pain associated with chemotherapy or radiation treatments. The therapeutic effects of games are attributed to the distraction that games provide that focus attention away from these aversive side effects. In an early report of two experiments (Redd et al., 1987), young patients (age range 11–20 years in Experiment 1; age range 9 –18 years in Experiment 2) in pediatric oncology who played a video game for 10 min during chemotherapy induction showed significant decreases in reported nausea compared with control patients. Children assigned to the video game group could choose from 25 different games on an Atari 800 XL computer system. Children in the control group were allowed to play with nondigital books, toys, games, or TV. These results suggest that there is something more engaging and distracting involved in video game play than with nondigital play objects or entertainment. A similar study (Vasterling, Jenkins, Tope, & Burish, 1993) compared patient groups provided cognitive distraction through video games or standard relaxation training with a control group of young cancer patients. The patients in the video game distraction group and the patients in the relaxation-training group reported less nausea prior to chemotherapy and had lower blood pressure following chemotherapy compared with controls. There were no differences between the distraction and relaxation-training patients, indicating that the treatments were similar in effectiveness. Practically speaking, however, relaxation training requires a trained therapist to administer. The cost, time, and availability of trained professionals make it difficult for many hospitals to take advantage of this technique. In contrast, computer games are less expensive over time, readily available, and considered acceptable therapies by the patients, making them ideal for interventions for conditioned nausea in young patients with cancer. Anxiety management. The previous studies demonstrating the effective use of video games as distractors for nausea management are classic examples of the early work of using commercially available games as therapy that capitalize on the ability of games to distract patients’ attention from aversive symptoms. The study presented below examined the use of commercial games as distractors to help young patients manage their anxiety in a hospital setting. This recent work explored the use of a portable game 114 KATO platform on which the games can be played, which may improve the ease of use and accessibility of this type of adjunct to therapy. In a study of 112 children (ages 4 –12 years) undergoing general anesthesia for elective surgery, patients were assigned to one of three groups: (a) parent present, (b) parent present oral midazolam (preop sedative), or (c) parent present a hand-held video game distraction (Patel et al., 2006). The video game distraction consisted of 10 commercial games to play on a Nintendo Gameboy platform (A. Patel, personal communication, November 4, 2009). Patients who did not have a hand-held video game showed significant increases in anxiety from baseline to induction of anesthesia. Patients who played the video games showed no significant increases in anxiety from baseline to induction and reduced anxiety compared with the parent-present group and no difference with the midazolam group during induction of anesthesia. These findings are significant for this population group and procedure because the games and hand-held device represent a low-cost, easy-toimplement, portable, and effective method of anxiety management in a vulnerable population during a critical time of care. Furthermore, the findings have clinical implications because the impact of the video games on anxiety was as effective as a pharmacological intervention for anxiety. Future studies should explore the use of this game platform for anxiety management with young patients in other stressful situations in the hospital (e.g., chemotherapy induction, venipuncture). Physical therapy and physical fitness. There are early reports in the literature that the mere physical requirements of playing a regular video game (e.g., joystick control, arm reaching) can have therapeutic effects as physical therapy for arm injury (Szer, 1983), Erb’s palsy (Krichevets et al., 1994), and traumatic brain injury (Sietsema, Nelson, Mulder, Mervau-Scheidel, & White, 1993). The success of video games as an adjunct to physical therapy can be attributed in large part to the increased engagement and motivation that video games add to typically mundane and repetitive tasks associated with physical therapy. In other words, patients may cooperate more fully with the procedures required in physical therapy when the procedures are combined with or are part of an entertaining game. Racing games have been used in combination with physical exercise equipment for physical therapy for different patient groups. For example, in one study, racing games were used with manual wheelchair interface called GameWheels with 35 patients with spinal cord injury (O’Connor et al., 2000). The interface turned the wheelchair into a virtual joystick in which users could control game play through the movement of their wheelchairs wheels on the rollers of the interface. Players were motivated to maneuver their wheelchairs on the device