Review Article

A Systematic Review on Serious Games in Attention Rehabilitation and Their Effects

Table 1

Summary of the included studies.

NumAuthor. (year)JournalCountryStudy designIntervention (game)Control groupTarget groupParticipantsMean ageSession number, frequency, durationResult

1Mercado et al. [52] (2020)Journal on Multimodal User InterfacesMexicoNon-RCT (quasi-experimental)A BCI video game (FarmerKeeper)CartoonsChildren with autism26 (; )13 sessions, 15 min, 3 blocks around 4 min eachAll measures of attention, sustained attention, and attentional control in all children show improvement
2De Giglio et al. [53] (2015)Neurorehabilitation and Neural RepairItalyPilot RCTA home-based cognitive rehabilitation program (Dr. Kawashima’s Brain Training)Waitlist (usual care)Multiple sclerosis35 (; )40 sessions, 8 consecutive weeks, 30 min/d, 5 d/wkSignificant improvement in the effect of DKBT on ST, SDMT, and some MSQoL subscales was observed. Improvements were also observed in the cognitive subscales MFIS and PASAT, but this improvement was not significant
3Montani et al. [42] (2014)Frontiers in PsychologyItalyUncontrolled before and after clinical trialA new adaptive video game Labyrinth (“diamond task” and “snake task”)Traumatic brain injury (TBI)2014 sessions, 40 min, 2 weeksThe results confirmed the strengthening of cognitive abilities by the game, especially the improvement of attentional control during the game
4Ballesteros et al. [54] (2015)Frontiers in Aging NeuroscienceSpainRCTNonaction video game training (Lumosity)Usual careElderly28 (; )20 sessions, 1 hour, 10–12 weeksProcessing speed, attention, and visual recognition memory as well as two dimensions of subjective well-being showed significant improvement
5Boivin et al. [55] (2016)AIDS Research and Human RetrovirusesUgandan+USARCTComputerized cognitive rehabilitation training (Captain’s Log)Usual careChildren with HIV157 (; limited ; )24 sessions, 1 hour, 3 days per weekThe overall KABC-II mental processing index, knowledge, and planning improved significantly compared to passive controls. Significant improvements were seen in CogState Groton maze chasing, card detection, and learning in both CCRT arms. However, in other CogState memory or attention measures, TOVA, BRIEF, and CBCL were there any different in the arms
6Franceschini et al. [56] (2013)Current BiologyItalyUncontrolled before and after clinical trialVideo gamesDyslexia209 sessions, 80 min per dayThe results showed that only action video games helped to increase children’s reading speed, attention abilities, and skills
7Guimaraes et al. [57] (2018)Journal of Physical Education and SportBrazilRCTActive video game-based (AVG) physical activity programAerobic exercise programElderly27 (; )36 sessions, 3 times a week, 12 weeksIn the AVG group, only executive function and delayed memory improved, and in the aerobic group, visual attention, executive function, delayed memory, short-term memory, and overall cognition improved. However, we did not find significant differences between groups in the performance of cognitive tests. This suggests that the benefits of AVG exercise may be similar to those of regular aerobic exercise
8Alqithami et al. [58] (2019)HealthcareSaudi ArabiaSingle-subject design (non RCT)Augmented reality game (AR-Therapist)ADHD1Depend on child performance and his engagement level, 10 trials of 1 minute eachThe patient performs better in selecting a predetermined object, which indicates a positive performance index
9Boletsis et al. [59] (2016)International Journal of Serious GamesNorwayUncontrolled clinical trialAugmented reality cube game (CogARC system)Dementia5To complete two levels of each minigame approximately 25–30 minutes in totalThe iGEQ test showed improvement in positive effect, immersion, and challenge. However, some values indicate specific problems in several small games. Also, the usability score by the SUS test in CogARC was higher
10Nouchi et al. [60] (2012)PloS OneJapanRCTA popular brain training game (Brain Age)A popular puzzle game (Tetris)Elderly32 (; )20 sessions, 15 minutes per day, 5 days per week, 4 weeksThe results showed that in all measures of executive function, TMT-B, and two measures of processing speed, the intervention game had a better result than the Tetris game as control. However, there is no significant difference between the effect of Brain Age and Tetris in measuring global cognitive status and all attention measures
11Ballesteros et al. [61] (2014)Frontiers in Aging NeuroscienceSpainRCT20 nonaction video games (Lumosity)Usual careElderly40 (; )20 sessions, 1 hour, 10–12 weeksAttention, processing speed, immediate, delayed visual recognition memory, and the two dimensions of the well-being scale (affection and assertiveness) showed significant improvement
12Vakili et al. [62] (2016)Cogent PsychologyAustraliaRCTAction video game (Medal of Honor: Rising Sun (MoHRS))Waitlist (usual care)Traumatic brain injury (TBI)26 (; )8 sessions, 2 hours, 8 weeksThe intervention resulted in a significant improvement in game performance and an effect of lag in both groups showed by the attentional blink task. The detection of the second target at all-time lags showed great progress for the intervention group. Also, the attention training group showed a significant improvement in map search (2 min), but this improvement was not significant in the other two TEA methods. In contrast, a significant decrease was observed in the TAU group. No improvement was observed in the BRIEF-A (executive performance) or GSES (self-efficacy) scales
13Gamito et al. [63] (2017)Disability and RehabilitationPortugalRCTA virtual reality-based serious game applicationWaitlist (usual care)Stroke20 (; )8-18 sessions, 2-3 sessions per week, 1 hour, 4–6 weeksUnlike the control group, in the intervention group, a significant improvement in patients’ WMS scores and efficiency was observed. Significant interaction was also seen on work efficiency of sustained attention
14Giordani et al. [64] (2015)Global Mental HealthUgandaUncontrolled before and after clinical trialA computer-based training platform (Brain Powered Games (BPG) package)At-risk African children3324 sessions, 45 min, 3 days per week, 2 monthsAttention measurements (TOVA omissions), processing speed (TOVA response time), basic visuomotor tracking speed (GMLT chase test), and problem solving (GMLT learning test) were significantly improved. In contrast, TOVA percent commission errors and KABC-II nonverbal index composite score did not significantly improve as a result of BPG training
15Mainetti et al. [65] (2013)Technology and Health CareItalyA case series (non-RCT)A set of designed games (Duckneglect)Neglect disorder120 sessions, 30 minutes, 5 days a week, 1 monthPeripersonal neglect on the line bisection task, MMSE, and the attentional matrices showed a significant improvement. Despite the improvement in postsession test performance, this improvement was not stable until the end of the rehabilitation period and a five-month follow-up showed that the patient remained stable
16Chen et al. [66] (2012)Turkish Online Journal of Educational Technology (TOJET)Taiwan+CanadaNon-RCTSomatosensory video game trainings (three games)Usual careElderly35 (IG: ; IG: ; CG: ; CG: )12-24 sessions, 30 min, 3 times per week, 4 and 8 weeksIn most participants, after 8 weeks of follow-up, selective attention in immediate effect, carry-forward effects, and overall effect improved significantly and did not show rapid improvement overall. In the end, they concluded that the use of somatosensory video games to promote the selective attention of the elderly with disabilities is a good approach
17Ballesteros et al. [67] (2017)Frontiers in Aging NeuroscienceSpainRCTNonaction video games from LumosityAn active control group with simulation strategy gamesElderly55 (; )16 session, 40–50 min, 10–12 weeksContrary to the measurement of selective attention and working memory, a significant improvement was seen in the performance of participants in the training sessions
While both groups progressed similarly in the Corsi block task, a marginal training effect was observed for the N-back task, and no progress was observed for the Stroop task in the experimental group
18Robert et al. [68] (2020)Journal of Medical Internet ResearchFranceRCTMeMo (Memory Motivation) web applicationUsual careNeurocognitive disorders46 (; )48 session, 30 min, 4 per week, 12 and 24 weeksAttention tests (trial making test A and correct digit symbol substitution test items), and the apathy inventory (AI) showed significant differences between MeMo and nonactive MeMo groups
19Sharma et al. [69] (2017)Disability and rehabilitationCanadaA case series (non-RCT)The cognitive training program (brain HQTM)Moderate-severe brain injury1060 sessions, 60 min, 5 days per week, 12 weeksPatients’ adherence to the intervention was moderate, and there was 70% patient retention
20Yoshida et al. [70] (2018)NeurorehabilitationJapanPilot RCTTwo types of video game tasks: a flow task and a control taskUsual careTraumatic brain injury (TBI)2040 sessions, 20 min, 2 in a day, 4 weeks
21Zickefoose et al. [71] (2013)Brain injuryUSASingle-subject design (non-RCT)Attention process Training-3 (APT-3) and Lumosity brain games (Birdwatching, Monster Garden, Playing Koi, Rotation Matrix, and Top Chimp)Traumatic brain injury (TBI)420 sessions, 30 min, 1 monthAlthough participants made significant progress in both interventions, there was a limited generalization
22Macoun et al. [72] (2020)Journal of Autism and Developmental DisordersCanadaNon-RCTA game-based cognitive training program (Caribbean Quest)Waitlist (usual care)Children with autism20 (; )24 sessions, 30 min, approximately 3 times per week, 8–10 weeksExecutive function or attention performance measures: the error rate in the intervention group was significantly lower compared to the control group. For KiTAP “owls” (divided attention) or “ghost ball” (sustained attention) tasks and WISC-IV spatial span or digit span tasks, no differences were observed compared to before the intervention. There was a significant difference in errors between the intervention and control groups in the visual-spatial WM task of “colored boxes.”
Academic fluency: fewer errors in the intervention group than the control group were significant. There was no difference in oral reading fluency in the intervention group
23Mayas et al. [73] (2014)PLOS OneSpain+AustraliaRCT10 video games selected from LumosityDiscussion meetings about general topics related to agingElderly27 (; )20 sessions, 1 hour, 10–12 weeksSignificant increase in alertness and decrease in distraction were observed in the experimental group, but no change was observed in the control group
24Yu et al. [74] (2021)International Journal of Environmental Research and Public HealthChinaRCTBrainastic computerized cognitive training (CCT)Video watching on history, art, literature, and science+physical exerciseElderly232 (IG1: multidomain ; IG2: two-domain ; video watching+)IG1, IG2: 24 sessions, 1 hour min Brainastic CCT sessionThe improvement in frailty status, learning ability, and verbal memory ability was quite visible in the participants in the intervention groups (multi-/two-domain CCT+PE) compared to the control participants. Multidomain CCT did not perform better in improving frailty status or cognitive function than two-domain CCT
25Fordell et al. [75] (2016)Topics in stroke rehabilitationSwedenUncontrolled before and after clinical trialMultisensory stimulation in virtual reality (RehAtt)Chronic neglect after stroke1515 sessions, 1 hour, 3 times per week, 5 weeksImprovement due to training was seen in the baking tray task, star cancellation test, and extinction test. Fewer missed goals in Posner’s task were improved. CBS continued to show improvements in daily activities, both immediately after training and after 6 months of follow-up
26Straudi et al. [76] (2017)BMC neurologyItalyExploratory, pilot RCTPreselected games (Kinect Adventures and Kinect Sports)A balance platform therapy (BPT) by Biodex Medical SystemsTraumatic brain injury (TBI)21 (IG:; CG:)18 sessions, 1 hour, 3 per week, 6 weeksCB&M scores improved in both groups, but only UBS and TUG increased in the VGT group. Also, in the VGT group, selective attention was significantly improved
27Janssen et al. [77] (2014)Journal of Clinical and Experimental NeuropsychologyUSAPilot RCTHybrid-variable priority training (HVT) program (Space Fortress game)WaitlistMultiple sclerosis28 (; )20 sessions, 1 hour (part task training: 10 sessions, variable priority training: 10 sessions)Except for the WTAR test, other tests (BDI-II, PASAT, SDMT, SRT, LTS, CLTR, and WLG) did not show significant improvement in the intervention group. There was evidence in improving skill acquisition and feasibility of the intervention, but there was no evidence of widespread transfer to cognitive function tasks. However, an improvement in spatial short-term memory was seen in participants. Also, attention and executive function did not show significant improvement, and verbal memory showed a higher rate in the control group. The visual memory in the intervention group showed a significant improvement. No significant change was seen in the transition to long-term spatial memory measurements by the 10/36 spatial recall delay version. Also, no significant results were observed for higher-order functions, which are measured by the demand for verbal fluency of the word list generation task
28Belchior et al. [78] (2013)Computers in Human BehaviourCanada+USARCTMedal of Honor: Rising Sun (MoHRS)A placebo control arcade game (Tetris), useful field of view (UFOV) training program, a usual care control groupElderly58 (IG: ; CG:; CG:; CG:)6 sessions, 90 min, 2–3 weeksSignificant improvement was seen in UFOV compared to game groups. On the other hand, a significant improvement was observed in all three intervention groups compared to the noncontact control group. Also, contrary to the findings observed in the younger adults, there was no difference between the two game states
29Muneer et al. [79] (2015)Disability, CBR, and inclusive developmentIndiaUncontrolled before and after clinical trial pilotVirtual reality-based games: Carnival games, Kinect AdventuresChildren with developmental disabilities54-6 sessions, 20-30 min, 1 monthSignificant improvements in specific motor skills and cognitive, social, and emotional skills were seen in children. No withdrawal of children was performed in any of the skills from different areas
30Castro-Rojas [80] (2018)GerontechnologyDenmarkUncontrolled before and after clinical trialA web-based game application (Lumosity)Elderly513 sessions, 2.5 hours, 6 weeksThe performance of online cognitive games in participants was improved by participants with repetitive practices. Unlike factors such as age, education, and a positive attitude towards technology, the significant effect of the number of game times on performance improvement was statistically quite clear

ADHD: attention-deficit hyperactivity disorder; HIV: human immunodeficiency virus; RCT: randomized controlled trial; BCI: brain-computer interfaces.