games are good examples of how interactive technology can be used not only to motivate behaviors, but also to train and to obtain higher than expected performance of target behaviors from a group of very young children. Bladder and bowel dysfunction. Video games, in particular those that employ biofeedback to control gameplay, have been used successfully to treat patients with pediatric voiding dysfunction or irritable bowel syndrome (IBS). Pediatric voiding dysfunction is diagnosed in children who do not empty their bladder normally and experience bedwetting and daywetting. Treatments include pharmacological interventions along with behavioral treatments that include dietary management, a timed voiding schedule, and muscle training of pelvic floor muscle groups that are involved in urinary continence. Biofeedback, an effective treatment modality to train the pelvic floor muscles among these patients (Pfister, Dacher, & Gaucher, 1999), is often a part of treatment. Similar to other interventions that 116 KATO involve behavior change, the success of biofeedback depends on patient motivation and compliance with the program. Children are generally not interested in dealing with the embarrassing topic of incontinence, and they also have difficulty remaining focused on the task of biofeedback training. Biofeedback combined with a game interface was used to increase interest and motivation to engage the therapy. In this method, sensors are placed by a nurse on the child’s perineum to detect pelvic floor muscle activity. Leads from the sensors connect to a port on the computer in which electrical activity from the sensors is transformed through algorithms to relate to actions in the game. The games used to treat pediatric voiding dysfunction were PC-based games of golf, spaceships, baseball, basketball, and a safari adventure. For example, in the golf game used in this study, pelvic floor contractions determined the distance a golf ball traveled. In the basketball game, accuracy of shooting a basketball through a hoop was related to the patient’s ability to relax the pelvic floor muscles. Studies of these biofeedback games showed improvements in symptoms and high levels of treatment compliance through self-report and objective measures (Herndon, Decambre, & McKenna, 2001; McKenna, Herndon, Connery, & Ferrer, 1999). In addition, the biofeedback computer game program proved to be useful in children with pediatric voiding dysfunction as young as 4 years old (Herndon et al., 2001), a group previously thought to be too young for biofeedback muscle training because of limited ability to cooperate and motivation to engage in it (De Paepe et al., 2000). A computer biofeedback game was also designed for patients with IBS, a gastrointestinal disorder characterized by abdominal pain, bloating, constipation, and diarrhea. Symptoms are controlled through medication and behavior management such as diet and stress management techniques. A biofeedback game that was developed for patients with IBS was designed to teach stress management through deep relaxation exercises (Leahy, Clayman, Mason, Lloyd, & Epstein, 1998). Biofeedback sensors connected to the patients’ fingers measured electrodermal activity, or microchanges in the skin’s sweat response. The patient was able to control the animated representation of bowel movement through changes in their electrodermal conductivity that the biofeedback sensors detected when the patient engaged in mental and physical relaxation techniques. The patients were able to control their movement in an animation of the gut (intestines) to the extent that they were able to relax. A study of 40 patients with IBS who were refractory to conventional treatment showed that four half-hour biofeedback sessions resulted in reports among half of the patients that the technique helped them control their symptoms. Patients also showed significant reductions in global and bowel-specific symptom scores. In long-term follow-up of the patients, 64% of the patients reported that they continued to use the techniques they had learned. The advantage of using this biofeedback game to teach stress management over interpersonal therapy is that it does not require the assistance and guidance of trained therapists because it can be self-administered. The game was probably also motivating and useful for this group because it allowed the users to deal with managing embarrassing aspects of their disease in a private manner. Pediatric cancer. Re-Mission is a game made for adolescents and young adults with cancer. The goal of the game is to improve treatment in this often “hard-to-reach” age group of patients. In the game, players control a nanobot named Roxxi. Roxxi flies through the body of different cancer patients to destroy cancer cells and tumors with chemotherapy and radiation. She also combats side effects of treatment such as pain, nausea, infection, and constipation. Information is provided visually through animations and direct interactions with environments. In a randomized trial (Kato et al., 2008) with 374 patients between the ages of 12 and 29 at 34 medical centers in the United States, Canada, and Australia, patients who played Re-Mission were compared with patients who played a control game, Indiana Jones and the Emperor’s Tomb. Patients