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TYPE Review
PUBLISHED 01 March 2024
DOI 10.3389/fresc.2024.1343057

Video games and disability—a risk

and benefit analysis
EDITED BY
Hassan Izzeddin Sarsak,
Hung Jen Kuo1*, Michael Yeomans1, Derek Ruiz2 and
Batterjee Medical College, Saudi Arabia

REVIEWED BY
Chien-Chun Lin3
Teresa Maria Sgaramella, 1
Department of Counseling, Educational Psychology and Special Education, Michigan State University,
University of Padua, Italy East Lansing, MI, United States, 2Rehabilitation and Disability Studies, Southern University and A&M
Khaled Al Hindi, College, Baton Rouge, LA, United States, 3Rehabilitation and Mental Health Counseling, Western
Batterjee Medical College, Saudi Arabia Oregon University, Monmouth, IL, United States

*CORRESPONDENCE
Hung Jen Kuo
[email protected] Purpose: Over the past decades, video games have become a substantial part of
the entertainment industry. While ubiquitous, video game participation remains
RECEIVED 22 November 2023
ACCEPTED 16 February 2024 low among people with disabilities amid potential negative effects. This article
PUBLISHED 01 March 2024 analyzes the risks and benefits that video games may present to individuals
CITATION
with disabilities.
Kuo HJ, Yeomans M, Ruiz D and Lin C-C Methodology: In this conceptual article, we explored the literature pertaining to
(2024) Video games and disability—a risk and video games and disability. To better understand the impact of video games on
benefit analysis. individuals with disabilities, we focused on the unique features of video games
Front. Rehabil. Sci. 5:1343057.
through the lens of the Self-Determination Theory.
doi: 10.3389/fresc.2024.1343057
Findings: Our findings show that individuals with disabilities are most at risk from
COPYRIGHT
© 2024 Kuo, Yeomans, Ruiz and Lin. This is an
excessive video game use, leading to increased aggression, sedentary behavior,
open-access article distributed under the and negative impact on academic performance. Identified benefits include
terms of the Creative Commons Attribution promoting physical rehabilitation and psychological well-being, improving
License (CC BY). The use, distribution or
reproduction in other forums is permitted,
cognitive abilities and emotional regulation, and utility in promoting exercises,
provided the original author(s) and the and managing chronic pain.
copyright owner(s) are credited and that the Originality: This article presents a number of strategies and resources to help
original publication in this journal is cited, in
accordance with accepted academic practice.
guide individuals with disabilities, educators, practitioners, and researchers in
No use, distribution or reproduction is maximizing the benefits of video games while controlling the risks.
permitted which does not comply with
these terms.
KEYWORDS

video games, disability, rehabilitation, risks, benefits, self-determination theory, motivation

Video game and disability—a benefit and risk analysis

The video game industry has grown exponentially over the past few years, and there
are no signs of slowing down (1). The revenue generated by the video game industry is
more than that of movies and sports combined (2). As Pallavicini et al. (3) mentioned,
video games have become a common daily activity for most adults, and the video game
population is equally distributed across gender and age. The number of people playing
video games is even more robust because of the COVID-19 pandemic, during which
other forms of entertainment, such as movies and live sports events, were restricted (4).
While video games seem ubiquitous, not everyone has equitable access to them. A
plethora of literature points out that individuals with disabilities have lower
participation in video games [e.g., (5–7)]. Individuals with disabilities typically
encounter two major challenges when playing video games. First, not all video games
are accessible. As Grammenos et al. (7) described, video games have higher or unique
demands for individuals’ motor, sensor, and mental skills. For example, in some
games, players need to press the exact button(s) on a controller at a specific time to
achieve the objectives. Super Mario Bros series, as an example, require players to
control the main character to run and jump precisely to pass the level. The precision

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of hand-eye coordination and short response times needed for benefits associated with video games, and (d) provide practical
mastering the games subsequently influence the overall playing strategies and resources for leveraging video games that
experience. In addition, individuals with cognitive impairments maximize the benefits while controlling the risks.
may find it challenging to navigate games with puzzle quests,
wherein players must fully comprehend and follow the
instructions to achieve the objectives (8). Compulsive use is The evolution and uniqueness of video
another common concern that may hinder individuals with games
disabilities from engaging with video games healthily. This
concern is particularly true for younger individuals with As the digital world evolves, video game technology has also
developmental disabilities. For example, Mazurek and advanced from traditional two-joystick and one-monitor
Engelhardt (9) indicated that some believe playing certain types entertainment to a more sophisticated and immersed player
of video game leads to certain behavioral problems, especially experience. To date, gaming consoles such as PlayStation and Xbox
those with developmental disabilities such as autism spectrum offer a much higher resolution picture (4 K) with vibrant colors,
disorder The reported issues range from inattention (10) and significantly improving players’ immersive experience. In addition,
oppositional behaviors (9) to video game addictions (11, 12). various control mechanisms have been introduced to allow for
Despite these concerns, researchers continue to invest in real-life simulation, such as a steering wheel for driving games and
what video games can offer for people with different abilities. simulated instruments for music games. The evolution of virtual
Some studies used video games as a motivator to promote reality technology pushes a step further for a more immersive
academic learning [e.g., (13–15)]; to improve cognitive abilities experience by submerging users in a three-dimension world. To
[e.g., (16, 17)]; and to enhance physical strength [e.g., (18, 19)]. accommodate individual preferences in content and style of play,
The undeniable benefits, in conjunction with potential risks, video game genres are many and varied, including action,
have yielded much discourse supporting and against the use of adventure, role-playing, puzzle, simulation, strategy, and sports
video games in educational and clinical settings. Whether to (details for each type of video games can be found in Table 1). A
leverage the utility of video games or altogether avoid them single-player game is optimal for individuals who enjoy playing the
becomes a result of personal choice and clinical judgment of game by themselves; for those who enjoy playing with friends,
educators, practitioners, and individuals. cooperative games (or “co-op games”) can be played. If the person
prefers to play cooperative games but cannot find anyone nearby,
an online game can be an option. More recently, accessibility
Purpose features were built natively in some games to assist individuals
with various disabilities. For instance, high-contrast color and
Considering the contentious nature of video games, this article captioning can be enabled to assist individuals with sensory
examined studies published in the past two decades that explore the impairments, and button remapping and adaptive controller can be
relationship between individuals with disabilities and their useful for those with finger dexterity challenges. The abundance of
engagement with video games. Specifically, we searched databases, options satisfies various preferences and abilities, thereby providing
including Google Scholar, ProQuest, EBSCOhost, and a great deal of freedom for users to choose whatever, however, and
ResearchGate, with keywords including disability, rehabilitation, whenever they would like to play these games.
video games, and gamification. For a more focused search, we set
the search limitation to include only peer-reviewed journal articles
and articles written in English. Although we attempted to capture Theoretical perspective—self-
as fully as possible, readers should be aware that this article is not determination theory
a systematic review of the literature but a summarization of what
we discovered from the literature. Therefore, interpreting our The freedom of choice, which gives players a sense of control, is
findings and suggestions should be cautious. perhaps best understood from the self-determination theory
In this article, our primary aim is to illustrate that, despite [SDT; (20)]. This empirically derived theory depicts the
being controversial and raising certain concerns, video games can psychological needs of an individual when engaging in an activity.
serve as a valuable tool due to their unique features for The satisfaction of these psychological needs leads to either
motivating engagement. We argue that whether to play video motivating or discouraging continue engagement of the activities.
games is not a simple all-or-none decision; instead, the key rests When these psychological needs are satisfied, the individual feels
on making players with disabilities aware of video game benefits empowered by self-determination. On the other hand, when the
and risks while facilitating their informed decisions. In addition, needs are somewhat deprived, the individual may choose, if
we seek to draw attention from practitioners, researchers, and allowed, to avoid such activities. These psychological needs can be
educators to leverage video games as valuable tools and advocate categorized into three dimensions: autonomy, competence, and
for equitable access to the digital entertainment world for relatedness (20) (see Figure 1). Autonomy pertains to an
individuals with disabilities. In this article, we (a) discuss the individual’s volition for engaging in specific tasks. Therefore, the
evolution of video games, (b) discuss the uniqueness of video individual may do certain things voluntarily or, in extreme cases,
games from a theoretical standpoint, (c) explore the risks and be coerced. In the context of playing video games, as Ryan et al.

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TABLE 1 Video game type.

Game type Descriptions Examples

Action games Action games prioritize physical challenges, hand-eye coordination, and reaction time. Players typically navigate • Super Mario Bros
levels, fight enemies, and complete tasks that require swift reflexes. • Devil May Cry
Adventure games Adventure games prioritize story-driven experiences, puzzle-solving, and exploration. To advance through a • The Legend of Zelda
storyline, players usually engage with characters and objects. • Life is Strange
Role-playing games (RPGs) In RPGs, players can become characters in make-believe worlds. These games often feature character • Final Fantasy
development, storytelling, and decision-making that have an impact on the game’s outcome. • Elden Ring
• Mass Effect
Simulation games Simulation games imitate real-world activities or systems. Players engage in tasks ranging from managing cities • The Sims
and farms to flying airplanes or driving vehicles. • Microsoft Flight
Simulator
Strategy games Strategy games require players to plan and make decisions to achieve specific goals. They can be turn-based or • Civilization
real-time, involving resource management, tactics, and sometimes warfare. • StarCraft
• Age of Empires
Sports and racing games Sports games simulate real-world sports, while racing games focus on competitive racing experiences. These • FIFA
games often feature realistic physics and gameplay mechanics. • Gran Turismo
• Mario Kart
Fighting games Fighting games involve one-on-one combat between characters, each with unique moves and abilities. Players • Street Fighter
compete to deplete their opponent’s health bar. • Mortal Kombat
Horror games Horror games aim to create a sense of fear and suspense. They often involve survival elements and focus on • Resident Evil
storytelling to immerse players in a tense atmosphere. • Silent Hill
Massively multiplayer online MMORPGs are online multiplayer games where large numbers of players interact in a persistent virtual world. • World of Warcraft
role-playing games They often involve character progression, social interaction, and cooperative play. • Guild Wars 2
Puzzle games Puzzle games challenge players with logic-based problems and tasks. They can range from simple puzzles to • Tetris
complex brain teasers. • Portal

Relatedness pertains to the need for belonging or connecting

with others. According to Ryan et al. (21), video games
effectively meet this need from two perspectives. First, computer-
generated personality and artificial intelligence can produce a
sense of belonging when players are immersed in the games. For
example, in a role-playing game (RPG), players may immerse
themselves in the stories and befriend non-player characters
(NPCs). Another source for the sense of relatedness can be
found in multiplayer or online games. As Hsu and Lu (23)
described, the online game community provides players with a
sense of group cohesiveness and, in turn, positively affects
players’ loyalty and motivation to the game.
FIGURE 1
Self-Determination theory. The three elements, autonomy,
The capacity of video games to satisfy an individual’s
competence, and relatedness, that drive people’s motivation in psychological needs of self-determination is a double-blade
self-determination theory. sword, however. For example, a sense of achievement obtained
from passing a game level can be uplifting, but if the pursuit of
such a feeling gets in the way of daily life, it becomes a problem.
We believe that only by understanding the risks and benefits of
(21) described, almost all cases are voluntary; therefore, the need for video games, we will be able to help individuals with disabilities
autonomy is easily satisfied. make informed choices. To this end, we discuss the risks and
Competence pertains to one’s need to be challenged, providing benefits associated with video games in the following section.
a sense of achievement. Based on effort justification theory,
Inzlicht and colleagues (22) explained that an individual’s effort
toward a given pursuit would add value to its outcome.
Therefore, completing an easy task may not be as satisfying as Risks of video games
completing a challenging task. In the video game sphere, players
usually start a game from an easier level, and by design, most The available literature on the risks of video games examines
games increase the level of challenge as they progress. As players their relationship to excessive use, their associations with
progress in the game, the sense of achievement becomes a aggressive and sedentary behavior, and the academic problems
natural gaming experience. that can develop because of overuse.

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Excessive use of video games world (33). About 90% of the games contain some form of
violent content, and 40% include serious violence against other
It should be noted that excessively playing video games differs characters (34). This is alarming because several studies have
from other forms of addiction. Video games, unlike substances found connections between violent video games and delinquent
such as alcohol and drug, do not directly manipulate or violent behaviors (35, 36). Specifically, an analysis of 3,372
neurotransmitters or alter brain functioning. Continuing to play Flemish adolescents revealed that violent video gaming was
video games is typically motivated by in-game rewards (24). In positively related to individual delinquent behavior. In contrast,
the context of SDT, it can be understood that playing video nonviolent video gaming was not found to be related to
games satisfies psychological needs that are otherwise difficult to problematic behaviors, suggesting that the content of video
achieve. Typically, an individual would fulfill self-determination games matters (36). Similarly, Anderson and his team (2010)
needs across various life events such as education, work, and reported that violent video game content was positively related to
recreation. Hence, a good balance can be maintained. However, aggressive behaviors, thought patterns, affect, and a lack of
when playing video games becomes the dominating source of prosocial behaviors (e.g., empathy) in real life.
self-determination need, it becomes problematic (25). Due to its However, while some research suggested that violent content in
impacts, problematic video game behavior and pathology have video games may promote higher levels of aggressive behaviors in
caught much attention lately (24). real life, others argued that the strength of its influence is debatable.
In addition, the diagnosis standards, such as the 11th revision For example, in a study of youth in eighth and eleventh-grade
of the International Classification of Diseases (ICD 11), have also students, DeCamp and Ferguson (35) noted that violent video
included gaming disorder as a formal diagnosis, defining it as a games were a weak predictor for violent behaviors compared to
gaming behavior of sufficient severity to result in significant other predictors (e.g., home environment, relationship with
impairment in areas of function. Similarly, the Diagnostic and parents, and demographics). Specifically, factors such as poor
Statistical Manual of Mental Disorders-Text Revision (DSM-5 family relationships and prior abusive experience were far more
TR) also identifies Internet Gaming Disorder (IGD) as a critical regarding youth violent behaviors.
condition that requires clinical attention (26). A recent study
conducted by Masi et al. (27) reported children with attention-
deficit/hyperactivity disorder (ADHD) are vulnerable to Sedentary behaviors
excessive use of video games compared. Similarly, in a survey of
23,533 adults, Andreassen et al. (28) found that ADHD, Sedentary behaviors, like watching television and playing
obsessive-compulsive disorder (OCD), anxiety, and depression video games, are highly prevalent in youth and may be
are associated with problematic use of social media (15%) and associated with physical and mental health markers. In a
video games (7%). systematic review, Kontostoli et al. (37) observed that the time
However, the prevalence and the etiology of problematic use of children and adolescents spent playing video games limited
video games may be debatable (29). In a comprehensive review, their time for healthier physical activities, raising health
Przybylski and colleagues argued that the prevalence rate may concerns such as cardiovascular disease (CVD). Similarly, in a
not be accurate as relevant studies do not distinguish between study of Korean adolescents, Byun and colleagues (38) found
passionate engagement and pathological symptoms. Specifically, that participants’ time spent watching TV or playing video
Przybylski et al. (30) indicated that of those who play games, games was associated with the risk of high adiposity. Consistent
more than two in three did not report any symptoms of IGD. results were reported in European and American children and
Furthermore, they also suggested that only a small proportion of adolescents (39, 40). Recognizing this potential issue, video
the general population—between 0.3% and 1.0%—may qualify game technology has evolved creatively to battle it. For
for a potential acute diagnosis of IGD. Similarly, although example, some games would prompt players to rest after a
pathological internet use (PIU) is commonly observed in those continuous playing period and those that require players to
who play online games (31), it is questionable to attribute the interact with full-body movements.
problem strictly to video games. For example, researchers argued
that the “gaming” component of the video game does not cause
PIU. Instead, it is the interactive feature, such as online chatting Poorer academic performance
and messaging, which generates a sense of companionship that
causes the problem (32). In the United State, it is reported that 60% of video gamers are
below 34 years old (41). Of these gamers, 40% are below 18. Due to
the ubiquitous video game engagement among the young
Aggressive behavior population, concerns regarding the impact of video games on
academic performance are common. One longitudinal study
Compared to more passive media such as television and conducted by Jackson et al. (42) sought to examine whether the
movies, the interactive nature of video games may increase the time spent on Internet use and video game playing influenced
likelihood of aggressive behavior by allowing players to engage in the academic performance of 12-year-old youths for a year. As a
behaviors that are not otherwise socially accepted in the real result, video games were found to be negatively correlated with

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academic performance. However, this relationship only existed Serious gaming

among those who had a lower GPA to begin with. Importantly,
Jackson et al. (42) noted that using GPA as a single measure There is a plethora of research conducted on using video games
may be misleading, particularly for young children. For example, for educational purposes [e.g., (53, 54)]. These are usually referred
playing video games was found to be beneficial to these to as serious games, which are designed with educational goals,
children’s development of visual-spatial skills. However, these such as science, mathematics, languages, history, spatial problem
skills may not yet be part of the academic requirement at the 6th solving, logic, and mental rotation skills while providing
or 7th-grade levels; thereby, the GPA did not reflect the benefit. engaging, interactive, and fun learning environments for single or
Nevertheless, the negative effect of playing video games on multiple players (53, 54). The utility of serious gaming has
academic performance was echoed by many others across caught much attention in K-12 classroom settings, both
different age groups [e.g., (43–45)]. mainstream and special education, for its unique features that
create authentic learning situations, promote intrinsic motivation,
and interactions to promote social learning and individualized
learning (55). Serious games can be found in many settings, such
Benefits of video games
as the military, medicine, and manufacturing (56).
For training individuals with disabilities, serious gaming can be
Despite the many risks associated with video games, many
helpful as well. For example, Papanastasiou et al. (55) reviewed
benefits have also been reported. For example, video games can
previous studies and suggested that serious games positively
be a vehicle for enhancing cognitive abilities, increasing
influence the executive functioning of students with intellectual
emotional regulation, managing chronic pain, and promoting
and developmental disabilities, ADHD, and ASD. Specifically,
physical activity.
they argued that multi-sensory stimuli can accommodate
students with different learning styles. From the lens of the SDT,
video game-infused learning can promote autonomous learning,
Cognitive abilities enhancement thereby motivating students’ engagement. Papanastasiou et al.
(55) reported that this type of learning can yield positive
The utility of video games to enhance human ability can be outcomes, including enhanced perception, attention and
traced back to 30 years ago when researchers first used them to cognition, phonological skills, visual-spatial attention, increased
teach children communication and spatial abilities (46). The social engagement, and independence. A more recent study also
highly customizable content and interactive feature make video demonstrated positive outcomes from playing serious games,
games unique when used as a training tool. Game designers which results in improved attention, time management, and
can embed learning content in the game and provide planning/organizing, and decreased hyperactivity symptoms
immediate rewards when learners complete a required task. among students with ADHD and learning disabilities (57).
These features, from the lens of the SDT, really help promote
the autonomy and competence needs of the users, and
ultimately motivate users to continue their engagement.
Leveraging this unique feature, researchers have also used video Emotional regulation
games to train people with disabilities. For example, video
games were found to be effective for developing social skills in Emotional regulation is the ability to monitor, evaluate, and
children with dyslexia, learning difficulties, and autism control one’s emotions. Emotional regulation is associated with
spectrum disorder (ASD) (47–50). In a recent study, Beaumont several important outcomes, including psychological well-being,
and colleagues found that children with ASD can benefit from relationship satisfaction, and overall mental health (58, 59).
video game-based social skills training, especially with parental In contrast, emotional dysregulation, which is commonly
involvement. Similarly, in a systematic review, Eichenberg and observed in ASD, ADHD (60, 61), and the chronic pain
Schott (51) aptly indicated that video games, when infused with populations (62, 63), is associated with many forms of
cognitive behavioral techniques, are valuable for improving psychopathology and maladaptive behaviors (64).
behavioral, cognitive, and emotional outcomes of those with In a systematic review, Villani et al. (65) found that video
learning and cognitive disabilities. games have a lot to offer regarding emotional regulation. First,
In addition, Ashinoff and Abu-Akel (52) demonstrated using video games provide players opportunities to actively interact
video games to improve the attention span among those with with the game, which directly influences their locus of control
ADHD. Specifically, they explained that when individuals with and sense of autonomy—a critical element of the SDT.
ADHD play video games, their alpha and beta levels in the Additionally, the exposure to negative emotional stimuli during
frontal lobe reduce. This reduction in alpha and beta levels gameplay (e.g., frustration during a difficult level in the game)
signifies that the individuals can maintain their engagement in a offers an opportunity for players’ ability to be aware of their
given task effortlessly, hence achieving a hyperfocus status. emotional state (66, 67) and build resilience to frustration (68).
Although the generability still needs testing, it shows promise for Importantly, Gaggioli et al. (69) and Tunney et al. (70)
maintaining attention in the ADHD population. argue that video games can be instrumental in training

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emotional regulation because of their highly customizable Active Video Games (AVGs), also referred to as “exergames,”
features. For example, gradually adjusting the game difficulty consist of games that require players to exert physical energy to
levels to be harder and harder can be useful for building progress through the game (89). AVGs have been used in
frustration tolerance. occupational and physical therapy settings for over 30 years.
Lastly, video games can also help people cope with stressors These game-based exercises are helpful for task-specific
such as job loss (71) and bereavement (72). In a survey study, rehabilitation that aims to enhance function in hands and
Iacovides and Mekler (73) explored the relationship between extremities (90, 91), movements, balance, and mobility after
video games and their effect on players’ coping mechanisms. brain injury (92–94). In addition, research also shows that some
Specifically, their attention was on whether the video game games may improve physical fitness for wheelchair users with
would help them escape temporarily from real-life distress. While spinal cord injuries, nerve diseases, and multiple sclerosis
escapism is often considered a maladaptive coping mechanism, (95, 96). Despite a small sample size, Singh et al. (97)
the study argued that adequate escapism can be a healthy demonstrated that playing interactive VR games would increase
distraction that is much needed for some. As Kuo et al. (74) reaction time in adults with disabilities.
further explained, healthy escapism represents a temporary shift Aside from rehabilitative goals, AVGs provide an opportunity
of attention from the self, which can be achieved by projecting to engage in physical activities that otherwise might not be
oneself onto in-game characters. This escapism allows players to possible due to social distancing or other life commitments such
explore versions of their ideal or aspirational selves, thereby as work and school (89). This increase in physical activity, in
fostering a better self-understanding. turn, can reduce depressive symptoms and improve mental
health (98). Studies also show that participation in exercise
games positively affects self-esteem and self-efficacy and may
promote intrinsic motivation to continue exercise outside of
Chronic pain management
video game play (99, 100).

Chronic pain is a common symptom shared by people with

various physical disabilities (75). It is associated with many
negative outcomes, such as poor goal attainment (76), school
Strategies and resources
performance (77) and social functioning (78). Chronic pain is
It is clear that playing video games can yield both risks and
also associated with higher rates of anxiety (79), insomnia (80),
benefits. The question is then how to maximize the benefits
and depressive symptoms (81).
while controlling the risks. In the following section, we provide
As early as the 1980s, Redd and colleagues (82) found that
some strategies for leveraging video games’ benefits and unique
video games were an effective way to distract attention and
features. Specifically, we suggest to (a) form a well-defined
manage pain. Since then, its applications for pain management
purpose for playing video games, (b) be cautious of content and
have been widely used. For example, video games were found to
disability populations that are associated with risks, and (c)
be effective pain relief for patients going through unpleasant
monitor and supervise the use of video games. Lastly, we
medical treatments such as chemotherapy (83, 84). Additionally,
recognize the fast evolving pace of video game technology. It is
occupational therapists and physical therapists have used video
becoming challenging to stay updated without reliable sources of
games with burn patients (85) as a means of distracting from
information. To this end, we would like to introduce a list of
pain as well as rehabilitating physical strengths (86, 87). To this
useful online video game resources that specifically aim to assist
end, video games can be a non-pharmaceutical complementary
individuals with disabilities to engage in video games.
intervention and can be easily integrated with existing medical
procedures and therapies.

Well-defined purpose

Increasing physical activities People choose to play video games for several reasons, such as
entertainment, education, social connection, rehabilitation, or any
Maintaining a regular exercise habit for a healthy lifestyle can combination of these. While video games were originally
be challenging for anyone. Willson et al. (88) used the SDT to designed to entertain players, their utility has since expanded.
explore factors influencing individuals’ motivation to maintain Although there can be numerous reasons for playing video
exercise. In their analysis, although each element of the SDT games, it is helpful for players to identify the primary reason for
interacts with the exercise motivation differently and may depend playing them in a particular setting. As Nebel et al. (101)
on the individual (e.g., females have a different competence emphasized, explicit goal-setting would improve video game
needs than males for exercises), their influences are without experiences by increasing motivation and lowering cognitive load
question. Interestingly, as mentioned earlier, video games bear compared to those without a well-defined goal. Similarly, Brusso
the capacity for fulfilling all three needs of the SDT. Therefore, et al. (102) highlighted the importance of realistic goal-setting to
using video games to motivate physical exercise can be an individual performance in video game-based training. Therefore,
effective application. if the reason for playing video games is not strictly for

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entertainment, a well-defined and explicit goal should be delineated time spent playing video games is interfering with other life
to set realistic expectations and accountability. A well-defined goal activities. It is important to design and implement the associated
would inform the outcome evaluation and monitoring, and help measurements when formulating the purpose for playing video
decide the types of games and the ways of interacting with them. games. In the context of educational video games, Padilla-Zea
For example, if the intent is to do more exercises or physical et al. (104) stressed the importance of continuous measurements
rehabilitation, AVGs (e.g., Just Dance, Ring Fit Adventure) would to make sure the targeted outcomes are not derailed. Similar
be ideal; if the individuals would like to enhance decision- suggestions were made by Thompson (105) when using video
making and critical thinking skills, puzzle and strategy games can games to improve the health behaviors of patients with Type II
be helpful. diabetes. Thompson emphasized that it is ideal for embedding
the evaluation in the game if possible.
Video games can become problematic if the individual has
Aware of the risks difficulties managing other life activites. Literature has
continuously emphasized the importance of close supervision to
Although video games can be helpful in many ways, their risks ensure the playing experience is healthy and productive
should be recognized and controlled. Importantly, attention should (106, 107). In addition, the focus of supervision should extend
be given to two aspects: content selection and disability population. beyond just playing time, frequency, and the content of video
As Glaubke and colleagues (34) illustrated, 90% of commercial games. It is also equally important to monitor with whom the
video games contain some level of violent content. Combined individual plays games. The effect of the company is bi-
with the finding reported by Excelmans et al. (36) that violent directional. For example, Osmanovic and Pecchioni (108)
video games may lead to delinquent behavior, victimization, and illustrated that video games can improve family relationships and
alienation, gamers should be selective of the appropriate content. connections when played with family members. On the other
In addition, certain disability populations (e.g., ASD, ADHD, hand, when playing online video games with strangers,
OCD) are more prone to overuse of video game, IGD, cyberbullying and cyber-victimization could happen (109, 110).
inattention, and aggressive behavior (103). It should be noted
that we are not arguing that video games should be avoided
completely for these populations. Instead, close monitoring and
supervision are needed. Resources

In this last section, we share useful resources (see Table 2) for

Monitoring and supervising those interested in leveraging video games in their work with
people with disabilities. Specifically, these websites and
As with many things, good things can quickly turn bad when information provide detailed ideas of encouraging healthy video
used excessively without close monitoring and supervision. To game habits and showcase real-life examples of how
maintain healthy video game-playing experiences, two aspects accommodations can be implemented in video games. We hope
should be monitored: First, whether the purpose of playing video it will serve as a start and spark more discussions on this
game is achieving the intended purpose, and second, whether the important but overlooked topic.

TABLE 2 Video game resource.

Resource Website Description

Ablegamers charity https://ablegamers.org/ A community that provides resources for individuals with disabilities to engage in video games. The
focus is on combating social isolation by playing games. A wealth of information about gaming specific
assistive technology is included on the website. In addition, the website also provides suggestions for
game developers to be more inclusive when designing the game.
Ability power http://www.abilitypowered.com/ Created by a person with a disability who found joy in playing video games. The website provides game
accessibility review. The support group format of the website offers discussion on the Discord and Steam.
Ability Power also has a YouTube channel that streams their video game play.
Blind gamers https://blindgamers.com/ A self-help website specifically created for players with visual impairments. The website has a clean look
and is screen reader friendly. The website provides a platform for players to rate how accessible and
enjoyable the games are.
Dager system gaming enabled https://dagersystem.com/ Founded in 2012 by a group of video game players with disabilities. The website provides reviews of
game accessibility using a four-point rating system on aspects including visual, audio and fine-motor
control. A database for gaming accessibility in on the way and will be available soon.
The controller project https://thecontrollerproject.com/ The website focuses on developing accessible controller for playing video games. Besides a library
showing how the controllers can be modified to be more accessible, they also accept requests from
players who are interested in customizing their controllers. A YouTube channel is available to show how
the controller can be modified.
International game developers https://igda-gasig.org/ A special interest group for video game accessibility under International Game Developers Association.
association: game accessibility The group provides a channel for communication between the game developers and players with
special interest group disabilities. In addition, it also provides suggestions for researchers who are interested in this topic.

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Kuo et al. 10.3389/fresc.2024.1343057

Conclusion MY: Conceptualizing, Resource, Writing – original draft. DR:

Conceptualizing, Resource, Writing – original draft. C-CL:
Video games stand to offer much to the field of rehabilitation. Conceptualizing, Writing – review and editing
There are numerous benefits that educators, practitioners, and
researchers can take advantage of to help those with disabilities.
With educational purposes in mind, educators can leverage serious
gaming design to teach students mathematic and spatial learning;
Funding
with the potential to improve emotional regulation, practitioners
The author(s) declare that no financial support was received for
can rely on video games to better serve their clients with
the research, authorship, and/or publication of this article.
psychological needs; with the cacpacity to promote self-
determination and motivation, researchers can design more game-
based intervention and gamify the intervention process. However,
there are also a number of risks that should be accounted for Conflict of interest
when designing or implementing interventions that use video
games. Certain disability populations may be more susceptible to The authors declare that the research was conducted in the
the negative effects of video games. Due to the concerns, such as absence of any commercial or financial relationships that could
eccessive use of video games, some decide to completely avoid it. be construed as a potential conflict of interest.
While we understand these concerns, we argue that with careful
and stragtegic planning, video games can be a useful tool. With
this in mind, users should strive to have a well-defined purpose,
be aware of the risks, and note the importance of monitoring and Publisher’s note
supervision when utilizing video games with vulnerable populations.
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
Author contributions organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
HK: Conceptualization, Formal Analysis, Methodology, claim that may be made by its manufacturer, is not guaranteed
Resources, Writing – original draft, Writing – review & editing. or endorsed by the publisher.

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