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.

 

 

Looking to get fit? Then get your videogame on!

The United States population is growing, and I don’t mean our numbers. There’s no delicate way to say this, but too many of us are fat—really fat. Obesity in this country is an epidemic: about a third of all adults and 17 percent of children—three times the rate of 20 years ago—are obese, and not a single state in the union has met the Healthy People 2010 goal to lower obesity rates below 15 percent. Obesity increases the risk of heart disease, type 2 diabetes, cancer… the list goes on. And the economic cost is staggering: obesity hammers us with a $200 billion medical bill, and it’s only getting worse. But most distressing of all, you know all those happy, carefree kids you see everyday? They’ll probably die before you do. That’s right, for the first time in US history, today’s generation of  kids probably won’t outlive their parents.

Okay, now that you’re paying attention, here’s the good news: The power to end obesity is in our hands. All we have to do is eat better and get more exercise—and there’s a great tool out there that can help. Anyone? Anyone?

You guessed it: videogames. Specifically, exergaming.

Active videogames have been around since 1982, but didn’t really take off until the introduction of Dance Dance Revolution in the early 2000s. The game’s surprising popularity tore the exergaming market wide open, and gave birth to the Nintendo Wii, Xbox 360 Kinect, and Playstation Move—all variations on a theme, and with the laudable goal of getting average Americans off their asses and moving.

And boy do we move. Kung Fu, boxing, cycling, tennis, bowling, dancing, track and field—the list of options is virtually endless, and more and better games come to market every year.

“Okay,” you ask, with perhaps a hint of cynicism, “but do they really work?”

According to researchers at Brigham Young University and the University of Massachusetts, they do. They found that kids who played exergames for 10 minutes got a workout as good as or significantly better than a 10-minute walk at three-miles-per hour on a treadmill. In the March 7 issue of Archives of Pediatrics and Adolescent Medicine, Bruce Bailey, PhD (Brigham Young) and Kyle McInnis, ScD (U. Mass), wrote that

Exergaming has the potential to increase physical activity and have a favorable influence on energy balance, and may be a viable alternative to traditional fitness activities.”

And guess which is more fun. In fact, the researchers noted that entertainment appeal is exactly what makes the games so effective: Kids enjoy them, and are more likely to stick with the program—and reap the benefits—as a result. Now before you accuse me of hailing videogames as a panacea for US health issues, no one believes that exergaming can, or should, replace regular physical activity. As McInnis and Bailey noted,

Although exergaming is most likely not the solution to the epidemic of reduced physical activity in children, it appears to be a potentially innovative strategy that can be used to reduce sedentary time, increase adherence to exercise programs, and promote enjoyment of physical activity.”

George Velarde agrees. He’s the chair of the P.E. department at Sierra Vista Junior High in Canyon Country, CA. In 2003, he added an exergaming room to the school’s fitness center, and had this to say about it:

The kids don’t even know they’re working out, but they are working out even more at moderate to vigorous levels because of exergaming.”

Dr. Adam Noah—Technical Director of Long Island University’s ADAM Center and MoCap Lab, and an avid (and quite accomplished) gamer—plays DDR regularly, and he can tell you from experience that it’s much more like working out than gaming:

So when I play at this level [the highest level], I’m reaching 15 times my resting metabolism. That’s roughly equivalent to running on a treadmill at 10, 12 mph. People don’t do that. Yet I’m enjoying playing the game.”

And running on a treadmill is, in a word, boring.

Alright, so what’s the point of all this anyway? Just this: videogames, rather than being evil devices that turn people into couch potatoes, can actually play a key role in helping us get healthier. They may never replace real-world physical exercise, but when was the last time you broke a sweat watching TV? Think about it.

The LA Times has an article on exergaming studies here…

…and WedMD has one on games and weight loss here.

For more on exergames and physical education, check out this link.

You can find a collection of news articles related to exergaming here.

There’s a discussion about exergaming research here.

Check out this article about gaming and fitness…

…and this one, too.

And for those interested, this link gives a brief history of exergaming.

Videogames will save us: G4H wrap-up, part 2

What do videogames have to do with Parkinson’s disease? Quite a lot, actually. According to recent research, active video games like Dance Dance Revolution, Wii Fit and others can help increase strength, cardiovascular fitness, confidence and mental awareness, and decrease reaction time in subjects who train with them. Why are these areas particularly important? They’re the main risk factors for falling—which is primarily what people with Parkinson’s die from. When I interviewed Dr. Adam Noah, Technical Director of the ADAMCenter and MoCap (motion capture) lab at Long Island University, he had this to say:

One of the major things is falling down can cause a cascade of events, which really ultimately can lead to death… they fall down, they break their hip, complications add up, and that’s eventually what puts them in a home. And if you can reduce the risk of falling, you can actually prolong somebody’s life.”

By training subjects on DDR, his group discovered improvement in all the risk factors, which should reduce the number of falls they have.

In related news, California-based Red Hill Studios was awarded two NIH grants (totaling $1.1 million) to develop and test videogames for treating Parkinson’s disease and cerebral palsy. In a joint press release from Red Hill Studios and the UCSF School of Nursing, here’s what Bob Hone, Red Hill Studios’ creative director, said about the grants:

These two grants are the start of what may become a massive new area of health care. The emergence of low-cost motion sensing technologies has created an entirely new type of rehabilitation: physical therapy games. As a baby-boomer with a bad back, I know firsthand that physical therapy can be boring and tedious. These games will help make rehab fun and productive.”

There’s a concept for you: fun and productive rehab. If either of these two groups demonstrate even half of what their research promises, they will have proven beyond a doubt that videogames can change, and even save, lives.

Check out the ADAMCenter here…

… and Red Hill Studios here.

Read the complete Red Hill Studios press release here.

Learn more about the serious games initiative here…

… and Games For Health here.

Parkinson’s, brain injury and videogames

Gearing up for Games For Health ’11 in Boston, tomorrow through Thursday. Of particular interest are several sessions addressing the effects of active videogames on people with Parkinson’s disease or acquired brain injury. For some time now, researchers have been delving into the ability of games like Wii Sports to treat neurological disorders and injuries. Among the presenters at G4H are Red Hill Studios and the ADAMCenter. Red Hill Studios (who received funding for a clinical trial from the NIH) and the School of Nursing at UCal San Francisco are developing games to treat Parkinson’s. The ADAMCenter is a research and teaching lab at Long Island University’s Brooklyn campus, focusing on human movement. Researchers there are looking at off-the-shelf games (Dance Dance Revolution, in particular) for neurological rehabilitation.

Learn more about Red Hill Studios here…

… and the ADAMCenter here.

For more info about the G4H schedule, click here.