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Hypothesis
Peer-Review Record

Serious Games for Cognitive Rehabilitation in Older Adults: A Conceptual Framework

Multimodal Technol. Interact. 2024, 8(8), 64; https://doi.org/10.3390/mti8080064
by Diego E. Guzmán 1,*,†, Carlos F. Rengifo 2,† and Cecilia E. García-Cena 3,†
Reviewer 1: Anonymous
Multimodal Technol. Interact. 2024, 8(8), 64; https://doi.org/10.3390/mti8080064
Submission received: 16 May 2024 / Revised: 2 July 2024 / Accepted: 16 July 2024 / Published: 23 July 2024

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript presents a framework for developing serious games aimed at cognitive rehabilitation in older adults. The integration of interdisciplinary insights, including cognitive psychology, game design, and virtual reality, enriches the framework's relevance. The clear categorization and logical structuring of key concepts, along with a helpful graphical synthesis, make the framework accessible and understandable.

Despite its strengths, the manuscript has several notable weaknesses. Firstly, the framework lacks empirical validation. It would benefit from at least one study testing its effectiveness in real-world settings to provide concrete evidence of its utility. Secondly, the exclusion of clinical studies from the literature review is a significant oversight. Including clinical studies would strengthen the credibility of the framework by providing direct evidence of the effectiveness of serious games in cognitive rehabilitation. Moreover, there is an overemphasis on technology-driven interventions without exploring non-digital approaches. A more balanced perspective would cater to diverse preferences and accessibility issues among older adults. The methodology section also needs more detail regarding the specific process of selecting and integrating key concepts. Providing more transparency in this process would enhance the framework's replicability.

Additionally, the paper does not discuss potential limitations of the proposed framework. Addressing these limitations would provide a more balanced view and guide future improvements. There is also a lack of detailed discussion on the implications of the framework for developers of serious games and researchers. The manuscript would benefit from a more detailed critical analysis and comparison of the existing frameworks [39, 40] with the proposed one. This would help to highlight the unique contributions of the proposed framework and identify areas for further development.

Comments on the Quality of English Language

The authors need to proofread the text and correct errors such as the typo in the title of section 4.2.

Author Response

Dear Reviewers,

Attached, you will find a document with a change control table for the submitted work. Thank you for your contributions to this paper.

Best regards,

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper proposes a conceptual framework for the development of serious games specifically designed for cognitive rehabilitation in older adults (65+). I believe this paper is important since the world’s population ages, and cognitive disorders such as dementia and Alzheimer’s disease are on the rise. Μinor modifications are suggested.

The heading of 2.2. (Related Works) could be modified to become more specific (e.g., conceptual frameworks on xxx). If reported/known, do mention which specific cognitive difficulties are targeted by the frameworks reviewed. This is suggested because cognitive rehabilitation is associated with the degree/level of cognitive decline (e.g., cognitive state of Alzheimer patients varies according to individual characteristics/needs, stage of illness, etc.)

For the purpose of this paper (design of a framework), the authors need to state the issue of users’ (older adults’) digital literacy skills; since such skills may affect how they will use (interact with) technology such as VR applications.

With regard to English language, within Figure 1 and heading 4.2, should it be “role” (rather than “rol”)? Similarly, in Figure 3, “promove” stands for “promote”?

Comments on the Quality of English Language

minor modifications are needed

Author Response

Dear Reviewers,

Attached, you will find a document with a change control table for the submitted work. Thank you for your valuable contributions to this project.

Best regards,

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Although the authors have successfully addressed most of my comments, the following issues need to be resolved before publication:

  1. Why is the selection of five experts considered sufficient for determining the relevance of the proposed framework components? A detailed rationale for this number should be provided, including any references to methodological standards or precedents in similar studies.

  2. How was the concordance among the experts assessed? Please elaborate on the statistical methods or qualitative measures used to determine inter-rater reliability. Additionally, is the degree of agreement obtained adequate, and how is this adequacy substantiated? Supporting evidence or benchmarks from the literature would strengthen this section.

  3. What makes the activities within the serious game representative enough to draw sound and generalizable conclusions? It would be beneficial to include a discussion on the selection process of these activities and their alignment with real-world scenarios or theoretical frameworks.

  4. How many patients participated in the study, particularly in the serious game sessions? Additionally, provide a breakdown of how many utilized each of the three scenarios and any observed differences in this context. Detailed participant demographics and usage statistics would offer valuable insights.

  5. Are the two mentioned clinical trials the only ones relevant, or are there others? Clarification on why these specific trials were chosen is necessary. The criteria for their selection should be explicitly stated, ensuring that they are representative of broader research efforts in the field.

  6. How does the authors' research compare with the cited clinical trials? A thorough comparative analysis, highlighting similarities and differences in methodology, participant demographics, and outcomes, would provide a clearer context for the study's contributions and limitations.

 

Comments on the Quality of English Language

Several errors have been identified, such as the capitalization of "To" in Figure 4. It is recommended that the authors thoroughly proofread the paper again and correct all such errors before resubmission.

Author Response

Thank you for your feedback on our manuscript. We appreciate the time and effort you have invested in reviewing our work. In response to your comments and suggestions, we have made the revisions and clarifications to improve the clarity and quality of our paper. 

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

Although the authors have addressed the majority of my comments, there are still some concerns that need to be addressed:

  1. When submitting the revised version of the manuscript, the authors should highlight the changes they made in it.
  2. If there is no acceptable level of agreement among experts based on the calculated Kappa coefficient, on what basis did the authors decide what to integrate in and how to implement their framework?
  3. If the authors have not empirically validated the proposed framework, how can we be confident in its usability and usefulness in the intended context?

 

Author Response

The modifications made are specified in the attached document, and the manuscript now includes the new parts highlighted. We want to thank the reviewer for their understanding and apologize for not having done this earlier.

Author Response File: Author Response.pdf

Round 4

Reviewer 1 Report

Comments and Suggestions for Authors

The authors successfully addressed all of my concerns from previous reviews.

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