Gaming the way to recovery
Harnessing the addictive nature of gaming to improve rehabilitation outcomes
Author: Dr Annabelle Painter, DCN Co-founder
Rehabilitation is a key component of recovery, whether from an injury, an operation or a neurological problem such as a stroke or a brain injury. Poor treatment adherence is one of the biggest factors impacting rehabilitation success. Therapist time is expensive and limited and performing regular repetitive exercises independently requires significant motivation and commitment [1]. Covid-19 has further restricted face-face therapy so there is now an even more pressing need to find new ways to help people to complete rehabilitation programs remotely. Gaming may be the answer.
Video game designers are experts in creating addictive products. ‘Internet gaming disorder’ is a recognised psychiatric diagnosis in the DCM V and gamers have been known to put the health of themselves and others at risk in order to get their fix [2][3]. By persuading these designers to turn their attention to rehabilitation, their skills could be harnessed to transform therapy exercises from a repetitive chore to a compulsive challenge.
An ideal rehabilitation game would need to be enjoyable, personalised, addictive and give real-time feedback towards tailored therapy goals. Gripping games tap into the reward and pleasure centres in the brain through a set of key features [1]. Short and long-term goals associated with rewards (e.g. points/badges or unlocking levels) are crucial to motivation. Game difficulty that increases as performance improves is also important, as it allows users to feel continually challenged. Multi-level immersive gaming experiences are an effective way to combine these features and produce a game that is inherently rewarding to play.
Several neurological rehabilitation games have already been developed and are showing promise in improving patient outcomes. The University of East Anglia have collaborated with Evolv to create a new gaming platform to help stroke patients suffering from visuospatial neglect[4]. ‘REHABILITY’ also creates neurological rehabilitation games tailored for people with stroke, MS and Parkinson’s disease.[5]
Feedback is critical to learning, an effective rehabilitation game should be able to analyse a person’s movements, reward them for good performance and teach them on how to improve. Effective movement tracking technology is essential to achieving this. Several optical and non-optical methods of movement tracking are used in popular game consoles such as Microsoft Xbox® Kinect™, Nintendo Wii™ and Sony PlayStation® Move. Studies suggest that it may be possible to repurpose these consoles for rehabilitation. Use of the Nintendo Wii has been shown lead to significantly improved motor function in stroke patients compared to boardgames [6]. It has also been used to improve exercise technique through a punishment and reward system that discourages compensation and encourages good technique. [7] PlayStation EyeToy games have also been shown to produce significant functional improvement in subacute stroke patients versus conventional rehabilitation. [8]
Virtual reality gaming has promising potential in this area. Companies such as Immersive rehab have created VR programs for neurological disorders whilst PRinVR is proving a useful tool in respiratory rehabilitation [9][10]. Combining non-optical movement tracking technology that uses gyroscopes, magnetometers, and accelerometers with VR optical tracking has the potential to produce the detailed whole-body analysis required for a successful physical rehabilitation product.
Machine learning can help personalise rehabilitation games. Algorithms that determine which tasks work most effectively for each person could be used to continually customise the game experience to meet an individual’s needs. The potential for such movement sensing algorithms extends far beyond rehabilitation and recovery; from training fine motor skills for surgery to learning a musical instrument and honing sporting skills. With so much scope to produce new personalised training programs at scale, we may soon be gaming our way to recovery.
References
[1] Lohse, Keith & Lambert-Shirzad, Navid & Verster, Alida & Hodges, Nicola & Loos, H. (2013). Video Games and Rehabilitation: Using Design Principles to Enhance Engagement in Physical Therapy.. Journal of neurologic physical therapy : JNPT. 37. 166–175. 10.1097/NPT.0000000000000017. Journal of Neurologic Physical Therapy: December 2013 — Volume 37 — Issue 4 — p 166–175
[2] https://www.psychiatry.org/patients-families/internet-gaming
[3] https://edition.cnn.com/2015/01/21/opinion/gaming-addiction-risks/index.html
[4] https://medicalxpress.com/news/2019-06-virtual-rehab-gamification-recovery.html
[5] http://www.rehability.me/#gallery
[6]. Saposnik G, Teasell R, Mamdani M, et al. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke. 2010;41:1477–1484.
[7]. Alankus G, Kelleher C. Reducing compensatory motions in videogames for stroke rehabilitation. In: Proceedings of the 2012 ACM Annual Conference on Human Factors in Computing Systems. New York, NY: ACM; 2012:2049–2058.
[8] Yavuzer G, Senel A, Atay MB, Stam HJ. ‘Playstation eyetoy games’ improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Eur. J. Phys. Rehabil. Med.44(3),237–244 (2008).
[9] https://immersiverehab.com/
[10] https://fabnhsstuff.net/fab-stuff/pr-vr-virtual-reality-pulmonary-rehab-programme
