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The first 3 framework phases are primarily about information gathering to develop a more well-accepted and scientific gamified task in later stages. Steps 4, 5, and 6 ideation, prototyping using OMDE, and development, respectively follow 2 main objectives: 1 generating gamification design ideas around targeted cognitive tasks stages 4 and 5 and 2 developing actual gamified cognitive tasks through frequent consultation with gamification and cognitive experts and regular testing with target users stage 6.

Finally, once the efficacy of a gamified cognitive task has been demonstrated in phase 6, the task is disseminated to its target audience and then monitored periodically to maintain its effectiveness over the long term stage 7. Defining objectives has been recommended in most reviewed gamification frameworks 9 of 11 and will support a later stage to figure out if the desired goals have been achieved [ 66 ].

The interdisciplinary team should list all potential objectives and then rank and justify the list in terms of importance since trade-offs of less important goals for more important ones might be needed [ 49 , 53 ].

Finally, as the team goes through gamification design and development, it can go back to the list to focus on what is really important [ 49 ]. Therefore, the defined objectives should be achievable, specific, relevant, measurable, and time-bound [ 66 ]. It can be carried out by detecting the problem that gamification should solve by gathering and analyzing quantitative and qualitative information. After determining the problem, the root reason that caused the problem must be motivational.

Otherwise, gamification is not suitable [ 66 ]. The segmentation helps the team choose a more acceptable design to gamify targeted cognitive tasks.

Typically, gamification through motivational affordances enriches information systems [ 53 ]. Therefore, it is essential to conduct this phase 9 of 11 frameworks have had one step for understanding users.

People are motivated by different motivational affordances based on characteristics such as their age, gender, and culture. The Octalysis gamification framework is widely used to segment users based on their motivations [ 68 ].

Octalysis was developed by Chou [ 68 ] as an octagon with 8 core drivers of individuals on each side: 1 epic meaning and calling, 2 development and accomplishment, 3 empowerment of creativity and feedback, 4 ownership and possession, 5 social influence and relatedness, 6 scarcity and impatience, 7 unpredictability and curiosity and, 8 loss and avoidance. The game strategies or elements that are associated with each driver have been grouped next to it.

The girls have a scarf Figure 5 since these children only identify women and girls who wear a scarf in Iranian culture, girls and women wear a scarf. For more information about designing a user-friendly interface for people facing cognitive and physical disabilities, please see [ 2 , 69 – 73 ]. At this stage, the interdisciplinary team should thoroughly acquaint itself with existing tools for assessing or training the targeted cognitive functions or impairments through methods such as consulting with cognitive experts and gathering quantitative and qualitative information.

This work helps the team incorporate game elements into these tools without changing their process and execution and find integration points for adding game elements [ 74 ].

Describing the tools at a granular level is required. Otherwise, it is not guaranteed that the next framework steps will lead to the desired outcomes [ 53 , 74 ]. Three main tools that can be explored for cognitive assessment and training purposes are standard computerized or not computerized cognitive tasks, existing cognitive games, and existing video games.

Selecting appropriate cognitive tasks is very important. Some tasks may have better performance than others [ 24 , 75 ]. Computer versions have now been made for many standard cognitive tasks, which are cheaper, more repeatable, and easier to administer and distribute [ 76 ]. Many of these tasks can be found in [ 77 – 79 ]. Regarding existing cognitive games, many games have been developed based on standard cognitive tasks [ 80 ].

It is beneficial to find these games since they can be reused for current cognitive assessment and training purposes, or the initial inspiration for gamifying current tasks can be obtained by reviewing the style of these games for integrating game elements into a cognitive task [ 25 , 33 , 43 , 75 ]. Regarding existing video games, it has also been demonstrated that classical video games of different genres that have not been inherently designed to assess or train cognitive functions can be reused as a standard cognitive task.

Video game challenges come in various forms, and players have to use their underlying neural systems and cognitive abilities to win these games [ 81 – 90 ]. Each cognitive function is typically characterized by a set of parameters estimated from a gameplay to reuse for assessing and training.

In other words, the team must identify which cognitive skills are central to each gameplay [ 91 ]. For winning games like Tetris and Candy Crush, mental rotation and spatial reasoning skills are required [ 91 ].

Card games like Solitaire and FreeCell have a reasonable correlation with classical measurements of executive functions and planning abilities [ 92 , 93 ].

The team can explore existing games from platforms such as the App Store and Google Play. According to Green and Bavelier [ 83 ], Doherty et al [ 91 ], and expert experiences, it is unnecessary to find appropriate games through earlier methods for categorizing games such as genre-based methods since they are no longer effective. Games that have never overlapped in terms of content and mechanics now have many points of overlap [ 83 ].

After collecting the tools, the interdisciplinary team should determine whether game-up and mapping techniques can be used instead of designing a new gamified cognitive task from scratch. Game-up refers to adding game elements such as colors, animations, sound effects, and a backstory into standard cognitive tasks without changing their fundamental properties such as stimuli, design, and procedure [ 5 , 26 , 94 ] 21 of 63 studies used the game-up technique.

The developed gamified cognitive tasks based on game-up are often presented in the form of a battery of mini-games. Each mini-game focuses on a specific cognitive function eg, [ 64 , 76 , 95 ].

For example, Zeng et al [ 76 ] gamified a computerized cognitive test battery to detect impairments in 5 cognitive functions involved in developing a major neurocognitive disorder. For each test, some mini-games were designed in the context of ADLs such as cooking, cleaning, and shopping. The main feature of game-up is simplicity in terms of its mechanics and design [ 7 , 65 , 96 , 97 ]. This feature is useful for individuals who suffer from cognitive impairments like children with learning disabilities and ADHD who have weak working memory capacity [ 65 , 96 ].

Therefore, gamified cognitive tasks for these children should be broken into short and discrete tasks [ 65 , 96 ]. Mapping refers to reusing an existing game cognitive and classical games as a cognitive task and can save considerable time and effort that have been applied in the design of explored games [ 98 , 99 ].

The mapping technique was used by 21 of the 63 studies eg, [ 72 , 92 , 93 , – ]. On the other hand, the used game elements and storylines may not align with participants’ preferences [ , , ].

Moreover, they may impose an additional cognitive load. Therefore, the exact cognitive demands of selected games should be identified by analyzing their structural characteristics [ 83 ]. Each game’s structural characteristics should be examined individually since different games, even those that fall into one category such as action or first-shooting person, may require greatly different cognitive demands [ 81 , 85 , , ].

In mapping, it is also possible to mash up various games for cognitive assessment and training purposes [ 81 ]. For example, dyslexia is associated with a variety of underlying deficits in phonological, auditory, motor, memory, and visual attentional processes. According to previous findings showing the core deficit in dyslexia is related to attentional problems, Franceschini et al [ 81 ] explored 10 action games to train dyslexic children.

Action games can enhance a wide variety of visual attentional abilities, such as segmenting items both in time and across space. The interdisciplinary team is involved in a highly iterative design process through the next 3 phases ideation, prototyping using OMDE, and development.

Iterative processes enable the team to obtain more creative and effective gamification designs. Of the 11 frameworks, 5 have one or more steps that should be iterated until the desired designs and outcomes are reached ie, [ 46 , 48 – 50 , 53 ]. The steps that are often performed iteratively are ideation, prototyping, and development [ 53 ].

At this stage, the team combines the analyses and materials obtained in new ways to produce apt and innovative ideas to engage target users. It is necessary to involve a cross-functional group of people from cognitive experts, gamification designers, and target users to start this stage [ 61 , 62 ]. This work helps the interdisciplinary team to collect a greater number of more varied and creative ideas [ 61 , 62 ]. The participants should be encouraged to use different ways to be creative [ 61 , 62 ].

Brainstorming, co-creation workshops, and mind mapping are some methods [ 53 , 61 , 62 ]. The important question at this stage is how to help participants find the ideas. One solution is to explore existing games, gamification designs, and examples that may be a perfect fit for the current project [ 62 ]. Various types of moles exist in different game versions, such as ninja, pirate, samurai, and batman moles [ ].

Exploring many games and gamification examples and then mashing them up to fit the current problem is another right approach for generating ideas to gamify the current task [ 62 ]. After preparing ideas, similar ideas should be clustered using affinity diagrams; then, the clusters should be prioritized using methods such as dot voting. This work helps the team to focus on important ideas in the next 2 phases [ 50 , 53 ]. After collecting the right ideas, the interdisciplinary team needs to start prototyping.

Prototyping is the stage in which the team implements the ideas into tangible forms to see how they actually work. Prototyping saves time and resources by helping the team to identify refinements required before solidifying a design [ 61 , 62 ].

During each iteration of the prototyping, the team can use the OMDE design guideline to 1 check the motivational characteristics of prototypes such as fun, flow, engagement, positive emotions and 2 validate prototypes from cognitive psychology aspects. OMDE divides the components of a gamified cognitive task into 4 categories: objects, mechanics, dynamics, and emotions.

Objects are a gamified cognitive task’s assets, such as visual assets, images, audios, videos, and animations [ 60 ]. Mechanics refer to a gamified task’s components at the level of game rules, algorithms, and data representation [ 60 ]. Emotions refer to whatever emotions users experience while interacting with the gamified task [ 44 ].

Participants may experience different emotions such as fear, happiness, anger, sadness, and pride while interacting with the gamified task [ 44 ]. Dynamics and emotions emerge from the selected objects and mechanics [ 44 , 52 , 60 ]. For instance, a leaderboard mechanic leads to dynamics such as competition and comparison and emotions such as fear and happiness. Some participants may be afraid of being judged by others, and the use of the leaderboard may demotivate them from continuing the gamified task.

Or, many participants may enjoy these dynamics, and the leaderboard can motivate them. Therefore, displaying participants’ statuses in the leaderboard must be an optional feature in a gamified task. Good dynamics and emotions are vital to ensuring a strong user commitment to participation [ 44 , 52 , 60 ]. Then, in each iteration, the team must list what dynamics and emotions emerge from the gamified task in practice and then compare the responses with the desired ones to determine if the desired responses have been reached.

The team cannot accurately predict what dynamics and emotions will emerge from a gamified task. Therefore, it is necessary to use OMDE iteratively [ 44 , 52 ].

In gamified cognitive tasks, it is also essential to validate the components of OMDE from cognitive aspects because they may impose an additional cognitive load. In this circumstance, participant errors increase, and the reliability of the data obtained decreases. In the standard task, a sequence of stimuli is presented for ms.

Participants should respond to circles but not to squares. In the standard task, a circle is very different from a square. If yes, how can we do so?

If yes, how should the degree of separation between cognitive and gamified sections be adjusted? During this stage, actual gamified cognitive tasks are developed through frequent consultation with relevant experts gamification and cognitive experts and regular testing with target users Figure 6.

Based on the examined gamification efforts in cognitive tasks, to test the efficacy of gamified tasks, rigorous evaluations are required in terms of user engagement and data quality eg, [ 9 , 19 – 21 , 23 – 27 , 34 , 38 – 40 ]. To assess how gamified cognitive tasks impact the quality of data and to indicate the maturity of these tasks to be used as a valid clinical tool, they must be evaluated for 2 essential properties [ 43 ]: 1 reliability, which refers to the extent to which a task’s results are consistent and repeatable, and there are 4 types of reliability test-retest reliability, parallel forms reliability, internal consistency reliability, and interrater reliability and 2 validity, which refers to how well a task measures what it claims and includes criterion validity, content validity, construct validity, face validity, external validity, and ecological validity.

In cognitive training, it may also be necessary to measure to what extent gamified tasks can impact transfer effects [ 38 , 41 , 83 ]. New tasks and situations are included to measure transfer effects. Transfer effects are divided into near and far transfer effects. Cognitive training has near transfer effects if it improves cognitive skills that are highly similar to trained cognitive skills. Far transfer effects refer to improvements in cognitive skills that are less similar to trained skills.

There are 2 other essential factors for conducting rigorous evolutions: 1 selecting sufficient sample sizes and 2 selecting an appropriate duration for evaluation.

Most gamification efforts in cognitive contexts have used small sample sizes to evaluate the efficacy of gamified cognitive tasks [ 9 ]. Also, little consideration has been given to using statistical analyses such as power analysis for a sample size calculation [ 9 , ]. For more information about how to calculate sufficient sample sizes, please see [ , ]. Insufficient sample sizes limit the reliability and generalizability of the results [ 9 , , ]. Moreover, only a few studies have used randomized controlled trials RCTs to evaluate gamified cognitive tasks [ 30 ].

In clinical research, RCTs are considered the most robust study design for evaluating the effectiveness of a new tool due to the ability of RCTs to minimize several forms of bias [ 61 ]. RCTs randomly assign participants to an experimental group and a control group.

The use of an RCT design comparing gamified experimental group and nongamified control group versions of the same cognitive task has been highly recommended to evaluate the potential efficacy of gamified tasks [ 9 , 30 ].

Regarding selecting the appropriate duration for evaluation, participants are not involved in the gamified task over the long term but instead participate for a short time. In turn, it remains unclear after how long participants feel boredom and how the quality of data will alter in these circumstances [ 19 , 25 ].

The study reinforced earlier research by Strayer and Drews showing that hands-free cell phones are just as distracting as handheld cell phones because the conversation itself — not just manipulation of a handheld phone — distracts drivers from road conditions. Human Factors Editor Nancy J. It took until now for the study to be completed, undergo review by other researchers and finally be published. Participants followed a simulated pace car that braked intermittently.

Both handheld and hands-free cell phones impaired driving, with no significant difference in the degree of impairment. In reality, 80 percent of all fatal alcohol-related accidents occur between 6 p. Average blood-alcohol levels in those accidents are twice 0.

Forty percent of the roughly 42, annual U. Researchers at the University of Utah found that drivers talking on a cell phone were four times more likely to fail at basic driving tasks than those talking with a fellow passenger. Published last December in the Journal of Experimental Psychology: Applied , the study shows that drivers on cell phones are apt to swerve into other lanes and miss exits.

David Strayer. Even hands-free cell phone use is substantially more dangerous than using no cell phone at all. For years, the University of Utah has studied the effects of cell phones on driver behavior and competence. Research in showed that drivers on cell phones were just as impaired as those with a 0. They found that the drivers took 50 percent longer to react to normal traffic changes. The likelihood of getting into an accident while talking on a cell phone, even hands-free, significantly increased.

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