear or sadness. Previous research has studied the positive effects of technology games on improving the hospitalization experience, but most do not focus on caregivers and none allow interaction with the real time observation of a zoo. The present study evaluates the impact of HabitApp and assesses the short-term impact on the psychosocial state of patients and caregivers in order to improve the hospitalization experience. The participants in this study were 39 patients plus 39 caregivers. A quantitative analysis revealed a significant improvement in patient's and caregiver's psychosocial factors from the pre-play period to 10 min play time, and a significant interaction effect between the psychological state and the impact of HabitApp. The children with highest levels of depression obtained most benefit from the positive effects. A qualitative analysis brought out four themes: physical state, emotional state, social interaction, and hospital routines. Using a user experience questionnaire the patients and caregiver reported high satisfaction rates with the app use. These results confirm that it is important to continue studying this type of technology in order to develop better interventions to be included in an integral approach to this pathology considering caregivers into pediatric oncology patients' play therapy.This work was supported by MINECO Spain and financed by EDRF-FEDER with the project SUPEREMOS TIN2014-60077-R.Carrion-Plaza, A.; Jaén Martínez, FJ.; Montoya-Castilla, I. (2020). HabitApp: New Play Technologies in Pediatric Cancer to Improve the Psychosocial State of Patients and Caregivers. Frontiers in Psychology. 11:1-16. https://doi.org/10.3389/fpsyg.2020.00157S11611Akabane, S., Inakage, M., Leu, J., Araki, R., Choi, J. won, Chang, E., … Furukawa, S. (2010). ZOOTOPIA. ACM SIGGRAPH ASIA 2010 Posters on - SA ’10. doi:10.1145/1900354.1900388Artilheiro, A. P. S., Almeida, F. de A., & Chacon, J. M. F. (2011). Uso do brinquedo terapêutico no preparo de crianças préescolares para quimioterapia ambulatorial. Acta Paulista de Enfermagem, 24(5), 611-616. doi:10.1590/s0103-21002011000500003Barbosa, D. N. F., Bassani, P. B. S., Mossmann, J. B., Schneider, G. T., Reategui, E., Branco, M., … Nunes, M. (2014). Mobile Learning and Games: Experiences with Mobile Games Development for Children and Teenagers Undergoing Oncological Treatment. Lecture Notes in Computer Science, 153-164. doi:10.1007/978-3-319-05972-3_16Barrera, M. E., Rykov, M. H., & Doyle, S. L. (2002). The effects of interactive music therapy on hospitalized children with cancer: a pilot study. Psycho-Oncology, 11(5), 379-388. doi:10.1002/pon.589Bers, M. U. (2009). New Media for New Organs. Convergence: The International Journal of Research into New Media Technologies, 15(4), 462-469. doi:10.1177/1354856509342344Bratton, S. C., Ray, D., Rhine, T., & Jones, L. (2005). The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes. Professional Psychology: Research and Practice, 36(4), 376-390. doi:10.1037/0735-7028.36.4.376Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oaBrokstein, R. T., Cohen, S. O., & Walco, G. A. (2002). STARBRIGHT World and Psychological Adjustment in Children with Cancer: A Clinical Series. Children’s Health Care, 31(1), 29-45. doi:10.1207/s15326888chc3101_3Caldwell, C., Bruggers, C., Altizer, R., Bulaj, G., D’Ambrosio, T., Kessler, R., & Christiansen, B. (2013). The intersection of video games and patient empowerment. Proceedings of The 9th Australasian Conference on Interactive Entertainment Matters of Life and Death - IE ’13. doi:10.1145/2513002.2513018Dragone, M. A., Bush, P. J., Jones, J. K., Bearison, D. J., & Kamani, S. (2002). Development and evaluation of an interactive CD-ROM for children with leukemia and their families. Patient Education and Counseling, 46(4), 297-307. doi:10.1016/s0738-3991(01)00166-5Farnham, S., Cheng, L., Stone, L., Zaner-Godsey, M., Hibbeln, C., Syrjala, K., … Abrams, J. (2002). HutchWorld. Proceedings of the SIGCHI conference on Human factors in computing systems Changing our world, changing ourselves - CHI ’02. doi:10.1145/503376.503444Favara-Scacco, C., Smirne, G., Schilirò, G., & Di Cataldo, A. (2001). Art therapy as support for children with leukemia during painful procedures. Medical and Pediatric Oncology, 36(4), 474-480. doi:10.1002/mpo.1112Fuchslocher, A., Gerling, K., Masuch, M., & Kramer, N. (2011). Evaluating social games for kids and teenagers diagnosed with cancer. 2011 IEEE 1st International Conference on Serious Games and Applications for Health (SeGAH). doi:10.1109/segah.2011.6165463Gerling, K., Fuchslocher, A., Schmidt, R., Krämer, N., & Masuch, M. (2011). Designing and Evaluating Casual Health Games for Children and Teenagers with Cancer. Lecture Notes in Computer Science, 198-209. doi:10.1007/978-3-642-24500-8_21Glaser, B. G., & Strauss, A. L. (2017). The Discovery of Grounded Theory. doi:10.4324/9780203793206Ibáñez, E. (2016). Beneficio del apoyo psicosocial a la calidad de vida de niños y niñas enfermos de cáncer: Una revisión sistemática cualitativa. Revista Colombiana de Enfermería, 4(4), 125. doi:10.18270/rce.v4i4.1417Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. H. (2008). A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial. PEDIATRICS, 122(2), e305-e317. doi:10.1542/peds.2007-3134Li, W. H., Chung, J. O., & Ho, E. K. (2011). The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing, 20(15-16), 2135-2143. doi:10.1111/j.1365-2702.2011.03733.xLima, K. Y. N. de, & Santos, V. E. P. (2015). Play as a care strategy for children with cancer. Revista Gaúcha de Enfermagem, 36(2), 76-81. doi:10.1590/1983-1447.2015.02.51514Liu, L. S., Inkpen, K. M., & Pratt, W. (2015). «I’m Not Like My Friends». Proceedings of the 18th ACM Conference on Computer Supported Cooperative Work & Social Computing. doi:10.1145/2675133.2675201Meier, A., Spada, H., & Rummel, N. (2007). A rating scheme for assessing the quality of computer-supported collaboration processes. International Journal of Computer-Supported Collaborative Learning, 2(1), 63-86. doi:10.1007/s11412-006-9005-xNilsson, S., Finnström, B., Kokinsky, E., & Enskär, K. (2009). The use of Virtual Reality for needle-related procedural pain and distress in children and adolescents in a paediatric oncology unit. European Journal of Oncology Nursing, 13(2), 102-109. doi:10.1016/j.ejon.2009.01.003Pedrosa, A. M., Monteiro, H., Lins, K., Pedrosa, F., & Melo, C. (2007). Diversão em movimento: um projeto lúdico para crianças hospitalizadas no Serviço de Oncologia Pediátrica do Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Revista Brasileira de Saúde Materno Infantil, 7(1), 99-106. doi:10.1590/s1519-38292007000100012Pinquart, M. (2017). Parenting stress in caregivers of children with chronic physical condition-A meta-analysis. Stress and Health, 34(2), 197-207. doi:10.1002/smi.2780Pintado, S., & Cruz, M. F. (2017). Factores de resiliencia en niños y adolescentes con cáncer y su relación con el género y la edad. CIENCIA ergo sum, 24(2), 137-144. doi:10.30878/ces.v24n2a5Sajjad, S., Abdullah, A., Sharif, M., & Mohsin, S. (2014). Psychotherapy Through Video Game to Target Illness Related Problematic Behaviors of Children with Brain Tumor. Current Medical Imaging Reviews, 10(1), 62-72. doi:10.2174/1573405610666140313004302Schultz, K. A. P., Ness, K. K., Whitton, J., Recklitis, C., Zebrack, B., Robison, L. L., … Mertens, A. C. (2007). Behavioral and Social Outcomes in Adolescent Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 25(24), 3649-3656. doi:10.1200/jco.2006.09.2486Shama, W., & Lucchetta, S. (2007). Psychosocial Issues of the Adolescent Cancer Patient and the Development of the Teenage Outreach Program (TOP). Journal of Psychosocial Oncology, 25(3), 99-112. doi:10.1300/j077v25n03_06Steliarova-Foucher, E., Colombet, M., Ries, L. A. G., Moreno, F., Dolya, A., Bray, F., … Bouzbid, S. (2017). International incidence of childhood cancer, 2001–10: a population-based registry study. The Lancet Oncology, 18(6), 719-731. doi:10.1016/s1470-2045(17)30186-9Suzuki, L. K., & Kato, P. M. (2003). Psychosocial Support for Patients in Pediatric Oncology: The Influences of Parents, Schools, Peers, and Technology. Journal of Pediatric Oncology Nursing, 20(4), 159-174. doi:10.1177/1043454203254039Muglia-Wechsler, A., Bragado-Álvarez, C., & Hernández-Lloreda, M. J. (2014). Eficacia de intervenciones psicológicas dirigidas a promover el ajuste de niños con cáncer y de sus padres: una revisión. Anales de Psicología, 30(1). doi:10.6018/analesps.30.1.149161Windich-Biermeier, A., Sjoberg, I., Dale, J. C., Eshelman, D., & Guzzetta, C. E. (2007). Effects of Distraction on Pain, Fear, and Distress During Venous Port Access and Venipuncture in Children and Adolescents With Cancer. Journal of Pediatric Oncology Nursing, 24(1), 8-19. doi:10.1177/104345420629601

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

Designing and evaluating casual health games for children and teenagers with cancer

Because they offer an easy entry into play, casual games have become an increasingly popular leisure activity among children and teenagers, engaging particularly broad target audiences. In this paper, we present a casual game that addresses childhood cancer: Besides mere entertainment, a health game that focuses on cancer may serve as a clinical tool in order to teach children about the particularities of the disease and initiate discussion among cancer patients, their parents and medical staff. In this context, the results of an empirical study revealed a generally high acceptance of the health game among young patients, while parents and medical staff highlighted the educational potential of health games addressing cancer. Additionally, we discuss the challenges of evaluating digital games in a hospital setting which were revealed during the evaluation phase. © 2011 Springer-Verlag

Designing and evaluating casual health games for children and teenagers with cancer

Because they offer an easy entry into play, casual games have become an increasingly popular leisure activity among children and teenagers, engaging particularly broad target audiences. In this paper, we present a casual game that addresses childhood cancer: Besides mere entertainment, a health game that focuses on cancer may serve as a clinical tool in order to teach children about the particularities of the disease and initiate discussion among cancer patients, their parents and medical staff. In this context, the results of an empirical study revealed a generally high acceptance of the health game among young patients, while parents and medical staff highlighted the educational potential of health games addressing cancer. Additionally, we discuss the challenges of evaluating digital games in a hospital setting which were revealed during the evaluation phase. © 2011 Springer-Verlag.</p

Influência dos ambientes virtuais no estado emocional de crianças com doença oncológica

Dissertação de Mestrado em Design de Interação apresentada na Faculdade de Arquitetura em parceria com a Faculdade de Belas Artes da Universidade de Lisboa para obtenção do grau de Mestre. ,A doença oncológica pediátrica em Portugal afeta anualmente, em média, cerca de 400 crianças e jovens. Nos dias que decorrem, a taxa de cura sobre a doença a nível pediátrico é 80% superior à de um adulto. Isto deve-se à eficácia dos métodos de diagnóstico e benevolência dos tratamentos, em que cerca de 90% das crianças sobrevivem. Uma criança que se encontra numa condição oncológica sofre grandes alterações na sua vida. Um internamento, num modo geral, acaba por ser aborrecido, complicado, onde o isolamento é presente e o negativismo dominante. Considera-se que algumas mudanças foram feitas para melhorar o internamento em alas pediátricas, como pinturas em paredes e a iluminação para harmonizar o espaço. Mas, mesmo assim, é sempre possível fazer um pouco mais para promover o pensamento positivo e a recuperação física da criança e fazer com que quase não pense na doença. Este projeto procurou levar até pacientes pediátricos oncológicos em ambiente hospitalar uma alternativa de fuga a partir da Realidade Virtual. O objetivo foi proporcionar novas experiências com implicações quer ao nível cognitivo quer emocional (relaxamento), criar uma experiência interativa em Realidade Virtual que criasse emoções positivas, diminuir o stress/ansiedade, minimizar os incómodos por vezes sentidos devido aos procedimentos médicos. Para este fim, seguiu-se uma metodologia mista. Iniciou-se com o método não intervencionista, com a revisão da literatura, onde foi possível estudar os fundamentos teóricos acerca do design de interação e emocional, de forma a explorar novas interações em meios imersivos e criar emoções positivas e desafiantes. Tentou-se entender como é que os ambientes virtuais são vistos em ambiente hospitalar pelas crianças com patologia oncológica. Realizaram-se também entrevistas e inquéritos a indivíduos que estão ou já estiveram numa situação oncológica bem com a interpretação de alguns estudos de casos. Num segundo momento, recorreu-se a uma metodologia intervencionista a partir da investigação ativa, onde se desenvolveu o projeto. Criou-se um conjunto de cenários virtuais capazes de potenciar o desenvolvimento psíquico e ajudar na estimulação de emoções e nível físico.ABSTRACT: Pediatric Cancer every year in Portugal affects around 400 children and young people. On these days, there is an 80% higher cure rate for a pediatric disease than an adult, due to the benevolence of diagnostic and testing methods, where about 90% of children survive. For a child in an oncological condition, there are undergoing changes in his/her life. An internment, in general, turns out to be boring, complicated and where isolation is present and negativity dominant. Some changes were made to improve internment in pediatricians, such as painting walls and lighting to harmonize the space. But even so, there is little to promote positive thinking and physical recovery of the children and make them hardly think about the disease. This project seek to provide oncological patients in hospital wards an escape through Virtual Reality. To provide new experiences both on a cognitive and emotional level (relaxation), to create and interactive experience in virtual reality, that seeks to generate positive emotions, thereby lowering the stress and anxiety levels. This also seeks to lower the uncomfortableness causes by the medical procedures. To this end, a mixed methodology was used. Initiated with and interventionist method, followed by literature review , where it was possible to study the theoretical elements of interaction design and emotional design, in order to explore new interactions in immersive ways to create positive and challenging emotions. We attempted to understand how children in oncological pediatric wards see virtual environments. We also conducted interviews and made questionnaires to people who currently are or have suffered from oncological disease, as well as the interpretation of case studies. Subsequently, an interventionist methodology was used, through active research, where the project was developed. A set of virtual scenarios were created, capable of enhancing the psychological development and helping to stimulate emotions and physical level.N/

Motion-Based Video Games for Older Adults in Long-Term Care

Older adults in residential care often lead sedentary lifestyles despite physical and cognitive activities being crucial for their well-being. Care facilities face the challenge of encouraging their residents to participate in leisure activities, but as the impact of age-related changes grows, few activities remain accessible. Video games in general – and motion-based games in particular – hold the promise of providing mental, physical and social stimulation for older adults. However, the accessibility of commercially available games for older adults is not considered during the development process. Therefore, many older adults are unable to obtain any of the benefits. In my dissertation, this issue is addressed through the development of motion-based game controls that specifically address the needs of older adults. The first part of this thesis lays the foundation by providing an overview of motion-based game interaction for older adults. The second part demonstrates the general feasibility of motion-based game controls for older adults, develops full-body motion-based and wheelchair-based game controls, and provides guidelines for accessible motion-based game interaction for institutionalized older adults. The third part of this thesis builds on these results and presents two case studies. Motion-based controls are applied and further evaluated in game design projects addressing the special needs of older adults in long-term care, with the first case study focusing on long-term player engagement and the role of volunteers in care homes, and the second case study focusing on connecting older adults and caregivers through play. The results of this dissertation show that motion-based game controls can be designed to be accessible to institutionalized older adults. My work also shows that older adults enjoy engaging with motion-based games, and that such games have the potential of positively influencing them by providing a physically and mentally stimulating leisure activity. Furthermore, results from the case studies reveal the benefits and limitations of computer games in long-term care. Fostering inclusive efforts in game design and ensuring that motion-based video games are accessible to broad audiences is an important step toward allowing all players to obtain the full benefits of games, thereby contributing to the quality of life of diverse audiences