Development of a Serious Game-based Cognitive Rehabilitation System for Patients with Brain Injury

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2023 Nov 29

PMID 38031072

Authors

Meysam Rahmani-Katigari

Fatemeh Mohammadian

Leila Shahmoradi

Affiliations

Soon will be listed here.

Abstract

Background: Traumatic brain injury (TBI) resulting from a forceful impact to the head can cause severe functional disabilities, with cognitive impairment being a major hindrance to patients' return to daily life. Encouraging patients to engage in rehabilitation programs consistently poses a significant challenge for therapists. To address this issue, gamification has gained momentum as an effective approach. This study aims to develop a serious game-based cognitive rehabilitation system tailored for patients with brain injury.

Methods: The study included four stages. Initially, the requirements were analyzed through focus groups. Then the system structure and game content were discussed and was agreed as a conceptual model. In second stage, the system design was drawn using various modeling diagrams. In third stage, a system prototype was developed using the Unity game engine and C# programming. Finally, a heuristic evaluation method was employed to assess usability.

Results: Based on the focus group meetings with seven participants, a conceptual model of the system structure and game content was designed. Game's interface was developed for both the therapist and patient versions. The focus groups determined a 2D casual gaming genre with a postman character and 10 missions on the smartphone platform. For example, in the first mission, the postman must move from mailboxes 1 to 10 and pick up the letters. This is according to Trail Making Test task. The 16 tasks in different subcategories of attention were selected to make these missions. The usability evaluation highlighted privacy, help and documentation, and aesthetic and minimalist design as the areas with the highest percentage of problems.

Conclusions: Cognitive rehabilitation is vital in facilitating patients' faster return to daily routines and enhancing their quality-of-life following brain injury. Incorporating a game-based system provides patients with increased motivation to engage in various cognitive exercises. Additionally, continuous monitoring by specialists ensures effective patient management. The game-based system offers different game stages to strengthen and rehabilitate attention in patients with brain injury. In the next step, the clinical effects of this system will be evaluated.

References

Johansson B, Tornmalm M . Working memory training for patients with acquired brain injury: effects in daily life. Scand J Occup Ther. 2011; 19(2):176-83. DOI: 10.3109/11038128.2011.603352. View

Pine R, Te Morenga L, Olson M, Fleming T . Development of a casual video game (Match Emoji) with psychological well-being concepts for young adolescents. Digit Health. 2021; 7:20552076211047802. PMC: 8529904. DOI: 10.1177/20552076211047802. View

Galetto V, Sacco K . Neuroplastic Changes Induced by Cognitive Rehabilitation in Traumatic Brain Injury: A Review. Neurorehabil Neural Repair. 2017; 31(9):800-813. DOI: 10.1177/1545968317723748. View

Gamito P, Oliveira J, Coelho C, Morais D, Lopes P, Pacheco J . Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil. 2015; 39(4):385-388. DOI: 10.3109/09638288.2014.934925. View

van der Kuil M, Visser-Meily J, Evers A, van der Ham I . A Usability Study of a Serious Game in Cognitive Rehabilitation: A Compensatory Navigation Training in Acquired Brain Injury Patients. Front Psychol. 2018; 9:846. PMC: 5996119. DOI: 10.3389/fpsyg.2018.00846. View

Giordani B, Novak B, Sikorskii A, Bangirana P, Nakasujja N, Winn B . Designing and evaluating Brain Powered Games for cognitive training and rehabilitation in at-risk African children. Glob Ment Health (Camb). 2017; 2:e6. PMC: 5269631. DOI: 10.1017/gmh.2015.5. View

Manly T, Anderson V, Nimmo-Smith I, Turner A, Watson P, Robertson I . The differential assessment of children's attention: the Test of Everyday Attention for Children (TEA-Ch), normative sample and ADHD performance. J Child Psychol Psychiatry. 2002; 42(8):1065-81. DOI: 10.1111/1469-7610.00806. View

Kim J, Sharma V, Ryan N . Predicting Methylphenidate Response in ADHD Using Machine Learning Approaches. Int J Neuropsychopharmacol. 2015; 18(11):pyv052. PMC: 4756719. DOI: 10.1093/ijnp/pyv052. View

Lundqvist A, Grundstrom K, Samuelsson K, Ronnberg J . Computerized training of working memory in a group of patients suffering from acquired brain injury. Brain Inj. 2010; 24(10):1173-83. DOI: 10.3109/02699052.2010.498007. View

10.

Ballesteros S, Mayas J, Prieto A, Ruiz-Marquez E, Toril P, Reales J . Effects of Video Game Training on Measures of Selective Attention and Working Memory in Older Adults: Results from a Randomized Controlled Trial. Front Aging Neurosci. 2017; 9:354. PMC: 5671951. DOI: 10.3389/fnagi.2017.00354. View

11.

Martin S, Armstrong E, Thomson E, Vargiu E, Sola M, Dauwalder S . A qualitative study adopting a user-centered approach to design and validate a brain computer interface for cognitive rehabilitation for people with brain injury. Assist Technol. 2017; 30(5):233-241. DOI: 10.1080/10400435.2017.1317675. View

12.

Savulich G, Menon D, Stamatakis E, Pickard J, Sahakian B . Personalised treatments for traumatic brain injury: cognitive, emotional and motivational targets. Psychol Med. 2018; 48(9):1397-1399. DOI: 10.1017/S0033291718000892. View

13.

Ballesteros S, Mayas J, Prieto A, Toril P, Pita C, Laura P . A randomized controlled trial of brain training with non-action video games in older adults: results of the 3-month follow-up. Front Aging Neurosci. 2015; 7:45. PMC: 4396447. DOI: 10.3389/fnagi.2015.00045. View

14.

Ishigami Y, Eskes G, Tyndall A, Longman R, Drogos L, Poulin M . The Attention Network Test-Interaction (ANT-I): reliability and validity in healthy older adults. Exp Brain Res. 2015; 234(3):815-27. DOI: 10.1007/s00221-015-4493-4. View

15.

Zickefoose S, Hux K, Brown J, Wulf K . Let the games begin: a preliminary study using attention process training-3 and Lumosity™ brain games to remediate attention deficits following traumatic brain injury. Brain Inj. 2013; 27(6):707-16. DOI: 10.3109/02699052.2013.775484. View

16.

How T, Hwang A, Green R, Mihailidis A . Envisioning future cognitive telerehabilitation technologies: a co-design process with clinicians. Disabil Rehabil Assist Technol. 2016; 12(3):244-261. DOI: 10.3109/17483107.2015.1129457. View

17.

Bowie C, Harvey P . Administration and interpretation of the Trail Making Test. Nat Protoc. 2007; 1(5):2277-81. DOI: 10.1038/nprot.2006.390. View

18.

Whyte J, Grieb-Neff P, Gantz C, Polansky M . Measuring sustained attention after traumatic brain injury: differences in key findings from the sustained attention to response task (SART). Neuropsychologia. 2006; 44(10):2007-14. DOI: 10.1016/j.neuropsychologia.2006.02.012. View

19.

Bench C, Frith C, Grasby P, Friston K, Paulesu E, Frackowiak R . Investigations of the functional anatomy of attention using the Stroop test. Neuropsychologia. 1993; 31(9):907-22. DOI: 10.1016/0028-3932(93)90147-r. View

20.

Cernich A, Kurtz S, Mordecai K, Ryan P . Cognitive rehabilitation in traumatic brain injury. Curr Treat Options Neurol. 2010; 12(5):412-23. DOI: 10.1007/s11940-010-0085-6. View