A strong theme in gamification is to create and deploy games that benefit people. Also, these are to ensure that the games that are created do not have unintended negative spillover effects in the real world.


Holly Tootell and Alison Freeman’s “The Applicability of Gaming Elements to Early Childhood Education” (Ch. 82) highlights the alignments between early childhood curricula and tenets and game-based learning. The six basic tenets of early childhood curriculum models include the following: child-centered, active learning, sufficient time for children’s pursuit of interests, studies or projects, “reading with dialog, questions, discussions,” and “creative, open-ended experiences” (Tootell & Freeman, 2015, p. 1643). The approaches include the concept of “Infinite play” or continuous learning until expertise is achieved (p. 1651). There is a complementary chapter—of sorts—from a Russian context. Svetlana Gerkushenko and Georgy Gerkushenko’s “The Play Theory and Computer Games using (sic) in Early Childhood Education” Ch. 64) provides an overview of computer games for preschool children in Russian kindergartens and frame selection of such games for developmental appropriateness. A core criteria for game selection is that it must allow children to freely engage in the computer game and to use their imaginations while engaging (Gerkushenko & Gerkushenko, 2015, p. 1291).

Niall McCarroll and Kevin Curran suggest the ability to speed up pre-schoolers’ learning of language and numbers by engaging a range of learning materials, activities, and technologies, in “A Literacy and Numeracy E-Learning Mobile Application for Pre-Schoolers” (Ch. 32). These authors describe SmartFun, an iPad app, with its age-appropriate characters (modeled after letters of the alphabet). The age at which children first access a mobile device has been dropping, according to the New Media Consortium, they observe. However, mobile devices do have some limits, including small screens, which limit finger-tracing.

Game-based learning is explored for those in elementary to high school learners as well. Hui-Chen Chu and Chun-Ming Hung’s “Effects of the Digital Game Development Approach on Elementary School Students’ Learning Motivation, Problem Solving, and Learning Achievement” (Ch. 23) involved the use of a game development curriculum for elementary school students—who were initially motivated by the novelty of the project but discouraged by the need to use educational software for the development. Joan J. Erickson reviews some 30 online math games designed for those in Grades 6 – 8 in “To Play or to Learn? A Review of Game-based Math Learning for Motivation and Cognition” (Ch. 104).


Games for health cover a wide range of applications: enhancing human health and security by raising awareness and promoting healthful habits, providing accessible and assistive tools, and enhancing rehabilitation.

Health and security through awareness and promotion of healthful habits. Edward Downs’ “Driving Home the Message: Using a Video Game Simulator to Steer Attitudes away from Distracted Driving” (Ch. 84) describes the use of a commercial off-the-shelf game used to emphasize the risks in distracted driving (texting, talking). This study found “more crashes, speed violations, and fog-line crossings than those in a non-distracted driving control group” (Downs, 2015, p. 1673). What was not specified was how long this effect lasts.

Andrew Sean Wilson’s “Game-based Learning as a Promoter for Positive Health Behaviours in Young People” (Ch. 66) posits a scenario in which young persons living with long-term medical conditions (cancer, diabetes, lung disease, heart disease, and stroke; substance abuse; musculoskeletal conditions; asthma; cystic fibrosis) may be trained early on in a range of self-care skills and provided feedback about their self-management competencies, to increase their well-being over a lifetime. In the UK, approximately 14% of youth have a long-term medical condition. The researcher proposes a general framework that may be used in the design of such health maintenance games, based on both patient and doctor checklists. He examines a range of objectives of such games based on the research literature, including the following: improved knowledge about subject, improved self-efficacy and self-management, improved communication skills, improved adherence to drug treatments, improved health outcomes, improved quality of life, and decreased visits to the doctor (Wilson, 2015, p. 1319).

There is a creative analog game to encourage older persons in low socio-economic status neighborhoods to walk more. Valentijn Visch, Wessel Bos, Ingrid Mulder, and Richard Prins’s “The Travelling Rose: A Persuasive Game to Stimulate Walking Behaviour of Older Persons in Low SES Neighbourhoods” (Ch. 65) describes a simple box with directions for the “persuasive” game. The idea is that people will create social connections among themselves and create surprises for each other—to motivate each other to go on shared walks. (This endeavor also may help mitigate some of the elder isolation issues that many face.)

Another work that raises awareness involves the neurofeedback capability. In “Neurofeedback and Serious Games” (Ch. 5), Manuel Ninaus, Jürgen Kurzmann, Matthias Witte, Erwin Hartsuiker, Silvia E. Kober, Christa Neuper, Elisabeth V.C. Friedrich, and Guilherme Wood describe the use of biofeedback loops during game play, which shows some of the player’s mental processes in interacting with a game. These physiological parameters may be fed back live to users and / or recorded to promote self-awareness and self-regulation. Their brain activation patterns may provide researchers with insights about what is being evoked in the player during gameplay. Game designers may identify the desired brain states and electrophysical signatures at any particular point in a game and potentially design to that. The authors write:

“With the increasing complexity of modern games one has to process huge amounts of sensory information, make ultra-fast decisions, memorize previous events of the game and finally react with an appropriate motor response. This human-computer interaction is interactive and due to highly realistic scenarios the popular media has begun to speak of a ‘new sensory reality’” (Ninaus, Kurzmann, Witte, Hartsuiker, Kober, Neuper, Friedrich, & Wood, 2015, p. 86)

Various types of technologies may be used to provide neurofeedback. One of the more recent is near-infrared spectroscopy (NIRS), which creates brain imaging from oxygenated blood flow to understand temporal brain dynamics.

Accessible and assistive gamification. Accessible games are those which are playable by a wide range of individuals with varying capabilities. Assistive games are those which are designed to support people in their daily living.

Alma Leora Culén and Anna Karpova’s “Designing with Vulnerable Children: A Researcher’s Perspective” (Ch. 30) explains well some of the challenges in designing assistive technologies for children “who have moderate to severe limitations, such as cognitive impairments, impulse control issues, strongly reduced vision, or speech problems” (Culén & Karpova, 2015, p. 611). Creating technologies to maintain or improve functioning requires careful work. First is the challenge of the abandonment of assistive technologies, often due to poor design and / or poor usability. Some users experience social stigma from using visible assistive technologies. Children with disabilities are multiply vulnerable to various risks, and even the label of “vulnerable” itself may be stigmatizing (Culén & Karpova, 2015, p. 613). The authors explain:

“Designing for and with children who have special needs is particularly challenging (Frauenberger, 2011; McNaney et al., 2013; Vines, 2013). For these children, the combination of power relationships, often reduced communication skills, the presence of additional stakeholders such as parents, teachers or caretakers, makes for a complex situation that needs to be handled with sensitivity, both methodological and ethical” (Culén & Karpova, 2015, pp. 615 - 616).

The authors go on to describe a multi-year endeavor to develop a game-based app for the iPad to use with a special education class. They initially started out with an analog paper prototype to elicit comments from individuals from their target user group. Some initial comments were that the children wanted iconic or real images for objects in the virtual store. The researchers observed that some of the children wanted to play the game alone instead of with others.

While the team initially started with a special education class of a half-dozen male students 8 – 12 years old in 2012, with a main teacher and two assistant teachers, in a participatory design approach, the students all dispersed to different classes in the next year by the time a digital prototype was ready. The researchers kept the project on track by working with an occupational therapist and testing their prototype with her patients. During the gameplay, they observed unintended behaviors, and they had to take those into consideration to design based on how children actually engaged the game prototype.

The cross-disciplinary team, including interaction designers, created with some gamification elements to stand in for some understandings that might otherwise be assumed to be handled by the children’s imaginations. The objective of the game was to teach the children expected behaviors in a store, such as the transactions during a purchase. The learning had to occur within the timespan of the children’s concentration. They designed in several levels of difficulty to maintain the interests of the children. This particular case conveyed a real-world sense of challenge and also helpful professional ethical insights.

Acquired Brain Injuries (ABI) are not uncommon phenomena. These result from health issues like strokes, tumors, degenerative diseases, and infectious disorders, motor vehicle or bicycle accidents, combat-based injuries, attacks, and other reasons. ABIs affect some 8.5% to about 17% of the world’s population, depending on sources. While video games may provide cognitive and physical therapy for those with brain injuries, many of the game interfaces are not conducive for easy manipulation by users. Jason Colman and Paul Gnanayutham, in “Assistive Technologies for Brain-injured Gamers”(Ch. 56), argue for increased accessibility of game interfaces. Standard game controllers should be replaced with “relatively large individual switches” that may be placed around a player who can use combinations of body movements to engage the game (Colman & Gnanayutham, 2015, p. 1122). The authors note that there have been advances in video game interfaces for home game consoles, including the Nintendo Wii, the Microsoft Xbox 360, and Sony Playstation 3. The “top ten” guidelines for video game accessibility are:

1. "Allow controller reconfiguration.
2. Provide alternative controller support.
3. Offer sound alternatives.
4. Provide separate volume controls for music, sound effects and dialogue.
5. Provide high visibility graphics.
6. Be colour-blind friendly.
7. Provide difficulty level and speed adjustment.
8. Offer practice modes.
9. Make menus as accessible as possible.
10. Publicise the accessibility features and game requirements" (Colman & Gnanayutham, 2015, p. 1126)

The authors also suggest that a one button interface is often desirable, where the control is a single button. It is also important to include those with ABIs in playtesting various games to ensure accessibility.

Ambient assisted living. Samuele Gasparrini, Susanna Spinsante, Enea Cippitelli, and Ennio Gambi describe the research field of Ambient Assisted Living, which enables automatic monitoring of the frail and elderly in a physical space using depth cameras (as enabled by Kinect). In “Depth Cameras in AAL Environments: Technology and Real-world Applications” (Ch. 53), Gasparrini, et al. show how modern technologies (computer vision, pattern recognition, depth sensors, and time-of-flight cameras) may enable people to age in place—to address the challenges of a global bulge in the aging population. If a person has fallen, for example, it is possible for the various technologies to observe this and notify a caretaker or emergency responder in a timely way.

Assistance in the workplace. In “Assistive Systems for the Workplace: Towards Context-Aware Assistance”(Ch. 97), Oliver Korn, Markus Funk, and Albrecht Schmidt suggest that context-aware assistive systems (CAAS)—most often used in industrial workplaces—could be applied in an assistive context for those with disabilities; CAAS functionalities may enable support for individuals in their homes or places of care.

Assistive techno.  Fiona S. Baker’s “Engaging in Play through Assistive Technology: Closing Gaps in Research and Practice for Infants and Toddlers with Disabilities” (Ch. 55) describes the importance of gameplay for infants and toddlers with special needs. For non-disabled infants and toddlers, they have a tendency towards natural play, which helps them engage with other people and the environment, and to learn critical life skills. Infants and toddlers with special needs may lack this sense of natural play. They may lack the cognitive skills, the mobility, the perception, and other elements that enable such play. Assistive games may be designed to promote more gameplay. Children with autism spectrum disorders may be supported in the development of daily life skills development through therapeutic video games, according to Toby Mehl-Schneider and Shimon Steinmetz in “Video Games as a Form of Therapeutic Intervention for Children with Autism Spectrum Disorders” (Ch. 60). Mehl-Schneider and Steinmetz (2015) suggest that some widely available off-the-shelf games may be used to help children on the autism spectrum improve their intercommunications and social competence, attentional control, facial recognition, and executive functioning and self-regulation. Carolyn Kinsell, Boaventura DaCosta, and Angelique Nasah, in “Simulation Games as Interventions in the Promotion of Social Skills Development among Children with Autism Spectrum Disorders” (Ch. 90), also observe the promise of games—particularly simulations and storytelling ones—for promoting both nonverbal and verbal communications skills.

John Gilligan and Peter Smith, in “A Formal Representation System for Modeling Assistive Technology Systems” (Ch. 57), used “CP-Nets” (coloured petri nets) to aid in the design of assistive technologies. This method involves the definitions of the current state and the desired outcomes. In between are the identified alternative ways of achieving the same goals, and the related activities that may be required to achieve the outcome and conditions (labeled “guards” here) necessary for the achievement of the goal. There are thought-through interventions which may enable the achievement of the desired end state. The formal modeling may show preferred alternatives. This system modeling approach from computer science offers a novel way of modeling assistive technology systems

Rehabilitation. Another type of health-related game involves rehabilitation which requires certain disciplined and repeated actions. Jamie Taylor and Kevin Curran’s “Glove-based Technology in Hand Rehabilitation” (Ch. 49) describes the uses of a sensor-laden glove and its use represented in 3D modeling in a tool designed to promote hand rehabilitation—to return it to full functionality and movement. Such rehabilitative therapy may apply in non-operative and post-operative situations—to deal with acute or chronic pain, de-sensitize a hand “following nerve injury or trauma” or based on hypersensitivity around scarring, re-educate hand senses after nerve injury, and others (Taylor & Curran, 2015, p. 985). In this work, OpenCV from the Open Source Computer Vision library was used for some of the visual modeling. In “Rehabilitation Systems in Ambient Assisted Living Environments” (Ch. 85), A.M. Middleton, R.P. Harte, and T.E. Ward describe some top technologies that may be used to enhance movement-based personalized rehabilitation in ambient assisted living situations.

To acclimate to the topic, Paula Alexandra Rego, Pedro Miguel Moreira, and Luís Paulo Reis introduce “A Serious Games Framework for Health Rehabilitation” (Ch. 20). Theirs is a fine overview work of the state-of-the-art of rehabilitation games and related technologies. They describe the challenge as a persistent one, of encouraging proper rehabilitation and treatment in the face of poor discipline and lack-of-patient-motivation. Health interventions are most effective when the rehabilitation work is done early, intensively, and repetitively, they observe. In this work, the authors describe core requirements for rehabilitation (application area, adaptability, performance feedback, progress monitoring, and portability) and game (interaction technology, game interface, competitive / collaborative, and game genre) criteria respectively (Rego, Moreira, & Reis, 2015, p. 406). They describe various technologies: pressure mats connected by USB cords to computers, body sensors, touch surfaces, rehabilitation gloves, puzzle games, webcams, wearable systems, motion detection and tracking, tangible interfaces, biofeedback devices, eye tracking and gaze detection tools, force feedback devices, facial expression detection devices, accelerometers, microphones, infrared sensors, and biosensors (listed in no particular order).

Finally, Tuomas Kari conducted a sparse selective literature review to examine whether exergaming could promote physical fitness and physical activity, in “Can Exergaming Promote Physical Fitness and Physical Activity? A Systematic Review of Systematic Reviews” (Ch. 103). The conclusion: The current evidence suggests that exergaming does not increase physical fitness or physical activity levels for “significant health benefits”. From 1040 articles discovered on databases, the author filtered the list down to six for review based on the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) tool, which requires a range of methods and shared information to indicate quality research. Articles filtered out suggests something about the implied poor quality of research methods and / or gappiness of relevant information in the area. Kari explains the standards for the research.  


This next section is Part 4: Promoting Science Learning with Games.

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