Using video games for the rehabilitation of stroke patients


Recently, I was handed an assignment for my group project unit. The aim of this assignment was to work in small teams (4-5 people per team) and create a game for a given scenario. The scenario was to create a game for the NHS in order to help rehabilitate patients suffering from a variety of issues. In this case, our group decided on doing rehabilitation for stroke ; upper arm, hand and fingers. This brief blog post will outline  my initial thoughts on the matter and how I believe our group should go about solving the given problem.

I’ll start off being explaining what a stroke is  for those who don’t know. There are three different types of stroke, the one I will be focussing  on is known as Ischemic stroke. This is where the brain is left starved of blood by a blockage of the arteries. When the cells in the brain are not supplied by oxygen for long periods of time these areas will cease to function and become dead tissue. Losing brain tissue can have varied and dramatic effects on the person. Survivors can be left with a wide range of both cognitive and physical impairments including: partial or complete loss of vision, changes in behaviour, memory function, damage to speech production both physical and verbal and muscle weakness. Other facts to note include the fact that  there are 1.1 million survivors of stroke in the UK alone and it’s the largest cause of serious long-term disability in the world affecting 150,000 people each year. There is no cure for stroke, recovery requires large amounts of practice and therapy to allow the brain to re-organise and adapt from the loss of brain tissue.  This is where games come into the equation. It’s no secret that the NHS is currently suffering financially and as the number of stroke cases increases with the growing and aging population, the NHS simply cannot afford to train enough staff in order to keep up with demand for therapists.  Therefore the NHS needs a system in place to make rehabilitation which is not only cheap, but easily accessible to patients.

The NHS has experimented using technology and  games for rehabilitation before. The main issue with this is the cost. Bespoke hardware/software is never cheap. Some device the NHS already uses  cost  them around £40,000 per device.  Other problems thrown up by these devices is that they weren’t intuitive, nor did it give the patient an experience they wished to repeat, which was most unfortunate since the tasks were a crucial part of the patient’s rehabilitation. This raised a question; can you use games and  off the shelf hardware to rehabilitate patients? Games have been proven to stimulate the brain in places which  not only commonly used, but also in areas less frequently used. Let me now ask another question. Games were used for rehabilitation before and  yet they weren’t very successful. So why would the NHS ask a bunch of second year university students to develop it? Free labour? Yes, the free labour helps, but the main reason lies in what we are at university to study; Games Development. Games that were used before, were created by science alone. In my opinion, they lacked the creative edge that dedicated games developers could achieve in products.

This leads me nicely to the first design aspect that needs to be achieved; it needs to be fun. In my opinion, this is probably the number one cause for video game addiction. Although addiction is rarely a good thing, in this scenario, it might just be the thing that’s needed. Games like Flappy Bird and Angry Birds have had a major success probably due to their addictive nature. Break it down for a second, Flappy Bird and Angry Birds have so much in common. Both games rely on birds for sprites, both games rely on doing repetitive actions in order to progress. They  are both also very simple and intuitive. This means the learning curve for this game is very small. There is nothing graphically outstanding, nor is there an engaging story to either game.

We have to consider what the effect of the stroke has had on a patient. This means some patients will struggle to be able to move their arms, some their fingers and sometimes both.  Although maybe a games like ‘Angry Birds’/’Flappy bird’ may be able to help with patients suffering with their finger movements,  it won’t be so useful for those finding it challenging to  move there full arm. We therefore need to tailor to both type of patients. This is when choosing the right hardware device is crucial. Our group particularly focused on the Microsoft Kinect for Xbox 360 as well as the revised version for Xbox One and Leap Motion. Some background into Leap Motion and Kinect:

  • Leap Motion uses two camera’s and three infrared LED’s in order to track from your fingertips to your elbow
  • Kinect for Xbox 360 utilizes one RGB camera and two Depth sensors in order to track 2 skeletons made up of 20 joints.
  • Kinect for Xbox One uses similar technology to the Kinect for Xbox 360. However, as well as the current features being improved, it also makes the use of infrared to increase the accuracy of the sensor. This version of the Kinect also allows for 26 joints to be tracked including fingertips and the shoulder joint.

From a development standpoint, both the Kinect for Xbox One and Leap Motion offer great SDK’s as well as good support for use with application like Unity. On the other hand, Kinect for Xbox 360 has poor documentation as well as a lack of official SDK. Another issues to consider would be the tracking capabilities of the devices. Both the Kinect for Xbox 360 and Leap Motion are limited as the Kinect won’t track fingers or the shoulder joint and Leap Motion won’t track anything above the elbow. This leaves us with the Kinect for Xbox One which will do both. Therefore, this is the device we will most likely use.

Another issue with stroke recovery, is that it’s a process of development. It’s learning how to walk again so to speak. So were going to have to develop a game in which it can dynamically change depending on patient progress as well . We therefore decided to construct  our product with mini games. This way we can make our games tailor to  both the patient’s needs and progress. See this as a level unlocking system. When the patient progresses so far in one of the mini games, if the software we develop believes that the user has reached a certain level of progress and consistency with their progress, then a new different/harder challenge is unlocked. This should not only stop the user getting bored of playing one game, but should also allow them to visibly see progress in order to keep them motivated. In addition, we want to use the data collected by the games to be accessible to the Doctor in charge of the patient’s recovery process. We will most likely provide them with data such as time played,  and the progress they’ve made. We will also try and use this data to suggest possible changes to the patient’s rehabilitation.

There are many other aspects to this project that we  will have to analyse in the weeks to come. Much of the topics I discussed will have to be challenged as well as being researched in great depth to gain a greater understanding.  I hope to keep this blog updated with this topic as the project progresses over this coming year.