Video game rehabilitation is a process of using common video game consoles and methodology to target and improve physical and mental weaknesses through therapeutic processes. Video games are becoming an integral part of occupational therapy practice in acute, rehabilitation, and community settings.
The design of video games in rehabilitation is focused on a number of fundamental principles, such as reward, goals, challenge, and meaningful play. 'Meaningful play' emerges from the relationship between player action and system outcome, apparent to the player through, visual, physical and aural feedback. Platforms that feature motion control, notably the Nintendo Wii, Microsoft's Xbox Kinect, Sony's Eye Toy, and virtual reality have all been effective in this field of research. Methodologies have been applied to all age groups, from toddlers to the elderly. It has been used in a variety of cases ranging from stroke rehabilitation, cerebral palsy and other neurological impairments, to tendinitis and multiple sclerosis. Researchers have promoted such technology based on the personalization of gaming systems to patients, allowing for further engagement and interaction. Gaming consoles have the ability to capture real-time data and provide instant feedback to the patients using the systems. Several researchers have performed case studies to demonstrate the benefits of this technology. Repeat trials and experiments have shown that outcomes are easily replicated among various groups worldwide. The outcomes have increased interest in the field, growing experiments beyond simple case studies to experiments with a larger participant base.
History Since the early 1980s, there has been evidence in the literature of commercially available video games used for therapeutic purpose for different patients. The use of virtual feedback has been seen scattered throughout history for quite some time. However, though the feedback was virtual, the performances were not widely virtual until the 1990s. With the early-stage experimentation, not many positive results were found causing some doubt of the systems. Some even found that too much virtual feedback increased poor performance outside of the controlled environment. As virtual reality systems and virtual environments became more accessible and affordable, though, so too did the implementations of and research on them. The use of these systems in positive motor skill development began somewhere in the late 1990s as more researchers realized the benefit of internal, corrective feedback in such environments. At the same time, researchers across the world began experimenting with the effect of virtual reality in therapeutic measures for anxiety disorder and phobias. With positive results, such as better motor control and lower anxiety in relation to phobias, coming from these experiments, researchers began looking into virtual reality systems as a form of rehabilitation in the early 2000s, and the research has expanded since. Now, common gaming consoles such as the Wii and Kinect allow researchers to use cheaper, more readily available systems in their labs, as well, opening up new possibilities for games and rehabilitation options. Case studies and use of systems in actual therapy offices have suggested that this field has the potential to impact therapy outside the lab setting, as well, making it a rapidly growing field of interest. Currently, several reviews of the findings have also suggested positive effects of this form of rehabilitation, garnering support for this field as well.
Several studies have been conducted regarding the potential of applying virtual reality to different therapies. A systematic literature review published in 2012 analyzed 963 publications regarding virtual reality and rehabilitation from 1996 and 2010. Investigators found an increasing number of research done in the field yearly, from less than 10 articles per year in 1997 to more than 40 in 2010. More than the number of articles analyzed, this literature review found important issues to be addressed in future studies: i) the need to consider a greater number of participants in each study to best represent the target populations; ii) to improve the use of control groups; iii) to enhance the uniformity of the tests applied and iv) to execute more follow-up studies in the field. These aspects would allow the comparison among different studies and the conceptualization of the results from different studies. Lastly, this investigation cites the importance of research in the field of virtual reality and rehabilitation, once the potential of this technology is recognized to support the neural and cognitive rehabilitation of different patients.
Rehabilitation through gaming vs. regular methods
Throughout its development, gaming in rehabilitation has gained a large amount of support for its differences in comparison to regular therapeutic methods. The biggest of these differences is the user engagement and enjoyment. It has been extensively shown that people feel more engaged in a gaming environment and less contained in a doctors office when interacting in a virtual reality, gaming environment.Griffin, Murray, PhD, Teshk Shawis, MBCHb FRCP, Rebecca Impson, MSc, Joseph Shanks, BSc, and Matthew J.D. Taylor, PhD. "Comparing the Energy Expenditure of Wii Fit-Based Therapy Versus Traditional Physiotherapy." Games for Health Journal: Research, Development, and Clinical Applications 2 (2013): n. pag. 4 Nov. 2013. Web. Those who are able to participate in gaming rehabilitation have also been shown to use less energy than those participating in normal therapeutic methods. While this may not be positive for all patients, this is beneficial for those patients who may be elderly or have minimal energy to expend in therapy-type settings. Saving energy while still participating in therapy has proven effective for these groups of people, since they are still able to progress in their goals towards rehabilitation, but not over-work themselves in the process. On the other hand, normal physical rehabilitation routine requires commitment to lengthy periods of difficult exercise, which causes the patient to drop out of the therapy routines. Rehabilitation through gaming provides the opportunity to address two important areas: accessibility of rehabilitation and patient motivation.
The ability for gaming consoles to exist anywhere and be purchased by anyone also allows this sort of therapy to be quite personalized to the patient. Patients who use gaming rehabilitation have been shown to be more engaged in the therapy efforts and more likely to continue their therapy outside of the doctor's office than those engaging in regular therapeutic efforts. Being able to bring their therapy into the comfort of their own home and at a relatively low cost contributes to these outcomes. As a result of their increased adherence to therapy and motivation to engage in therapy, patients who engage in gaming rehabilitation have also shown improved outcomes of their efforts.
Another benefit to using games for rehabilitation purposes is that they have the ability to be customized to real-life scenarios more so than typical therapy methods do. When asked about their therapy, patients have reported that they don't see the relation to their every-day life when performing the activities. Instead, they see it as an activity they do simply in their doctor's office, away from their regular life. Virtual reality-based rehabilitation has the ability to be designed to introduce real-life challenges and every-day hurdles that can be seen in the real world. They're tailored to the needs of the individuals and to the environment that they are expected to encounter on a regular basis. This consideration contributes to the "ecological validity" of the rehabilitation method. With gaming through rehabilitation, medical doctors have witnessed cancer patients who utilize video games during procedures have a lower pain tolerance when using an active distraction vs, a passive distraction.
Typical rehabilitation methods have also been seen to present difficulties to those participating in them. At times these difficulties keep anywhere from 30%–66% of people from reaching their goals for their therapy.Lucca, Lucia Francesca, MD. "Virtual Reality and Motor Rehabilitation of the Upper Limb after Stroke: A Generation of Progress?" J Rehabil Med Journal of Rehabilitation Medicine 41.12 (2009): 1003-006. Web. When the goals are not achieved people are generally made to participate in longer therapy sessions, more therapy sessions, or more in-depth and difficult sessions than before, such as constraint-induced movement therapy. In each of these cases, patients are generally forced to pay more than before and are also put through more work than they initially planned. It has been found through research, however, that virtual reality situations can likely increase a person's desire to participate in therapy and therefore increase their chances of reaching their therapy goals, unlike those left underachieved with regular methods.
Physical rehabilitation The University of Essex conducted a study to evaluate the efficacy of including the Wii in an established falls prevention training program to improve balance, mobility, and educate recovery from the instance of a fall. After a 7-week falls prevention training, the results indicated that Wii can positively support a standard rehabilitation, although the use of the game alone would not be encouraged. On the other hand, participants found the experience of Wii game as enjoyable, which can support patients engagement to training. A follow-up longitudinal study would be needed to conclude if the incidence of falls can be reduced along time. Extending this study, another research conducted by the same University of Essex found that training with Wii can improve mood and self-esteem. This behavior was observed in women who participated in this last mentioned research for fall prevention. As said by investigators, it would not be appropriate to generalize, however one participant who had the biggest improvement on the functional measures had the largest positive changes in well-being, which may indicate that the use of the Wii as an adjunct to standard falls prevention training can improve not only functional but also psychological outcomes. There are many advances in the physical rehabilitation community, advances such as technology has created a more effective and easier way for patients to approach their rehabilitation journey.
Neurological rehabilitation Several games have been created to support stroke rehabilitation and to alleviate boredom and frustration patients can face with frequent visits to the therapeutic centers.
The gaming therapy can be prescribed by physicians, physical or speech therapists to support the recovery of the damaged muscles and the brain to re-learn to control the damaged movements.
Circus Challenge, created by Newcastle University scientists, is a Wii game developed specifically to support hands and arms' muscles recovery.Video Game Helps Stroke Patients Regain Motor Skills , The Stroke Foundation The Wii fit balance board was another way that helped with the improvement of balance, gait and activities of daily living, which may benefit not only those that suffer from a stroke but other neurological disorders such as Parkinson's disease. The difficulty of the game is increased as the patient recovers, and their progress can be tracked by therapists.