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Abstract
The interest around the utilization of video games as a component of rehabilitative therapy has dramatically increased over the past decade. Research efforts have confirmed the positive effects of repetitive gaming in improving visual outcomes; however, there is limited knowledge on the mechanism of action delivered by repetitive gaming. Utilizing knowledge of the visual system, including targeting specific cells in the retina with visual stimuli, the authors captured the training effects of gaming to augment pre-selected skills. Specifically, the authors embedded a homerun derby style baseball game with a contrast threshold test, to stimulate parvocellular retinal ganglion cells. Parvocellular cells are the first line of the ventral, or “what” pathway of visual processing. Repetitive stimulation of the parvocellular system shows promising preliminary results in improving batting performance.
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Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes.
Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers.
Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers.
There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area.
Abnormal visual experience during a sensitive period of development disrupts neuronal circuitry in the visual cortex and results in abnormal spatial vision or amblyopia. Here we examined whether playing video games can induce plasticity in the visual system of adults with amblyopia. Specifically 20 adults with amblyopia (age 15–61 y; visual acuity: 20/25–20/480, with no manifest ocular disease or nystagmus) were recruited and allocated into three intervention groups: action videogame group (n = 10), non-action videogame group (n = 3), and crossover control group (n = 7). Our experiments show that playing video games (both action and non-action games) for a short period of time (40–80 h, 2 h/d) using the amblyopic eye results in a substantial improvement in a wide range of fundamental visual functions, from low-level to high-level, including visual acuity (33%), positional acuity (16%), spatial attention (37%), and stereopsis (54%). Using a cross-over experimental design (first 20 h: occlusion therapy, and the next 40 h: videogame therapy), we can conclude that the improvement cannot be explained simply by eye patching alone. We quantified the limits and the time course of visual plasticity induced by video-game experience. The recovery in visual acuity that we observed is at least 5-fold faster than would be expected from occlusion therapy in childhood amblyopia. We used positional noise and modelling to reveal the neural mechanisms underlying the visual improvements in terms of decreased spatial distortion (7%) and increased processing efficiency (33%). Our study had several limitations: small sample size, lack of randomization, and differences in numbers between groups. A large-scale randomized clinical study is needed to confirm the therapeutic value of video-game treatment in clinical situations. Nonetheless, taken as a pilot study, this work suggests that video-game play may provide important principles for treating amblyopia, and perhaps other cortical dysfunctions.
Trial Registration
ClinicalTrials.gov NCT01223716
The contrast sensitivity function (CSF) is routinely assessed in clinical evaluation of vision and is the primary limiting factor in how well one sees. CSF improvements are typically brought about by correction of the optics of the eye with eyeglasses, contact lenses or surgery. We found that the very act of action video game playing also enhanced contrast sensitivity, providing a complementary route to eyesight improvement.
Action video game play benefits performance in an array of sensory, perceptual, and attentional tasks that go well beyond the specifics of game play [1-9]. That a training regimen may induce improvements in so many different skills is notable because the majority of studies on training-induced learning report improvements on the trained task but limited transfer to other, even closely related, tasks ([10], but see also [11-13]). Here we ask whether improved probabilistic inference may explain such broad transfer. By using a visual perceptual decision making task [14, 15], the present study shows for the first time that action video game experience does indeed improve probabilistic inference. A neural model of this task [16] establishes how changing a single parameter, namely the strength of the connections between the neural layer providing the momentary evidence and the layer integrating the evidence over time, captures improvements in action-gamers behavior. These results were established in a visual, but also in a novel auditory, task, indicating generalization across modalities. Thus, improved probabilistic inference provides a general mechanism for why action video game playing enhances performance in a wide variety of tasks. In addition, this mechanism may serve as a signature of training regimens that are likely to produce transfer of learning.
A variation of "stripe therapy" for amblyopia is described, using a composite video presentation of a television game with horizontal or vertical moving stripe backgrounds. The initial study has been carried out with two groups of amblyopic subjects, one group exposed to stripe backgrounds while playing the television games, and a small control group playing the games without any striped backgrounds. A wide range of results was obtained over several weekly exposure sessions, from possibly significant improvement to essentially no change in visual acuity. The results obtained from the group exposed to striped backgrounds do not appear to be markedly better than those obtained from the control group.
As video-game playing has become a ubiquitous activity in today's society, it is worth considering its potential consequences on perceptual and motor skills. It is well known that exposing an organism to an altered visual environment often results in modification of the visual system of the organism. The field of perceptual learning provides many examples of training-induced increases in performance. But perceptual learning, when it occurs, tends to be specific to the trained task; that is, generalization to new tasks is rarely found. Here we show, by contrast, that action-video-game playing is capable of altering a range of visual skills. Four experiments establish changes in different aspects of visual attention in habitual video-game players as compared with non-video-game players. In a fifth experiment, non-players trained on an action video game show marked improvement from their pre-training abilities, thereby establishing the role of playing in this effect.
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