Serious Games as a Therapeutic Tool in Pediatric Urology: A Review of Current Applications and Future Directions

Article information

Int Neurourol J. 2024;28(3):185-195

Publication date (electronic) : 2024 September 30

doi : https://doi.org/10.5213/inj.2448322.161

Hyung Jun Park ¹

, Eun Joung Kim ²

, Jung Yoon Kim^,³

¹Department of Game and Interactive Media, Graduate School, Gachon University, Seongnam, Korea

²Department of Game Contents, College of Smart Content, Kyungil University, Gyeongsan, Korea

³Department of Game Media, College of IT Convergence, Gachon University, Seongnam, Korea

Corresponding author: Jung Yoon Kim Department of Game Media, College of IT Convergence, Gachon University, 1332 Seongnam-daero, Sujeong-gu, Seongnam 13120, Korea Email: kjyoon@gachon.ac.kr

Co-corresponding author: Eun Joung Kim Department of Game Contents, College of Smart Content, Kyungil University, 50 Gamasil-gil, Hayang-eup, Gyeongsan 38428, Korea Email: eunjoungkim@kiu.ac.kr

Received 2024 August 4; Accepted 2024 September 10.

Abstract

This paper examines the use of serious games that integrate engaging gameplay with educational and therapeutic benefits with a particular focus on their application in urology. The study reviews both domestic and international cases to evaluate the current practices and implications of these digital therapies. While serious games have been widely utilized in the treatment of pediatric cancer and psychiatric disorders—areas that require long-term care and management—their application in urology, in particular pediatric urology, has been limited. Although digital therapies like serious games are still emerging in the field of urology, they hold promise as effective supplements to traditional treatments while offering new options for managing a range of urological conditions. Pediatric conditions such as bedwetting, urinary incontinence, and dysuria, which often benefit from long-term training and habit formation, are particularly well-suited to this approach. By helping pediatric patients better understand and manage their symptoms, serious games can play a supportive role in the treatment process and have shown positive medical outcomes. This paper reviews the definitions and therapeutic effects of serious games, analyzes their current use in the medical field, and argues for their increased application in treating pediatric urinary conditions.

Keywords: Urology; Pediatric urology; Serious game; Digital therapeutics

INTRODUCTION

Pediatric urology addresses disorders of the kidneys, bladder, urethra, and genitals including incontinence and enuresis in infants, children, and adolescents. This field differs significantly from adult urology in terms of diagnosis and management strategies [1,2]. Approximately 7% to 10% of school-aged children, between the ages of 4 and 16 years, experience urinary conditions such as recurrent urinary tract infections (UTIs) or incontinence. These conditions can adversely affect a child’s quality of life, thus leading to low self-esteem, negative body image, and difficulties with social interactions, with these symptoms being about 2.5 times more likely to have such impacts [3,4].

Incontinence-related symptoms require regular fluid intake, the establishment of consistent voiding habits, and appropriate treatment. However, younger children often find it challenging to manage these processes on their own [5]. Moreover, the psychosocial issues and externalized behaviors such as anger, defiance, aggression, and hyperactivity that result from these symptoms cha have detrimental effects on the physical and emotional well-being of families supporting children with UTIs [6,7].

Recently, serious games have been developed and applied across various fields by demonstrating their effectiveness in the medical domain. In particular, these games have shown promise in the management of pediatric cancer, mental health issues, and overall health maintenance [8-10]. However, their use in pediatric urology still remains limited. The Screening for Cognitive, Emotional, and Behavioral Problems Pediatric Symptom Checklist (PSC), indicates that 19.2% of school-aged children with urological conditions are at risk for psychosocial issues, a rate that surpasses the diagnostic criteria for significant behavioral problems in children with diabetes (20%), gastrointestinal disorders (14%), and neurological conditions (38%) [6]. This suggests a pressing need to integrate functional games into the management of urological conditions in pediatric patients. In this regard, the purpose of this paper is to provide the current applications of serious games in the field of pediatric urology and explore the potential benefits and future directions for their use in this field.

DEFINITION AND EFFECTS OF SERIOUS GAMES

Definition of Serious Games

A serious game is a game designed for purposes beyond entertainment by using game mechanics to engage users and achieve specific objectives including educational or therapeutic benefits. They blend elements of enjoyment with purposeful content to achieve a synergistic effect that enhances both engagement and learning [11,12]. The concept of serious games was first introduced in the 1970s by Clark Abt, who coined the term ‘Serious Games’ to describe these types of games [12-14]. Currently serious games are employed across various sectors, as outlined in Table 1 to demonstrate their versatility and growing impact in areas such as education, healthcare, and training.

Table 1.

Areas of serious games

Effectiveness of Serious Games

Serious games have proven to be highly effective for adults, and their benefits are even more pronounced for children [3,15]. With the widespread use of computers and smart devices, the time spent playing digital games among pediatric and adolescent populations has significantly increased. In this regard, incorporating serious games into therapy for pediatric patients possibly can offer advantages over traditional face-to-face consultations with physicians [15,16]. These games leverage the engaging aspects of video games to enhance disease management and improve treatment adherence. The positive effects of functional gaming are summarized in Table 2 [17,18].

Table 2.

Positive outcomes of serious games

APPLICATIONS AND EFFECTS OF SERIOUS GAMES IN HEALTHCARE

Recently, serious games have gained traction in the medical field due to their ability to motivate and actively engage users, thereby enhancing treatment adherence and continuity [3]. These games effectively create environments conducive to physical rehabilitation and medical training while also positively influencing sociopsychological aspects such as self-efficacy, treatment intention, and anticipated outcomes [19,20]. Previous reviews and studies emphasize the growing integration of serious games in healthcare. Their applications are categorized by purpose and form as shown in Table 3, which illustrates their diverse roles and benefits across various medical contexts.

Table 3.

Taxonomies of serious games in healthcare

Table 4 summarizes previous reviews and studies on serious games in healthcare, clearly demonstrating their medical benefits. Randomized controlled trials with real patients confirm that serious games are highly effective across various health and medical contexts. These studies indicate that serious games positively impact the health and quality of life for patients with diverse medical conditions, including chronic diseases [21,22].

Table 4.

Research areas or applications for health-related serious games

Despite their broad application in therapeutic settings, serious games are underutilized in urology, especially pediatric urology. As shown in Table 5 [1,8,9,12,15-17,23-35], the limited applications and research in the field of urology highlight a significant opportunity to expand the use of serious games in pediatric urology.

Table 5.

Titles of serious games for healthcare

MEDICAL APPLICATOINS AND EFFECTIVENSS OF SERIOUS GAMES IN PEDIATRIC AND ADOLESCENT POPULATOINS

Pediatric Cancer

For pediatric cancer patients, continuous and regular self-management of chemotherapy, radiation therapy, and medication is crucial. Patients often face side effects such as infections, nausea, vomiting, and other complications. The challenges of longterm hospitalization and treatment require significant pain tolerance and patience. To address these challenges, serious games have been introduced to motivate patients and improve their adherence to treatment regimens [36,37].

Re-Mission

In Re-Mission, the user takes on the role of a nanorobot navigating the human body to combat threats like cancer cells, bacteria, tumors, and carcinogens. As shown in Table 6, the game requires players to choose and deploy therapeutic weapons, such as radiation, anti-inflammatory drugs, and anticancer medications, to halt the spread of cancer cells. Through this interactive experience, pediatric cancer patients gain insights into chemotherapy and drug effects within their own bodies [37-39]. Studies have shown that after engaging with these games, 70% of cancer patients acquired relevant knowledge more rapidly, followed complex medication regimens more accurately, and increased their antibiotic intake by 16% [1].

Table 6.

Detail information of “Re-Mission”

Kimo

Kimo is a virtual reality interactive game that immerses players in a simulated hospital environment in which they can participate in routine activities such as taking medication, eating, and maintaining hygiene. By engaging in these realistic scenarios, patients can develop a better understanding of the cancer treatment process. This virtual experience is designed to reduce anxiety, enhance quality of life, and potentially improve treatment outcomes [31]. Detail information can be found in Table 7.

Table 7.

Detail information of “Kimo”

Child Psychiatric Disorders

The World Health Organization estimates that by 2030, mental illnesses such as depression, anxiety, eating disorders, psychosis, substance addiction, autism, and phobias will constitute the largest global disease burden [10]. The scarcity of specialists and services for mental health conditions, combined with the stigma that often prevents patients from seeking help, complicates treatment efforts. Serious games present a promising alternative for preventing, diagnosing, recognizing, monitoring, and treating mental illnesses due to their interactivity, accessibility, and potential to provide anonymity [10,22,26,40]. Below are examples of serious games for children designed to address mental illness.

Dr. Zoo

Needle phobia affects approximately 19% of children aged 4 to 6, often leading to fear and refusal of necessary injection therapy. As shown in Table 8, the serious game Dr. Zoo allows users to step into the role of a veterinarian in a virtual zoo, where they administer injections to sick animals and observe their recovery. This gameplay experience helps children alter their perception of needles and reduce their phobia [25].

Table 8.

Detail information of “Dr. Zoo”

Vil Du?!

Pediatric victims of sexual abuse often struggle to articulate their experiences due to limited vocabulary, expressive abilities, and feelings of shame, fear, and guilt. Vil Du?! is a serious game designed to facilitate nonverbal communication between children and therapists. By engaging in activities like dressing a character, children can express their experiences in a familiar, game-based therapy environment. This approach helps reduce tension and stress, enabling communication and interaction with therapists without the need for face-to-face meetings. Detail information can be found in Table 9.

Table 9.

Detail information of “Vil Du?!”

APPLICATIONS OF SERIOUS GAMES AND NEW TECHNOLGIES IN PEDIATRIC UROLOGY

A study using the PSC on 600 pediatric patients revealed that approximately 15.2% exhibited sociopsychological difficulties. This indicates a need for mental health treatment in this population [6]. Among those with urinary-related symptoms such as dysuria and urinary incontinence, the prevalence of sociopsychological difficulties increased to 19.2%. Notably, pediatric patients with dysuria or single symptomatic incontinence were found to be approximately 2.5 times more likely to experience externalizing or attention problems compared to other subjects. These findings underscore the high risk of both physical and sociopsychological challenges in pediatric urologic patients and highlight the importance of active treatment and mental health follow-up [6,14]. Therefore, new technologies including artificial intelligence (AI) and the Metaverse are increasingly being utilized to achieve medical outcomes, and serious games are also emerging as a novel form of digital therapeutics.

Application of New Technologies in Pediatric Urology

AI is increasingly being utilized across various fields including medicine, where it plays a pivotal role in personalized medicine and diagnostic image analysis [41]. In urology, AI is used to automatically record and monitor patients’ urination activities with high accuracy (94.2%). Additionally, AI technologies such as machine learning, deep learning, and image processing are applied in the diagnostic process to more accurately identify and visualize pathological signs, such as atypical deformity patterns that may be difficult for the human eye to detect [42-44].

In addition, the Metaverse, a technology that merges virtual reality with physical reality to create three-dimensional stereoscopic images on a 2-dimensional screen or through a head mounted display (HMD), is recognized as an innovative tool that can enhance treatment outcomes through active patient participation. In the medical field, the Metaverse facilitates improved communication between doctors and patients by providing precise visualizations of human structures and anatomy [10,45]. Multiple users can simultaneously access a virtual operating room within the Metaverse, which allows for the exchange of opinions on medical education and treatment. The Metaverse is also being used as a digital therapeutic tool for cognitive behavioral therapy in neurological and psychiatric disorders, the management of chronic and severe diseases, and neurorehabilitation for conditions such as stroke and attention deficit disorder with hyperactivity [42,45].

New technologies including AI and the Metaverse are also being applied to pediatric urology. Through display devices such as HMDs connected to the Metaverse, pediatric patients and their caregivers can better understand complex medical terms and visualize anatomical defects, thereby improving communication with medical staff and aiding in treatment decision-making. The distraction therapy that uses virtual reality can enhance the treatment experience for pediatric patients who experience pain and anxiety during medical visits [45,46].

Application of Serious Games in Urology

The application of serious games in pediatric urology is still in its early stages, especially when compared to their more established use in pediatric cancer, mental health, and emerging technologies like AI and the Metaverse. Current examples are often not fully developed games but rather mobile applications with some game-like features or prototypes designed for research purposes. Despite this, several studies have shown that these games can have significant positive effects on both pediatric and general urological conditions [18,29].

This paper first examines serious games designed for adults with focus on their structure, trends, and production styles. It then extends the analysis to pediatric audiences in order to identify current trends within the broader category of serious games in urology.

IUPROST

IUPROST is a mobile-based application developed for male patients who have undergone surgery for prostate cancer. Its primary goal is to promote self-management and improve the quality of life for patients experiencing urinary incontinence. The application incorporates serious gaming elements into behavioral therapy exercises, making the process more engaging for users. A study on IUPROST showed clinically significant improvements in symptoms of involuntary urinary incontinence, with benefits such as reduced stress and enhanced exercise performance [47]. Detail information can be found in Table 10.

Table 10.

Detail information of “IUPROST”

Time After Time

Time After Time is another serious game, designed as an interactive decision support tool for older men diagnosed with localized prostate cancer. The game aims to boost patient confidence by helping them understand the impact of different treatment options on their health-related quality of life (HRQoL). The research has demonstrated the educational effectiveness of this game-based tool in enhancing patient focus on HRQoL and increasing engagement in selecting symptom treatments [29]. Detail information can be found in Table 11.

Table 11.

Detail information of “Time After Time”

Kegel Quest

As shown in Table 12, Kegel Quest is a serious game designed to aid in retraining the pelvic floor muscles, where players earn points and rewards by completing in-game missions and quests. The game has been shown to improve voiding dysfunction and constipation in children and adolescents. In a study involving pediatric urology patients with an average age of 7.2 years, 89%–100% of participants experienced significant improvements in symptoms such as bedwetting, daytime incontinence, constipation, and vitiligo. Additionally, 42% of the patients reported a reduction in post-void residual volume. By integrating biofeedback technology with serious gaming, users can visually and audibly monitor their muscle contractions and exercise performance so that it can help them learn the correct techniques and achieve effective symptom improvement [35].

Table 12.

Detail information of “Kegel Quest”

UrScore

UrScore is an application developed for pediatric patients with bladder dysfunction to help them exercise core muscles and treat non-neurogenic bladder dysfunction. The app is designed to strengthen core muscles to improve bladder function and treat related disorders, utilizing a gamified format that allows users to earn points and track their performance as they complete exercises. It also includes features for setting new goals and is designed to be easily adaptable and engaging for children [48]. Detail information can be found in Table 13.

Table 13.

Detail information of “UrScore”

The Challenges of Applying Serious Games in Urology

The application of serious games in urologic care presents several challenges related to costs and resources. Developing these games requires significant financial investment, human resources, and ongoing efforts to validate their effectiveness, as well as maintaining the necessary hardware and software. The creation of serious games involves the organic collaboration of experts from various fields including urologists with specialized technical knowledge, game developers, and educational experts who provide guidance [49]. When integrating serious games into urological care, several barriers must be addressed. Technical issues such as accessibility and data management, personal challenges like understanding the game and managing excessive time and workload, and organizational obstacles including financial constraints, management support, policy establishment, and the need for collaboration all play crucial roles [50]. In addition, factors like the cognitive development of children, the organization of game mechanics such as controls and interfaces, and the duration of gameplay interaction must be carefully considered [51]. Moreover, the content of these games should be enriched with engaging elements like challenges and storytelling in order to maintain user interest and effectiveness [3].

CONCLUSIONS

This paper reviews the current use and potential impact of serious games in the field of urology with a focus on games that have been medically applied and shown to be effective. To this objective, the paper examines the definition and scope of serious games—those designed to combine training and education with an enjoyable experience. In the medical field, serious games are particularly valuable in helping patients with chronic conditions to better understand their illnesses, recognize treatment options, and develop consistent treatment habits. For pediatric patients, serious games are especially beneficial in helping them understand and adhere to long and often challenging treatment processes, thereby improving their outlook on recovery. These games not only enhance the sociopsychological wellbeing and quality of life of the patients but also have a positive effect on their caregivers.

Given the demonstrated medical benefits of serious games, their applications in pediatric urological treatment hold considerable promise. Treatment for urological conditions such as kidney disorders, bladder dysfunction, incontinence, sexual health issues, and enuresis in children often requires prolonged treatment processes, along with the development of regular bowel habits, consistent water intake, symptom comprehension, and sustained motivation—similar to the challenges faced in treating pediatric cancer and mental illnesses. Children with incontinence or urinary issues often experience social and psychological difficulties in daily life and in interactions with their peers. Repeated instances of these difficulties can lead to low self-esteem, a diminished quality of life, and significant externalizing behaviors. If a child does not fully understand or appreciate their condition, the treatment process can result in increased family conflict. Therefore, there is a compelling need to actively introduce and apply serious games in pediatric urology. Given that children and adolescents are generally more familiar with and have greater access to games, they are likely to be more receptive to therapeutic approaches that incorporate functional gaming. Through these games, children can naturally learn to manage their urinary symptoms, form healthy habits, and engage more effectively in the long-term treatment process.

Notes

Grant/Fund Support

This research was supported by Culture, Sports and Tourism R&D Program through the Korea Creative Content Agency grant funded by the Ministry of Culture, Sports and Tourism in 2023 (Project Name: Cultural Technology Specialist Training and Project for Metaverse Game, Project Number: RS-2023-00227648, Contribution Rate: 100%) and this work was also supported by the Gachon University Research Fund of 2024 (GCU-202406250001).

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTION STATEMENT

· Conceptualization: HJP, JYK

· Data curation: HJP

· Formal analysis: HJP, EJK

· Funding acquisition: JYK

· Methodology: HJP, EJK, JYK

· Project administration: JYK

· Visualization: HJP, EJK

· Writing - original draft: HJP, EJK

· Writing - review & editing: HJP, EJK, JYK

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Article information Continued

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Sector	Purpose	Example
Public sector	-Informing and promoting	Eco, PowerHouse
-Raising citizenship awareness
Medical and healthcare	-Disease prevention and treatment	Re-Mission, Kimo, SuperBetter
-Risk awareness
-Physical fitness
-Cognitive functioning
Military and defense	-Military awareness and enlistment promotion	America’s Army, VBS4 (Virtual Battlespace 4)
-Simulation training
-Weapons training
Education	-Educational courses	Foldit, Words With Friends
-Awareness campaigns
-Knowledge transfer and acquisition
Corporate sector	-Product promotion	Road Warrior, Ribbon Hero
-Work training
-Management training
-Corporate promotion
Sports	-Realistic experience	Wii Fit, Just Dance, Beat Saber
-Leisure-related activities

Positive outcomes	Details
Creating fun and excitement	They increase engagement by making the experience enjoyable and stimulating for users
Encouraging active participation	Users actively engage and focus on the game voluntarily, enhancing their involvement
Increasing motivations	The combination of fun and educational elements helps users stay focused on performance goals and mastery objectives
Immediate feedback	They provide users with instant results, which motivates them and reinforces their learning
Seamless information delivery	They transform dry and monotonous learning content into fun and engaging experiences that encourage repetition
Improving information retention	The information gained during gameplay is retained more effectively, eventually leading to behavioral changes
Encouraging repetitive learning	They facilitate knowledge acquisition by promoting review and reinforcement of learned content through repeated play
Connecting theory and practice	They offer opportunities to apply learned theories in virtual scenarios, bridging the gap between knowledge and real-world application
Promote cooperation and competition	Multiplayer games foster cooperation, negotiation, communication, and social skills, while also encouraging healthy competition

Section	Purpose
Physical fitness	Managing and promoting physical fitness through engaging activities and exercises
Voluntary self-management education	Teaching the prevention and management of conditions that require self-management skills
Distraction therapy	Providing distraction from painful procedures and aiding in the rehabilitation process
Healthcare professional training	Simulating surgeries and treatments to train healthcare professionals effectively
Disease and risk factor prevention	Educating users on various diseases and presenting strategies for prevention and response
Self-management	Empowering patients to improve and alleviate conditions through proper self-management of their diseases
Recovery and rehabilitation	Supporting psychological treatment after physical or mental trauma and assisting in post-operative rehabilitation
Cognitive enhancement	Preventing and treating cognitive decline through training in number/letter sequences and other cognitive tasks
Mental and psychiatric disease management	Encouraging psychological and psychiatric patients to self-manage their conditions effectively
Diagnostic tools	Facilitating accurate diagnosis through the use of physiological indicators and biofeedback mechanisms

Areas	Applications
General health	Smoking/tobacco cessation, stress management, children’s diseases, oral health, diabetes management, and cancer
Rehabilitation	Upper extremity rehabilitation, physical rehabilitation, Parkinson disease, stroke rehabilitation, psychological/mind-body rehabilitation, neurological rehabilitation, bone/soft tissue rehabilitation, cerebral palsy, musculoskeletal rehabilitation, digital health, and pain management
Virtual reality	Exercise rehabilitation, neurocognitive disorders, and clinical research applications
Video games	Childhood diet, eating disorders, overweight/obesity, pediatric obesity, decision-making and learning, and emotional regulation
Educational games	Mediation adherence, asthma management, chronic obstructive pulmonary disease, neonatal resuscitation, neonatal healthcare, medical education, health education, disease prevention, oral hygiene, and cardiopulmonary resuscitation training
Mental illness	Child/adolescent health, depression, anxiety, developmental disabilities, autism spectrum disorders, Alzheimer disease, dementia, attention deficit disorder with hyperactivity, posttraumatic stress disorder, schizophrenia, and cognitive functioning
Other	Alcohol consumption disorders, behavior and cognition in the chronically Ill, smoking, substance use disorders

Table 5.

Titles of serious games for healthcare

Section	Title	Description
Exergame	Just Dance	Players mimic the movements of a virtual dancer, combining fun with physical exercise [8]
	Wii Fit (Sport)	It utilizes sensor technology to capture the gamer’s movements to integrate them into the gameplay [12]
	Beat Saber	It encourages player’s upper and lower body activities by cutting blocks with a lightsaber in a rhythmic pattern [23]
Psychoterapy	Family of Heroes	It is designed to assist veterans in adjusting to life and family after returning from war [1]
	SuperBetter	In-game goals help reduce symptoms of depression and anxiety [8]
	Virtual Iraq	It is tailored for soldiers who served in Iraq and Afghanistan as a PTSD therapy [24]
	SPARX	It is adventure-style game that aims at preventing and treating depression in adolescents [8]
	Journey to the Wild Divine	It uses biofeedback to induce psychological stability [8]
	Freeze-Framer 2.0	It induces psychological stability by using biofeedback mechanisms to manage stress responses through real-time heart rate variability monitoring [8]
	Vil Du?!	Interactive simulation game is designed to help understand and treat mental health issues arising from sexual abuse [17]
	ReachOutCentral	As a role-playing game, it treats anxiety disorders including panic disorder and agoraphobia in children [8]
	Dr. Zoo	It is designed to reduce needle phobia and anxiety in children, including those with autism [17]
	New Horizon	The game helps to reduce anxiety levels by providing children with a safe, interactive environment where they can practice relaxation techniques at their own pace [25]
	ReWIND	It is a role-playing game to treat patients with anxiety disorders [25]
	Lumi Nova	Reducing anxiety symptoms such as panic disorder and agoraphobia in children [25]
	Zen Garden	It contains virtual gardening and similar activities aimed at relieving stress and calming the mind and body [26]
	ReadySetGoals	It gives cognitive behavioral therapy and treatment for externalizing disorders, etc. [26]
Healthcare	Squire’s Quest!	It encourages children to eat more fruits and vegetables through engaging missions and quizzes [1]
	Health Hero	It contains in-game missions and quizzes that provide health information in an engaging format [27]
	PlayForward: Elm City Stories	It is designed to help adolescents recognize and make informed choices about risky behaviors, such as sexual activity and substance abuse [28]
Cancer treatment	Time After Time	It is interactive decision support tools for elderly patients with localized prostate cancer [29]
	Re-Mission	It involves piloting a nanorobot to fight cancer cells inside the body [1, 16]
	Kimo	It provides simulations that allow pediatric cancer patients to experience treatment-related activities in a controlled, virtual environment [30]
	Adventure Academy	It provides learning experiences for pediatric cancer patients who have difficulty attending school [31]
	Ben’s Game	It allows pediatric patients destroy cancer cells in a virtual world within the body [9]
	START LINE plus	It simulates lifes after-effects of cancer and health care, such as virtual employment, marriage, etc. [15]
	FUN QUEST	It conducts conversations with pediatric cancer patients in a question-and-answer format, focusing on health-related topics [15]
Rehabilitation	CliniPup	It is designed to prevent pain and reduce anxiety before and after surgery for pediatric patients [32]
Neurology and dementia	Sea Hero Quest	It is a sea sailing game designed to measure and improve cognitive and spatial perception skills [33]
Neurology and dementia	Words With Friends	It contains puzzle games such as crosswords in order to support neurological rehabilitation and dementia care [34]
Drug addiction	Playsafety	It describes and simulates decision-making processes in dangerous situations involving drugs, helping to educate about the risks [26]
Drug addiction	CancerSpace	It is designed to educate youth about the harms of tobacco use, encouraging smoking cessation [9]
Urology	Kegel Quest	It is designed to re-train pelvic floor muscles to help improve pediatric dysuria and constipation [35]
Urology	Time After Time	It is interactive decision support tools for elderly patients with localized prostate cancer [29]
Other	Tetris	It involves spatial and temporal cognitive activities to help alleviate PTSD [8]
Other	Bejeweled II	It enhances concentration and problem-solving skills by challenging users to match like-colored gems [8]

Game name	Re-Mission	Developer	Realtime Associates, Inc., HopeLab
Release date	April 3, 2006, 2013	Platform	PC, Mobile (IOS, Android)
Genre	Third-person shooters	Nation	United States of America

Game name	Kimo	Developer	Tendril
Release date	2013	Platform	Mobile (IOS, Android)
Genre	Adventure	Nation	Canada

Game name	Dr. Zoo	Developer	GameChanger Charity
Release date	2010	Platform	Mobile (IOS, Android)
Genre	3D Adventure	Nation	United States of America

Game name	Vil Du?!	Developer	The Danish Centre for Child Abuse
Release date	2010	Platform	Mobile (IOS, Android)
Genre	Casual	Nation	Denmark

Game name	IUPROST	Developer	-
Release date	-	Platform	Mobile (IOS, Android)
Genre	Healthcare	Nation	United States of America

Game name	Time After Time	Developer	-
Release date	-	Platform	Web, Mobile (IOS, Android)
Genre	Interactive Decision Support Tool	Nation	United States of America