Video Games in Chronic Illness Management and Prevention

Video Games in Chronic Illness Management and Prevention
1. Benefits of Video Games in Chronic Illness Management
The benefits of using video games in the management of chronic illnesses are now starting to change the opinions of many physicians. Advancements in technology and modern medical science have now allowed us to use these video games as a key part to helping with various different illnesses. Firstly, for many adolescents who suffer from chronic pain, they are first offered medication such as opioids for the management of their symptoms. However, we are now learning that the activation of the brain structures associated with emotional and cognitive control can actually lead to an analgesic effect as well – in other words, something that helps to relieve pain. By using video games as a distraction method or an alternative to medication, the brain’s limbic system is activated which can then activate the brain’s pain inhibition system, sort of like ‘switching off’ our body’s ability to sense the pain. The University of California has even opened up a second clinic in America that treats adolescents with chronic pain through a program that heavily features the use of video games. Katie Vo, a former pediatric patient who was treated essentially through the use of video games, had chronic pain for nearly two years and was struggling with her inability to walk because of the pain. However, after she started playing video games, her recovery in her own words was ‘prompt and remarkable’. After eight days of video gaming treatment, she was able to walk without any aids and says that ‘my pain was nearly gone’. Moreover, in the systematic review and meta-analysis conducted by ‘JAMA Pediatrics’, it was concluded that the virtual therapies, such as video games, are in fact more effective for children, helping to alleviate their symptoms and also correct any physical developmental problems, than more traditional physiotherapies. With people from all ages it has been found that as well as cognitive stimulation and physical therapy, digital games, particularly those which involve virtual dancing, have been seen in trials to be beneficial in Parkinson’s patients. This again is because it helps to distract the patient from focusing on walking and reduces any anxiety they may feel when it comes to undertaking the movements needed for walking – in other words, it can increase their stride length and reduce any risk of them having freezing episodes. This evidence – that shows how virtual technologies and video game therapy can have a physical impact on someone’s symptoms – shows how a combined approach to helping chronic patients can really provide holistic help and support for the patients.
1.1. Distraction from Pain
Some researchers have demonstrated that as little as 10 minutes of playing video games can reduce perception of pain. Therefore, video games can be effective as a non-pharmacological distraction from chronic pain. Pain distraction is not a new concept in psychology and has been present for many years. It is based on the idea that there is a finite amount of attention that the human brain can devote to pain at any given time and pain experiences can be altered by a person’s focus of attention. According to the attention and distraction theory based on Melzack and Wall’s Gate Control Theory of Pain, conscious attention directed to environmental stimuli can influence the neural processing of pain input. This means that the nerve endings of pain sensations have to be stopped by the gating mechanism in the spinal cord and brain. An active engaging task like playing video games that requires users’ visual and motor skills can draw on the cognitive resources that are needed to process pain sensations. This allows the gating mechanism to diminish the number of pain signals travelling to the central nervous system, resulting in a lower perception of pain. Furthermore, the immediate feedback from the video game can provide a sense of accomplishment and positive reinforcement, breaking the cycle of negativity and pain experienced in chronic illnesses. This is further supported by the pleasure and immersion theory on the psychological and behavioural effects of video games, based on the idea that video games fulfil the human need for positive experiences such as competence, engagement, and achieving goals. As a matter of fact, previous research evidence found that even after physical immersion in the game was controlled, high levels of absorption, presence, challenge, and negative emotion were associated with reduced pain unpleasantness and increased tolerance to experimental pain. Moreover, the distraction effect from playing video games on different people of various ages has been well-documented in many types of research. For example, a study involving 25 subjects aged 23 to 59, compared the level of pain experienced by each subject before and after engaging in two types of trial tasks. The experiment consisted of a test of general cognitive distraction, which is simple reading, and a test of active distraction involving a virtual reality maze. The results showed that distraction did significantly reduce pain unpleasantness from pre-trial to post-trial, despite their age difference which would be associated with different pain coping mechanisms. This is to say the potential effectiveness of video games in reducing pain for people with chronic illnesses is promising and worth further exploring.
1.2. Cognitive Stimulation
Following her studies on the benefits of video games on cognitive function, Dr. Fenn was also able to support this idea that games can provide a good cognitive workout. She completed research on a number of participants, divided into two roughly similar groups with one group playing a vocabulary game and the other playing a more visually based game for an hour each day. Dr. Fenn used the Rey Auditory Verbal Learning Test, a psychological assessment that measures verbal memory capability, at the beginning and end of her study. The great thing about the results of Dr. Fenn’s study is that they showed that the cognitive benefits of playing the visual game only became evident after a certain amount of playing time. This means that her results can be used to suggest that continued, frequent exposure to video games – particularly the fast-paced visual ones – is necessary to really derive those cognitive benefits. Dr. Fenn also acknowledged in the discussion section of her article that her subjects performed better on another, similar test as well, which indicates that the group that played the visual game may have shown to have improved in visual memory capacity too. However, it is important to recognize that the latest research on this issue is still surrounded with some criticism. Work in this area is still quite new and most of the studies have relatively small sample sizes and have been carried out over relatively short periods of time. Cognitive psychology is a very large area of study and recommending that playing video games can have any long-lasting and far-reaching positive effects on cognitive function is quite a bold statement. One concern is that psychological studies into aggressive video games have produced evidence to suggest that violent content can, in fact, desensitize people to seeing aggressive behavior and violence in the real world. It is possible that a similar criticism might be made in relation to studies into the cognitive benefits of video games in that the level of stimulation provided by games may have the negative effect of overloading the brain. As the brain becomes used to coping with the high levels of stimulation that a visual game provides, everyday tasks may become more difficult. The American Psychology Association action group raised concerns over these kinds of studies, suggesting that important socio-psychological factors such as age, class, education level, and the generalization made between experimental results and the real world have been left out of the analysis. These criticisms reduce the validity of existing findings in this area and highlight the necessity of more in-depth corroboration between them for further research.
1.3. Physical Rehabilitation
Physical therapy is a very important aspect of chronic illness management and can have a lasting impact on a patient’s quality of life. Physical rehabilitation is often specifically used for the recovery of physical impairments and disabilities, and can include a wide variety of health care professionals such as physical therapists, occupational therapists, and speech language pathologists. Physical therapy is able to help “patients of all ages who have medical conditions, illnesses or injuries that limit their regular ability to move and function” (Physical Therapy Benefits, Medical Review Board – Learn About Physical Therapy and its Benefits, BetterPT). By helping to “increase a patient’s strength, balance, and coordination,” physical therapy is able to minimize the impact of patients’ impairments on their daily lives and get them back to “normal,” healthy living as much as possible. Video games used for physical rehabilitation, or “serious games or exergames” that are designed “not just for fun but to improve physical and mental well-being” (Martin Nortvig, “The Future of Physical Therapy: How Virtual Rehab and Video Games will Change the Game”, Reflektive) can greatly improve a patient’s motivation to complete exercises and comply with regular physical therapy regimens. There are many recent studies demonstrating the benefits of using video games for physical rehabilitation. For example, in a randomized controlled trial (RCT) by Turolla et al., virtual reality was used to compare the effects of virtual reality motor cognitive training to traditional motor cognitive therapy for “balance, gait, and quality of life” for Parkinson’s Disease patients. The results of the trial “provide clear evidence for the equivalent effectiveness” of virtual reality motor cognitive training compared to traditional therapy and show that “it could be considered even more effective in improving balance and quality of life” (Michele Xiloyannis, et al. “Virtual Reality for Rehabilitation of Parkinson’s Disease: Vascular and Nodal Hypotheses of Disease”, Dementia and Geriatric Cognitive Disorders). Additionally, there is evidence to suggest that video game therapy “can lead to better retention of material learned, increased need for the patient to solve problems and stay engaged during therapy, and improved patient motivation” (Cory Shaffer, “Video Game Therapy Attracts Patients, Researchers at Cleveland Clinic Innovation Summit”, Cleveland). By providing patients with a “compelling reason for them to do their exercises”, patients are more likely to stick to their physical therapy regimen and engage in their exercises with a better attitude (Donna Lu, “Computer Games Help People with Huntington’s Disease – It’s a Breakthrough Innovation”, Digital Trends).
2. Incorporating Elements for Chronic Illness Management
While video games can provide patients with an enjoyable escape and a method of managing symptoms, “Video Games in Chronic Illness Management and Prevention” also explores the more practical side of incorporating gaming elements into chronic illness management. This is the longest chapter in the book and covers all manner of different ways that game mechanics and features can be harnessed to provide powerful new methods of looking after patients. Focusing on the ways that video games can provide assistance for different conditions and chronic illnesses, the chapter starts off by exploring the ring-con technology used in the game “Ring Fit Adventure”. This device is essentially a Pilates ring that is used in conjunction with a running-based role play game which was praised for managing arthritis. By focusing on health and fitness tracking, and the ways that game data can be used to monitor patient progress, “Video Games in Chronic Illness Management and Prevention” delves into the cutting edge of what technology can offer. The book introduces the concept of a game’s “mechanics”. This is the term used to describe the different rules, functions, and features of a game- all the little building blocks that make it up. This section explains how in order to develop a successful game for managing or preventing a chronic illness it’s important to align the mechanics of the game with the goals of the user and the aims of the treatment. From this point, the chapter focuses on specific digital gaming elements that can be applied to chronic illness management and prevention. For example, it discusses the use of reminders and notifications- such as the way in which digital smartwatch technology has been linked to games like “Pokemon Go” to help remind users to maintain certain exercise levels. It also talks about the potential benefits of introducing a controlled level of unpredictability into games. This could help to provide essential cognitive stimulation for conditions such as dementia by maintaining nerve cell connections and reducing cell loss. The chapter also discusses other features, like the use of avatar representation in self-management games and the establishment of a community element with online games. Prof. Parkinson shared that even elements as simple as the colour choices for a game’s interface can have real importance; providing contrast settings that personalize the gaming experience for those with visual impairments.
2.1. Health Tracking and Monitoring
Some games include an option to monitor the player’s health at any given time. The book talks about “direct health tracking” in video games and how the method can be used for chronic illness. With advancements in technology, many games now come with the ability to track the player’s health in the game. This can be done through a variety of methods, such as monitoring heart rate, calories burnt, and even stress levels. Health tracking can be used to measure a player’s progress in a game, and the player’s in-game health might even affect the way the game is played. For example, if a player’s heart rate is found to be high during a session, the game might suggest the player to take a break or remind the player to stay calm. Alternatively, if the player’s heart rate stays at a high level for a very long time indicating a prolonged period of stress, the game might change the environmental settings to give the player some stress relief. Also, the game may report these records to the game designers, and the data can be used to make improvements to the game to enhance the user’s experience. The possibilities are endless, but there are still some hurdles to overcome before health tracking in video games can be used for chronic illness. For instance, user consent and data security and protection are two main challenges – if sensitive user data is going to be recorded. Video game consoles may have to meet certain hardware standards before health data can be officially recorded, for example securing user data and preventing unauthorized access to such data. At the same time, software would need to be developed to a high standard to ensure that health tracking tools provide accurate results. This includes testing the software to ensure that health tracking methods work in real-life gaming scenarios and provide useful data for the player. Finally, more research and development is needed to adapt the health tracking games in such a way that they can be effectively used for chronic illness. For example, the book talks about managing a long-term illness that may require the patient to have regular health checks, such as blood pressure monitoring. A game that allows a patient to use a video game console to not only monitor their health in a fun and interactive way, but also to keep a record of their progress and even report the data to their health providers, would be an innovative and useful tool for the patient’s treatment and management.
2.2. Medication Reminders and Management
The chapter explores how video games can offer medication schedules and management systems in a fun and interactive way. Medication adherence – or consuming the correct types and amounts of medications at the right times – is crucial for the effective management and prevention of chronic illnesses. Non-adherence can lead to serious issues, such as health deterioration, the progression of the illness, or, at worst, in the case of serious illnesses, death. It is often the case for chronic illness sufferers that there are complex medication schedules to adhere to. For example, a person may have to take different medications at various times through the day and alongside certain types of food or drink. The book provides a personal story from a 30-year-old woman who has been diagnosed with Multiple Sclerosis since 2013. This story highlights the difficulties of managing one’s own health and medication, once transitioning from pediatric services run by Great Ormond Street Hospital. Additionally, what it is designed to do is to help the user establish a daily routine in distributing the required medication to the allocated day and night sections, as well as assisting in picking out the required dosette box. The user would physically need to slide the dosette box into an allocated empty slot and by doing so it will start a new sequence. This is an example of a ‘Medication Management System’ device which is currently being developed for older people who have visual or perceptual problems in requiring them to take multiple doses of medication on a regular basis. Such devices not only enable the user to receive prompts, such as audio and visual indicators to inform them of the next action, but they can also notify a carer or a family member of the user’s compliance in using the device.
2.3. Symptom Management and Education
Symptom management can be enhanced by reducing social isolation and encouraging communication among patients with similar conditions. Patients can share their experiences in a team-based puzzle game for empowerment, creating an enjoyable way in the learning process of the nature of their illness. Many of these games can be circulated on social media platforms which help to connect people with chronic conditions in the cyberspace. The social element, such as shared experience and mutual support, is highlighted as beneficial factors of using digital games for symptom management. It is mentioned that the level of enjoyment and fun factor of the games help to elevate the mood of the patient. Such positive emotions can actually initiate the internal motivation for symptom management in our daily routine as it was suggested that play activities in general support emotional self-awareness and regulation.
When wellbeing digital games are played, the patient’s symptoms and reactions are measured by the tracking equipment or applications. The results are then sent to the medical professional in a report. Such games offer an innovative approach to patient education and health promotion, providing patients with knowledge of their condition and promoting healthy lifestyles which is one of the key targets of symptom management.
Video games are a big part of digital health or even a stand-alone treatment for symptom management as they aim to enhance patient knowledge, support self-management, provide a form of distraction and monitor symptoms as well as how they affect the individual’s life. Such games are designed to enhance engagement in medicine routines such as exercising, diet control, symptom tracking and remote consultation with medical specialists. Video games for symptom management also aid the clinical monitoring, as they provide functionalities to report and record symptoms and track the treatment progress digitally. This implies better symptom management efficacy as professionals are able to use the digitized data for clinical decision making.
Symptom management in chronic illness often focuses on reducing physical discomfort and the emotional distress it causes, as well as using video games that are both enjoyable and provide educational material. Many scholars view video games as a way to educate patients about their condition and the best methods for managing it day-to-day. This is especially the case for conditions which are chronic, meaning that they require an ongoing process of symptom management and that patients need a certain level of expertise.
2.4. Stress and Anxiety Reduction
Video games are particularly effective in stress and anxiety reduction. Research has shown the calming effect of controlling a game character; when playing a game, the mind focuses on the game rather than the stressful life. The concentration on the game distracts the person from the stressful environment and is therefore a successful way to manage stress and anxiety. There are more than just anecdotal accounts of this theory, and many scientific studies have shown that playing video games helps in managing stress and anxiety. For example, a study published in the medical journal “Social Psychiatry and Psychiatric Epidemiology” revealed that video games, both with and without physical activity, can reduce anxiety. The results of the major study, completed by researchers at the School of Health Sciences at the IUPUI, found that people who use games in low to moderate frequency tend to be less anxious and had a lower level of stress than those who did not use any games at all. Also, many hospitals today are using video games and, in particular, virtual reality for treating chronic pain. Virtual reality gaming systems have been proven in studies as an effective way as adjunct therapy for pain management. One of the reasons for virtual reality being successful in chronic pain treatment is that it can encourage 2-way communication and social interaction. In current, standard pain treatment using medication, the physician tends to give instructions to the patient, who is then passive in the process of taking medication. With the immersive experiences supported by virtual reality, it can transform such “passive mode” into a more active involvement in the pain management with the entertainment and distraction of being in a virtual world. Also, the unique experience of relating and engaging with the virtual environment can provide an enhanced stress-free and enjoyable experience because the virtual reality game further immerses and engrosses the user in the virtual environment, rendering the familiarization of the pain signals and therefore reducing the pain perception. The successes of video games and virtual reality in treating and managing chronic pains definitely suggest that there is potential in such games becoming part of stress and anxiety management therapies. These add on existing supports such as tender loving care, support groups, and cognitive-behavioral therapies, where patients utilize their free time in the hospitals or at home whenever they feel the need to escape from the stress reality. It is a non-pharmacological method and therefore it is not addictive. The inclination of using video games in managing stress and anxiety in the young generation is particularly uncommon because according to the Pediatrics State of Health in 2004, almost 58% of children hospitalized for mental illness were diagnosed with anxiety disorder. This makes this new method very eye-catching for medical professionals who are struggling to find solutions to depression, stress, and anxiety in children. Young adults and teenagers also tend to like the idea of managing their stress through playing video games. There are several games available for popular gaming consoles such as PlayStation, Xbox, and also for computers to help reduce stress and anxiety. For example, Flow, which is available as an internet game and also on PlayStation 7, is based on the flow experience theory—one’s mind is fully immersed into the activity, resulting in a deep, effortless involvement and enjoyment.
3. Prevention of Chronic Illness through Video Games
Studies have shown that one way video games prevent illness is by promoting healthy lifestyle choices. Most chronic illnesses can be prevented through healthy lifestyle: eating nutritious food, maintaining a healthy weight, and getting regular physical activity. There are video games today that offer players practical activities and knowledge, such as virtual cooking, yoga, or sport. These games create a playful environment that enables and sustains behavior change, and reinforces the habits that lead to a healthy lifestyle. This concept, utilizing video games as a means of creating and sustaining behavior change as opposed to the traditional education approach, is studied and known as “exergaming”. A review by Peng and Crouse found that games such as Wii Fit, DDR (Dance Dance Revolution), and Xbox Kinect have the most potential to promote and measure physical activity levels. These games are played using physical movements of the body, and the energy expended can be objectively measured. On top of promoting a healthy lifestyle, these games can also contribute to significant improvements in weight loss, physical health, and quality of life. For example, Wii Fit has been studied extensively in the past decade, and the research found that Wii Fit led to significant improvement in balance, increased activity levels, and significant loss of body weight over time. With the ever-increasing and diversified genre of video games, the potential of integrating different aspects of nutritional education is becoming more and more promising. There are games nowadays focusing on teaching players about the health benefits of certain types of food, how to create balanced meal plans, and maintain a healthy diet. For example, a game called “The Cafeteria Caper” allows students to play as Jorge the detective, whose job is to identify the high sugar and high-fat food in the school cafeteria served by the villain, Lunch Lady Doris. Such video games, as pointed out by Michael and Snelling, offer unique opportunities to reach and engage children in prevention as they “provide instant reinforcement, rewards, feedback, and a socially acceptable way to learn new behaviors”. This is particularly important as technology, including video game consoles, has become an integral part of young people’s daily life.
3.1. Promoting Healthy Lifestyles
Another potential advantage of video games in chronic illness prevention relates to promoting healthy lifestyles in a holistic manner. Unlike tradition-based interventions and programs, video games can deliver health education content in more engaging and interactive ways. “Escape from Diab” is a computer video game designed to teach children about diet and physical activity – children play as one of five “rebels” in a dystopian society and progress through the game as they change their health behaviors. Such types of games not only capture children’s attention, but also provide comprehensive and coordinated approaches to address historically fragmented health education programs that focus only on physical well-being but lack attention to children’s safety or psychological needs. It is important to choose the right type of video games that promote a healthy lifestyle because without proper monitoring and supervision, gameplay could simply reinforce sedentary habits and unhealthy diet, and totally defeat the purpose of preventing chronic illnesses. The game applied is “Re-mission,” a science-based action that puts young people into the control of “Roxxi,” a nanobot with the mission to fight against the evil “cancerous forces” in the body of a “fictional” cancer patient. This game is no ordinary video game – it is not only geared to benefit both the physical and emotional health of the patient but also designed to integrate with medical treatment and help young patients understand cancer and increase their compliance to critical cancer treatments. Players not only engage in entertaining and visually stimulating games but also address their safety or psychological needs.
3.2. Encouraging Physical Activity
Physical activity is already an established method of preventing chronic illnesses. However, with increasing technological advancements and the demand for more entertaining exercise, traditional forms of physical activity such as running and cycling are losing their attraction to children and adults alike. Video games that require body movements can be the solution. As compared to just watching a movie, playing video games involve ‘active participation’. That means, games are not considered as ‘passive’ anymore. This section focuses on the potential of video games in promoting physical activity and preventing chronic illnesses. Earlier studies have demonstrated that playing motion-based video games together with children leads to light-to-moderate intensity of physical activity. Light-to-moderate intensity of physical activity was also identified when playing motion-based video games among young adults. The heart rate significantly elevated during and after playing the video games as compared to the resting state. These studies proved that active video games not only produce health benefits on children, but also on young adults. As technology advances, video games are no longer played exclusively on home consoles. Mobile games, virtual reality, augmented reality and location-based games have been developed and become increasingly popular in recent years. These games utilise the usage of mobile devices, motion sensors, GPS signals, heart rate monitors and even the environment around the players in order to create new health benefits. One of the best examples is the worldwide sensation – Pokémon Go. By encouraging players to walk around catching virtual Pokémon, this game has established a new form of virtual reality games and physical activity. Another example includes ‘Zombies, Run!’ – an immersive running app and audio adventure, players are required to do physical exercises in order to collect items and upgrade the in-game characters, just like playing traditional sports. These kinds of augmented reality games help to bridge the gap between virtual and reality – combining the benefits of both the virtual platform and real-world moving. Research is beginning to report the promising potential of these new genres of video games. With the utilization of physical exercises and constant body movements, the health benefit profile of both traditional sports and active video games has the possibility to be combined. However, more studies are needed to be carried out on the comparisons of different video games and the sustainability of playing these games among different age groups, so that a wider prospect and the long-term potential of these active video games could be revealed in the future. It is undeniable that video games have solidified themselves as a major form of entertainment. The usage of video games in chronic illness prevention is promising and revolutionary. By adopting active video games as a supplementary activity to the traditional physical sports, it is possible to create new dimensions and choices in engaging physical activities, which would indirectly benefit the prevention of chronic illnesses that are related to the lack of physical exercises. Given the various options of active video games that are available, from indoor electronic gaming to outdoor reality simulation base, people would be able to find a suitable game according to their own preferences. Video games can transform the traditional image of gaming from a ‘time-wasting’ activity to a potentially revolutionary new way of keeping people moving and preventing the occurrences of chronic illnesses.
3.3. Nutritional Education and Monitoring
In a study led by Gao et al., the researchers found that children playing the Dance Dance Revolution experienced an increase in energy expenditure of 400 per cent compared to sedentary activities, indicating that this kind of games that offer both entertainment and physical activity could serve as a satisfying alternative to sedentary behaviours. This is a very useful concept, whereby video games not only attract players by providing entertainment, but also educate and engage the players on the significance of a healthier lifestyle.
For example, a health-promotion game called “Escape from Diab” is a health promotion action-adventure game that integrates a method for advancing game characters only when the real-life player makes healthier lifestyle choices. The game offers guidelines and a detailed resource of nutritional knowledge and allows the player to assess their diet and compare it to healthy nutritional standards. Moreover, researchers have suggested that the use of exergaming (a combination of exercise and video games) can aid in attenuation of childhood obesity by introducing a new and modified fidgeting measure.
In addition to promoting healthy lifestyles and encouraging physical activity, video games have a great potential to provide nutritional education and monitoring to the players. Some games have incorporated features that offer guidance on what to eat and what to limit so as to build a healthy diet. This is particularly important for young children as they are the main target group for this game genre, and by learning to make healthy food choices and develop healthy eating habits through these games, it is hoped that they will carry these healthy practices into their adult lives.

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