Games for Health

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Games for Health

• MLG 31 Mar 08

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Health Promotion by Social Cognitive Means
(Bandura 2004)

• Human health is a social matter
• Belief in self-efficacy is core to making and
  maintaining healthy lifestyle choices
• Health promotion should begin with goals, not
  means
• Current health practices focus on medical supply
  side. Social cognitive approaches focus on the
  demand side.

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Social Cognitive Theory

• Core determinants
• Knowledge of health risks benefits of different
  lifestyle choices
• Perceived self-efficacy that one is in control
• Outcome expectations about expected costs
  benefits of different choices
• Health goals and concrete plans
• Social facilitators and impediments

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Examples

• Heart Disease
• Exercise
• Diet
• Cancer
• Smoking
• Regular examinations
• Other examples?

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Games for Health

• Games can
• Provide knowledge of choices
• Practice (via role playing) self-efficacy
• Illustrate outcome expectations
• Engage users in forming health goals and plans
• Facilitate social interaction between players
• Sometimes actually provide therapeutic benefit

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Examples

• Packy and Marlon role-playing video game to
  teach children about their diebetic condition,
  and learn to regulate diet, insulin, and blood
  sugar

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6 Month Follow-Up Results
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Games for Health Conference

• May 8-9, 2008 in Baltimore
• 58 sessions, including epidemiology in World of
  Warcraft, Game Addiction, Nurse Training,
  Rehabitainment
• New themes
• Multi-player social games that build social
  networks / social support
• Games that require serious physical movement for
  exercise or rehabilitation
• Games to education professionals as well as
  ordinary folks

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World of Warcraft as model for epidemiology

• An outbreak of a deadly disease in a virtual
  world can offer insights into real life
  epidemics, scientists suggest. The "corrupted
  blood" disease spread rapidly within the popular
  online World of Warcraft game, killing off
  thousands of players in an uncontrolled plague.
• The infection raged, wreaking social chaos,
  despite quarantine measures.
• The experience provides essential clues to how
  people behave in such crises, Lancet Infectious
  Diseases reports.
• In the game, there was a real diversity of
  response from the players to the threat of
  infection, similar to those seen in real life.
• Some acted selflessly, rushing to the aid of
  other characters even though that meant they
  risked infection themselves.
• Others fled infected cities in an attempt to save
  themselves.
• And some who were sick made it their mission to
  deliberately infect others.

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Selections from the 2006 Games for Health
Conference
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Games About Health

• How do commercial games represent health?

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Other Notes

• RPGS show poison, disease, potions, healers.
• Ultima IV allows the player to give blood to show
  sacrifice.
• Many sports games now have injuries.
• Grand Theft Auto has an ambulance, and also has a
  representation of endurance (run more, gain
  stamina).
• Team Fortress, BF1942, and America's Army have
  medic characters who have specific roles.

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The Sims

• Hygiene is a key aspect of your sims life and
  social capability
• Lifespan issues in Sims 2
• Children Aging

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Trauma Center Second Opinion

• Nintendo Wii Launch Title
• Uses Wiis unique controller

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BrainAge Big Brain Academy

• Cognitive Exercise Sales Pitch
• Aimed at much older demographic (successfully)
• Tie in initially with Japanese based SME
• Diary Tips

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Health in Games

• Often Fairly Binary
• Dead or Alive
• When you deplete your health, your game is over.
• Health 0-100
• Pick up health pack Healed
• Food Health
• Nutrition via Recipes
• Caloric Values
• Example of pushing decisions/actions a few more
  levels

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Health in Games

• Healing is usually about finding objects or
  makeing a purchase only when you must...
• but rarely do you practice preventative
  treatment in games.
• IRONICALLY
• doesn't this seem a lot like healthcare in the
  real world?

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The Next Opportunity

• Make games offer more decisions about health
• Even a couple other levels of decisions could
  offer lots of rich opportunity
• Tighten the accuracy a bit to improve the
  representation and messaging but dont make the
  game educational
• Nutrition

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Presented toGames for Health Conference
2006Presented byRandy BrownCTO, Virtual
Heroes Inc.
Biofeedback for Therapy and Training
September 28, 2006
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Overview BRAIN-BASED BIOFEEDBACK GAMES FOR
HEALTH

• Biofeedback systems are increasingly becoming a
  critical part of the Games for Health space. Uses
  for biofeedback fit both training and personal
  health. This session brings together two example
  uses of biofeedback in gaming to help demystify
  the opportunities surrounding biofeedback
  hardware interfaces and software applications.
• Virtual Heroes will demonstrate how they've
  integrated biofeedback as an assessment tool into
  recent non-health projects dealing with Adaptive
  Thinking Leadership. This presents an excellent
  overview of both the technical hurdles and
  interface approaches toward using biofeedback for
  training applications.

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3DiMD Gaming Environment for Training Healthcare
Team Coordination Skills

• We are performing this project in collaboration
  with Duke University Medical School and the Duke
  Human Patient Simulation Center
• Funded by TATRC
• Background Effective team coordination is
  critical for the safe delivery of care
• Planning for an assessment of ease of use and
  efficacy through an experimental trial at Duke
  University Medical Center

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EmSense-Enabled Environments

• Usability/HCI studies
• Frustration/Resignation
• Attention
• Novel thought (frontal)
• Real-time monitors
• Wireless
• Hard Soft form factors
• Statistics tracking
• Multi-player

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EmSense-Enabled Environments

• Raw vectors
• Oxygenation
• Heart Rate
• Blink Rate
• Head motion
• Skin temperature
• Frontal-lobe activity
• Virtual vectors
• Mental Response
• Physical Response
• Engagement
• Zen
• Stealth
• In the Zone

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Demo!
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Multiplayer ATL session Video
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After Action Review (Real Time)
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Obesity Prevention Meet-Up

• Games for Health Conference
• Baltimore, MD
• September 28-29, 2006

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Plans for the Session

• National initiative for obesity prevention
  through gameplay
• Guided discussion and sharing
• 2 minute review of existing games and initiatives
• Call for needed research
• Call for future action

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NMSU Learning Games Lab
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Obesity Prevention through Video GamesResearch,
Development, Outreach

• Develop games to prevent obesity
• Target 12-14 year old youth
• Use as goal to drive research in message
  development and assessment
• Assess game impact

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Improving Attitudes Toward the Disabled with a
Game

• Dov Jacobson
• Dov_at_GamesThatWork.com
• GAMES FOR HEALTH
• Baltimore

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Process Subject Matter Expert

• Parathletic champions
• Murderball
• Personal Experience
• Wheelchair Field Trip
• All artists
• All programmers

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Play

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Analysis Did it Work?

• Testing Strategy
• Informal Study
• Unscientific
• Unbudgeted
• Methodology
• Test, Play, Re-test
• Yuker Instrument
• Participants
• 29 Kids
• Ages 8-13

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Games for Health in Japan
Games for Health Conference 2006 09/29/2006

• Toru Fujimoto
• Fumitaka Beppu

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Topics

• Games for Health in Japan updates
• Brain exercise games
• Games for rehabilitation
• Game Prescription project by Namco
• Non-visual game
• COTS games for Health in Japan
• Manga for Health
• Game reviews

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Brain Exercise Games

• These were sold very well (Brain Age was sold
  over 4M copies worldwide)

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Why was it well-accepted in Japan?

• Previous success with the book version
• Fear for aging
• 20 of entire population is over age 65
• Cultural soft spot for scientific support

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Theyve gotten so many followers..
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more in PSP
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and more in PC
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Boom of the brain exercise games

• Nintendo expanded the market for adult casual
  gamers
• It came mainly from marketing breakthrough, not
  from game design innovation
• Caused the return of not-so-creative-edutainment
  folks
• The future might be not so bright

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Games for Rehabilitation

• Namcos Rehabilitainment games
• Research indicated the improvement effect by
  using the games for rehabilitation
• used by 122 hospitals and nursing-care facilities
  

cycling game
Taico drum master
whack-a-mole game
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(No Transcript)
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Games for Rehabilitation (cont.)

• Developing a new wack-a-mole type game to train
  lower-body functions
• Train iliopsoas muscles to prevent from falling

Doki-Doki Snake Beater
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Games for Rehabilitation (cont.)

• XaviX
• Pilot testing at 160 nursing-care facilities in
  Kyoto area

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Game Prescription project

• Joint research project by Waseda Univ, Namco, and
  New technology foundation
• Four research topics
• Psycho-physiological effects of videogames
• Evaluation of videogame interaction
• Effects of playing videogames on children with
  developmental disorder
• Evaluation of literacy learning system using
  multi-layer display for developmental dyslexia

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Psycho-physiological effects of videogames

• Pre/post tests on salivary amylase and Profile of
  Mood States
• Games used Redge Racers, Lumines, Digdag,
  Moji-pittan, Taiko Drum Master

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Psycho-physiological effects of videogames

• The study indicated
• Videogame-play may causes psycho-physiological
  effects
• The type and degree of the effect varies
  according to the players preference and the type
  of the game
• The more skilled and concentrated, the more
  effects actively

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Non-visual surround audio game

• A joint project of Yudo, Keio Univ., and Dolby
• First-person action game using surround audio
  technology and no visuals

Player
Trap
Treasure
e.g. Treasure hunting game
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SG Labs Game

• Subsidiary of Square Enix Gakken

Nutritional education game
Recycle education game
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COTS games for Health in Japan

• Taka Beppu
• Visiting scholar
• USC

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Overview

• Backgroundmanga (Japanese comic) and TV shows
  regarding health care in Japan
• COTS games review
• Click Medic (1999 PS)
• Maiden Love Revolution (2006 PS2)
• DS surgery games Trauma Center Under the Knife,
  Kenshuui Tendo Dokuta 2 (2005 Nintendo DS)

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BackgroundManga and TV shows regarding health
care in Japan
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(No Transcript)
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Healthcare manga

• Medical mangas (and TV shows)
• Main characters are MD, NS or patient
• Medical heroic stories describe challenges and
  conflicts in the realistic contexts
• Consumed as entertainment
• Some of them were made into TV drama series and
  appealed to the wider audiences

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Recent cases
Team medical dragon Genius surgeon
challenges The authority and hierarchy of
medical community
Nurse Aoi A story of a nurse with a sense of
justice and compassion
circulation
2 million ? 4 millon
circulation
rating 14.8 ave, not bad
rating 14.2 ave, not bad
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COTS Games for Health Review
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Click Medic Overview

• Designed by Satoshi Tajiri (Designer of Pokemon
  game)
• Text-based adventure game
• Going through the human body to remove fictional
  viruses

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Pros

• Players can learn the anatomy and physiology of
  the human body
• Players are required to read the texts several
  times to accomplish a stage
• Players can learn the importance of communicating
  with patients and other medical staff

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Cons

• Weak design for learning support
• Poor visual support Limitation of a text-based
  adventure game
• Fictional virus buggles are unrealistic
• Sacrifices many educational elements to enhance
  the excitement of the game
• Using real viruses could be still exciting (e.g.
  bird-flu, o-157, SARS)

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Maiden Love Revolution (PS2, 2006)
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Love-Revo Overview

• Date diet simulation for girls
• A high school heroine attempting to slim down to
  attract the cool boys in her class
• The goal is to reduce her weight by managing her
  diet and fitness
• Coaching mentoring by other characters
• Dating with boys as a reward
• Communication on dieting

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Main charactersHeroine (100kg, former beauty
queen)
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Heroines elder brother
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Wakatsuki School teacher
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Ren Senior at school
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Masaki Classmates
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Kennosuke Junior in school
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Toru Childhood friend and classmates
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Yurika a rival of heroine
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Pros

• Engage players in considering dietary topics
• Coaching Mentoring
• Enemies rival girls
• Learn from the heroines psychological conflicts
• e.g. Weight rebound issues
• Learn how to manage everyday life with the goal
  of loosing weight
• Character descriptions and story settings
• Attractive stories and characters are important
  to keep player interest

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Cons

• Advice and guidance could be more informative
• Negative effects
• Unrealistic solutions poor messages
• To earn money and buy as many beauty salon
  treatments as possible is the best way to win the
  game
• The game makes dieting seem easy

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DS Surgery Games Features

• Medical adventure game with mini-games on surgery
  
• Stories of interns who need to learn how to
  surgery
• Using unique functions of DS to play the
  treatment process

Kenshuui Tendo Dokuta 2 (2005, Nintendo DS)
Trauma Center Under the Knife (2005, Nintendo DS)
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Suggestions

• The opportunity to instill the dream of becoming
  a surgeon among players
• Story depends largely on your skills and
  success or failure of surgery
• If you screw up, game ends on a sour note
• Ability to realize its heavy responsibility and
  challenge
• To elaborate on the surgery part of the game in
  order to raise the excitement and learning
  elements
• Adding quiz dialogues to check factual knowledge
• Providing more support on medical information
  (e.g. anatomy, physiology, pathology)
• Improve storytelling (e.g. TV shows)
• Deepening on the medical drama
• Ability to learn from premiere TV series in the
  U.S. (eg.ER, HOUSE, Greys Anatomy)

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Summary COTS games as a health communication
tool

• Strategy for accuracy and validity
• Hints from other areas, TV programs, Manga
• eg. Hollywood, Health Society
• Push and Pull
• Entertainment vs Social norm
• Enjoyable vs enlightening or informative
• Video games vs TV programs vs manga, etc.
• COTS games vs educational or non-commercial

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Simulation-Based Triage Training Games for
Health Mass Casualty Care Panel
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Masscasualty Triage

• Rapid physical assessment of key physiologic
  conditions
• Provides objective systematic method for
  determining patient acuity
• Occupation scope independent
• Perishable cognitive skill
• Opposes normative care

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START Primary Triage Method
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Sim-Patient Platform
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Physiology Models

• Cardiovascular
• Beating heart
• Arterial venous compartments
• Circulating blood transport
• Tissue compartments
• Respiratory
• Ventilation waveforms
• O2 / CO2 gas exchange
• O2Hb transport / O2 dissociation
• O2 utilization / CO2 production
• Pharmacological
• IV, IM, and INH. routes
• Metabolism and excretion
• Rx effects (CV, neural, muscular)
• Other
• Cerebral pulse pressure
• Level of consciousness
• Chemical Biological agent modeling
• Traumatic sequelae

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Duke Disaster Intersession

• Two hundred sixty-one students from advanced
  degree programs
• Nursing 22.9 (n60)
• PA 19.9 (n52)
• PT 15.7 (n41)
• Medicine 37.9 (n99)
• Pharmacy 3.4 (n9)

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DDI-06

• Randomized into two groups
• Constructive
• VR
• Completed written test
• Course evaluations

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DDI Evaluation
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Training Model Primary Providers (TMPP)
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(No Transcript)
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TMPP-SBTT Task Outcomes

• Thirty-one physicians identified by the Ministry
  of Health participated in two 2-day courses.
• Participants evaluated the curriculum using a
  five point Likert scale.
• Comments were 95 positive (n75) and 5 negative
  (n4).

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Future Directions

• It has been suggested that this training, if made
  readily available to the medical first responders
  in Iraq, would make an immediate and measurable
  impact on the survivability of casualties in the
  field.

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Whats next?

• Continuing RCTs
• X-platform analysis
• Twelve month retention among DDI participants
• Continued development targeting the simulation of
  medical assessment in the austere environment.

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Virtual World Collaboration Fred Hutchinson
Cancer Research Center andMicrosoft Research
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How the Project Came About

• Microsoft Research approached the Hutch with an
  idea and a software demo
• The Hutch reviewed and approved the collaboration
• The Arnold Library and designated staff were
  selected to project manage and liaise with
  Microsoft
• Microsoft made a charitable donation to the Hutch
  to cover project costs including networking
  housing facility

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Goals

• Microsoft To research and develop tools and
  technologies that contribute to effective online
  communication between individuals and among
  groups
• FHCRC Opportunity to research and enhance
  services for patient community

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Research Questions

• Social support/community
• Can social support be enhanced by computer
  mediated interactions?
• Can online social support improve well-being?
• Online identity
• How does online social identity affect online
  interaction?
• Use of attention for communication
• How are the demands on a users attention
  affected by different types of communication?

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Design Process Audience

• Defining audience
• Researchers at the Hutch?
• Patient community?
• Extend existing BMT listserve?
• Appropriate for patients as extension of
  inpatient activity? For former patients? For
  pre-admits?
• Caregivers, friends and family?
• Trial Caregivers and patients in Hutch housing

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Design Process Content

• Defining content
• Medical
• Social support
• Identify content experts
• Patient care administrators, social work,
  psychologists, medical director, volunteer
  services, patients, chaplain, management,
  researchers
• Develop and review designs
• Prototype and iterate

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Design Issues

• Imaginative versus real life?
• Include medical information?
• Include information? Games? Communication?
• Open or password protected?
• Moderation and ownership? Peer patient world?
  Staff moderated?
• Sync vs. async communication?

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Measuring Success Clinical Trial

• Collect real data on measurable outcomes
• Determine value of study and effects on social
  well being
• Determine what components are valuable (both
  computer usage and HutchWorld software)
• Study results recognized by both medical and
  computer science fields

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Clinical Trial Difficulties

• Setting up and maintaining system
• includes consent, assessment, hardware,
  training, software and network maintenance, etc.
• Managing study participation
• ill or dying patients
• fluctuations/variations/unpredictability in
  caregivers
• Determining critical mass
• getting enough people on the system at once to
  have simultaneous accessing and support

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FHCRC Research ProtocolP.I.s Janet Abrams
Psy.D., Karen Syrjala Ph.D.

• Design 2 group randomized controlled clinical
  trial
• Protocol approval all institutional scientific
  reviews IRB (human subjects) review
• Deployment Pilot Trial June 00-Jan.01
• Control Patients and caregivers in Hutch
  housing able to use their own computers
• Intervention Patients and caregivers in Hutch
  housing provided computer, HutchWorld software
  and high speed Internet access.
• Data collection computer usage and standardized
  self-report measures
• Longitudinal evaluation of outcomes (3 months)

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FHCRC Research Protocol (contd)

• Conducting pilot study prior to full (phase 3)
  study
• Patients and their caregivers in Hutch housing
• 20 apartments given computers and HutchWorld
• 20 apartments not given computers
• Pilot Study Objectives
• Evaluate and resolve implementation questions
• Evaluate feasibility appropriateness of study
  design
• Preliminary assessment of usefulness of HutchWorld

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V-Chat Trial
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HutchWorld Re-design
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HutchWorld Re-design (cont.)
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Overview
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Help
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Hutch Desk
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Seattle Desk
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Discussion Area
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Gift Carts
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Music Garden
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My Profile Tab My Appearance
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People Tab
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My Things Email
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My Things Tab - Journal
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My Things Tab - Web Page
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Next Steps

• Run V-Chat prototype (10/98 completed)
• Run trial at Hutch housing sites (6/00-1/01)
• Source release (7/00)
• Evaluate and prepare for next phase (Q1 2001)

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Papers and Conferences

• Papers
• HutchWorld Lessons LearnedA Collaborative
  Project Fred Hutchinson Cancer Research Center
  Microsoft Research
• Conferences
• Virtual Worlds International Conference July
  2000, http//www.virtual-worlds.net/
• Medicine Meets Virtual Reality Jan. 2001,
  http//www.amainc.com/mmvr_virtual_reality.html

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Contacts

• HTTP //vworlds.org
• VWorlds platform source
• HutchWorld sample summer 2000
• Fred Hutchinson Cancer Research Center Ann
  Marie Clark, Janet Abrams, Karen Syrjala,
  Christopher Hibbeln, Debbie Fraley
• Microsoft Linda Stone, Melora Zaner, Lili Cheng,
  Shelly Farnham