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GEQ metrics from the summative study in relation to the participant's age. A trend line and the corresponding R 2 value are overlaid.
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Reduced heart rate variability (HRV) is an indicator of a malfunctioning autonomic nervous
system. Resonant frequency breathing is a potential non-invasive means of intervention for improving the
balance of the autonomic nervous system and increasing HRV. However, such breathing exercises are
regarded as boring and monotonous tasks. The use of gami...
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Citations
... However, it is worth noting that the participants in both studies were exclusively male, which limits the generalisability of the results. This carry-over effect was further supported by Wollmann et al. (2016), who explored how gamified HRV biofeedback enhanced user engagement with breathing exercises, improving motivation and adherence. Together, these studies illustrate the broad applicability of biofeedback games in helping users manage stress not just in real-time, but in the long-term too. ...
... The results from the review support the proposal that integrating biofeedback games into teacher programmes could significantly benefit not only the teachers themselves but also the students. These games, which were shown to be successful in anxiety and stress management (Almeqbaali et al., 2022;Burkhart et al., 2018;Chand & Khosla, 2022;Condron et al., 2009;Dillon et al., 2016;Parnandi et al., 2014;Weerdmeester et al., 2017;Wollmann et al., 2016;Zafar et al., 2017Zafar et al., , 2020, could be highly beneficial in teacher training. As mentioned previously, early-career teachers often experience high levels of stress. ...
Biofeedback games use physiological feedback such as heart rate variability, electrodermal activity, breathing rate, and EEG data to help individuals improve awareness and control of their emotional responses. These tools have become increasingly recognized for their role in enhancing cognitive development, emotional regulation, and stress management. While biofeedback games have demonstrated substantial benefits in therapeutic contexts, their use in teacher training remains significantly underexplored. This review synthesizes the current research on biofeedback games, highlighting their therapeutic effects and cognitive benefits, followed by a discussion on their potential for application in teacher training settings. Through a critical disability studies lens, we propose the potential of these tools in supporting teachers' emotional well-being and reducing teacher burnout, thereby fostering more inclusive learning environments. The review concludes with the limitations of current research, along with recommendations for future studies to address the research gap and enhance teacher well-being and resilience through biofeedback interventions.
... These games can adapt the gameplay itself (e.g., control mechanics, enhance difficulty) [78,82] or promote selfawareness of emotional and physical states through a fun and engaging approach [2,70]. Digitally incorporated biofeedback, such as heart rate (HR), has been studied in Human-Computer Interaction (HCI) as a tool to understand and improve the player experience in games [23,45,67,126]. However, the integration of HR into board games, particularly in multiplayer contexts, remains largely unexplored. ...
... In addition, current research offers little direction on transforming physiological data into meaningful mechanics within this social, physical space. We specifically focus on user experience in our work, building on Wollmann et al. [126]'s usability work (for us, it would be the hybrid board game experience). This is because much of the existing research in biofeedback integration prioritizes the technical aspects over how users actually experience and interact with the technology. ...
Biofeedback provides a unique opportunity to intensify tabletop gameplay. It permits new play styles through digital integration while keeping the tactile appeal of physical components. However, integrating biofeedback systems, like heart rate (HR), into game design needs to be better understood in the literature and still needs to be explored in practice. To bridge this gap, we employed a Research through Design (RtD) approach. This included (1) gathering insights from enthusiast board game designers (n = 10), (2) conducting two participatory design workshops (n = 20), (3) prototyping game mechanics with experts (n = 5), and (4) developing the game prototype artifact One Pulse: Treasure Hunter’s. We identify practical design implementation for incorporating biofeedback, particularly related to heart rate, into tabletop games. Thus, we contribute to the field by presenting design trade-offs for incorporating HR into board games, offering valuable insights for HCI researchers and game designers.
... User engagement can be assessed through temperature monitoring of blood flow in the supraorbital region, which allows for dynamic adjustment of game difficulty(Yun et al., 2009), or through temperature monitoring of blood flow in the supraorbital vessels and frontalis muscle, which allows for monitoring of mental engagement and thus enjoyment of routine activities(Shastri et al., 2010). Also, video games have been identified as effective tools for motivating HRV training(Wollmann et al., 2016), and they exert significant physiological, physical, and cognitive effects on users(Drachen et al., 2010;Lin et al., 2008). For example, a study byWollmann et al. (2016) evaluated user satisfaction and the disruptive nature of various game elements during paced breathing training. ...
... Also, video games have been identified as effective tools for motivating HRV training(Wollmann et al., 2016), and they exert significant physiological, physical, and cognitive effects on users(Drachen et al., 2010;Lin et al., 2008). For example, a study byWollmann et al. (2016) evaluated user satisfaction and the disruptive nature of various game elements during paced breathing training. ...
The cardiovascular system is responsible for circulating blood throughout the body, delivering oxygen and nutrients to tissues, and removing waste products, while also helping to regulate body temperature and to support the immune system's defense mechanisms. Based on a literature review of 64 empirical studies, we analyze how interactions with different digital technologies affect physiological responses related to the cardiovascular system. We group the studies into seven major themes: emotion, gaming and control, health, mental effort and strain, stress, usability and user satisfaction, and virtual reality and simulation. Moreover, our review not only contextualizes current knowledge, but also identifies avenues for future research aimed at improving user experience and promoting healthier interactions with digital technologies. Overall, this review highlights the importance of integrating cardiovascular considerations into HCI design and research to promote user well-being in an increasingly digital world.
... The following are the essential biofeedback methods used in medical practice: Biofeedback on skin temperature is useful in treating patients with circulatory problems or endocrine diseases [1], and Electrodermal Activity (EDA) biofeedback has a few specific applications that are limited to reduce stress levels [4,5], Electroencephalographic (EEG) biofeedback has been used to treat many mental problems such as anxiety and cognition problems [6]. Heart rate variability (HRV) biofeedback is used to monitor and regulate many mental situations like anxiety, negative emotions, and chronic stress [7][8][9][10][11][12], and electromyography (EMG) biofeedback is used in many aspects of treatment like stress reduction, urinary incontinence, and stroke. This review will focus on this biofeedback type. ...
Introduction:
Expanding the use of surface electromyography-biofeedback (EMG-BF) devices in different therapeutic settings highlights the gradually evolving role of visualizing muscle activity in the rehabilitation process. This review evaluates their concepts, uses, and trends, combining evidence-based research.
Areas covered:
This review dissects the anatomy of EMG-BF systems, emphasizing their transformative integration with machine-learning (ML) and deep-learning (DL) paradigms. Advances such as the application of sophisticated DL architectures for high-density EMG data interpretation, optimization techniques for heightened DL model performance, and the fusion of EMG with electroencephalogram (EEG) signals have been spotlighted for enhancing biomechanical analyses in rehabilitation. The literature survey also categorizes EMG-BF devices based on functionality and clinical usage, supported by insights from commercial sectors.
Expert opinion:
The current landscape of EMG-BF is rapidly evolving, chiefly propelled by innovations in artificial intelligence (AI). The incorporation of ML and DL into EMG-BF systems augments their accuracy, reliability, and scope, marking a leap in patient care. Despite challenges in model interpretability and signal noise, ongoing research promises to address these complexities, refining biofeedback modalities. The integration of AI not only predicts patient-specific recovery timelines but also tailors therapeutic interventions, heralding a new era of personalized medicine in rehabilitation and emotional detection.
... Generally, a lower heart rate allows greater variability between successive heartbeats, indicating higher HRV (Persson et al., 2021). Increased mental effort leads to higher HR and reduced HRV due to sympathetic dominance over the parasympathetic system (Loeches (Wollmann et al., 2016), gesture videos (Brucker et al., 2022), and visual merchandising displays for fashion stores (Liu et al., 2018), the outcomes of this study suggest that gauging the perceived usability of in-vehicle agents during driving using objective measures remains a formidable challenge. ...
To improve the interaction between drivers and the in‐vehicle information system (IVIS), various intelligent agents, such as robot agents, virtual agents, and voice‐only agents, have been integrated into vehicles. However, it is not yet clear which type of in‐vehicle agent is best suited to the driving context. This study aims to investigate the effect of in‐vehicle agent embodiment on drivers' perceived usability and cognitive workload. In a within‐subject simulated driving experiment, 22 participants interacted with three different in‐vehicle agents (smartphone agent, robot agent, and virtual agent). Functional near‐infrared spectroscopy and electrocardiogram (ECG) were used to record prefrontal cortex activation and electrical changes associated with cardiac activity during simulated driving, respectively. The results show that the smartphone agent had the lowest perceived usability scores, oxygenated hemoglobin concentration variation (ΔHbO), and maximum ECG signal variation compared to baseline. There were no statistical differences in cognitive workload, perceived usability scores, brain area activation, and ECG signals between the robot agent and the virtual agent. The research findings demonstrate the positive effects of the anthropomorphic appearance of in‐vehicle agents on perceived usability and contribute to improving the design of in‐vehicle intelligent agents.
... ,Mühl et al. (2010),Hilborn et al. (2013),Spapé et al. (2013),Wollmann et al. (2016) andSekhavat (2020). ...
The recent advancements in Brain-Computer Interfaces (BCIs) technology made possible for its employment in entertainment applications, such as brain-controlled games. However, there are still many challenges to overcome in the design and development of such applications, especially when considering the interaction between multiple users. This paper presents the results of a controlled experiment aimed at comparing the performance and game experience of both competitive and collaborative matches in a multiplayer BCI game. In the experiment, sixteen subjects were divided in pairs into two groups, and each pair played a total of five competitive or collaborative matches of the attention-based game. Quantitative and qualitative data were collected to investigate key features of the subjects' interaction with both the BCI platform and the other players. It was found that there is no statistically significant difference in performance between the subjects of both groups, and between multiplayer and single player modes. Although the group playing competitively reported overall better scores for game experience, there was no statistically significant difference between groups. There were significant correlations between performance and positive aspects of game experience for both modes, and multiplayer matches were significantly shorter than single player ones, although this effect could not be attributed to the mode of interaction alone.
... MECHANICS Score -This regards the total score accumulated as the game progresses. it is usually the result of the score acquired by correct actions subtracting the score resulting from wrong actions. In the heart rate variation biofeedback system [37] this device is used so that the user can continuously improve his performance to control breathing and calm down. In the case of the exercise Exergame for the lower limbs [39], improving the score helps the user remain motivated in his/her legs-rehabilitating process. ...
... The more specific ways of evaluating a system depend on the context in which the experience takes place and also on the system itself, as stated by Brooke [119], the creator of this scale. For the heart rate variation biofeedback system [37], the SUS result was 69 points, which indicates a good result, and below 50 points it is considered a bad result, and above 80.3 it is an excellent result. The Think-aloud approach tool [121], is a way to quickly assess user interfaces while using a software, in which participants are encouraged to verbalize any sensation they perceive during the experiment. ...
... Practically all systems that were investigated or underwent some kind of validation test concluded that the gamification was positive, except for the study in [76], which did not achieve significant results or demonstrate the real benefits of gamification. Phrases like "Improved the frequency" [10], "potential to motivate people to engage" [37] and "obtained beneficial effects" [41], for example, show many of the researchers' conclusions in the selected articles. ...
Inclusion of game elements in health education has proved to be effective in helping student training. Commonly termed as “serious games”, these gamified systems can be an alternative to empower and motivate students during the learning process. The literature contains serious games for professional training in many health-related areas, including several motivating and playful gamification elements, and a variety of evaluation techniques used. Some review studies have compiled articles that present serious games for health-related areas analyzing aspects such as development methodologies and assessment techniques. However, the playful aspects that contribute to the health education process have not yet been compiled. This article focuses on a systematic review that analyzes the state of the art regarding serious games for health-related education, and evaluates the following: game elements, platforms, evaluation methods and requirements analysis methods. The findings indicate that “Tasks”, “Score” and “Level Progression” were the most used gamification elements. Physiotherapy, Psychology and Physical Education were the areas most covered by the included articles. Pre- and post-test questionnaires were identified as the main methods used to evaluate the serious games. The article contributes with an overview of the serious games design process, abstracted from the performed review and depicted in a diagram showing the phases commonly found in our study. The paper also proposes a categorization for the most used game elements and evaluation methods.
... Rockstroh et al. (2019) argue that the high level of control may make the feedback more intuitive and more powerful than abstract and sometimes complex graphical visualisations on a two-dimensional screen. Simplified and intuitive feedback might also reduce cognitive load (Sun, Cao, & Ma, 2017;Wollmann et al., 2016). Several studies found that experiencing BF in VR via HMD leads to greater attention and less mind-wandering than practising BF on a two-dimensional screen Rockstroh et al., 2019). ...
... Therefore, we believe that in this study breathing at exact RF during HRV-BF is the primary reason for the significantly different increases of CR and LF during HRV-BF compared to sPB only, rather than the BF learning process, i.e., the visualised changes of HRV as a means of BF. However, we decided against a more fine-grained continuous HRV feedback in this single-session experiment in order to reduce participants' cognitive load and limit frustration (see Makransky & Petersen, 2021;Sun et al., 2017;Wollmann et al., 2016). ...
Heart rate variability biofeedback (HRV-BF) is frequently used for stress management. Recently, virtual reality technology has gained attention for delivery, promising higher immersion, motivation, and attention than classical screens. However, the effects of different technologies and breathing techniques are not yet understood. In this study, 107 healthy participants completed a session in one of four conditions: HRV-BF on a desktop screen, HRV-BF via head-mounted display (HMD), standardised paced breathing without feedback (sPB) on a screen, or sPB via HMD. All setups significantly reduced perceived stress and increased heart rate variability (HRV). Practising HRV-BF, however, led to significantly greater increases in the low frequency band of HRV and cardiac coherence than sPB, and using an HMD rather than a screen also led to greater increases in cardiac coherence. As for user experience, immersion adaptation and interface quality were higher for HMDs and facilitating conditions were better for screens. While all technique and technology combinations are feasible and effective for stress management, immersing oneself in virtual reality with an HMD for HRV-BF might yield increased benefits in terms of HRV target outcomes and several user experience measures. Future research is necessary to confirm any long-term effects of such a mode of delivery.
... Cognitive engagement can be determined through the heart rate since the exposure to stimulus or tasks activates neural mechanisms and, consequently, triggers an acceleration or deceleration in the heart rate, which has been an indicator of alertness and drowsiness [36][37][38].The advantages of using heart rate include it is noninvasive, easy, and cheap to get [33,34], experiments with heart rate are simple to set up and can be used in conjunction with other biometric measures like facial expressions and respiration [38,39]. The disadvantages associated with the heart rate are the conditions of the environment under which happen the data collection since they are challenging to eliminate, and also the response time to a stimulus is long; these two points generate more uncertainty [30,40,41]. ...
Student engagement allows educational institutions to make better decisions regarding teaching methodologies, methods for evaluating the quality of education, and ways to provide timely feedback. Due to the COVID-19 pandemic, identifying cognitive student engagement in distance learning has been a challenge in higher education institutions. In this study, we implemented a non-self-report method assessing students’ heart rate data to identify the cognitive engagement during active learning activities. Additionally, as a supplementary tool, we applied a previously validated self-report method. This study was performed in distance learning lessons on a group of university students in Bogota, Colombia. After data analysis, we validated five hypotheses and compared the results from both methods. The results confirmed that the heart rate assessment had a statistically significant difference with respect to the baseline during active learning activities, and this variance could be positive or negative. In addition, the results show that if students are previously advised that they will have to develop an a new task after a passive learning activity (such as a video projection), their heart rate will tend to increase and consequently, their cognitive engagement will also increase. We expect this study to provide input for future research assessing student cognitive engagement using physiological parameters as a tool.
... It should be noted that the NDVI has a stronger correlation with PWV than precipitation and SSD, which was not investigated in previous studies. Some studies have also concluded that there is a correlation between PWV and NDVI [45][46][47]. Some studies have also found that there is a correlation between precipitation and NDVI [48][49][50][51][52], which indirectly proves the correlation between PWV and NDVI. ...
... There is also the possibility of excessive precipitation leading to floods and thus affecting the growth of vegetation. Some studies have also concluded that there is a correlation between PWV and NDVI [45][46][47]. Some studies have also found that there is a correlation between precipitation and NDVI [48][49][50][51][52], which indirectly proves the correlation between PWV and NDVI. ...
... Some studies have also found that there is a correlation between precipitation and NDVI [48][49][50][51][52], which indirectly proves the correlation between PWV and NDVI. However, the specific change trend of the correlation between PWV and NDVI is different due Some studies have also concluded that there is a correlation between PWV and NDVI [45][46][47]. Some studies have also found that there is a correlation between precipitation and NDVI [48][49][50][51][52], which indirectly proves the correlation between PWV and NDVI. ...
Zhejiang province in China experienced an extreme climate phenomenon in August 2014 with temperature rises, sunshine duration decreases, and precipitation increases, particularly, the successive heavy rainfall events occurring from 16 to 20 August 2014 that contributed to this climate anomaly. This study investigates the spatial-temporal variation characteristics of precipitable water vapor (PWV) and the normalized difference vegetation index (NDVI) associated with this phenomenon. Multiple sources of PWV values derived from the Global Positioning System (GPS), Radiosonde (RS) and European Centre for Medium-Range Weather Forecasts (ECMWF) ERA-Interim data are used with different spatiotemporal resolutions. The monthly averaged PWV in August 2014 exceeded the 95% percentiles of climatological value (53 mm) while the monthly averaged temperature was less than the 5% percentiles of climatological value (26.6 °C). Before the extreme precipitation, the PWV increased from the yearly averaged value of about 35 mm to more than 60 mm and gradually returned to the August climatological average of 50 mm after the precipitation ended. A large-scale atmospheric water vapor was partially conveyed by the warm wet air current of anticyclones which originated over the South China Sea (25° N, 130° E) and the Western Pacific Ocean. The monthly NDVI variation over the past 34 years (1982–2015) was investigated in this paper and the significant impact of extreme climate on vegetation growth in August 2014 was found. The extreme negative temperature anomaly and positive PWV anomaly are the major climate-driven factors affecting vegetation growth in the north and south of Zhejiang province with correlation coefficients of 0.83 and 0.72, respectively, while the extreme precipitation does not show any apparent impact on NDVI.
