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3D Game O' is not easy to get used to, but that stands to reason, since it does so much more than a typical mouse. Once I got used to it, however, I found that the programmability and the additional degrees of freedom really gave me more control over my games and applications, and reduced or completely eliminated the need for the keyboard.
The multiple degrees of freedom are achieved through the addition of something Sandio calls "3D buttons." These are circular buttons which act as "hat switches" or "D-pads"; you don't press them in, but push them in one of four directions, based on your desired effect. By locating two of these buttons on opposite sides of the Game O', new types of movement become fairly intuitive. Rotating left can be assigned, for instance, to pointing the left 3D button back while pushing the right 3D button forward. Clockwise rotation, similarly, feels intuitive when the left 3D button is pushed upward and the right 3D button is pushed downward. If you imagine holding a block out in front of you with your right hand such that your thumb is on the left and your middle finger is on the right side of the block, then you can see that to rotate the block clockwise, you would move your thumb upward and your middle finger downward. These same fingers performing the same action on the two 3D buttons on either side of the Game O' will produce this effect, as well.
In addition to being able to use the 3D buttons in combination to control new degrees of freedom, they are programmable and can be used individually for whatever you like. While reviewing Vanguard: Saga of Heroes, I made a profile for the game that mapped the individual pressing of the 3D buttons to different hot keys. Most worthy of note was mapping the right side 3D button's forward direction to my custom macro that greatly simplified my combat, as is explained in my Vanguard review. This allowed me to approach an enemy, begin combat and handle movement and combat all with my mouse-hand. Other than text and emotes, I ended up only using my keyboard for jumping. Truthfully, it would have been easy to move the jump functionality to the Game O' as well, but I didn't want my keyboard hand to atrophy and wither away, so jumping seemed a reasonable use for the keyboard.
The 3D Game O' has a removable plastic "platform" that gives your hand a place to rest while using the mouse, and allows you to move the mouse without having to "grab" it. I tried it with and without this platform, but I found that using the platform helps to reduce undesired accidental pressing of the side 3D buttons.
Another feature of the 3D Game O' is on-the-fly DPI changing. You can change the DPI to be 400, 800, 1600 or 2000 DPI, by pressing two buttons on the side of the mouse together. An optional audio indicator will provide aural feedback indicating the new DPI selection; an asian woman's voice speaks the current DPI setting.