One of the big challenges for therapists is finding ways to enable people with neurological conditions, for example after stroke or brain injury, to undertake practice of meaningful movements outside of therapy sessions. This repeated practice of individual movements or better still, of tasks comprising multiple movements that have meaning and relevance to an individual, is the corner stone of rehabilitation and recovery after damage to the brain.
Whilst the estimates of the number of repetitions needed to promote recovery in the weeks after stroke vary, it's generally agreed that in excess of 400 is required to relearn movements. In most healthcare settings, this number of repetitions simply can't be completed in routine therapy sessions because of time and cost constraints. This means that we need interesting, challenging and engaging ways to help people after stroke or with other neurological conditions to be able to increase practice of tasks without a therapist being present.
Interactive computer gaming systems provide a potential way of meeting this need. By utilising games that require players to produce sequences of movements, people can increase the repetitions of movement and so promote recovery. Whilst a recent piece of research found that outcomes aren't better when using interactive computer games in comparison to traditional games and exercise, there's still a good argument that computer based gaming has a key place in rehabilitation. This is because games are fun to play, don't require other people to play against, are challenging and provide real time feedback on progressions and so make achieving hundreds of movement repetitions outside of therapy eminently achievable.
However, there are currently no targeted therapy games available for individuals to purchase to play on mainstream commercial gaming systems such as the Microsoft XBOX or Nintendo Wii. Whilst fitness games are available and have a place in general health and exercise, often they are just too difficult for many people with neurological conditions to be able to play and progress. They also don't always require the player to produce movements that are used in most activities we undertake every day. This means that although they can promote practice of general movements, their relevance to daily tasks and so their benefit to every day function is limited. Whilst there are several custom made games and gaming systems specifically targeted towards rehabilitation out there, their availability to the general public is currently pretty limited as they are typically limited to specialist rehabilitation centres; the majority of people after stroke or head injury will not have access to these.
I've recently been working with a group of great computer gaming students at Manchester Metropolitan University to develop a therapeutic game to improve upper limb movements for stroke survivors. It's a simple game based in a supermarket. To progress, the player has to reach to get items from a shelf. The game runs on a laptop using a readily available Microsoft Kinect sensor, is easy to play and as players get better, the speed and accuracy required by the game increases, providing a continual challenge.
Whilst it might not have the high specification graphics and enhanced playability of many commercial games, it does allow people of varying ability to practice challenging and functional arm movements in a real life supermarket setting and so could have benefits to everyday function. It also provides clear markers of performance and improvement which is a key motivator for players.
The students did a great job in building this game; the next step is to get the views of stroke survivors after playing it, refine it based on their feedback, then maybe get some funding to develop the game further and evaluate it on a larger scale to determine any benefits it may have.
But this project is just a drop in the ocean. The market for these types of games is potentially huge; stroke alone affects 33 million people worldwide. From my experience and our research, a lot of people with a neurological condition, after stroke or brain injury would love to have something that they can use to improve their ability and that's fun and relatively cheap. Hopefully, the big game producers will take notice and expedite their development of similar games for people with rehabilitation needs.
However, it's crucial that Microsoft and their competitors develop games with significant input from therapists and people with neurological conditions to make sure that games are playable and maximally useful for rehabilitation. Whilst gaming will never replace physical and occupational therapy, for many it is a valuable and engaging adjunct to allow practice of movements outside of therapy, and it is a fun and challenging way to achieve meaningful goals.
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