Document Type : Original Article


1 1 Halal Research Center of IRI, FDA Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences

2 Department of Health Information Management, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences

3 Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences


INTRODUCTION: The virtual reality‑based (VR) game can be considered as a new approach to
education and to enhance the skills of health‑care students.
AIMS: The purposes of this research were to design a VR game and to apply it to teach physiotherapy
in neurological diseases.
METHODOLOGY: In this study, at first, a VR game was designed for upper limb rehabilitation in
brain‑injured patients based on the literature and the opinions of physiotherapy experts and game
designers. Then, the designed game was used for teaching physiotherapy in neurological diseases.
Thereafter, the opinions of 31 undergraduate students about the teaching session were evaluated
by two anonymous questionnaires. Data analysis was performed using descriptive statistics through
SPSS (version 19).
RESULTS: The VR game developed under expert supervision. The evaluation showed that the
median score for students’ perception of learning was 3.11. The median scores of questions related
to the “facilitating level of virtual reality” and “student satisfaction” were 8.66 and 9, respectively. The
analysis of students’ responses to open‑ended questions highlighted the therapeutic aspect of the
game compared to its educational aspect.
CONCLUSIONS: Application of VR games in education can enhance the students’ perception
of learning. Furthermore, it can provide a better understanding of physiotherapy in patients with
neurological diseases as well as the satisfaction of students. However, the survey indicated that the
good results of this teaching method are due to the use of VR for guiding the patient’s movements.


  1. Blakely G, Skirton H, Cooper S, Allum P, Nelmes P. Use of
    educational games in the health professions: A mixed-methods
    study of educators’ perspectives in the UK. Nurs Health Sci
    2. Bergmark U, Westman S. Student participation within teacher
    education: Emphasising democratic values, engagement and
    learning for a future profession. Higher Educ Res Develop
    3. Elison‑BowersP, SnelsonC, Casa de CalvoM, ThompsonH. Health
    science students and their learning environment: A comparison
    of perceptions of on‑site, remote‑site, and traditional classroom
    students. Perspect Health Inf Manag 2008;5:2.
    4. Graafland M, Schraagen JM, Schijven MP. Systematic review of
    serious games for medical education and surgical skills training.
    Br J Surg 2012;99:1322‑30.
    5. Ricciardi F, Paolis LTD. A comprehensive review of serious games
    in health professions. Int J Comput Games Technol 2014;2014:9.
    6. Stokes B. Videogames have changed: Time to consider serious
    games. Develop Educ J 2005;11:2.
    7. de Paolis LT. Serious Game for Laparoscopic Suturing Training.
    IEEE Sixth International Conference on Complex, Intelligent, and
    Software Intensive Systems (CISIS); 2012. p. 481‑5.
    8. Fissler P, Kolassa IT, Schrader C. Educational games for
    brain health: Revealing their unexplored potential through a
    neurocognitive approach. Front Psychol 2015;6:1056.
    9. Schneider MV, Jimenez RC. Teaching the fundamentals of
    biological data integration using classroom games. PLoS Comput
    Biol 2012;8:e1002789.
    10. Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA,
    Fiander M, et al. Educational games for health professionals.
    Cochrane Database Syst Rev 2013; Jan 31;(1):CD006411. doi:
    11. Pohl M, Rester M, Judmaier P. Interactive game based learning:
    Advantages and disadvantages. In. Stephanidis C, editor.
    Universal Access in HCI, PartIII, HCII. Volume 85142009. p. 92‑10.
    12. Chan WY, Qin J, Chui YP, Heng PA. A serious game for learning
    ultrasound‑guided needle placement skills. IEEE Trans Inf
    Technol Biomed 2012;16:1032‑42.
    13. Delbressine F, Timmermans A, Beursgens L, de Jong M,
    van Dam A, Verweij D, et al. Motivating arm‑hand use for stroke
    patients by serious games. Conf Proc IEEE Eng Med Biol Soc
    2012;? 2012:3564‑7. doi: 10.1109/EMBC.2012.6346736.
    14. Kurenov SN, Cance WW, Noel B, Mozingo DW. Game‑based
    mass casualty burn training. Stud Health Technol Inform
    15. Knight JF, Carley S, Tregunna B, Jarvis S, Smithies R, de Freitas S,
    et al. Serious gaming technology in major incident triage training:
    A pragmatic controlled trial. Resuscitation 2010;81:1175‑9.
    16. Hannig A, Kuth N, Özman M, Jonas S, Spreckelsen C. eMedOffice:
    A web‑based collaborative serious game for teaching optimal
    design of a medical practice. BMC Med Educ 2012;12:104.
    17. ScepanovicS, ZaricN, MatijevicT. Gamification in higher education
    learning–state of the art, challenges and opportunities. The Sixth
    International Conference on e‑Learning (eLearning‑2015),
    24‑ 25 September 2015, Belgrade, Serbia.
    18. O’Leary S, Diepenhorst L, Churley‑Strom R, Magrane D.
    Educational games in an obstetrics and gynecology core
    curriculum. Am J Obstet Gynecol 2005;193:1848‑51.
    19. Ballon B, Silver I. Context is key: An interactive experiential and
    content frame game. Med Teach 2004;26:525‑8.
    20. Eckert GU, Da Rosa AC, Busnello RG, Melchior R, Masiero PR,
    Scroferneker ML. Learning from panel boards: T‑lymphocyte and
    B‑lymphocyte self‑tolerance game. Med Teach 2004;26:521‑4.
    21. Barclay SM, Jeffres MN, Bhakta R. Educational card games to
    teach pharmacotherapeutics in an advanced pharmacy practice
    experience. Am J Pharm Educ 2011;75:33.
    22. Koivisto JM, Haavisto E, Niemi H, Haho P, Nylund S, Multisilta J.
    Design principles for simulation games for learning clinical
    reasoning: A design‑based research approach. Nurse Educ Today
    23. Qin J, Chui YP, Pang WM, Choi KS, Heng PA. Learning blood
    management in orthopedic surgery through gameplay. IEEE
    Comput Graph Appl 2010;30:45‑57.
    24. SabriH, CowanB, KapralosB, PorteM, BacksteinD, DubrowskieA.
    Serious games for knee replacement surgery procedure education
    and training. Procedia Soc Behav Sci 2010;2:3483‑8.
    25. Sabus C, Sabata D, Antonacci D. Use of a virtual environment
    to facilitate instruction of an interprofessional home assessment.
    J Allied Health 2011;40:199‑205.
    26. Seefeldt TM, Mort JR, Brockevelt B, Giger J, Jordre B, Lawler M,
    et al. A pilot study of interprofessional case discussions for health
    professions students using the virtual world second life. Curr
    Pharm Teach Learning 2012;4:224‑31.
    27. Nilashi M, Ibrahim O, Ahmadi H, Shahmoradi L.
    A knowledge‑based system for breast cancer classification using
    fuzzy logic method. Telematics Inform 2017;34:133‑44.
    28. Nilashi M, Bin Ibrahim O, Ahmadi H, Shahmoradi L. An
    analytical method for diseases prediction using machine learning
    techniques. Comput Chem Eng 2017;106:212‑23.
    29. Nilashi M, Ibrahim O, Ahmadi H, Shahmoradi L, Farahmand M.
    A hybrid intelligent system for the prediction of Parkinson’s
    Disease progression using machine learning techniques.
    Biocybern Biomed Eng 2018;38:1‑15.
    30. Nilashi M, Ibrahim O, Dalvi M, Ahmadi H, Shahmoradi L.
    Accuracy improvement for diabetes disease classification: A case
    on a public medical dataset. Fuzzy Inform Eng 2017;9:345‑57.
    31. Bashiri A, Ghazisaeedi M, Safdari R, Shahmoradi L, Ehtesham H.
    Improving the prediction of survival in cancer patients by using
    machine learning techniques: Experience of gene expression data:
    A narrative review. Iran J Public Health 2017;46:165‑72.
    32. Ahmadi H, Gholamzadeh M, Shahmoradi L, Nilashi M,
    Rashvand P. Diseases diagnosis using fuzzy logic methods:
    A systematic and meta‑analysis review. Comput Methods
    Programs Biomed 2018;161:145‑72.
  2. 33. Riazi H, Larijani B, Langarizadeh M, Shahmoradi L. Managing
    diabetes mellitus using information technology: A systematic
    review. J Diabetes Metab Disord 2015;14:49.
    34. Bashiri A, Ghazisaeedi M, Shahmoradi L. The opportunities of
    virtual reality in the rehabilitation of children with attention
    deficit hyperactivity disorder: A literature review. Korean J
    Pediatr 2017;60:337‑43.
    35. Shahmoradi L, Farzanehnejad AR, Arji G. Guideline‑based clinical
    decision support systems as an inseparable tool for better cancer
    care management. Iran J Public Health 2016;45:962‑3.
    36. Safdari R, Shahmoradi L, Garavand A, Aslani N, Valipour A,
    Bostan H. Design and evaluation of a mobile‑based application
    for patients with type 2 diabetes: Case study of Shariati hospital
    in Tehran. Hosp Pract Res 2018; Oct; 3(4):130‑6. [Doi: 10.15171/
    37. Ghazisaeedi M, Shahmoradi L, Ranjbar A, SahraeiZ, Tahmasebi F.
    Designing a mobile‑based self‑care application for patients with
    heart failure. J Health Biomed Inform 2016;3:195‑204.
    38. Veneri D. The role and effectiveness of computer‑assisted learning
    in physical therapy education: A systematic review. Physiother
    Theory Pract 2011;27:287‑98.
    39. Brunnstrom S. Motor testing procedures in hemiplegia: Based on
    sequential recovery stages. Phys Ther 1966;46:357‑75.
    40. Lawshe CH. A quantitative approach to content validity 1.
    Personnel psychol 1975;28:563‑75.
    41. Pedraza‑Hueso M, Martín‑Calzón S, Díaz‑Pernas FJ,
    Martínez‑Zarzuela M. Rehabilitation using kinect‑based games
    and virtual reality. Procedia Comput Sci 2015;75:161‑8.
    42. Ebert D, Metsis V, Makedon F, editors. Development and
    Evaluation of a Unity‑Based, Kinect‑Controlled Avatar
    for Physical Rehabilitation. In Proceedings of the 8th ACM
    International Conference on PErvasive Technologies Related
    toAssistive Environments. ACM; 2015. p. 88.
    43. Webster D, Celik O. Systematic review of Kinect applications
    in elderly care and stroke rehabilitation. J Neuroeng Rehabil
    44. Roff S, McAleer S, Ifere OS, Bhattacharya S. A global diagnostic
    tool for measuring educational environment: Comparing Nigeria
    and Nepal. Med Teach 2001;23:378‑82.
    45. Koohpayehzadeh J, Hashemi A, Soltani Arabshahi K, Bigdeli S,
    Moosavi M, Hatami K, et al. Assessing validity and reliability of
    Dundee ready educational environment measure (DREEM) in
    Iran. Med J Islam Repub Iran 2014;28:60.
    46. Fallah kheiri Langroudi S, Badsar A, Hosseini Z, Rouhi M.
    Validation of the persian version of the dundee ready educational
    environment measure. RME 2012;4:24‑33.
    47. Hodge E, Tabrizi M, Farwell M, Wuensch K. Virtual reality
    classrooms strategies for creating a social presence. Int J Educ
    Pedag Sci 2007;2:106‑9.
    48. Fairen M, Farrés M, Moyes J, Insa E. Virtual reality to teach
    anatomy. Annual Conference of the European Association for
    Computer Graphics; Lyon: European Association for Computer
    Graphics (Eurographics); 2017. p. 51‑8.
    49. Reichlin L, Mani N, McArthur K, Harris AM, Rajan N, Dacso CC.
    Assessing the acceptability and usability of an interactive serious
    game in aiding treatment decisions for patients with localized
    prostate cancer. J Med Internet Res 2011;13:e4.
    50. Nicolaidou I, Antoniades A, Constantinou R, Marangos C,
    Kyriacou E, Bamidis P, et al. A virtual emergency telemedicine
    serious game in medical training: A quantitative, professional
    feedback‑informed evaluation study. J Med Internet Res
    51. Liu CC, Cheng YB, Huang CW. The effect of simulation games
    on the learning of computational problem solving. Comput Educ
    52. Gallegos C, Tesar AJ, Connor K, Martz K. The use of a game‑based
    learning platform to engage nursing students: A descriptive,
    qualitative study. Nurse Educ Pract 2017;27:101‑6.
    53. Veneri D. The role and effectiveness of computer‑assisted learning
    in physical therapy education: A systematic review. Physiother
    Theory Pract 2011;27:287‑98.
    54. van Grimbergen B, Thienpont G, De Moor GJ, Buysse H.
    Test‑based E‑Learning: A new path in training medical students.
    Stud Health Technol Inform 2002;93:33‑8.
    55. Rowe M, Frantz J, Bozalek V. The role of blended learning in the
    clinical education of healthcare students: A systematic review.
    Med Teach 2012;34:e216‑21.
    56. Graafland M, Bemelman WA, Schijven MP. Game‑based
    training improves the surgeon’s situational awareness in the
    operation room: A randomized controlled trial. Surg Endosc
    57. Kron FW, Gjerde CL, Sen A, Fetters MD. Medical student attitudes
    toward video games and related new media technologies in
    medical education. BMC Med Educ 2010;10:50.
    58. Del Blanco Á, Torrente J, Fernández‑Manjón B, Ruiz P, Giner M.
    Using a videogame to facilitate nursing and medical students’
    first visit to the operating theatre. A randomized controlled trial.
    Nurse Educ Today 2017;55:45‑53.
    59. Katz D, Zerillo J, Kim S, Hill B, Wang R, Goldberg A, et al.
    Serious gaming for orthotopic liver transplant anesthesiology:
    A randomized control trial. Liver Transpl 2017;23:430‑9.
    60. Pesare E, Roselli T, Corriero N, Rossano V. Game‑based learning
    and gamification to promote engagement and motivation in
    medical learning contexts. Smart Learning Environm 2016;3:5.