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Serious Games and Mixed Reality Applications for Healthcare

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Computing and Artificial Intelligence".

Deadline for manuscript submissions: closed (10 January 2022) | Viewed by 32207

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Special Issue Editors

Prof. Marco Gesi

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Guest Editor

1. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
2. Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56126 Pisa, Italy
Interests: rehabilitation and sports physiotherapy; virtual reality; mixed/augmented reality; medical and surgical simulators; navigation surgical simulation
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Dr. Sara Condino

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Guest Editor

Information Engineering Department, University of Pisa, 56126 Pisa, Italy
Interests: computer-assisted surgery; design of innovative instrumentation for surgical navigation; design of virtual and augmented reality applications for surgical navigation and simulation; design of innovative technologies based on virtual reality; physical and hybrid simulation for rehabilitation specialists
Special Issues, Collections and Topics in MDPI journals

Prof. Giuseppe Turini

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Guest Editor

Department of Computer Science, Kettering University, Flint, MI 48504, USA
Interests: computer graphics and computer vision; interactive physical simulation; computer-assisted surgery; medical imaging; human–computer interaction; virtual and augmented reality; serious games

Dr. Rosanna Maria Viglialoro

E-Mail Website
Guest Editor

Department of Translational Research and New Technologies In Medicine And Surgery, University of Pisa, 56126 Pisa, Italy
Interests: mixed/augmented reality; surgical simulation; innovative technologies based on AR for rehabilitation specialists

Dr. Marina Carbone

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Guest Editor

Information Engineering Department, University of Pisa, 56126 Pisa, Italy
Interests: biomedical imaging elaboration; augmented reality; surgical navigation; surgical simulation; physical and hybrid simulation for rehabilitation specialists
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Virtual reality (VR) and augmented reality (AR) have a long history in the healthcare sector, offering the opportunity to develop a wide range of tools and applications aiming at improving the quality of care and efficiency of services for professionals and patients alike.

The best-known examples of VR-AR applications in the healthcare domain include surgical planning and medical training by means of simulation technologies. The techniques used in surgical simulation have also been applied to cognitive and motor rehabilitation, pain management, and patient and professional education.

Serious games are games in which the main goal is not entertainment, but a serious purpose ranging from the acquisition of knowledge to interactive training, to name just a few.

These games (already applied in sectors like military, education, politics, management, and engineering) are attracting growing attention in healthcare because of their several benefits: motivation, interactivity, adaptation to user competence level, flexibility in time, repeatability, and continuous feedback.

Recently, healthcare has also become one of the biggest adopters of mixed reality (MR), which merges real and virtual (VR) content to generate new environments where physical and digital objects not only co-exist, but are also capable of interacting with each other in real-time. MR encompasses both VR and AR applications.

These novel applications are attracting growing attention from users and researchers, but many cognitive and perceptual issues still need to be fully understood and resolved in order to fully take advantage of the disruptive potential of these emerging technologies in healthcare, and to minimize side effects of VR-AR technologies such as “cybersickness”. Moreover, efforts should be made to strengthen the experience of “presence”, the level of acceptance, and the compatibility of MR technology with the general population, including elderly and sick people.

This Special Issue aims at gathering and publishing original scientific contributions that explore opportunities and address challenges in both theoretical and applied aspects of VR-AR and MR applications in healthcare.

Potential topics include but are not limited to the following:

Serious games for cognitive and motor rehabilitation;
Serious games for medical and surgical training and education;
Mixed reality applications for physical rehabilitation;
Mixed reality applications in computer-assisted surgery;
Mixed reality hardware/software systems for rehabilitation, medicine, and surgery;
Wearable technologies for mixed reality applications in healthcare;
Validation studies of simulators in healthcare;
Physiological signal processing for validation and testing of serious games and mixed reality applications in Healthcare;
Investigation of mixed reality cognitive and perceptual issues.

Prof. Marco Gesi
Dr. Sara Condino
Prof. Giuseppe Turini
Dr. Rosanna Maria Viglialoro
Dr. Marina Carbone
Guest Editors

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Keywords

serious games
mixed reality
wearable technologies
healthcare
surgical training and education
cognitive and motor rehabilitation
mixed reality cognitive and perceptual issues

Published Papers (9 papers)

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Editorial

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4 pages, 187 KiB

Open AccessEditorial

Serious Games and Mixed Reality Applications for Healthcare

by Sara Condino, Marco Gesi, Rosanna Maria Viglialoro, Marina Carbone and Giuseppe Turini

Appl. Sci. 2022, 12(7), 3644; https://doi.org/10.3390/app12073644 - 5 Apr 2022

Cited by 3 | Viewed by 2072

Abstract

Serious games are games in which the main goal is not entertainment, but a serious purpose ranging from the acquisition of knowledge to interactive training, to name just a few [...] Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

Research

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30 pages, 6268 KiB

Open AccessArticle

Mild Cognitive Impairment Detection Using Machine Learning Models Trained on Data Collected from Serious Games

by Christos Karapapas and Christos Goumopoulos

Appl. Sci. 2021, 11(17), 8184; https://doi.org/10.3390/app11178184 - 3 Sep 2021

Cited by 9 | Viewed by 3136

Abstract

Mild cognitive impairment (MCI) is an indicative precursor of Alzheimer’s disease and its early detection is critical to restrain further cognitive deterioration through preventive measures. In this context, the capacity of serious games combined with machine learning for MCI detection is examined. In particular, a custom methodology is proposed, which consists of a series of steps to train and evaluate classification models that could discriminate healthy from cognitive impaired individuals on the basis of game performance and other subjective data. Such data were collected during a pilot evaluation study of a gaming platform, called COGNIPLAT, with 10 seniors. An exploratory analysis of the data is performed to assess feature selection, model overfitting, optimization techniques and classification performance using several machine learning algorithms and standard evaluation metrics. A production level model is also trained to deal with the issue of data leakage while delivering a high detection performance (92.14% accuracy, 93.4% sensitivity and 90% specificity) based on the Gaussian Naive Bayes classifier. This preliminary study provides initial evidence that serious games combined with machine learning methods could potentially serve as a complementary or an alternative tool to the traditional cognitive screening processes. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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17 pages, 9398 KiB

Open AccessArticle

An Exergame Solution for Personalized Multicomponent Training in Older Adults

by Vânia Guimarães, Elsa Oliveira, Alberto Carvalho, Nuno Cardoso, Johannes Emerich, Chantale Dumoulin, Nathalie Swinnen, Jacqueline De Jong and Eling D. de Bruin

Appl. Sci. 2021, 11(17), 7986; https://doi.org/10.3390/app11177986 - 29 Aug 2021

Cited by 9 | Viewed by 2863

Abstract

In addition to contributing to increased training motivation, exergames are a promising approach to counteract age-related impairments. Mobility limitations, cognitive impairment, and urinary incontinence are very common in older adults. To optimally address these conditions, exergames should include interventions for strength, balance, cognition, and pelvic floor muscle training. In this study, we develop a personalized multicomponent exergame solution for the geriatric rehabilitation of age-related impairments. The exergame can provide interventions for balance, strength, cognition, and urinary incontinence in one single session, accommodating the needs of older adults with multiple disabilities. For its development, we involved a multidisciplinary team that helped us to specify the structure and contents of the exergame considering training requirements, game design principles, and end-user characteristics. In addition to allowing the customization of the training components, the exergame includes automatic adaptation of difficulty/load, in line with player progress over time. The game mechanics ensures the fulfilment of training needs as defined by the therapist. The exergame is cross-platform compatible (web-based) and includes novel means of interaction with wearable sensors. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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24 pages, 2718 KiB

Open AccessArticle

A Multivariate Randomized Controlled Experiment about the Effects of Mindfulness Priming on EEG Neurofeedback Self-Regulation Serious Games

by Nuno M. C. da Costa, Estela Bicho, Flora Ferreira, Estela Vilhena and Nuno S. Dias

Appl. Sci. 2021, 11(16), 7725; https://doi.org/10.3390/app11167725 - 22 Aug 2021

Cited by 2 | Viewed by 2676

Abstract

Neurofeedback training (NFT) is a technique often proposed to train brain activity SR with promising results. However, some criticism has been raised due to the lack of evaluation, reliability, and validation of its learning effects. The current work evaluates the hypothesis that SR learning may be improved by priming the subject before NFT with guided mindfulness meditation (MM). The proposed framework was tested in a two-way parallel-group randomized controlled intervention with a single session alpha NFT, in a simplistic serious game design. Sixty-two healthy naïve subjects, aged between 18 and 43 years, were divided into MM priming and no-priming groups. Although both the EG and CG successfully attained the up-regulation of alpha rhythms (F(1,59) = 20.67, p < 0.001, η_p² = 0.26), the EG showed a significantly enhanced ability (t(29) = 4.38, p < 0.001) to control brain activity, compared to the CG (t(29) = 1.18, p > 0.1). Furthermore, EG superior performance on NFT seems to be explained by the subject’s lack of awareness at pre-intervention, less vigour at post-intervention, increased task engagement, and a relaxed non-judgemental attitude towards the NFT tasks. This study is a preliminary validation of the proposed assisted priming framework, advancing some implicit and explicit metrics about its efficacy on NFT performance, and a promising tool for improving naïve “users” self-regulation ability. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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16 pages, 4817 KiB

Open AccessArticle

Target Maintenance in Gaming via Saliency Augmentation: An Early-Stage Scotoma Simulation Study Using Virtual Reality (VR)

by Alexandra Sipatchin, Miguel García García and Siegfried Wahl

Appl. Sci. 2021, 11(15), 7164; https://doi.org/10.3390/app11157164 - 3 Aug 2021

Cited by 4 | Viewed by 2574

Abstract

This study addresses the importance of salience placement before or after scotoma development for an efficient target allocation in the visual field. Pre-allocation of attention is a mechanism known to induce a better gaze positioning towards the target. Three different conditions were tested: a simulated central scotoma, a salience augmentation surrounding the scotoma and a baseline condition without any simulation. All conditions were investigated within a virtual reality VR gaming environment. Participants were tested in two different orders, either the salient cue was applied together with the scotoma before being presented with the scotoma alone or the scotoma in the wild was presented before and, then, with the augmentation around it. Both groups showed a change in gaze behaviour when saliency was applied. However, in the second group, salient augmentation also induced changes in gaze behaviour for the scotoma condition without augmentation, gazing above and outside the scotoma following previous literature. These preliminary results indicate salience placement before developing an advanced stage of scotoma can induce effective and rapid training for efficient target maintenance during VR gaming. The study shows the potential of salience and VR gaming as therapy for early AMD patients. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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29 pages, 6607 KiB

Open AccessArticle

Biofeedback Applied to Interactive Serious Games to Monitor Frailty in an Elderly Population

by Serhii Shapoval, Begoña García Zapirain, Amaia Mendez Zorrilla and Iranzu Mugueta-Aguinaga

Appl. Sci. 2021, 11(8), 3502; https://doi.org/10.3390/app11083502 - 14 Apr 2021

Cited by 7 | Viewed by 2362

Abstract

This article proposes an example of a multiplatform interactive serious game, which is an additional tool and assistant used in the rehabilitation of patients with musculoskeletal system problems. In medicine, any actions and procedures aimed at helping the rehabilitation of patients should entail the most comfortable, but at the same time, effective approach. Regardless of how these actions are orientated, whether for rehabilitation following surgery, fractures, any problems with the musculoskeletal system, or just support for the elderly, rehabilitation methods undoubtedly have good goals, although often the process itself can cause all kinds of discomfort and aversion among patients. This paper presents an interactive platform which enables a slightly different approach to be applied in terms of routine rehabilitation activities and this will help make the process more exciting. The main feature of the system is that it works in several ways: for normal everyday use at home, or for more in-depth observation of various biological parameters, such as heart rate, temperature, and so on. The basic component of the system is the real-time tracking system of the body position, which constitutes both a way to control the game (controller) and a means to analyze the player’s activity. As for the closer control of rehabilitation, the platform also provides the opportunity for medical personnel to monitor the player in real time, with all the data obtained from the game being used for subsequent analysis and comparison. Following several laboratory tests and feedback analysis, the progress indicators are quite encouraging in terms of greater patient interest in this kind of interaction, and effectiveness of the developed platform is also on average about 30–50% compared to conventional exercises, which makes it more attractive in terms of patient support. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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17 pages, 10614 KiB

Open AccessArticle

Hybrid Spine Simulator Prototype for X-ray Free Pedicle Screws Fixation Training

by Sara Condino, Giuseppe Turini, Virginia Mamone, Paolo Domenico Parchi and Vincenzo Ferrari

Appl. Sci. 2021, 11(3), 1038; https://doi.org/10.3390/app11031038 - 24 Jan 2021

Cited by 8 | Viewed by 2799

Abstract

Simulation for surgical training is increasingly being considered a valuable addition to traditional teaching methods. 3D-printed physical simulators can be used for preoperative planning and rehearsal in spine surgery to improve surgical workflows and postoperative patient outcomes. This paper proposes an innovative strategy to build a hybrid simulation platform for training of pedicle screws fixation: the proposed method combines 3D-printed patient-specific spine models with augmented reality functionalities and virtual X-ray visualization, thus avoiding any exposure to harmful radiation during the simulation. Software functionalities are implemented by using a low-cost tracking strategy based on fiducial marker detection. Quantitative tests demonstrate the accuracy of the method to track the vertebral model and surgical tools, and to coherently visualize them in either the augmented reality or virtual fluoroscopic modalities. The obtained results encourage further research and clinical validation towards the use of the simulator as an effective tool for training in pedicle screws insertion in lumbar vertebrae. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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14 pages, 1238 KiB

Open AccessEditor’s ChoiceArticle

Evaluation of the Reaction Time and Accuracy Rate in Normal Subjects, MCI, and Dementia Using Serious Games

by Yen-Ting Chen, Chun-Ju Hou, Natan Derek, Shuo-Bin Huang, Min-Wei Huang and You-Yu Wang

Appl. Sci. 2021, 11(2), 628; https://doi.org/10.3390/app11020628 - 11 Jan 2021

Cited by 15 | Viewed by 3817

Abstract

The main purpose of this research is to evaluate the differences in the reaction time and accuracy rate of three categories of subjects using our serious games. Thirty-seven subjects were divided into three groups: normal (n₁ = 16), MCI (Mild Cognitive Impairment) (n₂ = 10), and dementia—moderate-to-severe (n₃ = 11) groups based on the MMSE (Mini Mental State Examination). Two serious games were designed: (1) whack-a-mole and (2) hit-the-ball. Two dependent variables, reaction time and accuracy rate, were statistically analyzed to compare elders’ performances in the games among the three groups for three levels of speed: slow, medium, and fast. There were significance differences between the normal group, the MCI group, and the moderate-to-severe dementia group in both the reaction-time and accuracy-rate analyses. We determined that the reaction times of the MCI and dementia groups were shorter compared to those of the normal group, with poorer results also observed in accuracy rate. Therefore, we conclude that our serious games have the feasibility to evaluate reaction performance and could be used in the daily lives of elders followed by clinical treatment in the future. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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Review

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20 pages, 1364 KiB

Open AccessEditor’s ChoiceReview

Augmented Reality, Mixed Reality, and Hybrid Approach in Healthcare Simulation: A Systematic Review

by Rosanna Maria Viglialoro, Sara Condino, Giuseppe Turini, Marina Carbone, Vincenzo Ferrari and Marco Gesi

Appl. Sci. 2021, 11(5), 2338; https://doi.org/10.3390/app11052338 - 6 Mar 2021

Cited by 53 | Viewed by 7839

Abstract

Simulation-based medical training is considered an effective tool to acquire/refine technical skills, mitigating the ethical issues of Halsted’s model. This review aims at evaluating the literature on medical simulation techniques based on augmented reality (AR), mixed reality (MR), and hybrid approaches. The research identified 23 articles that meet the inclusion criteria: 43% combine two approaches (MR and hybrid), 22% combine all three, 26% employ only the hybrid approach, and 9% apply only the MR approach. Among the studies reviewed, 22% use commercial simulators, whereas 78% describe custom-made simulators. Each simulator is classified according to its target clinical application: training of surgical tasks (e.g., specific tasks for training in neurosurgery, abdominal surgery, orthopedic surgery, dental surgery, otorhinolaryngological surgery, or also generic tasks such as palpation) and education in medicine (e.g., anatomy learning). Additionally, the review assesses the complexity, reusability, and realism of the physical replicas, as well as the portability of the simulators. Finally, we describe whether and how the simulators have been validated. The review highlights that most of the studies do not have a significant sample size and that they include only a feasibility assessment and preliminary validation; thus, further research is needed to validate existing simulators and to verify whether improvements in performance on a simulated scenario translate into improved performance on real patients. Full article

(This article belongs to the Special Issue Serious Games and Mixed Reality Applications for Healthcare)

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