Side Program Presentation at Games for Health Europe Conference 2014. Benny van der Vijgh - Game-based stress manipulation Petra Hoogendoorn - Remind a cognitive training app and game for brain tumor patients, lessons learned: opportunities and obstacles

2. GASICA
Generic Automated Stress Induction
and Control Application
Benny van der Vijgh, Robbert-Jan Beun
Maarten van Rood, Peter Werkhoven

3. Stress induction & manipulation
Stress dependent/confounding variable
Currently no application available

4. GASICA

5. Stressor component
Multidimensionality
Adjustability
Real-time
Continuity
Digital game stressor
Requirements

6. Stressor component
Meta-analysis
83 studies (1978 – 2012)
Coded 19 game and study characteristics & 29 physiological signals
Analyzed 10 characteristics & 3 physiological signals (HR, SBP, DBP)
High mean weighted effect sizes (0.76 – 0.97 g*)
Metaregression: 4 game characteristics & 2 study characteristics
Digital game stressor characteristics

7. Stressor component
Digital game stressor characteristics
Game type
Realism
Aversive stimuli
Game music
Time pressureFrustration I/O

8. Measurement component
Requirements
Responsitivity
Response consistency
Measurement continuity
Measurement inertion
Low response latency

9. Measurement component
Characteristics
Heart rate (HR)
Blood pressure (BP)
Electrodermal response (EDA)

10. Feedback model
Stress state
Rules Selection

11. GASICA revisited

12. Implementation
Game type
Narrative
Stressor

13. Implementation
Stressor characteristics instantiations

14. Implementation
Stressor engine requirements
Data exchange
Characteristic implementation
High-level programming language
Real-time adjustment
Virtual BattleSpace 2 (Bohemia Interactive)

15. Implementation
Stressor

16. Implementation
Measurement equipment requirements
fMRI compatible
Continuous
Broad spectrum
MP150 System (Biopac Systems Inc.)

17. Implementation
Feedback model requirements
High-level Biopac compatible classes
Python

18. Implementation
Open source Ease of use
Gasica.com
General requirements

19. Implementation

20. Testing
Debugging
S/N ratio
EEG timing

21. Pilot 1
N = 27
Usability & perceived stress
Questionnaire
Sufficient quality & slightly stressed

22. Pilot 2
Proof of concept
N = 6 (3M, age = 33.7Y)
10m fitting, 30m manipulation
2x5m baseline
High & low stress
HR, SBP, DBP, EDA

23. Pilot 2

24. Summary
Automated
Open source Induction
Manipulation
Standardized
Ease of use
Generic
Multi-dimensional

25. Conclusion
Currently larger validation study
N= 42, HR, BP, EDA, Cortisol, subjective stress
GASICA potential for easy to use tool,
allowing for standardized
stress induction and manipulation.

27. Remind
cognitive training for (brain) tumor patients
life in years opportunities for families affected by cancer
Games for Health Europe
Petra Hoogendoorn
Utrecht, October 2014

28. name, e-mail address, country code
‘on top of your mind’
‘mind blowing or mindful’ afterburners:
petrahgndrn@gmail.com
thank you!

33. name, e-mail address, country code
‘on top of your mind’:
what other cancer apps / games are
you aware of?

35. WHO (1948): a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity
Huber et al. (2011): the ability to adapt and to self manage, in
the face of social, physical and emotional challenges

36. tumortumor
change of focus
tumor tumor
treatments
treatments
what can you
do yourself
functioning
with tumor
personalized
functioning
with a tumor

37. the other 99,95% of time
coping, self management, life
Sara Riggare (Sweden)
researcher and Parkinson (im)patient
(with permission)

38. lots (family) functioning with cancer
issues waiting to be attended to

39. name, e-mail address, country code
‘on top of your mind’:
what apps / games for other diseases
could be interesting for cancer
patients and/or their loved ones?

40. significant numbers
and financial opportunities

41. and probably lots more award winning
research currently not available to
patients and families

43. Dutch government e-health agenda

44. name, e-mail address, country code
‘on top of your mind’:
how would you rate opportunities and
support for e-health / health games in
your country?

45. a number of obstacles encountered
upfront:
• researchers are rewarded for (funding and) articles not apps
• rather an investment with unsure benefits, pricing, numbers reached, knowledge who to target
(physician, insurance, ‘publishers?’) and procedures and rules to follow, perhaps reputation risks
• and what is a reasonable division of benefits for accomplishments in research on the one hand and
business on the other? (in publishing books standards already in existence)
funding:
• funding is project and time bound, app development not necessarily easy to predict upfront plus
ongoing development is a necessity from technical - , physician - and patient perspective
• funding channels traditionally familiar for researchers are not necessarily keen to support
‘commercial’ activities, yet would like a sustainable product
development:
• building apps and doing medical research are two entirely different worlds with different notions of
time, approach, budget flexibility, finished products, etc. etc.
implementation:
• no such thing as a sales, support or ongoing development organization (like book publishers)
• researchers and physicians tend to be rather focused, specializing in a certain area / domain,
opportunities outside it are not necessarily seen, (considered) easy to enter and used
• not invented here syndrome
• how are patients and physicians supposed to know what is available where and how and good
value for money and time / energy?
• availability devices and skills within certain groups of patients or clinical practices
• proof to be used in practice / reimbursed requires (preferably less throughput time consuming)
research, yet much more expensive face to face treatments without real evidence are reimbursed
• …

46. name, e-mail address, country code
‘on top of your mind’:
what could / should we do ourselves /
together to enhance uptake and use
of e-health / health games?
what can governments or other
organizations contribute?

47. Thank you!
petra.hoogendoorn@your-years.nl