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.

 

 

Forget the gym and get Active!

It’s official: summer vacation’s ended, taking with it the days of unscheduled freedom and marking a return to the sharp contrast between weekday and weekend—something that I, as a self-employed writer, don’t experience as keenly when my son’s not in school. As such, I thought it appropriate that I bring my long blogging hiatus to a close and get back to business (plus, people were beginning to wonder what happened to me, and I couldn’t give them a good answer).

Hand-in-hand with this, I decided to pick up my exercise routine where I’d left it languishing about two months ago, so I woke up early this morning, threw on some sweats, and got to it. My trainer seemed happy that I was back, and didn’t even lay the “nice-to-see-your-lazy-butt-again, didn’t-know-you-still-lived-around-here” guilt trip on me. He ran me through a full workout—cardio, strength training, upper and lower body, core. I did 35 exercises (including eight stretches) in just under 48 minutes, averaged a heart rate of 136 bpm, and burned 223.9 calories.

And I did it all by playing a videogame.

Okay, an exergame, really. Electronic Arts’ Sports Active 2, to be exact. And I can tell you, though it’s a game by classification, it’s serious exercise by any other measure. Designed by both game developers and certified professional trainers, it includes more than 70 different exercises and fitness activities that target all the major muscle groups—core, upper and lower body—and cover everything from flexibility and strength training to cardio and aerobic health. You can pick from several canned workouts (designed, again, by professional trainers), have EASA 2 create a custom workout based on the amount of time you have and what area you want to work, or build your own to meet your specific needs. And the system tracks everything: heart rate (there’s a monitor included in the package), calories burned, miles traveled, reps, number and duration of workouts, lifestyle and nutrition info (through surveys you can fill out). There’s even a virtual personal trainer (two, actually) to guide you through the exercises and help keep you motivated.

“Alright,” you say, with perhaps a degree of skepticism, “but does it really work?” In a word, yes. For those who prefer a longer answer, it ranges from “provides an excellent workout” to “kicks my ass six ways to Sunday.” And I love it. I’ve lowered my resting heart rate, gotten stronger and more physically fit, gained energy, and even rehabbed an injury to my arm—and, heaven forefend, I’ve had fun doing it. The variety keeps me engaged, and the results keep me coming back for more.

As a country, we all need to exercise more. According to the CDC, almost 36 percent of US adults and 17 percent of our children are obese. Obesity currently costs us around $140 billion a year, and it’s rising: by some estimates, additional healthcare spending on obese Americans could reach more than half a trillion dollars over the next 20 years. If you’re still standing, you might want to read that again. I don’t know about you, but I can’t even conceive of that amount. But I do know this: it’s absolutely critical that we reverse this trend. Our physical and economic survival depends on it—and getting us off the couch and moving is a good place to start.

And if videogames can do that, maybe they’ll save us after all.

For more on EA Sports Active 2, check out their website here (though be advised that it’s an older title, so you may be better off just Googling it).

To check out the CDC’s statistics on obesity, click here.

And here’s an LA Times article on obesity in the US.

Home fitness gets Active

This morning, I woke up, put on sweats and a T-shirt, and got my ass moving. I ran, practiced my soccer skills, got on the skateboard, did some dedicated strength training, cardio, and stretching, even set up with a sparring partner and worked on jabs, hooks and uppercuts—all in the space of about 30 minutes, and all in the comfort of home.

How is this possible, you ask? Do I have an athletic facility in the basement, complete with my own personal trainer? No… well, not exactly. What I’ve got is a Wii and Electronic Arts’ most advanced exergame, EA Sports Active 2, which transforms the humble gaming console into a state-of-the-art fitness machine—and it comes with not one but two personal trainers dedicated to the sole purpose of keeping me healthy.

The beauty of EASA 2 comes from two factors: the variety of available exercises and the flexibility to combine them into a virtually limitless array of workout routines. You can target upper body, lower body, strength, balance, coordination, aerobics, your legs, your core… it was actually a bit overwhelming, at first. So I had my personal trainer create a workout for me. EASA 2 asked me a few simple questions—how long did I want to exercise, at what intensity, and what did I want to focus on (I chose a general workout for strength and conditioning)—and a few clicks of the Wiimote later I was ready to roll.

And I loved it. EASA 2’s environment is visually engaging and transforms with each exercise (sometimes, as with running, even while you’re exercising). The exercises are fun to do, they got me working hard, and they change frequently enough to keep things interesting—thus avoiding the often mind-numbing repetition that causes people to abandon many traditional workout programs. Your trainer is always there, helping you through your workout and providing encouragement and motivation. And most importantly, you’re there as well—in the form of an avatar that you create as part of your personal profile. This is powerful: Not only do you see yourself performing the exercises, you get immediate visual feedback as to how well you’re doing. I identified with my avatar, and really wanted it to succeed—and often pushed myself a little harder—running faster than my trainer, timing jumps better or trying to jump higher—to ensure that it did.

But is it as good as real exercise? No. It is real exercise—as real as any of the glut of exercise videos on the market today (if not more so). EASA 2 goes far beyond what any video can offer, though. Consider this: an exercise video is static. It’s always the same length, looks the same each time you watch it, you perform the same exercises in the same order for the same duration… in a word, boring. EASA 2 provides a degree of variety and gives you a level of customization beyond even the best video’s wildest aspirations. You can create and revisit favorite routines as often as you like, or you can go through an entirely different routine every time you workout. The choice is yours—but as with any form of exercise, what you get out of it depends entirely on what you put in. I can tell you this: I gave each exercise everything I had, and by the end I’d done some serious work.

Now let’s see how I feel tomorrow…

To learn more about EASA 2, navigate over to EA’s website 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.

Games for health?

Safe sex, clinical depression, PTSD, knee replacement rehab, Parkinson’s, acquired brain injury, nutrition, weight loss, diabetes, Cystic Fibrosis, nightmares, cancer, dancing, HIV, emergency response. What do these have in common? They’re all subjects of videogames, and are all featured topics at the seventh annual Games For Health conference in Boston next week.

The Games For Health conference is one of the largest gatherings of researchers, medical professionals and game developers interested in learning about and shaping the impact that videogames have on health and health care. For three days (5/16-5/19), several hundred people will hear how videogames and game technology are being used across a variety of disciplines—neuroscience, healthcare, defense, game development, pediatric medicine, and behavioral health among them. There are games for things like weight loss, smoking cessation, disease management, and pandemic preparedness, and game technology has been adapted to help soldiers recover from traumatic stress, train paramedics in emergency response, and speed up post-injury rehabilitation.

For more information about Games For Health, follow this link:

About Games For Health

And be sure to preview the conference schedule here:

G4H ’11 schedule

Check back here throughout the week, as I’ll be posting updates from the conference.