Enhancing Cognition, Self-Efficacy, and Postural Control Skills of Persons with Schizophrenia Spectrum Disorders Using Immersive Puzzle Video Games

Introduction: Players’ engagement in video games is dependent on their level of immersion in the virtual gaming environment. Tabletop (TT) puzzle video games (PVGs), which are usually played in a sedentary posture and require upper limb motor skill, improve players’ cognition and upper limb motor performance. Immersive PVGs, such as Angry Birds, have been created recently. These games are played in a standing mode and require the players to shift their center of gravity (COG) to achieve the gaming goals. Their task-oriented nature makes it possible for these video games to improve players’ self-efficacy. However, there is a lack of research into the cognitive, upper and lower limb motor performance, capacity to shift the COG, that is, stability limit, and self-efficacy benefits of immersive PVGs played in standing mode. Objectives: This study examined the effects of an immersive physics-based PVG (PBPVG), the Angry Birds, on cognition, motor outcomes, and self-efficacy. Immersive video games were developed in order to enable a high level of immersion and engagement. We hypothesized that following three sessions per week for 12 weeks of training, players would demonstrate improvements in cognition, upper and lower limb motor performance, stability limit, and self-efficacy. Methods: A sample of 82 adults with schizophrenia spectrum disorders recruited from two psychiatric rehabilitation units were assigned by lottery randomization to an experimental group or a control group (n = 41 respectively). Participants in the experimental group played Angry Birds in standing mode for three 50-minute sessions per week for 12 weeks. Processing speed and cognitive flexibility (two critical components of integrated cognition), upper and lower limb motor performance, stability limit, and self-efficacy were evaluated at baseline and at 12 weeks. Results: A repeated measures two-way analysis of variance revealed significant interaction effects (P = 0.021-P < 0.001) with medium to large effect sizes (η_p² = 0.064-0.241) for stability limit and self-efficacy. Significant main effects (P < 0.001) with medium to large effect sizes (η_p² = 0.095-0.277) for processing speed and upper and lower limb motor performance were found. The following simple main effects examined with one-way analysis of covariance showed significant improvement (P < 0.001) with medium to large effect sizes (η_p² = 0.151-0.249) for stability limit and self-efficacy. A near significant difference (P = 0.063) with a near medium effect size (η_p² = 0.040) showed improvement in cognitive flexibility, but nonsignificant improvement (P > 0.05) with a trivial effect size (η_p² = 0.001) for processing speed and a small effect size (η_p² = 0.021-0.027) for upper and lower limb motor performance were found. Conclusion: PBPVGs could improve cognitive flexibility, stability limit, and self-efficacy. These effects might depend on the level of immersion, type of motor skill and body part involvement, and demands of cognitive components when playing, which might stem from the task-oriented nature of the chosen game and gaming mechanism.