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Video games as a therapeutic tool
Video games as a therapeutic tool
Video games have been used in imaginative and innovative contexts such as physiotherapy and occupational therapy among many different groups of people, including those who are physically handicapped, learning disabled and/or emotionally disturbed. Exercises for the physically injured patient can be boring and repetitive, so video games have the potential for huge therapeutic benefit. This CPD module has a technological twist, which I am sure will be of immense value to occupational therapists and physiotherapists alike. It has already stimulated interest from York St John head of OT, Peter Gray, who offers his reflection in this article. What is it about video games that, potentially, make them so useful in a physiotherapeutic context? Most importantly, perhaps, they can be used for cognitive “distractor” tasks, which aid the management of pain. Studies have shown that cognitive and attentional distractions can block the perception of pain. Playing video games appears to offer an ideal way to provide distraction in symptom control for a range of patients. Redd et al (1987) argued that video games are likely to engage much of a person’s individual attention through the cognitive and motor activity required, and that most games challenge the player to achieve sustained success through progression to increasingly difficult levels. In physiotherapy, game playing can easily be integrated with most administration procedures, and can be more cost-effective than many traditional interventions. Games can also be played without the need for therapist supervision. Video games have been used innovatively as a form of physiotherapy for arm injuries (Szer 1983), in training the movements of a teenager with Erb’s palsy (Krichevets et al 1994), and as a form of occupational therapy to increase hand strength (King 1993). For example, King showed that just three-minute “exercise" periods on computer games could be used in an OT setting to increase a patient’s hand strength. Video game playing has also been used as a therapeutic intervention to promote and increase arm reach in people with traumatic brain injury (Sietsema et al 1993). This study reported on the use of a game – described as an “occupationally-embedded intervention” – to promote and increase arm reach in people with traumatic brain injury. The game significantly increased the range of motion in all 20 participants. The therapeutic benefits of video games have also been reported for wheelchair users, burns victims, and muscular dystrophy sufferers. One reason is that some wheelchair users find regular exercise programmes too difficult physically and/or psychologically, and many find the use of standard arm crank or roller systems monotonous. O’Connor et al (2000) looked for ways in which people with spinal cord injuries could be motivated to exercise on a regular basis. Consequently, they developed an interactive video game system – Gamewheels – which provided an interface between a portable roller system and a computer. This system enabled wheelchair users to play commercially available games. The results demonstrated improved physical fitness in a sample of people with spinal cord injuries and diseases, amputations, nerve diseases and multiple sclerosis. Most participants (86%) said they would like to be able to use a Gamewheels system at home. Adriaenssens et al (1988) reported the use of video game playing (using a variety of small and large joysticks) as an exercise programme to facilitate rehabilitation of upper-limb burn victims. This technique not only helped overcome initial therapy resistance and offered a distraction from pain, but also encouraged and shaped movement of the hand, wrist and elbow by providing feedback for the desired performance. Video games have also been used as a respiratory muscle training aid for young patients with Duchenne muscular dystrophy (Vilozni et al 1994), in rehabilitation programmes to improve sustained attention in patients with cranio-cerebral trauma (Lawrence 1986 and Funk et al 1997) and as a training and rehabilitation aid to cognitive and perceptual-motor disorders in stroke patients (Lynch 1983). The use of video games in almost all these contexts capitalises on a number of inter-related factors. One of the most important is motivation to succeed. Furthermore, it has advantages over traditional therapeutic methods, which rely on passive, repetitive movements and painful limb manipulation. However, there has been no long-term follow-up assessment of these interventions, and it is unclear whether patients eventually tire of playing video games. So questions concerning novelty, game preference and relative level of difficulty, need to be explored. It would appear that, in the right context, video games can have positive therapeutic benefits for patients in a wide range of physio and OT settings. It seems likely that the games’ pain “distracting” effects can be attributed to most commercially available products, although the positive effects reported in some studies derived from specially designed games. It is hard, therefore, to evaluate the therapeutic value of video games as a whole. It may well be the case that some games are particularly beneficial, whereas others have little or no therapeutic benefit at all. Clearly, there are many opportunities for future research and development in this field. Test your knowledge 1. What is the name of the national charity which provides services aimed at helping people to access technology in workplace, college or home? 2. What can voice control offer to those who play computer games? References Adriaenssens E, Eggermont E, Pyck K, Boeckx W and Gilles B (1988): The video invasion of rehabilitation. Burns. (14): 417-419. Funk J, Germann J and Buchman D (1997): Children and electronic games in the United States. Trends in Communication. (2): 111-126. King T (1993): Hand strengthening with a computer for purposeful activity. American Journal of Occupational Therapy. (47): 635-637. Krichevets A, Sirotkina E, Yevsevicheva I and Zeldin L (1994): Computer games as a means of movement rehabilitation. Disability and Rehabilitation. (17): 100-105. Lawrence G (1986): Using computers for the treatment of psychological problems. Computers in Human Behavior. (2): 43-62. Lynch W (1983): Cognitive retraining using microcomputer games and commercially available software. Paper presented at meeting of International Neuropsychological Society, Mexico City. O’Connor T, Cooper R, Fitzgerald S, Dvorznak M (2000): Evaluation of a manual wheelchair interface to computer games. Neurorehabilitation and Neural Repair. (14): 21-31. Redd W, Jacobsen P, DieTrill M, Dermatis H, McEvoy M and Holland J (1987): Cognitive-attentional distractionin the control of conditioned nausea in pediatric cancer patients receiving chemotherapy. Journal of Consulting and Clinical Psychology. (55): 391-395. Sietsema J, Nelson D, Mulder R, Mervau-Scheidel D and White B (1993): The use of a game to promote arm reach in persons with traumatic brain industry. American Journal of Occupational Therapy. (47): 19-24. Szer J (1983): Video games as physiotherapy. Medical Journal of Australia. (1): 401-402. Vilozni D, Bar-Yishay E, Shapira Y, Meyer S and Godfrey S (1994): Computerised respiratory muscle training in children with Duchenne muscular dystrophy. Neuromuscular Disorders. (4): 249-255. Although many allied health professionals may not yet feel ready to use computer gaming as a specific treatment modality, it is obvious that, as a leisure pursuit, it is becoming increasingly popular. So therapists, particularly OTs, must consider their role in helping to mitigate the impact of impairments – such as arthritic hands, poor eyesight, poor concentration and back pain – on a person’s ability to play computer games. Anyone who has used the tiny screens, miniature buttons and complex keyboards involved in playing many of the most rewarding games will realise that even the smallest degree of impairment is likely to create difficulties. Although a network of support and access to adaptive technology exists for computers used in the work environment, the hardware and software systems used in mainstream gaming remain largely inaccessible to those people who cannot reach the same levels of visual acuity and hand–eye co-ordination as that of the game designers. Therapists will need to develop a sound understanding of the hardware and of the playing skills required if they are to help people overcome the impairments that prevent them from enjoying computer games. Those who have played on a Nintendo, Playstation or Gameboy, or even a mobile phone, will know that games that can be played on a standard personal computer (PC) offer more potential for adaptation to meet an individual’s needs. Many games are available for a PC and, although a particular favourite may not be available in PC format, something with similar content, cognitive demands and rewards may be. The positioning requirements of a disabled person may demand that the input device is placed some distance from the screen. This is usually not possible with small hand-held games, but input devices such as keyboards and joysticks, connected to a PC by cable, can be placed in an optimum position for hand function, while good monitor positioning will encourage correct posture. The new lightweight LCD monitors offer large, flicker-free screens that can be mounted in positions which, with old technology, would have been impossible. LCD monitors are highly mobile and can be mounted on a desktop, over a bed or on the floor to facilitate comfortable play. A wide range of input devices is available to moderate the degree of dexterity or strength required to play a game. Large or small joysticks, roller balls or touch pads may all help someone with limited hand function to input the necessary commands. An increasing number of specialist games is available (www.levelgames.net) for people unable to cope with the rapid pace demanded by many traditional games. These often have builtin adaptations such as speed adjustments, low vision options and multiple access modes. It could be argued that computer games have more to offer those who, because of illness or disability, have difficulty participating in sport and outdoor activities. There is a need for urgent action to prevent people with disabilities being excluded from the fun, excitement and sense of mastery offered by computer gaming. And AHPs need to be at the head of the battle to ensure that people with minor impairments are not excluded from playing computer games. Many of the new generation of graduate AHPs will bring, over future years, a wide range of gaming skills to their first posts. This knowledge will not result from their university degree programmes, but from hours spent playing video games in their youth. What about the rest of us? Can we afford to ignore something that is set to play such a vital role in our clients’ lives? Peter Gray, head of OT, York St John College Reader tasks
Portfolio work: 20 minutes Having completed this week’s CPD study, utilise the information within your practice and portfolio as required by the Health Professions Council. Professor Mark Griffiths |
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