Positive attention bias trained during the Rethink therapeutic online game is linked to improvements in children and adolescents’ externalizing symptoms and peer relationships (Preprint)

BACKGROUND Attentional bias towards positive stimuli is considered a resilience factor for mental health and well-being. OBJECTIVE Attentional bias towards positive stimuli is considered a resilience factor for mental health and well-being. The aim of the present study was to analyze the effects of an attentional bias training for positive faces in a preventive therapeutic game for children and adolescents. METHODS Participants played the REThink game, which included an attentional bias training level based on the visual search paradigm, where children had the task to quickly find the happy face among other angry faces. RESULTS Attentional bias indicators demonstrated acceptable reliability and results showed that increases in attentional bias towards positive faces were associated with improvements in children and adolescents’ conduct problems, hyperactivity, and peer relationship problems. CONCLUSIONS Overall, our results support the protective role of training attentional bias towards positive faces as part of a preventive therapeutic game for children and adolescents.

A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation

Background Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. Objective This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). Methods The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. Results Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! Conclusions The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients.

Does the gamification aspect of an online focal ambient visual acuity stimulation therapeutic game for treating amblyopia in children improve adherence? (Preprint)

BACKGROUND The golden standard treatment for amblyopia is patching the better eye. Visual acuity improvement of the amblyopic eye is significantly impacted by adherence of the patching therapy. It is known that the overall adherence is rather low. OBJECTIVE This retrospective study evaluated whether an updated version of attention binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in an improved patient adherence in 4- to 16-year-old patients with amblyopia. METHODS We analyzed pseudonymised electronically recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older (2015) and the other group the newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the amount of minutes using the therapeutic games as monitored in the automatized logbook versus prescribed minutes of using the games. RESULTS Children in Group 2015 (n=138) spent on average 2009.3±1372.1 (36 to 5472) minutes using FAVAS; children in Group 2020 (n=129) spent on average 2695.5±1526.8 (37.5 to 5672) minutes using the improved therapy. Group 2020 spent on average 686.2 more minutes on FAVAS than Group 2015 (t=3.87, P<.001). Although patient adherence was very variable, compared to the 57%±34% in Group 2015, it significantly improved up to 78%±46% in Group 2020 (t=4.3, P<.001). CONCLUSIONS FAVAS 2020 with an improved gamification aspect as well as tablet computer functionality increased adherence significantly compared to the earlier version FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. CLINICALTRIAL DRKS00017633

Objective adherence to an online FAVAS therapeutic game for treating amblyopia in children

ABSTRACTAimThis retrospective study was to evaluate whether an updated version of attention binding digital therapeutic games based on the principle of Focal Ambient Visual Acuity Stimulation (FAVAS) would result in an improved patient adherence of patching in 4- to 12-year-old patients with amblyopia.MethodsWe analyzed pseudonymised electronically recorded data from patients treated with two different versions of attention binding digital therapeutic games in 2015 and 2020. Two groups of children treated with occlusion therapy and attention binding digital therapeutic games, divided in treatment version, were compared. Patients in Group 2015 used the old version of therapeutic games without tablet computer functionality, while Group 2020 used more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the amount of minutes using the therapeutic games as monitored in the automatized logbook versus prescribed minutes of using the games.ResultsChildren in Group 2015 spent on average 2009.3±1372.1 (36 to 5472) minutes using FAVAS; children in Group 2020 spent on average 2695.5±1526.8 (37.5 to 5672) minutes using the improved therapy. Meaning, Group 2020 spent 686.2 more minutes on FAVAS than Group 2015 (t=3.87, P<0.001). Although patient adherence was very variable, it significantly improved up to 78% ± 46% in Group 2020 compared to the 57% ± 34% in Group 2015 (t=4.3, P<0.001).ConclusionFAVAS 2020 with an improved gamification aspect as well as tablet computer functionality increased adherence significantly compared to the earlier version FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support patching amblyopia treatment.

Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation

Purpose Design and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension. Methods A robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant’s game play performance was sampled and analyzed, and system modifications made between sessions. Results Participants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable. Conclusions The novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.

Multitasking a Perceptual Activity

Performing vision therapy with a preschooler, especially one with developmental delays, can be very exhausting - especially in the current times of COVID quarantine. Turning therapy into a fun and interactive (yet therapeutic) game is how I have best found to perform therapy with my own such little patient. If done with some imagination, a simple game can be turned into a whole therapy session all on its own.

A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation (Preprint)

BACKGROUND Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. OBJECTIVE This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). METHODS The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. RESULTS Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! CONCLUSIONS The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients.