## 3 Results
### Validity
#### 3.4.2 Construct Validity  
Following the application of the assessment framework for the construct validity, a case study was conducted to measure differences in the skills it intends to train. It is important to highlight that due to the non-experimental nature of this study, the findings detailed here are suggestive and not conclusive. The identified trends and insights from the case study only intend to fulfill the holistic evaluation of HapHop-Physio as exer-learning game (eHealth application). Twelve children voluntarily participated in the study (four female participants). The age range was from 6 to 15 years old (mean: 10.93 \(\pm\) 3). All patients completed a median of 69% of the proposed therapies (minimum completion of 50%). The initial memory volume of the children was established (memory span) with the ENI battery. Patients had an initial median memory span of four words (auditory-verbal memory) and four figures (visual memory) in phase I. For phase III (after interaction with HapHop-Physio), the median memory span improved to five words and five figures. \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Validity** & **Feature** & **Previous Versions** & **Current Version** \\ \hline \multirow{6}{*}{Scoring system} & \multicolumn{2}{c}{The game’s scoring system did not rate the mini-games according to the score ranges designated by the ENI battery. The scoring was standardized according to a different criteria due to misunderstandings between experts and developers.} & After two assessment and feedback sessions, the scoring system was corrected. Now, it follows the ENI battery guidelines considering the number of questions and correct answers for each mini-game and its levels. \\ \cline{2-4}  & \multirow{2}{*}{Login system} & There was no login system, thus the game progress information was lost from the HapHop-Physio system at the end of each session. & The login system was developed to save user performance information during multiple sessions. The ultimate goal of saving this information is for the expert to see how the child is progressing. \\ \cline{2-4}  & \multirow{2}{*}{Clinician’s dashboard} & Experts guiding the therapies did not have a tool to retrieve or visualize the patients’ information. & The clinician’s dashboard was developed to display summarized information about each patient and their progress on each game session. \\ \hline \multirow{6}{*}{Game structure} & \multicolumn{2}{c}{The structure of the game presented three types of mini-games according to the type of skill they trained: selection, writing, and sequencing. Each module of the game presented different types.} & An improvement of the game structure allowed to add two more mini-game types: reaction and numbering. \\ \cline{2-4}  & \multirow{2}{*}{Game structure} & \multicolumn{2}{c}{A set of avatars representing the user in different ways (6 characters, 6 animals, and 6 customs divided to represent male or female gender) was created. The design of these characters is consistent with the natural environment of the game and its visual aesthetics.} \\ \cline{1-1} \cline{2-4}  & \multirow{2}{*}{Set of avatars} & Children could only play as the main character, [PERSON]. This could reduce their engagement to the game. & A set of avatars representing the user in different ways (6 characters, 6 animals, and 6 customs divided to represent male or female gender) was created. The design of these characters is consistent with the natural environment of the game and its visual aesthetics.} \\ \cline{1-1} \cline{2-4}  & & & \\ \end{tabular}
\end{table} 
Table 3: Improved features of HapHop-Physio. Figure 4 shows the distribution of the children's cognitive profiles before (green) and after (yellow) the training. The cognitive profiles were classified according to each children's evaluation results using the measurement in Table 1. For example, in the auditory-verbal memory, the results of phase I showed that two children presented a very low performance. In phase III, only one child was found to present a limited performance.