How Video Games Can Help Manage Pain, Disabilities and More

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Through video games, people are able to reduce their anxiety, relieve tension, and make friends with people all across the world. While the psychology of video games is beneficial to our mental health, can this psychology be applied to our physical health?

In this article, I will be discussing how the psychology of video games can be used to help manage pain, help with disabilities, help cancer patients and more. As usual, there will be a summary at the bottom if you do not wish to read everything. Thank you and please enjoy!

Contents

1. 1. Pain Management
   2. Intensive Care Rehabilitation
   3. Cancer Rehabilitation
   4. Stroke Rehabilitation
   5. Improving Life with Cerebral Palsy
   6. Summary
   7. References

Pain Management

There are times in our life where pain is unavoidable, like going through a medical procedure. While this pain may be unavoidable, it is in our best interests to minimise it as much as possible. For example, research shows that if we report high levels of pain and discomfort during a medical procedure, this can actually slow down our healing process later on (Kain et al., 1999).

So what is the best way to minimise pain and discomfort during a medical procedure?

This was researched in a study conducted by Inan and Inal (2019). In this study, they wanted to figure out how best to minimise pain and discomfort in young people. For this, they researched three options: having parents talk to the child, having the child watch a cartoon, and having the child play a video game. They would compare this data to a control group of children who did not experience any type of distraction.

For this study, they recruited 180 children aged between 6-10 from a Turkish hospital. These children were visiting hospital to undergo a blood test. The blood sample was taken from the same nurse to ensure standardisation across all children.

A number of measures were used to determine which distraction techniques were most effective. To rate their discomfort, the Children’s Fear Scale was administered to children before and during the procedure. To measure amount of pain experienced, the Wong-Baker Faces Pain Scale was used to determine pain levels during the procedure. Not only were young people asked about their pain and discomfort, but their parents and the nurse were also asked to rate how much pain and discomfort they felt the child was in.

When analysing the data, the researchers found that the children who played a video game experienced lower pain and discomfort than the other distraction techniques. This is an exciting finding as video games can be a cheap, non-invasive and entertaining method of reducing pain and discomfort during medical procedures.

It should be noted that this is a very recent finding as the study was published in February 2019. I look forward to researchers reading this study and conducting their own research on video games and pain using different age groups and different medical procedures. For now, it’s a very promising finding.

Intensive Care Rehabilitation

Hopefully you never have to spend time in an intensive care unit. But if you do, you may be exposed to what is known as ICU-acquired weakness. ICU-acquired weakness refers to muscle deterioration as a result of spending so much time in bed. More than 25% of those who survive their ICU stay experience this weakness (Needham et al., 2012), and it can have long-term detrimental effects on your quality of life (Rawal et al., 2017).

To combat this, researchers are developing methods of mobilising these patients from the comfort of their bed. One such method is in-bed cycling.

Two researchers, Hendriks and Buise (2019), hypothesised that they could improve the efficiency of in-bed cycling by gamifying it. To test this, they conducted a small-scale pilot study of 16 ICU patients. They compared regular in-bed cycling with a gamified version of in-bed cycling, challenging participants to travel longer distances at higher resistances.

They found that participants who had a video game attached to their in-bed cycling travelled significantly longer distances with a higher peak resistance and average resistance than those with regular in-bed cycling. The physiotherapists responsible for delivering the therapy also noted that participants who played the video game had a lot more fun and enjoyed the additional challenge that it offered.

Similar to the pain study, this study is very recent as it was also published in 2019. As it is a pilot study, the findings act as a proof of concept that gamifying physiotherapy for a vulnerable population is effective. I can’t wait to see the pieces of research that this finding inspires.

Cancer Rehabilitation

So far, I have looked at recently published individual studies that act as inspiring proof of concepts. Instead of looking at an individual study regarding cancer rehabilitation, I have decided to use what is known as a systematic review. To keep things brief, a systematic review is a thorough review of a topic of research, meaning that multiple studies are discussed in one published paper.

Following cancer treatment, cancer patients’ quality of life may be reduced in a number of ways, including cancer-related fatigue, reduced strength, reduced mobility and increased pain and mood disturbances (Barsevick, 2007; Cheng & Lee, 2011; Theobald, 2004; Gritsenko et al., 2015; Van Gerpen & Becker, 2013). While it is difficult enough living with cancer, the evidence suggests that cancer treatments can temporarily weaken those who receive it, both physically and mentally.

To counteract this weakness, bodies such as The American College of Sports Medicine and The National Comprehensive Cancer Network recommend that those receiving cancer treatment should resume their regular levels of daily activity and exercise as soon as possible (Schmitz et al., 2010; National Comprehensive Cancer Network, 2017).

In an attempt to boost activity levels in this population, interventions such as aerobics training have been prescribed in the past (Venthuis et al., 2010). While these exercises could reduce cancer-related fatigue and improve quality of life, it was found that it was sometimes a struggle getting people to show up, with lessons sometimes containing less than half the participants. This means that while exercise programmes can help cancer patients, it can be a challenge to even get them there to benefit from it.

This is where video games come in. Noting the shortcomings of previous interventions, it was theorised that video games could help in three ways.

1. Due to affordable technology such as the Nintendo Wii, cancer patients could exercise from the comfort of their own home rather than getting ready, travelling to the location and travelling back. Removing these obstacles is a benefit to those suffering from cancer-related fatigue and mobility issues.
2. Software made for systems such as the Nintendo Wii is designed to be user-friendly. This means that patients don’t have to fit their exercise around a certain instructor or teacher, they can just get up and go whenever they like.
3. Due to the range of software available for systems such as the Nintendo Wii, it was theorised that it could be useful for combating the low attendance rates of previous exercise programmes. One of the most cited reasons why participants didn’t attend is because they simply found doing the same monotonous exercises over and over to be boring. Researchers speculated that providing a range of software with a range of different tasks would help combat the monotony and incentivise patients to keep playing and keep moving.

In 2018, a systematic review on the effectiveness of video game exercise programmes for cancer patients, henceforth referred to as ‘exergaming’, was published by Tough et al. They screened 4,276 research articles to find exergaming research conducted on cancer patients aged 18 and over. After a strict and comprehensive review process, they found eight publications containing seven pieces of exergaming research.

These studies were conducted in a range of countries including Germany, Japan, the USA and South Korea. It was noted that the severity, type and stage of cancer differed among participants. Four out of seven studies used the Nintendo Wii, while the remaining three studies opted to use other exergaming hardware such as the Interactive Rehabilitation and Exercise system.

A number of benefits were found for exergaming in the studies reviewed. Through exergaming, muscle strength and balance could be improved, and accidental falls could be minimised. It was found that shoulder, elbow and forearm function could be improved through exergaming. Not only did exergaming significantly improve average number of steps taken per day (from 4,650 to 6,393), but it improved participants’ walking confidence.

Regarding mental health, exergaming was found to significantly decrease depression scores, and participants stated via interviews that exergaming made them feel less stressed, more relaxed and happier.

So what about adherence rates? Are cancer patients more likely to stick with exergaming programmes? Compared to the less than 50% adherence rate found in non-exergaming programmes, the lowest reported adherence rate in the studies identified was 87.6% – the highest was 100%! When asked what they thought of exergaming, participants reported the programme to be fun, easy to use, convenient and relaxing. It should also be noted that one study set out to evaluate how safe exergaming was for cancer patients to use. They found that there was no muscle, skeletal or general adverse effects associated with exergaming.

By reviewing these studies, we can see that exergaming is a safe, affordable, enjoyable and convenient method of dealing with cancer-related fatigue and muscle weakness associated with cancer treatment. It is particularly useful for combating the low adherence rates to exercise programmes for cancer patients. Exergaming is so enjoyable that cancer patients want to continue with it, resulting in both physical and mental health benefits.

Stroke Rehabilitation

Every two seconds, someone across the world will suffer from a stroke (Stroke Association, 2018). While more people than ever are surviving their strokes (Feign et al., 2013), almost two thirds of stroke survivors leave hospital with a disability (Stroke Association, 2018). A common impairment stroke survivors suffer from is torso malalignment, also known as trunk malalignment. This means that stroke survivors may have problems maintaining balance and distributing their weight, resulting in common tasks such as reaching out for an object becoming a difficulty (Jung et al., 2007).

To correct trunk malalignment, it is necessary to engage in intensive and repetitive exercises. This results in a similar issue to cancer rehabilitation: while these exercises help them and strengthen them, it can be difficult to keep people engaged and interested. With this in mind, Kim et al. (2018), a research team in Korea, set out to combine robotic Trunk Control Training (TCT) with a video game. During a four-week research period, 18 chronic stroke patients were given five sessions of TCT per week, while 20 patients were given ten sessions per week.

The TCT itself was quite fascinating. As seen above, patients sat in what was described as a ‘robotic mechanical frame’. This frame was equipped with pressure sensors to detect how patients were distributing their weight. While in this frame, patients played one of four video games controlled by moving the cursor on the screen. They could pop balloons, catch fruit, aim an arrow or throw a basketball.

Patients were assessed on three key areas: how well they kept their balance while sitting, how well they kept their balance while moving, and their trunk coordination. After the four-week period, it was found that patients had significantly better sitting balance, moving balance, and better trunk coordination. It was also found that results didn’t significantly differ between the five session group and ten session group.

This has interesting implications for stroke survivors. These findings suggest that playing a game via TCT around twenty times is enough to significantly improve stroke-induced disability. However, the study does have two limitations. Firstly, there is no control group. This means that we can’t directly compare how effective video game TCT is to regular TCT. Secondly, there is no data pertaining to whether the patients enjoyed engaging in video game TCT. While this would be beneficial for learning how to keep people engaged and interested, this is possibly due to speech limitations that have arisen due to stroke.

Improving Life with Cerebral Palsy

Cerebral palsy is a developmental disorder that affects movement, posture, cognition, language and vision (Bax et al., 2005; Odding et al., 2006). Cerebral palsy can differ in its severity from person to person, but its effects are lifelong. With this in mind, research attention has focused on how to improve the quality of life for those with cerebral palsy.

Returning to systematic reviews, a systematic review was published in 2018 by Lopes et al. This review set out to identify research which used video games to improve the lives of those with cerebral palsy. Starting with an initial sample of 561 papers, they identified 16 studies which used video games to improve quality of life. From this, they split the papers into two categories: home-based interventions and clinical-setting interventions. While home-based interventions involved playing video games at home, clinical-setting interventions took place in locations such as rehabilitation centres. The findings of these studies will be discussed under their respective categories.

Seven of the 16 studies identified took place at home, using either a Nintendo Wii, Microsoft Kinect or PlayStation Eye. These studies aimed to improve either upper-limb function, mobility, balance or motor performance. An example of a study’s time frame includes playing for one hour per week for twelve weeks.

The home-based intervention group produced positive findings. The majority of studies reported high levels of engagement and enjoyment with the therapy, and studies were able to produce such benefits as longer exercise time, increased physical activity, and improved motor control. However, two studies noted that participants grew bored with the selection of games that they were provided, with one study noting that only four minigames were made available. A benefit identified from playing at home was that families would become involved in the participant’s treatment and help encourage them and motivate them. It is possible that the user-friendly and entertaining nature of video games helps involve other people, turning what could be an otherwise monotonous muscle-strengthening exercise into an exercise that is fun for all the family.

Nine of the 16 studies identified took place in a clinical setting. These studies used a range of hardware including the Nintendo Wii, Wii Fit Board, Microsoft Kinect and VR headsets. These studies aimed to improve either mobility, motor skills, balance, ankle strength, or general physical activity. An example of a study’s time frame includes playing for 20 minutes per week for 24 weeks.

The clinical-setting intervention group also produced positive findings. In a clinical setting such as a rehabilitation centre, video games were able to improve coordination and motor skills, balance, and increase physical activity. Participants noted how fun the video games were to play and preferred them over other types of rehabilitation, but it was also noted that efforts should be made to include a range of video games rather than repeatedly using the same games. Participants also noted great enjoyment when being able to play multiplayer games with other participants.

This review shows that no matter where the setting, video games have the power to improve the functioning and quality of life of those with cerebral palsy. At home, families can get involved with the comradery of gaming and help young people feel less like they are engaging in physical therapy. In a clinical setting such as a rehabilitation centre, those with cerebral palsy could potentially meet friends like them and bond while playing multiplayer games.

Summary

• Researchers are investigating how best to minimise pain and discomfort during medical procedures as it can slow down the healing process. A study of young people was conducted in a Turkish hospital to explore how to minimise pain and discomfort while taking a blood sample. When comparing distraction via talking, distraction via cartoons, and distraction via video games, playing a video game resulted in the lowest reported pain and discomfort.
• It is common for those who spend time in an intensive care unit (ICU) to experience muscle weakness. To combat this weakness, in-bed cycling is used to mobilise patients from the comfort of their bed. However, it was theorised that combining in-bed cycling with a video game could challenge participants to cycle for longer at higher resistances. This was indeed found by Hendriks and Buise (2019), with participants also reporting that they found in-bed cycling enjoyable and challenging.
• To manage cancer-related fatigue from cancer treatment, exercise programmes such as aerobics training have been prescribed. However, these programmes have a low attendance rate. To combat the low attendance rate, it was theorised that video game exercise programmes (exergaming) could help. Not only was attendance for exergaming programmes significantly higher than traditional exercise due to its enjoyment, but exergaming could improve physical functioning, steps taken per day, and significantly reduce depression scores.
• Following a stroke, stroke survivors may experience difficulties maintaining their balance and distributing their weight. This can be corrected with repetitive movements and exercise, but these may become boring. Trunk Control Training (TCT) was combined with a video game to assess its effectiveness. It was found that playing a TCT video game around 20 times was enough to significantly improve sitting and moving balance in stroke survivors.
• Cerebral palsy is a developmental disorder that affects movement, posture, cognition, language and vision. Video games have been used in an attempt to improve the physicality and quality of life of those with cerebral palsy. In both a home and clinical setting, video games were found to improve motor control, increase exercise time, and increase physical activity. When playing at home, families enjoyed getting involved in the therapy. In a clinical setting, patients enjoyed playing multiplayer games with others. Not only can video games improve the quality of life of those with cerebral palsy, but they can introduce an enjoyable and social aspect to their lives.

Thank you all very much for reading! This hard work would not be possible without the support of my wonderful Patrons. I would particularly like to thank my Platinum Patrons: Matt Demers, Albert S Calderon, Kyle T, redKheld, DigitalPsyche, Brent Halen, Dimelo ‘Derp’ Waterson, Hagbard Celine, Aprou, Nathan, Austin Enright, Dr. Shane Tilton, SK120, NotGac, ——– and Shaemus. Thank you!

 

References

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