Assessing HapHop-Physio: An Exer-Learning Game to Support Therapies for Children with Specific Learning Disorders

Round 1

Reviewer 1 Report

The authors describe the validation of an exer-learning game within a healthcare setting following an assessment framework for serious games. Game’s rationale, functionality, and data safety were described and construct validity was assessed through a case study. Often, studies report only criterion validity and treatment effects. Especially in the case of serious games in healthcare, other aspects such as data security and functionality for the target group must be taken into account. The present study addresses this issue by means of an assessment framework for healthcare serious games. However, the theoretical framework of treatment content is not well described and the existing evidence on treatment approaches of the described target group of children with SLD has not been considered. It is necessary to present the theoretical framework and existing evidence on treatments of specific learning disorders and link it to the content of the game in order to provide the scientific background of the game.

Here are my concerns outlined in more detail:

Line 62/63:

It should be explain in more detail how maintaining attention levels improves children's reading and spelling skills, as attention is generally not impaired in children with SLD. Furthermore, impairments in memory skills such as working memory differs between learning disorders (dyslexia, dyscalculia). Authors should take this into account. Since the age range of the target group is 5-16, it should also be addressed how effects can be achieved over such a wide age range.

Line 74-76

Again, what is the impact of increased attention or improved visuospatial skills in children with SLD?

Line 133/134

This is especially important in the multidisciplinary development of scientifically based serious games. The authors could emphasize this more and describe it in more detail.

Line 171

Authors describe in the abstract and introduction that the target group of the game and participants of the case study are children with SLD. Here the authors report that children with mild or slight mental retardation or with SLD were included. It must be clearly described which children were included.

In which health care setting did the study take place?

Line 201

What means the abbreviation TRL?

Line 290

It should be described in more detail how the mini-games train memory and attention, and whether the task trains other skills, such as reading.

Line 263

How was the ranking of the scores determined?

Line 340

In Figures 5-7 it should be labeled that the percentile of the ENI is indicated on the Y-axis.

Figure 6: no abbreviation should be used for the legend (male, female).

Line 346

The authors do not explain why they compared the effects of male and female participants. What is the rational? The same applies to the age groups

Line 347

Men and Women should be replaced by male and female participants or girls and boys.

Line 351

How were the age groups determined and what is the sample size of the age groups?

Line 429

Why is it challanging to calculated  the minimum number of children who need to be involved in the experiment with HapHop-Physio.

Line 431

If the target group of the game is children with SLD and the goal is to support therapy, how can the effect be proven using a sample of children without SLD or other cognitive difficulties?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

This paper describes the use of a framework to validate health care applications. 

The framework is divided into five categories, each one with several items. But in some categories, the number of items evaluated for HapHop-Physio was a subset. But it is not explained how some of them were excluded. Please clarify/justify these issues in the paper.

Author Response

Please see the attachment

Author Response File: Author Response.pdf