GAMES AS A PEDAGOGICAL PLATFORM was the focus of this column in the May/June 2008 issue of NURSING EDUCATION PERSPECTIVES. Since that publication, I became aware of two major events that served as a catalyst for continued research into gaming. The first event was the Games for Health International Conference held in Baltimore, Maryland, May 8 to 9. The second event was the award of $2 million to 12 research teams that are investigating how video games can motivate healthy behaviors. Both events highlighted the growing popularity of games as a mechanism for learning about health and engaging in activities that promote healthy behaviors, not only in academic setting but also for consumers, both young and old.
But first, let's start with a newly created Taxonomy of Serious Gaming. Serious games is a term used to describe "games that are driven by educational goals, not entertainment" (1). Ben Sawyer and Peter Smith developed their taxonomy for several reasons: to dismiss the myths around serious gaming; to have common definitions; to assess the current state of the art of gaming; to identify gaps; and to create a foundation for future efforts (2). In one of their taxonomy tables, they list columns that show types of games (health, advergames, training, education, sciences and research, production, and games as work), and they list rows that describe users (governmental and nongovernmental organizations, defense, health care, marketing and communication, education, corporate and industry). An excerpt from their health care area is shown in the Table. Now that we can appreciate the scope of serious games, let's delve deeper into the world of games for health.
Games for Health Three major trends emerged at the recent 2008 Games for Health Conference (3): 1) the increased used of games for therapy and rehabilitation, 2) the use of games in gyms and other settings to promote physical activity, and 3) the greater involvement in gaming of corporations and health care providers. We will examine these trends and highlight some of the newest games presented at the conference. To view slides from the conference, visit www.slideshare.net/event/games-for-health-2008.
Over the last few years, there has been an increased use of games for therapy and rehabilitation. Early pioneering efforts in this area include the work of the Starlight Starbright Foundation, whose goal is to create a variety of games to help children and families cope with their fears of serious illness and their feelings of isolation and pain. Information about the wealth of games available on the Starlight website and the multiple studies that have been conducted to examine the impact of gaming is available at www.starlight.org/site/c.fuLQK6MMIpG.
Another example of video games as therapy is a product called Ditto, now being used at the Royal Children's Hospital, Brisbane, Australia. This is a multimodal distraction device used as a handheld game to distract children from pain and anxiety while they undergo invasive medical interventions. A prototype is being studied with young burn victims. This devise is particularly targeted to younger children, who may not be able use the virtual reality games used by adolescents and adults, to distract them from the pain of medical treatments. To learn more, check out the following blog: http://elianealhadeff.blogspot.com/2008/04 /g4h-2008-serious-games-divert-kids.html.
A new and exciting game created by Enrik Hautop Lund, a professor of robotics and artificial intelligence at the University of Southern Denmark, uses robotic therapy tiles. According to Sandhana, "Patients recovering from surgery or injuries may soon be able to physically play their way to a full recovery with intelligent robotic systems that generate specialized games to challenge the human body's abilities" (4). Lund's research team has tested the use of therapy tiles with cardiac patients, lung patients, people with sports injuries, autistic children, and mentally handicapped children. For more information, visit www. e-robot.dk/therapy.html.
With the introduction of Nintendo's Wii(TM) (pronounced we) system (http://wii.com/), games are being developed to help with rehabilitation. The Wii system allows you to interact with a gaming system connected to your television. Using a remote and various other devices, you can play tennis, play games, surf the Internet, and complete your rehabilitation. As Norman states, "Physical movement is the major method of interacting with its video games. The Wii has completely changed the game world" (5). Tanner reports that what some call wiihabilitation is being used as rehab therapy for patients recovering from strokes, broken bones, surgery, and even combat injuries (6).
Dr. Glenna Dowling, professor of nursing at the University of California at San Francisco, received a National Institutes of Health grant to study the efficacy of an interactive game to improve the gait and balance of patients with Parkinson's disease. Her work uses the Wiiplatform and is done in collaboration with Red Hill Studios. She will be assessing the game's impact in terms of both physiological and psychosocial variables. Learn more at http://nurseweb. ucsf.du/www/ffdowlg.htm.
A modified Guitar Hero game was introduced at the Games for Health Conference. This game can be used to aid arm amputees with their rehabilitation. Benjamin Heckendorn created a one-handed Guitar Hero peripheral, replacing the "strum and whammy bar" with foot petals to allow for one-handed play (7).
Games for Physical Activity The use of tools like the Wu platform is closely related to the second trend, the increased use of exergames, or the use of video games in an exercise activity. This concept was introduced in the 1980s but did not reach the public's attention until the introduction of Konami's Dance Dance Revolution (www.konami.com/Konami/ctl3810/ cp20103/sil740498/cll/dance_dance_revolution_ultramix_4). Since then, more exergames have been developed, including PCGamerBike, NeoRacer, EyeToy, Gamercize, and Cybex TRAZER. Two notable exergames were introduced at the Games for Health Conference. The first, Zyked, is a product that combines video games with online and mobile services to motivate people. You can compete against yourself, interact with teams, and compete against other teams. To see more, watch the video at www. zyked.com/.
The second game reminds us that we must not forget those of us over 50 who want to partake in the world of exergames. Visit www.dancetown.us to learn about Dancetown, which is targeted to gray gamers. To read more about the world of exergames, check out the research review by Debra lieberman at www.comm. ucsb.edu/faculty/lieberman/exergames. him.
The Gaming Marketplace and the Use of Games by Health Care Professionals Humana, a primary sponsor of the Games for Health Conference, showcased its own entrée into the gaming field: Games for Health (HG4H). Check out www.humanagames.com, the Humana website, to learn about this initiative to promote wellness and disease prevention. And then see www.humanagames.coin/tt/experience/ anthem/ for a video of seniors using Humana games,
Another example is K.I.C.K. (Kid's Interactive Creation Kiosk), developed by graduate students at Carnegie Mellon's Entertainment Technology Center. The group's initial project, called Project ER, was used to lower the stress of children at the emergency department of the University of Pittsburgh Medical Center. Read more about this project at www.etc.cmu.edu/projects/childrenshospital/ and at http:// elianealhadeff.blogspot.com/2008/03/ g4h-2008-kick-serious-games-for.html. You can also check out kiosk tools that can be used in all hospitals; visit http://electricowlstudios.com/products.html.
As for educating health care professionals, here is an update to my May/June column. You may want to learn more about these three new games:
Fold.IT is a game about protein folding that allows you to be part of a research endeavor. It "attempts to predict the structure of a protein by taking advantage of humans' puzzle-solving intuitions and having people play competitively to fold the best proteins" (http://fold.it/portal/info/ science) (8).
Life and Death in the Age of Malaria is a simulation game under development by two nurses, Laurie Hartjes and Linda Bauman, at the University of Wisconsin School of Nursing. The game allows student players to advise travelers and manage their health care abroad. Check out a slideshow presented by Hartjes at www.slideshare. net/lhartjes/life-and-death-in-the-age-of-malaria.
3DiMD is a simulation game focusing on team coordination skill training in military health care environments. The Telemedicine and Advanced Technology Research Center, US Army Medical and Material Command, funded the 3DiMD project. The current platform is being tested to see if it can be transferred to other health care environments, such as public health. For more information, go to the Duke University Human Simulation and Patient Safety Center website at http://simcenter.duke.edu/projects/.
Why Should We Care About These Games? These are important tools that you should be incorporating into your health promotion content. The use of some of these games with various populations in the community could provide great service-learning projects for your students. And, if you operate any school-based clinics or other nurse-operated clinics, you might want to incorporate some of these tools into your care plans. Finally, this is a fruitful area of research if you are looking for a dissertation topic or a research focus area. Most importantly, there is funding to support health games research.
In 2007, the Robert Wood Johnson Foundation announced the allocation of $8.25 million to support a research program that investigates design strategies and the impact of interactive games on health care outcomes and the health care system. The Health Games Research Center is located at the University of California at Santa Barbara. Go to www.healthgamesresearch.org/ to learn more about this center, its initiatives, and the 12 new grant recipients. And, as always, if you are using gaming, drop me an email at Diane. Skiba@ucdenver.edu.
1. New Media Consortium and Educause Learning Initiative. (2007). The Horizon Report 2007 edition. [Online]. Available: www.nmc.org/pdf/2007_Horizon_Report.pdf.
2. Sawyer, B., & Smith, P. (2008). Serious games taxonomy. Serious Games Initiative. [Online]. Available: www.seriousgames.org/index2.html.
3. Games for Health/The Serious Games Initiative. Woodrow Wilson International Center for Scholars. [Online]. Available: www.gamesforhealth.org/index3.html.
4. Sandhana, L. (2007). Robotic therapy tiles: Playing your way to health. Wired. [Online]. Available: www.wired.com/medtech/health/ news/2007/10/therapy_tiles.
5. Norman, D. (2007). The next UI breakthrough: Part 2: Physicality. Interactions, 14(4), 46-47.
6. Tanner, L. (2008). New form of physical therapy: Wii games. LiveScience. [Online]. Available: www.livescience.com/health/080209-ap-wii-therapy.html
7. Heckendorn, N. (2008). Guitar hero pedal controllers. [Online]. Available: http://benheck.com/05-08-2008/guitar-hero-pedal-controllers.
8. American Association for the Advancement of Science. (2008). Foldit game. Science Update. [Online].Available: www.scienceupdate.com/show.php?date=20080612.…