More than skin deep: about the influence of self-relevant avatars on inhibitory control

Measuring the Reliability of a Gamified Stroop Task: Quantitative Experiment

BACKGROUND

Few gamified cognitive tasks are subjected to rigorous examination of psychometric properties, despite their use in experimental and clinical settings. Even small manipulations to cognitive tasks require extensive research to understand their effects.

OBJECTIVE

This study aims to investigate how game elements can affect the reliability of scores on a Stroop task. We specifically investigated performance consistency within and across sessions.

METHODS

We created 2 versions of the Stroop task, with and without game elements, and then tested each task with participants at 2 time points. The gamified task used points and feedback as game elements. In this paper, we report on the reliability of the gamified Stroop task in terms of internal consistency and test-retest reliability, compared with the control task. We used a permutation approach to evaluate internal consistency. For test-retest reliability, we calculated the Pearson correlation and intraclass correlation coefficients between each time point. We also descriptively compared the reliability of scores on a trial-by-trial basis, considering the different trial types.

RESULTS

At the first time point, the Stroop effect was reduced in the game condition, indicating an increase in performance. Participants in the game condition had faster reaction times (P=.005) and lower error rates (P=.04) than those in the basic task condition. Furthermore, the game condition led to higher measures of internal consistency at both time points for reaction times and error rates, which indicates a more consistent response pattern. For reaction time in the basic task condition, at time 1, rSpearman-Brown=0.78, 95% CI 0.64-0.89. At time 2, rSpearman-Brown=0.64, 95% CI 0.40-0.81. For reaction time, in the game condition, at time 1, rSpearman-Brown=0.83, 95% CI 0.71-0.91. At time 2, rSpearman-Brown=0.76, 95% CI 0.60-0.88. Similarly, for error rates in the basic task condition, at time 1, rSpearman-Brown=0.76, 95% CI 0.62-0.87. At time 2, rSpearman-Brown=0.74, 95% CI 0.58-0.86. For error rates in the game condition, at time 1, rSpearman-Brown=0.76, 95% CI 0.62-0.87. At time 2, rSpearman-Brown=0.74, 95% CI 0.58-0.86. Test-retest reliability analysis revealed a distinctive performance pattern depending on the trial type, which may be reflective of motivational differences between task versions. In short, especially in the incongruent trials where cognitive conflict occurs, performance in the game condition reaches peak consistency after 100 trials, whereas performance consistency drops after 50 trials for the basic version and only catches up to the game after 250 trials.

CONCLUSIONS

Even subtle gamification can impact task performance albeit not only in terms of a direct difference in performance between conditions. People playing the game reach peak performance sooner, and their performance is more consistent within and across sessions. We advocate for a closer examination of the impact of game elements on performance.

A touching advantage: cross-modal stop-signals improve reactive response inhibition

The ability to inhibit an already initiated response is crucial for navigating the environment. However, it is unclear which characteristics make stop-signals more likely to be processed efficiently. In three consecutive studies, we demonstrate that stop-signal modality and location are key factors that influence reactive response inhibition. Study 1 shows that tactile stop-signals lead to better performance compared to visual stop-signals in an otherwise visual choice-reaction task. Results of Study 2 reveal that the location of the stop-signal matters. Specifically, if a visual stop-signal is presented at a different location compared to the visual go-signal, then stopping performance is enhanced. Extending these results, study 3 suggests that tactile stop-signals and location-distinct visual stop-signals retain their performance enhancing effect when visual distractors are presented at the location of the go-signal. In sum, these results confirm that stop-signal modality and location influence reactive response inhibition, even in the face of concurrent distractors. Future research may extend and generalize these findings to other cross-modal setups.

A framework for equitable virtual rehabilitation in the metaverse era: challenges and opportunities

Introduction

Metaverse technology is spurring a transformation in healthcare and has the potential to cause a disruptive shift in rehabilitation interventions. The technology will surely be a promising field offering new resources to improve clinical outcomes, compliance, sustainability, and patients' interest in rehabilitation. Despite the growing interest in technologies for rehabilitation, various barriers to using digital services may continue to perpetuate a digital divide. This article proposes a framework with five domains and elements to consider when designing and implementing Metaverse-based rehabilitation services to reduce potential inequalities and provide best patient care.

Methods

The framework was developed in two phases and was informed by previous frameworks in digital health, the Metaverse, and health equity. The main elements were extracted and synthesized via consultation with an interdisciplinary team, including a knowledge user.

Results

The proposed framework discusses equity issues relevant to assessing progress in moving toward and implementing the Metaverse in rehabilitation services. The five domains of the framework were identified as equity, health services integration, interoperability, global governance, and humanization.

Discussion

This article is a call for all rehabilitation professionals, along with other important stakeholders, to engage in developing an equitable, decentralized, and sustainable Metaverse service and not just be a spectator as it develops. Challenges and opportunities and their implications for future directions are highlighted.

A proof-of-concept study exploring the effects of impulsivity on a gamified version of the stop-signal task in children

This proof-of-concept study provides an appraisal of a remotely administered gamified Stop-Signal Task (gSST) for future use in studies using child sample. Performance on the standard Stop-Signal (SST) task has been shown previously to differentiate attention-deficit-hyperactivity-disorder groups from controls. As is the case with the SST, it was envisaged that those with greater impulsivity would perform worse than those with lower levels of impulsivity in the gSST. The potential advantage of the gSST is that it could be perceived as less monotonous than the original SST and has the potential to provide higher data quality in child samples, however future research will need to be conducted to determine this. The gSST was administered remotely via video chat to 30 child participants within a community sample aged 8-12 to investigate the effect of ADHD symptoms and intrinsic motivation on gSST performance. Qualitative data was collected based on feedback from participants to gain insight into how the gSST was received by participants. A positive correlation was observed between impulsive/hyperactivity and gSST performance, however there was insufficient evidence to suggest that impulsivity predicted performance. With regards to accuracy, results suggested that impulsivity level significantly predicted the rate of go-omission errors. No relationships were observed between intrinsic motivation inventory (IMI) subscales and performance or IMI and impulsivity. Nevertheless, mean IMI scores were overarchingly high for each of the IMI subscales, suggesting that regardless of performance and/or level of impulsive behaviour, the child sample obtained in this study demonstrated high levels of intrinsic motivation, which was supported by the predominantly positive subjective feedback provided by the child participants. The present study provides some evidence based on quantitative and qualitative results for the efficacy of gSST for use with children. Future research with a larger sample of children is warranted to examine how performance on the SST and gSST compare/differ.

Tasting inhibition: A proof-of-concept study of the food stop-signal game

Self-Control is an important skill in everyday life when attention is automatically drawn toward certain stimuli. For instance, food stimuli automatically capture visual attention and are processed preferentially. Therefore, efficient response inhibition is crucial to refrain from careless overeating. In the present proof-of-concept study we use a novel adaptation of a previously evaluated Stop-Signal Game (SSG) to measure reactive, food-specific, response inhibition in healthy adults. We analyzed a sample of 83 participants (60 female, mean age=24.1, mean BMI=21.71kg/m2) split into three groups. In a gamified stop-signal task, participants navigated an avatar in an urban environment toward high-calorie food, low-calorie food, or non-food stimuli in go-trials and were asked to inhibit the approach reaction in stop-trials. Hunger, eating styles, food craving, and impulsivity were assessed via self-reports to investigate their relationship with (food-specific) response inhibition. Results showed that response inhibition (in terms of stop-signal reaction time, SSRT) did not differ between the high-calorie, low-calorie, and non-food SSG which might be explained by characteristics of the sample. However, impulsivity was positively correlated with SSRT in the low-calorie SSG, whereas food-craving and hunger were positively related to response inhibition in the high-calorie SSG. Future studies could build upon the food SSG to measure and train food-specific response inhibition in the treatment of overeating.

Evaluating attention deficit hyperactivity disorder symptoms in children and adolescents through tracked head movements in a virtual reality classroom: The effect of social cues with different sensory modalities

Background

Attention deficit hyperactivity disorder (ADHD) is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic and controlled manner. The objective of this study was to investigate the correlation between participants’ head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities.

Methods

Thirty-seven children and adolescents with (n = 20) and without (n = 17) ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test (VR-CPT) was conducted under four conditions: (1) control, (2) no-cue, (3) visual cue, and (4) visual/audio cue. A quantitativecomparison of the participants’ head movements was conducted in three dimensions (pitch [head nods], yaw [head turns], and roll [lateral head inclinations]) using a head-mounted display (HMD) in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT.

Results

The magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control (HC) groups.

Conclusion

Children and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner.

The (Gami)fictional Ego-Center: Projecting the Location of the Self Into an Avatar

A rich body of research suggests that self-associated stimuli are preferentially processed and therefore responses to such stimuli are typically faster and more accurate. In addition, people have an understanding of what they consider their “Self” and where it is located, namely near the head and upper torso—further boosting the processing of self-related stimuli if they are presented near the felt location of the self. We were interested in whether the same mechanism can be found when people transfer their “Self” into a static avatar. We investigated this in two studies with N = 33 and N = 39 young, healthy adults, respectively. Taken together, the results showed that (i) people indeed show enhanced processing for self-avatar-related stimuli and (ii) that self-associations are stronger if the to-be-associated stimuli are closer to the avatar’s upper torso—suggesting some kind of a projected location of the self in the avatar. This implies that attention is not equally distributed across the avatar. Beyond a theoretical level, this also has implications for practical use. For example, digital games opting for a non-traditional user interface where information is displayed on or in the direct vicinity of the character should take this effect into account when choosing which information to present where (i.e., present the most crucial piece of information close to the self-center of the avatar).