Games for Health

Cognitive & Emotional Health Track

An Experimental Game for Traumatic Brain Injury

Post-mortem

Bob Waddington, COO

SimQuest LLC

Supported by the US Army Medical Research and Materiel Command under Contract No. W81XWH-09-C-0122.

What I’m Playing…

Although many TBI patients may return to normal lives, many are circumscribed with disability, unmet care needs, or inability (sometimes temporarily, sometimes permanently) to successfully re-enter home, military, vocational, and/or community life.

Bob Woodruff

Gabby Gifford

The effectiveness of rehabilitation in TBI patients has been demonstrated repeatedly in the literature, with results that include changes in cortical organization,

improved test scores, faster recovery, increased level of function, and increased functional independence

Cognitive/Motor Therapy Application Using Console-Based Video Game Platform

SimQuest, LLCNovint Technologies, Inc.

The Institute for Rehabilitation and Research (TIRR) at Memorial Hermann Hospital

Project Objectives1. Analyze effective TBI rehabilitation protocols2. Establish TBI rehabilitative training goals and

define strategies/performance metrics3. Investigate technology options for TBI

rehabilitation4. Develop technology-based TBI rehabilitation

game-goal structure5. Select candidate game/goal therapy topic for

development6. Develop game presentation strategies7. Demonstrate sample scenario for prototype

Therapeutic Challenge

Although a continuum of care is in place, many veterans do not get therehabilitative services they require.

• Lack of local support services• Limited inpatient coverage – visit caps• Difficult to track at home exercise

compliance

ConsultationMet with therapists from TIRR’s Challenge Program and Project Victory.

• Physical • Speech • Occupational• Vocational

ConsultationReviewed

• Therapy goals• Assessment tools • Therapy protocols• Patient demographics• Use of games in therapy

ConsultationFindings

• Multi-modal requirement• Stimulation of multiple

areas of brain leads to more rapid return to function

• Link to function• Games designed specifically

for TBI offer potential over off-the-shelf games.

Mapping

Conceived game organization and complexity scale that acknowledges that game play and interaction • are blended processes requiring

multimodal brain functionality, • can support therapists’ desire for

multimodal stimulation, and • allows leveling from very basic

games to increasingly complex games.

Proposed solution

Support TBI rehabilitation goals in an intuitive, entertaining fashion and extend the reach of rehabilitation services to underserved service

members

Series of games with multimodal stimulation

Proposed solution

• Develop on XBOX 360 (console required)

• XNA offered portability to PC(key segment of target population did not have game consoles)

• Investigate use of haptics technology• Phase I proof of concept

Novint Falcon Xbox 360 Gamepad PC Mouse/Keyboard

Phase I Effort• Determine the severity level of TBI (mild,

moderate, or severe) • Area of function (cognitive, motor, sensory,

behavioral)• ID segment of the continuum of care of most

pressing need• Develop prototype game using a

sophisticated haptics device connectable to a videogame console or PC.

Game options• Mini-game collections

• Conducive to brain training• Faster development• Bridge to real-world function• Difficult to create something truly novel

• Traditional adventure style game• Increased engagement• Difficult if too challenging

• Games embedded in storyline

Prototype Evaluation Criteria• demonstrate multiple, increasingly challenging, levels;• demonstrate that the levels address multiple brain functions;• be able to be demonstrated on the Xbox 360;• be targeted toward patients with mid- to high-range FIM scores;• integrate with haptics on a PC;• integrate with haptics (Falcon) on the Xbox 360;• be able to demonstrate different haptic effects;• have short-turnaround development time; and• be low in cost.

Prototype Evaluation Criteria• Vision• Fine motor skills• Memory

Abstract game selected for prototype proof-of-concept

Sample Ideas

Sample Ideas

Sample Ideas

Sample Ideas

ResultsTBI rehabilitation games should not focus on single brain functions but should be multimodal to reflect the fact that in TBI therapy, stimulation of multiple areas of the brain leads to a more rapid return of functionality

Established TBI rehabilitative training goals and defined strategies/performance metrics, subsequently determining that the game would focus on identification of target areas of function (cognitive, motor, sensory, behavioral) and would target Challenge Program and Project Victory patients

Results• Demonstrated the feasibility of interfacing the Novint Falcon to the

Xbox 360 platform, • Successfully demonstrated the Novint Falcon manipulating an object

running on the Xbox, • Implemented an XNA puzzle game for the Xbox that is controllable

through the gamepad or the Falcon

Critical points that aided game structure and provided guidance for game complexity and type, i.e., • A certain level of function is required for a patient to interact with a

computer and comprehend a game’s goal and mechanism of play, • Inherent to the process of computer interaction is stimulation of

multiples areas of brain function

ResultsSelected a collection of mini-games as the candidate approach, established a design framework to provide a contextual mechanism for the mini-games, and developed sample mini-game concepts.

Chose a prototype mini-game targeted at the less complex end of the functional independence scale that would focus on vision, fine motor movement, and memory.

Conclusions

Games have the potential to increase the reach of rehabilitative services to currently underserved individuals and

would improve performance, thus reducing costs of care and other

dependent services.