Game Design, Gamification, Learning Design and Assorted Other Strangeness

Moving Beyond Training Games in Medicine

The training of medical professionals has always relied on simulations, be it from autopsies conducted to teach gross anatomy to suture kits to practice surgical skills to the more modern virtual reality training games that allow doctors to practice on virtual patients. When coupled with role-playing exercises that are commonly used for doctor’s examination boards it is clear that medicine and gaming have many overlaps. These types of simulations and games have been widely studied and written about. However there are other uses of games in the medical field that have not been as widely studied. These include the use of games as diagnostic tools, the use of games as psychological interventions, games as knowledge creation methods and most interestingly use of games as potential physical treatments of conditions.

Games used in diagnostics.

One of the problems with diagnosis of psychological conditions is the attention span of the subject. So for example the diagnosis of dyslexia relies on a Visscher Kincaid[check spelling] IQ test this makes it unsuitable for students below a specific age threshold. In response to this diesel – X was produced it is a game designed to examine early warning markers for dyslexia in young children. It works by turning the testing procedure into a game which increases the amount of time children are willing to engage with the system thus increasing the reliability of the diagnostic tool.

Games are also being used in the diagnosis of concussion syndrome. By measuring a player’s response times to the stimulus a clearer picture can be produced of the reaction speeds and if there is potential damage to the brain. By presenting these diagnostic tests in game format it encourages the players to both test themselves and push themselves. John Gardner delivered a talk at the games for change conference in 2018 on this subject and the book super better by Jean McGonagle details her own use of games in her recovery from a traumatic brain injury.

Diagnosing autism is a complex process; one of the methods of diagnosis is the identification of repetitive body motions. A trained diagnostician can look at a video of the client and identify through their body language if they are likely to be on the autism spectrum. However this is time-consuming and difficult to do because the client must be recorded from multiple camera angles and the diagnostician has to carefully examine each of the movements. A recent study showed how using a cave system virtual reality where the images are projected on three walls can be used to record the body motions of a player in the environment. During the testing various stimuli are introduced, ranging from the smell of fresh blueberry muffins, to a character walking across the screen and waving at the client. During the stimulus testing several cameras map the clients movements to a wire frame skeleton which then allows the analysis to be conducted. Early results are very positive in being able to correctly differentiate between children who are on the autism spectrum and those who are neuro typical.

Games used as psychological interventions

When a person is exposed to a traumatic incident such as a car crash there is a high likelihood that they will relive the incident several times at inappropriate moments. This can cause a great deal of stress to the person and severely inhibit their ability to proceed with their daily lives. However it has been shown in a study of car accidents conducted in the United Kingdom that people who had been in a car accident who played Tetris for 10 minutes within four hours of the car crash had a lower amount of intrusive memories of the incident than those who were given other tasks. It has been theorised that by playing a game that is hyper visual it helps to overwrite and interrupt the brain’s memory of the visual trauma. The study went on to show that this did not interfere with the ability of the person to recall the incident on command. This could have great implications for the treatment of first responders and other individuals who are placed into traumatic scenarios.

Another way in which games are being used as psychological interventions is in the training of people to recognise mood changes in themselves. The company mightier offers a product which allows players to visualise their pulse rate while playing a game. As their pulse rate accelerates scratch that is the pulse rate increases the level of difficulty of the game also increases encouraging them to be aware of their physiological responses. The use of biofeedback mechanisms and making the physiological visible to the player encourages them to find and deploy coping mechanisms that work for them so that they can continue to play the game. The studies of this intervention have been very positive but should be taken with a grain of salt as they have been sponsored by the company.

Games as knowledge creation methods

Foldit is a game in which the player is asked to fold the proteins over onto each other and get them to connect. This puzzling game judges the quality of the connections that the player makes and has a leaderboard attached. What is interesting is these puzzles are in fact central to the development of new drug technologies. While machines are very good at running through all the possible combinations, human players are much better at intuitively seeing shortcuts and connections that the machine will not be able to identify. Foldit has been responsible for several breakthroughs including work on the Maison Pfizer monkey virus which was published in nature.

Games have also been used to outsource difficult tasks like the identification of cancerous cells on slides and other tasks which humans are much better suited to doing. The movement toward citizen science dovetails beautifully with the design of games that encourage players to engage with the science.

Games as physical interventions

So far we have talked about how games can be used in diagnostics, psychological interventions and even in the creation of new knowledge. There is evidence however that games can also have an impact on the physiological well-being of an individual. 

There is a growing body of evidence that games can be used to improve eyesight and the communication between the brain and the eyes. The treatment of Amblyopia or a lazy eye has traditionally been the covering of the dominant eye with an eye patch for several hours a day thus forcing the patient to use the weaker eye and train it up. The problem with this treatment is both uncomfortable and takes a lot of time. This discourages patients, especially young children from engaging with the treatment fully. Using virtual reality headsets this treatment can be conducted as a form of game where the view of the dominant eye is slowly faded out so that the weaker eye is encouraged to take up the strain. There is also anecdotal evidence of games being useful in the treatment of conditions like ocular albinism and other eyesight problems. The theory behind these  is that usage rewires the brain to make better connections to the input but further study is needed to see if this is in fact happening.

The treatment for burn victims is especially difficult, third-degree burns must be cleaned regularly to prevent infection. The process of cleaning or debreement is both painful and traumatic with many patients reporting reliving the incident in which they were burnt. The standard medical practice is to dose the patient with high levels of opiates before cleaning takes place. There are many issues with the use of opiates in patients including long term addiction, drug toxicity and resistance to the opiate. Snow world is a virtual reality game in which patients throw snowballs at snowmen and penguins while riding a boat through a snow covered canyon. The VR headset is held on a special mount and the player engages with it while their wounds are being treated. Players have reported a decrease in the discomfort that they felt during treatment sessions and less intrusive thoughts during treatment. The levels of opiates needed to be administered to help the patients control the pain also decreased by up to 50%. FMRI readings of patients while playing the game showed a decrease in pain perception and a direct physiological effect.

Conclusions

While one of the main functions of games is and will continue to always be the training of people there are other functions that games can serve as well. Within the area of medicine it is clear that games can be used as diagnostic tools, as research tools and as interventions both psychologically and physically. Further research will be needed to expand these frontiers and to see how effective these treatments may be in the future.

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