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Video game-based physical therapy aims to make rehabilitation a little more fun—and effective


If Janet Johnson had to choose between doing her at-home physical therapy exercises and playing video games, she would choose the latter.

"It's boring," she says of the exercises she had to do when she had her brain stroke in 2009.

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Marientina Gotsis and two students testing Skyfarer, a mixed reality video game for people with spinal cord injuries.

If therapy is not fun, it's very hard to keep doing it.
Janet Johnson, stroke victim

Thankfully for Johnson, 63, she doesn't have to choose. Researchers around the country are looking at how they can use video game-based therapy to make at-home exercises more fun and easier to adhere to. Johnson made sure to be a part of as many clinical trials as possible near her home in Los Angeles, California.

"Game-based therapy is something that you're going to be motivated to do because it's fun," says Johnson. "If therapy is not fun, it's very hard to keep doing it."

She's not the only one with that sentiment. A 2016 in the Journal of Physical Therapy Science found that about half of patients didn't adhere to at-home exercise programs or performed them inaccurately. That's why sine universities are looking at how they can use video games to improve the at-home physical therapy experience. The Creative Media and Behavioral Health Center at the University of Southern California is one of them, and it's trying to do so with virtual and mixed reality.

"When you're doing stuff with a physical therapist, they provide the motivation," says Marientina Gotsis, an associate professor of research in the Interactive Media and Games Division in the USC School of Cinematic Arts. "They monitor you and they give you feedback and encouragement and make sure you do things right, but then you have do to stuff on your own. It's a little harder."

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In Skyfarer, this is what the patients see when they're sitting inside the wheelchair station.

Gotsis is also the director of the Creative Media and Behavioral Health Center at USC. She and her team of 25 students, faculty and health professionals have developed Skyfarer. Patients with spinal cord injuries play the game to perform a variety of tasks. In one stage, they have to use their shoulder to drive a bucket of water up a pulley. So far, they've done a few clinical trials with this technology.

We're very careful about how we design things also in terms of not requiring that people sit down for very long time to do something.
Marientina Gotsis, USC Center for Creative Media and Behavioral Health

"[Patients] were quite enthusiastic," said Gotsis. "Some of them expressed a desire to have had something like this earlier when they were injured because of their [lack of] motivation. We do see that some of these things could be used earlier with people to provide motivation and set up some good habits for them."

The program—which is in partnership with the Rancho Los Amigos National Rehabilitation Center, the USC School of Social Work and the Craig Neilsen Foundation—hopes to publish its findings in a year or so. There are some game-based physical therapy instruments already available on the market. The MusicGlove, for example, is a $349 glove that's supposed to help with dexterity. While they wait for more research to be done and more products to be released, stroke victims like Janet Johnson say they're swearing by video games.

"If they give you a game to play, and it's got music, and you're playing ping pong or whatever, virtual reality whatever, next thing you know, it's getting dark and you've been doing it all day," said Johnson.

Gotsis makes it a point to stress that they've worked really hard to not make the video games addicting. She says games don't have the reward mechanisms a lot of video games are known to have.

"I think that we're very careful about how we design things also in terms of not requiring that people sit down for very long time to do something," said Gotsis. "That can really be built into the design so that you just do it and then you move on, and you can come back and do it again."

Janet Johnson, who was a pilot and aerospace engineer when she had her stroke at 54 years old, had discarded going back to work. But she says her newfound mobility nine years after her stroke has her changing her mind.

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Janet Johnson shows off the mobility in her right hand. A brain stroke in 2009 left her entire right side paralyzed.

"You see this hand?" she asks moving her fingers back and forth simultaneously. "It's not as fast as the other one. But it moves. It used to be stuck like this. Look at it now."

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