A Giant’s Passing

Last weekend, videogames lost their father: On Saturday, December 6, at the age of 92, Ralph Baer—inventor of the videogame and progenitor of a 100-billion-dollar global industry and an obsession, hobby, or pastime for more than a billion people—passed away.

The story begins in 1951. New York-based electronics company Loral tasks one of its engineers—Ralph Baer—with designing the best TV set the world has ever seen. An engineer other than Baer might have stayed within the bounds of the request, designed the set and left it at that. But Baer’s curiosity gets the better of him, and he runs with it. The standard method of testing televisions—using a piece of equipment that allows you to manipulate lines and patterns on the screen—gives Baer an idea. What if, he thought, you built that functionality directly into the set, and allowed users to control it? You’d transform TV-watching from a passive to an active experience.

In short, you could make it a game. But would anyone care?

It would take some time to find out. Loral didn’t bite—in retrospect, a spectacularly shortsighted move—and Baer’s idea lay dormant for 15 years. But on a late summer day in 1966—while he was running the Equipment Design Division of Sanders Associates—it came back with a vengeance. During a New York City business trip, inspiration struck, and Baer laid it all out in a four-page document. There it was: in a single stroke, he’d written videogames’ origin story and the Book of Genesis for an entire industry. A year later, he and fellow Sanders techs Bill Harrison and Bill Rusch demoed the first target-shooting game—complete with light-gun controller—and by the end of 1967, they’d finished the world’s first ping-pong videogame. Baer dubbed the machine the Brown Box, and in 1972, the world met it as the Magnavox Odyssey.

The rest, as they say, is history: The Odyssey begat Pong!, Pong! begat the video arcade and the home console, and the arcade and the console together begat the vast multitude of games around us.

Baer has repeatedly said that if he didn’t invent the videogame, someone else would have. But the fact is, he did, and it’s hard to overstate the impact of his creation: For better or worse, every MMO, casual game, FPS, mobile game, platformer, tower defense, RTS, side-scroller and exer-game, every virtual world, world-builder, open world game, trainer and simulation, all owe their existences, at least in part, to Ralph Baer and the Brown Box.
And we who play them, who work with them, who create them, all of us who take pleasure in their distractions, marvel at their wizardry, or stand captivated by their beauty—we all owe him a debt of gratitude. Mr. Baer, you will be missed but not forgotten, and we who remain to game raise our D-pads and thumbsticks, our tablets and Wiimotes, our quarters and tokens, with respect and reverence. And with a press of a button or the drop of a coin, we play on.

Beating stroke by a (bottle)nose

Kata Project logo

Stroke. The word is enough to drive fear deep into the stoutest of hearts. They strike with little or no warning, and without rapid and adept medical attention, they can be fatal. For survivors, recovery is by no means certain: about half come through the experience permanently disabled—debilitated and dependent, cutoff from bodies they can no longer control. Every year, nearly 800,000 people in the United States fall victim to stroke’s crushing hammer, their lives often irreparably altered.

Sadly, the standard approach to stroke therapy offers little hope. It’s rooted in the science of centuries past, is driven by economics, and at best is often too little, too late. The current model—an hour each of speech, physical, and occupational therapies per session—is 150 years old, says Justin McArthur, director of the Department of Neurology at Johns Hopkins University, and “not adequate or up to today’s scientific knowledge.”

Dr. John Krakauer, professor of neurology and neuroscience at Hopkins, is less diplomatic. He has only one word for the contemporary state of stroke rehabilitation therapy: medieval.

If you have a stroke in the United States,” he says, “you’re better off if you’re a rodent than if you’re a human being.”

In his eyes, it’s high time for a revolution. And he knows just the dolphin to lead it.

Dr. Krakauer has a reputation for challenging the status quo—and ruffling not a few feathers in the process. He came to Johns Hopkins in 2010, and immediately began recruiting for a bleeding-edge stroke recovery research center, taking a wrecking ball to the traditional staffing model. Krakauer’s BLAM lab (brain, learning, animation, and movement) includes robotics and software engineers, an animator, a computer scientist, and, as consultants, an animal intelligence expert and the director of animal programs at the National Aquarium in Baltimore. Together, they form the brain powering BLAM lab’s Kata Project, whose mission is to create computer games for post-stroke rehab and neurological research. But the heart and soul of the project is a dolphin named Bandit.

Bandit’s no ordinary marine mammal: he’s a digital amalgam of three of the National Aquarium’s bottlenose dolphins, with a pinch of spinner dolphin for spice. The team spent countless hours studying the animals, distilled their research into the essence of dolphin-ness, translated that into digital form, and gave virtual birth to Bandit—a cybernetic dolphin that moves with the grace and fluidity of the real thing. A user (ideally, a post-stroke patient) controls Bandit on a screen, via movement of his or her arm placed in a robotic sling. For all intents and purposes, the player becomes Bandit. Omar Ahmad, director of the Kata Project, describes the effect as being “jacked into the creature.”

It’s visceral feedback; every subtle movement you do is reflected in the dolphin.”

But why go to all this trouble? Why create such a hyper-realistic, detailed virtual creature in the first place? Because movement—early and often—is key to recovering from a stroke, and taking on the role of a beautiful aquatic mammal is far more engaging and fun than anything conventional physical therapy has to offer. According to Krakauer, there’s no reason why the PT environment has to be bleak and depressing.

Why shouldn’t a hospital be more like a gaming arcade? Why can’t it be a place where you want to explore and play?”

He makes a valid point, but the idea of using games for therapy is not exactly groundbreaking. Physicians and therapists have turned to the Nintendo Wii to aid in stroke recovery for years. Others, like Yale University’s Dr. Adam Noah, have noted the ability of Dance Dance Revolution and other so-called exergames to reduce symptoms of Parkinson’s disease (and they may even help repair damaged areas of the brain). And senior centers and assisted living facilities often have the Wii on hand so that residents can get up and moving, and stay active with something that’s both enjoyable and accessible (I’ve covered this in previous blog posts, as well as in my book, Virtual Ascendance: Video Games and the Remaking of Reality).

What’s new with Krakauer’s team is their intent, their focus. Bandit is the first virtual creature designed to help stroke patients get better (of course, he’ll have many other uses, but that’s his original purpose). And the BLAM lab is the first medical research facility dedicated to the idea of creating computer and video games specifically for physical therapy (as opposed to adapting off-the-shelf games to the task).

But more than that, it’s Bandit himself. He is delightful and engaging, and he responds so intuitively to the motions of the person controlling him that it effectively erases the line between player and object: you become him, and you can’t help but get caught up in his gracefulness, his antics, and his sheer joy at simply being alive. Stroke rehabilitation can be a lonely and forbidding process. For those setting out on this journey, slipping into Bandit’s skin and moving through his watery world—creating a deeply emotional connection to a creature whose every movement is the paragon of grace—may be the beacon guiding them down the long, hard road to recovery.

You can read more about Dr. Krakauer’s research in the National Geographic article here.

To watch a video of Bandit in action, check out this link.

You can learn more about the Kata Project here.

Krakauer’s team is also developing an iOS game based on Bandit called I Am Dolphin. You can read about it here.

And there are two more articles about video games and stroke therapy here…

… and here.

 

 

War’s Humanity

Screenshot, This War of Mine. 11 Bit Studios.

Picture this: you’re trapped in a war zone, forced to take shelter in an abandoned, derelict building. You’re with a couple of strangers, all separated from their families; your homes and possessions are gone, destroyed in the conflict. You have no weapons, no way to defend yourselves, no comforts but what you can fashion from wreckage, and nothing to eat but what you can scavenge from your war-torn city. You’re hungry, tired, and scared, and your only options are to die tonight, or survive the night and try not to die tomorrow.

This is the reality that This War of Mine depicts: war is not heroic and it is not glamorous. War is harsh and brutal. It is a grim struggle for survival, and it spares no one.

War, in short, is hell.

Developed by Warsaw, Poland-based 11 Bit Studios—known for its tower-defense-on-its head Anomaly series—This War of Mine portrays armed conflict from a perspective that game aficionados rarely consider, and developers never present: the civilians all too often caught in the crosshairs. The game is about survival, about hunkering down and waiting out, about risking your life—and the lives of others—just to scrape by for another day. You don’t take up arms and fight, you stay quiet and invisible, and pray for the return of the sheltering dark, when you can venture out once again.

The game is slated for release later this year, so I haven’t had a chance to play it yet. However, reviewers at Polygon were treated to a preview by the developer, and even watching the gameplay is harrowing. This War of Mine is dark—literally and figuratively—and intense: everything about it, from the environment to the gameplay, is designed to engender unease. The game sets you on edge from moment one and holds you there for as long as you can stand to play.

Perhaps more significantly, This War of Mine is morally and ethically challenging: You’re forced to make life-or-death decisions every step of the way, some of which involve stealing food or medicine from others in need, or withholding help to conserve resources for your own group. While this may turn the odds of staying alive in your favor, it does so at the expense of someone else who, like you, was simply in the wrong place at the wrong time. The message is clear: during war, all bets are off. The laws of nature reign supreme, and the only rule is survival.

Though this game may never put an end to war, for those with the courage to play, it sheds a welcome light on the human cost that others so often leave in the shadows.

For 11 Bit’s official game website (including a trailer), click here.

Polygon has some gameplay footage on their website here.

And you can read more about the game and the developers behind it here.

 

 

 

The Ascension of Lara Croft

For a few years now, I’ve been raving about Crystal Dynamics’ reboot of Tomb Raider and their reimagining of its protagonist, Lara Croft, from a scantily clad, hypersexualized, adolescent male fantasy to a more realistic, appropriately dressed and anatomically restrained, tough, gritty survivor (see my earlier post here). I applauded their depiction of her as an imperfect woman forced by circumstance to make difficult choices and carry out some fairly gruesome acts in order to stay alive and save her friends. Lara’s not proud of what she does, nor does she take pleasure in it. She does it because she has to, because her only other option is to give up.

That both gamers and critics praised Tomb Raider came as no surprise. At long last, the franchise had a game that looked stunning, played beautifully, and featured a tough, intelligent heroine that both men and women cared about and could believe in. Here, at last, was the Lara Croft we’d all been waiting for.

And now, Crystal Dynamics has done it again. At Microsoft’s E3 press conference this past Monday, they revealed a teaser trailer for Rise of the Tomb Raider, slated for a late 2015 release. The trailer features all the energy and excitement of the first game, including a few very tense moments of Lara in peril—no surprise there. But it features something else, something unprecedented in the history of gaming.

The video begins, not with Lara escaping death or brutally overcoming an attacker, but with her in therapy. You read that right: therapy. We see her on the edge of a chair, cloaked in a hoodie, head downcast. As the therapist talks, Lara digs her fingers into the upholstery, clenches her fist, bounces her leg. She can’t sit still. She’s clearly anxious and uncomfortable. This is not the bulletproof heroine we’ve come to expect, casually shaking off the death she’s dealt. Lara has experienced horrors the likes of which most of us can’t imagine, and she’s been deeply affected by them. But neither is she a broken woman. Battered and scarred yet alive, she’s found away to exist in between. Her therapist continues:

For many people, these traumas become a mental trap. They get stuck, like a ship frozen in ice.”

PTSD. That’s what he’s talking about. This is classic Post-Traumatic Stress Disorder. Lara is suffering from something that affects nearly eight million American adults, that’s all too common among veterans of war and survivors of abuse, that can strike at any age, and that can tear families and communities apart. She has PTSD, and she’s dealing with it. That a video game is so directly dealing with this is extraordinary. And that Lara is working through and recovering from the trauma of her ordeal may provide hope to those facing traumas of their own. I’ll leave you with the experience of a young woman suffering from PTSD who, while playing Tomb Raider, discovered just that:

It didn’t hold any punches, but it didn’t need to… it affected me in a way years of therapy never did. It healed me in a way that no one’s physical comfort, words, and condolences could ever do. It made me realize that, much like Lara Croft, I survived as well—and that I had my own path to walk. That my experiences were real and tangible and yes, they defined me, but that I’d have it no other way. I am a survivor and I am alive.”

After years of buried trauma and hidden pain, this young woman had found solace and salvation by her own hand, through Lara Croft and the game. By reimagining Lara, Crystal Dynamics has done the impossible: from a game heroine, they’ve created a human being.

The Fine Art of Video Games, redux

Are video games art? It’s a question that’s been posed many times, particularly over the last decade as the power and speed of graphics processors and gaming machines (exemplified by the Xbox One, PlayStation 4 and Wii U) have reached the point where digital artists have virtually unlimited ability to give their imaginations free rein, allowing them to create and deliver visual landscapes of stunning beauty, richness, and depth. Many of these worlds are so engrossing that gamers regularly find themselves captivated, forgetting, for a moment, to play and pausing to admire the view—to, in essence, stop and smell the virtual roses.

Okay, fine. Video games are visually spellbinding. But, again, are they art? The late Roger Ebert, film critic and bearer of the almighty thumb, famously said “no” and paid the price for it, as outraged game aficionados called him to the mat for failing to recognize the virtues of their favorite medium. In contrast, the National Endowment for the Arts declared, in 2011, that video games are art, and for the first time in history opened up the possibility of federal funding to assist digital artists in the development of video games. Of course, neither of these points of view answers the question, but both clearly indicate the range of opinion on the subject.

I suspect that no matter who you ask, you’ll hear a variety of responses, and most won’t be a simple yes or no—and the debate will probably never be settled (at least not to anyone’s satisfaction). Nevertheless, museums around the country are throwing their hats in the ring through a traveling exhibit entitled, appropriately, The Art of Video Games. And though it doesn’t claim to be the final word on the subject, it aims to at least push the conversation forward. The exhibit kicked off in March of 2012, at the Smithsonian American Art Museum in Washington, D.C. (as good an institutional judge of art as any, I suspect) and is now on a ten-city tour—including a stop a stone’s throw from my hometown at the Hudson River Museum in Yonkers, NY.

Which is where I’m writing this, books in hand and ready to extoll the social, cultural, and, yes, artistic value of video games. It’s not that I feel any particular need to validate them to professional critics or anyone else who staunchly refuses to see any merit in the form (though I do have game developer friends, and I’d like to see their work taken seriously and truly appreciated). It’s just that I truly believe that they are art—and further, that when you really spend time with games and explore what goes into creating them, the issues developers are attacking, and the messages they’re trying to communicate, that conclusion becomes inescapable. Take Jonathan Blow’s Braid, for example, which deals with forgiveness and desire; Ryan Green’s That Dragon, Cancer, an attempt to cope with his own son’s terminal illness; or Flower, by Jenova Chen, which explores our relationship to nature. As you progress through each of these games—as well as a host of others for which there isn’t the time or space to do them justice here (Bioshock, Super Meat Boy, and Deus Ex, just to name three)—the story gradually falls into place, and you gain insight into the developer’s world view. Even the infamous and, I would argue, mostly misunderstood Grand Theft Auto series reveals some scathing social commentary for those who care to look just a bit below the surface. Some games, like Fez, are boundlessly joyful and beautifully presented, and some, like Myst, Riven, the Halo series, the recent reboot of Tomb Raider, Uncharted 2, and the unfortunately canceled Star Wars 1313 are simply gorgeous to behold, their worlds rendered in artistic splendor, filled with music befitting a symphony hall. By any definition you care to apply, these games—and many others—are, quite simply, art.

The biggest criticism of video games seems to be that their very nature—their interactivity and reliance on a player—invalidates their inclusion in the list of artistic media. This stems from a quaint and woefully mistaken concept of art as a unidirectional exchange: the artist presents us with a vision or an idea, and we passively receive and, at most, react to it—as if viewing it through a one-way mirror. But true art is a conversation. We take it in, react to it, and seek to understand the artist’s frame of reference and what s/he’s trying to tell us about a particular time or place. We examine our reaction—how do we feel? Why? How does our frame of reference affect our response, and what does that say about us? How does approaching a work of art from our reference point and our experiences change the original work? And ultimately, what is the artist trying to communicate about humanity at large, about our perception of and place in the world? Certainly, not all video games achieve this—but then neither do all works of more popularly accepted forms of art. However, when they do, their interactivity gives video games an immediacy and impact that can far exceed traditional artistic works.

Like painting, sculpture, writing, photography, and music, video games range from simple to complex, derivative to revolutionary, and profane to sublime. They can elicit feelings of hope and fear; longing and despair; grief, loss, joy, and love. They can heal our bodies and open our minds. And if we let them, they can teach us about the world, about each other, and about ourselves. In the final analysis, that is the mark of true art.

But don’t take my word for it, come and see for yourself. For those in the Westchester County region, the exhibit’s at the Hudson River Museum until May 18. For more information, check out the museum’s website. You can also find out the next stops for The Art of Video Games on the Smithsonian’s website here.

One of the biggest issues with Roger Ebert’s criticism of video games was that he’d never played them—and refused to do so, ever. Since that time, people with actual video game experience have weighed in on the question. You can read some of their answers here.

There’s also an in-depth look at the artistic aspirations of one particular game, Journey—developed by Jenova Chen’s studio Thatgamecompany (of Flower fame)—in The New Yorker.

Keith Stuart, games blogger for The Guardian, has an excellent piece on the issue here.

You can also find information here about a new journal, The Arcade Review, and its mission to, as the author says “push the dialog of video games and art.”

And finally, New York’s Museum of Modern Art has been acquiring video games as part of its Applied Design exhibit. You can find a list of some of the games here.

Failing safely: video games invade the OR, part 2

In 1999, the Institute of Medicine published a study that concluded the following: medical errors in the US cost the lives of as many as 98,000 people each year (and run up a $17- $29 billion bill to boot). Ten years later, the Safe Patient Project reported that, rather than showing improvement, in the intervening decade the situation may have actually gotten worse—to the tune of more than 100,000 deaths each year as a result of “preventable medical harm.” Given that the CDC puts the number of deaths from hospital infections alone at around 99,000 annually, the SPP’s number seems conservative.

Let me put this into perspective. A Boeing 737—the most popular aircraft family in service today—seats 360 people, give or take. So consider this: the Safe Patient Project’s estimate of preventable fatalities is akin to 277 airliners plummeting to Earth and killing everyone on board—every year. How long do you think the FAA—or the public, for that matter—would stand for that?

Fortunately there’s a solution: video games.

Being a videogamer doesn’t get a lot of respect in a lot of mainstream professions, but it has been instrumental to me in becoming a surgeon.”

Red Dragon simulator, ISIS

That’s Dr. Andy Wright, surgeon and core faculty member at the University of Washington’s WWAMI Institute for Simulation in Healthcare (WISH). The Institute’s goal is to use technology to improve the quality of healthcare education, patient safety, and surgical outcomes. Simulations are particularly effective as they allow trainees to easily repeat procedures until they’re successful, and provide a safe place for them to fail when they’re not. In Dr. Wright’s experience, the skill and manual dexterity necessary to play video games proficiently translate directly to surgical simulators—resulting in more effective training and fewer accidents in the OR.

Gamers have a higher level of executive function. They have the ability to process information and make decisions quickly, they have to remember cues to what’s going around [them] and [they] have to make split-second decisions.”

Accomplished gamers show heightened abilities to focus on critical elements while maintaining peripheral awareness of the surrounding environment, function amidst distraction, and effectively improvise if a situation doesn’t go according to plan. Past studies have repeatedly demonstrated this, and it makes sense: effectively navigating through and surviving a video game’s virtual world demands it. There are other characteristics of video games that make them particularly well-suited to prepare surgeons for the operating room: you interact with the game’s world through a video screen, and you have to be adept at manipulating images and items with a handheld controller. These skills are especially useful in the areas of laparoscopic (see my previous post here) and robot-assisted surgery.

da Vinci Surgical System

Take da Vinci, for example. It’s a robotic surgical system that allows surgeons to perform delicate, complex procedures through tiny incisions. The da Vinci system combines 3D, high definition video with four interactive robot arms (there’s even a dual-console option where trainees can watch an actual procedure, and a switching mechanism that allows surgeons and trainees to exchange control during an operation). Surgeons manipulate these arms using precision controllers that scale the speed and range of their movements down to the much smaller size of the surgical instruments, allowing for unparalleled accuracy. Put simply, the most advanced robotic surgical system in the world employs an interface intimately familiar to video gamers.

Take gaming into the land of simulation, though, and you can start tapping into the medium’s real power. Virtual reality (VR) simulators are an effective means of getting fledgling surgeons comfortable with a variety of procedures, allowing them to perform a given surgery dozens of times before ever opening up a live patient. They also provide an environment in which surgeons can, in essence, fail safely. Within a simulation, they can develop critical skills and expertise without putting anyone at risk, experimenting with different techniques, learning what does—and doesn’t—work, and becoming safer and more effective. A 2002 Yale University study provided strong evidence for this: surgical residents trained in VR were 29 percent faster and six times less likely to make mistakes than their non-VR trained colleagues.

You can also customize a simulation to closely reflect reality, matching the conditions and characteristics of actual patients. In 2009, Halifax neurosurgeon Dr. David Clarke made history when he became the first person to remove a brain tumor in a patient less than 24 hours after removing the same tumor virtually, on a 3D rendering of that same patient. Two years later, doctors in Mumbai performed PSI knee replacement surgery on a patient after first running the operation virtually on an exact 3D replica of the patient’s knee.

Earlier this year, VR training took another leap forward: using the online virtual world Second Life, London’s St. Mary’s Hospital developed three VR environments—a standard hospital ward, an intensive care unit, and an emergency room—and built modules for three common scenarios (at three levels of complexity, for interns, junior residents, and senior residents) within them. According to Dr. Rajesh Aggarwal, a National Institute for Health Research (NIHR) clinician scientist in surgery at St. Mary’s Imperial College,

The way we learn in residency currently has been called ‘training by chance,’ because you don’t know what is coming through the door next. What we are doing is taking the chance encounters out of the way residents learn and forming a structured approach to training. What we want to do—using this simulation platform—is to bring all the junior residents and senior residents up to the level of the attending surgeon, so that the time is shortened in terms of their learning curve in learning how to look after surgical patients.”

After running interns and junior and senior residents through the VR training, researchers compared their performances of specific procedures against those of attending surgeons. They found substantial performance gaps between interns, residents, and attendings—validating the VR scenarios as training tools. As Dr. Aggarwal explained,

What we have shown scientifically is that these three simulated scenarios at the three different levels are appropriate for the assessment of interns, junior residents, and senior residents and their management of these cases.”

In the future, the team at St. Mary’s plans to study how this type of VR training can improve clinical outcomes of patients treated by residents—ultimately using this tool to bring their interns’ and residents’ skills up to the level of the attendings, help them better manage clinical patients, and, at the end of the day save lives.

Not just for fun: video games invade the OR, part 1

What can surgeons do for six minutes that enhances performance, reduces errors, and improves patient outcomes?

Play video games.

As unlikely as it sounds, specialists in laparoscopic surgery are finding that they can improve their results in less time than it takes to boil water, simply by picking up a controller and getting their game on. I can hear the protests already. Video games are a scourge, a blight. They’re incubators of violence, and responsible for the downfall of modern society. They can’t possibly offer anything positive.

Actually, they can. Laparoscopic surgery is minimally invasive and very small-scale: surgeons insert a tiny video camera and set of miniature surgical instruments into a patient and use video game-style controllers—like joysticks and d-pads—to manipulate these tools from outside the body. This requires precise hand-eye coordination, keen depth perception, and a high level of manual dexterity—the exact skills needed to excel at video gaming, and which games are uniquely suited to develop. According to Dr. James C. Rosser, a laparoscopic surgeon at Florida’s Celebration Health hospital,

I use the same hand-eye coordination to play video games as I use for surgery… I could come in, sit down, and put this [the surgical tool controller] in my hand and not find it foreign to look on that screen and do something with my hands.”

Dr. Rosser proved this in 2002, while practicing at Beth Israel Medical Center. He had 33 surgeons participate in a three-month study that involved, among other activities, playing a series of video games before simulating laparoscopic surgery. About half of the participants had a history of game play, though all of them played throughout the study. Researchers compared the results between participants, as well as against non-gaming colleagues. Across the board, they found that surgeons who played video games were faster and more accurate than those who didn’t—dramatically so: at the low end of the skill spectrum, gaming docs made a third fewer errors and were a quarter faster than their non-playing counterparts. Among participants, the most skilled surgeon gamers were nearly half again as accurate and more than a third faster than those at the bottom of the heap. Further, after controlling for extent of training and number of cases completed, the best predictors of surgical success were video game skill and amount of past gaming experience. Said surgeon and participant Asaf Yalif,

We were surprised and actually awed by the fact that your video game skill, meaning how well you play, as well as the number of hours you have spent on video games were very highly correlating — meaning if you do this well you will be less error-prone, you will be faster and you will perform better at laparoscopic surgery.”

Dr. Rosser recently conducted a follow-up at Celebration Health hospital with 300 laparoscopic surgeons, half playing a video game just prior to scrubbing in. The results? A six-minute video game warm-up resulted in more effective performance and better patient outcomes.

Another study at the University of Rome, Italy, published this past February in the journal PLOS ONE, provides further evidence of gaming’s impact on laparoscopy. Researchers gathered 42 post graduate students in general, vascular and endoscopic surgery, and split them into two groups. Both groups received standard training, but one group also trained on the Nintendo Wii. After four weeks, the Wii group showed significant performance improvement in several areas, including economy of instrument movements and efficient cautery. The authors’ conclusions? The Wii could be a valuable tool for laparoscopic training, and an effective, inexpensive, and entertaining means of enhancing standard surgical education.

Surgeons can’t operate on live patients every day. It’s a numbers game: there just aren’t enough people who need surgery to go around. Other means of honing surgical skills—such as simulators—are therefore critical. The catch is that typical medical simulators run into the hundreds of thousands of dollars—an expense that can be hard for many hospitals to swallow. A game console—like the Wii, Xbox, or Playstation—costs a fraction of that, and provides a viable and effective way to keep surgeons sharp.

Consider this: According to both the Institute of Medicine and the Safe Patient Project, medical errors in the United States run up between 17 and 29 billion dollars in hospital expenses, and result in around 100,000 deaths each year. If video games can reduce even a fraction of these, then perhaps it’s time to get our surgeons playing.

You can find Dr. Rosser’s JAMA Surgery article here.

The New York Times has a piece about Dr. Rosser here.

And you can learn more about Dr. Rosser’s recent work here.

For information about the study at the University of Rome, check the link to PLOS ONE…

… and the write-up in Science Daily.

 

Dancing across reality’s edge

In my previous two posts, I talked a lot about avatars and some of the rather intriguing and exciting developments happening regarding virtual worlds. In brief, both are evolving far beyond what early digital pioneers could have envisioned when they took their first steps into virtual reality. We have the ability today, as demonstrated by LucasArts’ E3 reveal of Star Wars: 1313, to render near-photo-realistic environments in real-time. Absolute photo-realism is a mere skip in time away—five years at the outside—and completely immersive, realistic virtual worlds experienced through any connected device are already on the horizon.

This does not spell the death of the avatar. Avatars will, I’m fairly certain, always have a place within gaming and VR. But we’re fast approaching a technological revolution the likes of which humanity has never experienced. Soon we will have the ability to interact with virtual environments directly, without filtering our actions through a digital intermediary.

Very soon, in fact. Prototypes of The Oculus Rift VR headset show great promise in delivering fully-immersive 3D gaming to the masses. With it, you can climb into the cockpit of a star fighter and engage in ship-to-ship combat, surrounded on all sides by the vastness of space and the intensity of interstellar battle (as with EVE VR). Combine the Rift with the Wizdish omni-directional treadmill and a hands-free controller like the Xbox Kinect, and you can transform a standard first-person shooter into a full-body experience—allowing you to ditch the thumbsticks and literally walk through a game’s virtual environment, controlling your actions via natural motion of hands, feet, arms, legs, and head.

In the world of augmented reality (AR), Google Glass will hit the streets later this year, providing users with a wearable, hands-free interface between the real and the virtual, enhancing your interaction with reality, and allowing you to transmit  your view of the world across the globe.

But the real future lies in a recently Kickstarted project by startup tech company Meta. Meta’s developing a system for interacting with the virtual world that tears open the envelope of the possible, and drives the line dividing virtual from real one step closer to extinction. It’s a combination of stereoscopic 3D glasses and a 3D camera to track hand movements—allowing for a level of gestural control of the virtual world previously unseen (think Minority Report or The Matrix Reloaded).

Unlike the Oculus Rift, the Meta system includes physical control and also works in real space (not strictly a virtual gaming world). And unlike Google Glass, Meta creates a completely immersive virtual environment. According to a recent article by Dan Farber on CNET,

Meta’s augmented reality eyewear can be applied to immersive 3D games played in front of your face or on [a] table, and other applications that require sophisticated graphical processing, such as architecture, engineering, medicine, film and other industries where 3D virtual object manipulation is useful. For example, a floating 3D model of a CAT scan could assist doctors in surgery, a group of architects could model buildings with their hands rather than a mouse, keyboard or stylus and car designers could shape models with the most natural interface, their hands.”

In other words, with the Meta system, the wearer can actually enter and manipulate the virtual world directly, altering it to serve whatever purpose s/he desires. Atheer, another recent entry into the field of AR, is working on a similar system. Like Meta, Atheer’s technology uses a 3D camera and stereoscopic glasses for gesture control, and also provides direct access to the virtual world. According to Atheer founder and CEO Sulieman Itani,

We are the first mobile 3D platform delivering the human interface. We are taking the touch experience on smart devices, getting the Internet out of these monitors and putting it everywhere in [the] physical world around you. In 3D, you can paint in the physical world. For example, you could leave a note to a friend in the air at [a] restaurant, and when the friend walks into the restaurant, only they can see it.”

The biggest difference between the two systems is that Atheer isn’t building a hardware-specific platform; it will be able to run on top of existing systems like Android, iOS, Windows Mobile, or Xbox. Apps built specifically with the Atheer interface in mind will be able to take full advantage of the technology. Those that aren’t optimized for Atheer will present users with a virtual tablet that they can operate by touch, exactly like an iPad or Galaxy Tab. Here’s Itani’s take:

This is important for people moving to a new platform. We reduce the experience gap and keep the critical mass of the ecosystem. We don’t want to create a new ecosystem to fragment the market more. Everything that runs on Android can be there, from game engines to voice control.”

We’re rapidly approaching a critical stage in our technological evolution, nearing the point at which we’ll be able to work, play, and live, at least part-time, in hyper-realistic, fully-immersive virtual worlds, just as we do in real-world spaces today. So, what does this mean? Games will get better. Virtual worlds will become richer and more complex, and take on greater significance as we spend more time in them. And we, as humans, may begin to lose our grasp of the real. I spoke to Kim Libreri at Industrial Light and Magic about this, and he agreed that this could become a real problem. The human brain, he said, is a very flexible learning device. With the gains in fidelity that we’ll see in AR over the next decade, he believes that, as the human race evolves, it’s going to become more and more difficult to separate what’s real from what’s not. The longer we coexist within those places, the harder it will become, and this could begin to create problems. As Libreri said,

There’s a real, tangible threat to what can happen to you in the cyber world, and I think as things visualize themselves more realistically . . . think about cyber-crime in an AR world. Creatures chasing you. It’s gonna be pretty freaky. People will have emotional reactions to things that don’t really exist.”

It might also render people particularly susceptible to suggestion. It’s a bit like the movie Inception, where ideas are planted deep within a subject’s subconscious—except this would be easier. If you can’t distinguish the virtual from the real, a proposal put to you in a virtual world could seem like a really good idea someone presented in reality. If this sounds like science fiction, consider for a moment how vulnerable we are to the power of subliminal suggestion or even direct messages within everyday advertising. No, if anything, the intricacies of our approaching reality will most likely far exceed our ability to imagine them.

Of course, there are positives and negatives with any technology. Through highly accurate simulations, immersive virtual worlds could allow people to visit places they might otherwise not be able to. They could also provide greater and more intuitive access to information, and the ability to use and manipulate it in ways that are today all but unthinkable. Whether the looming future of alternate reality will be predominantly good or bad is irrelevant. It is coming, one way or another, and there’s nothing we can do to stop it. If our past history and the ever-increasing speed of development and change are predictive—or at least indicative—of future events, then alternate reality, in whatever form it assumes, is poised to bring an end to the separation of virtual and real. And if that happens, we will all bear witness to the birth of a singularity beyond which the nature of human interaction—and indeed, of humanity itself—will be changed, fundamentally, forever.

You can learn more about the Oculus Rift here.

… and the Wizdish treadmill here…

.. and here.

There’s a video demo of Google Glass here.

And a demo of EVE VR here:

More info about EVE VR is here.

You can learn more about Meta and their computing eyewear here…

… and here.

You can read about Atheer here:

And for an overview of the future of AR, check out this article:

Dawn of a New Reality

In my last post, I said that avatars were all the rage, and they are—and most likely will only become more so within the next five years. Why then? That’s when Philip Rosedale believes we’ll see intricately detailed virtual worlds that begin to rival reality. If you don’t know Rosedale, you know his work: back in 2000, he created the first massively multiuser 3D virtual experience. It was more alternate reality than game, and with perhaps a nod to his desire to build a world that would become an essential component of daily existence, Rosedale called his creation Second Life.

For many people, Second Life became just that. Users (residents, in the SL lexicon) could log in, explore the world, build virtual places of their own, shop, find support groups, run businesses, have relationships… in short, everything people do in “real” life. The experience is engaging—so much so that some actually find it as involving as their first lives, if not more so. However, no one would mistake Second Life for reality: visually it resembles animated film—the fidelity is good, but it has nothing on the real world. To become truly immersive, the virtual component must be thoroughly unquestionable—enough to fool our brains into believing that we’re in the grip of the real.

That’s where we’re headed—rushing headlong towards, in fact—and Rosedale is at the fore in getting us there. At the recent Augmented World Expo in Santa Clara, CA, he dropped a few hints as to what his new company, High Fidelity, is cooking up. At its heart, it could be a 3D world that’s virtually indistinguishable from reality, offering a vastly increased speed of interaction, employing body tracking sensors for more life-like avatars, and applying the computing power of tens of millions of devices in the hands of end-users the world over. Within five years, he believes that any mobile device will be able to access and interact with photo-realistic virtual worlds in real time, with no discernable lag.

We’re already seeing the first signs of this. Last summer, I spoke with Kim Libreri at ILM (this was before the Disney purchase) regarding the stunning but now-doomed Star Wars 1313:

We’ve got to a point where many of the techniques that we would have taken as our bread-and-butter at ILM a decade ago are now absolutely achievable in real-time. In fact, you know, a render at ILM—or any visual effects company—can take ten hours per single frame. This is running at thirty-three milliseconds—that’s like a million times faster than what we would have on a normal movie.  But the graphics technology is so advanced now that the raw horsepower is there to do some incredible things.”

And this is today. Within five years, he told me, they’ll achieve absolute, indistinguishable-from-reality photo-realism. Regarding the ability of mobile devices to connect to the type of virtual world Rosedale envisions, he’s a little more conservative. In this case, the bottleneck isn’t computing power but the speed of Internet connectivity, which depends on more factors. Still, Libreri sees that being cleared within 10 years. And that’s it—we’ll have removed the last barrier to delivering hyper-realistic, fully immersive virtual worlds to any device, anywhere. From that point on, the possibilities will be limitless, bounded only by the extent of our imagination.

The implications of this, though, are another matter entirely—and one I’ll take up in my next post. Until then, I’ll leave you with a taste of the possible: Star Wars 1313 videos here…

… and here.

You can read more about Philip Rosedale’s Augmented World Expo talk here.

And you can learn more about the Augmented World Expo here.

I, Avatar

Avatars are all the rage these days. Facebook profile pics, World of Warcraft and EVE Online characters, Second Life and OpenSim personas—these are just a few examples of a growing phenomenon. We all seem to have some sort of digital representation of ourselves that we project into cyberspace—and we spend a fair amount of time designing and customizing them, getting their appearances just right.

Who can blame us, really? After all, they are us, the digital faces we present to the virtual world. That doesn’t mean they have to perfectly replicate our real-world identities, though. In fact, the beauty of designing an avatar is the ability to get creative, to choose exactly who we want to be, to build our ideal selves.

At first blush, it would appear that this is a one-way exchange: through the creative process, we affect the avatar, which we then use to interact with the virtual world. Certainly, with things like static photos and images, this is the case. However, with respect to a 3D digital persona that responds to our commands, it gets a little more complicated. In fact, as several researchers are discovering, situations that we experience virtually through our avatars can impact and even alter our reality.

Palo Alto research scientist Nick Yee dubbed this the Proteus Effect, after the Greek sea god Proteus, who could assume many different forms (and whose name lends itself to the adjective protean—changeable). He first described it in 2007 while studying how an avatar’s appearance and height affected the way people behaved in the virtual world. In his initial research, Yee provided study subjects with avatars that were attractive or unattractive, tall or short, and then watched them interact with a virtual stranger (controlled by one of Yee’s lab assistants). Here’s what Yee’s team discovered:

We found that participants who were given attractive avatars walked closer to and disclosed more personal information to the virtual stranger than participants given unattractive avatars. We found the same effect with avatar height. Participants in taller avatars (relative to the virtual stranger) negotiated more aggressively in a bargaining task than participants in shorter avatars.”

Yee’s work demonstrated clearly that an avatar’s appearance could change how someone acted within a virtual environment and interacted with its residents.

Okay, so what? It’s interesting, but what relevance does it have to the real world?

In 2009, Yee asked the same question: did changes in virtual-world behavior translate to physical reality? He revisited his 2007 study, adding another task: After concluding their virtual interaction, Yee had each participant create a personal profile on a mock dating site and then, from a group of nine possible matches, select the two s/he’d most like to get to know. Without fail, Yee says,

… we found that participants who had been given an attractive avatar in a virtual environment chose more attractive partners in the dating task than participants given unattractive avatars in the earlier task. This study showed that effects on people’s perceptions of their own attractiveness do seem to linger outside of the original virtual environment.”

The Proteus Effect has been credited with more than just creating more aggressive negotiators or making people feel better about themselves: weight loss, substance abuse treatment, environmental consciousness, perception of obstacles… all affected by people’s experiences through their avatars within virtual reality. According to Maria Korolov, founder and editor of the online publication Hypergrid Business—and who’s been studying virtual worlds since their inception—people who exercise within a virtual world…

… will exercise an hour more on average the next day in real life, because they think of themselves as an exercising-type person. It changes the way you think.”

Researchers at the University of Kansas Medical Center back this up. A weight loss study there found that people who lost weight either through virtual or face-to-face exercise programs were more effective at managing their weights if they took part in maintenance programs delivered through Second Life.

Regarding substance abuse, Preferred Family Healthcare, Inc., found that treatment outcomes for participants in their virtual programs were as good as or better than those for people who took part in real-life counseling. More significantly, fewer people dropped out of virtual treatment—vastly so: virtual programs saw a 90 percent completion rate, as opposed to 30-35 percent completion for programs at a traditional, physical facility.

Environmental consciousness may seem like a stretch, but researchers at Stanford University’s Virtual Human Interaction Lab found that people who felled a massive, virtual sequoia used less paper in the real world than those who only imagined cutting down a tree.

And perhaps the most interesting example, a study at the University of Michigan showed that participants who saw that a backpack was attached to an avatar consistently overestimated the heights of virtual hills—but only if they’d created the avatar themselves. Participants assigned an avatar by the researchers were much more accurate in their estimations. Said S. Shyam Sundar, Distinguished Professor of Communications and co-director of the Media Effects Research Laboratory, Penn State, who worked on the study,

You exert more of your agency through an avatar when you design it yourself. Your identity mixes in with the identity of that avatar and, as a result, your visual perception of the virtual environment is colored by the physical resources of your avatar… If your avatar is carrying a backpack, you feel like you are going to have trouble climbing that hill, but this only happens when you customize the avatar.”

Of course, there is a dark side to the Proteus Effect. A study co-written by Jorge Peña, assistant professor in the College of Communication at the University of Texas, Austin, Cornell University Professor Jeffrey T. Hancock, and graduate student Nicholas A. Merola (also at Austin), showed that avatars could be used to prime negative responses in users within a virtual world. In two separate studies, researchers randomly assigned participants dark- or white-cloaked avatars, or avatars wearing physician or Ku Klux Klan-like uniforms. They were also asked to write a story about a picture or play a video game on a virtual team and then come to consensus on dealing with infractions. Those in the dark cloaks or KKK robes consistently showed negative or anti-social behavior. What really causes concern, though, is that they were completely unaware that they’d been primed to do so. According to Peña,

By manipulating the appearance of the avatar, you can augment the probability of people thinking and behaving in predictable ways without raising suspicion. Thus, you can automatically make a virtual encounter more competitive or cooperative by simply changing the connotations of one’s avatar.”

Behavior modification through manipulation of appearance is nothing new: Traditional, face-to-face psychological experiments have shown that changes in dress can affect a person’s behavior or perception of themselves. That this also happens in the virtual world says something interesting about the human brain and its ability to distinguish reality from virtuality.

It should also give us pause. We’re rushing headlong into a brave, new virtual world, and it seems all but unstoppable. This, in itself, is not a bad thing. However, as we move forward, we would do well to proceed deliberately and with caution. Our history is rife with examples of decisions made ignorant of the potential outcome, and good intentions corrupted. If we are going to plunge into the virtual, we must consider the consequences—intended or otherwise—that our choices, and our actions, may beget.

You can read a summary of Nick Yee’s work here.

For a discussion of the University of Kansas study, check this link.

You can read about the Preferred Family Healthcare study here.

The Virtual Human Interaction lab study is here.

Check out the University of Michigan study here.

And you can find a discussion of the potential negative aspects of avatar manipulation here.