Serious-gaming, video games as a therapeutic approach for patients

Bruno Bonnechère‘s interview

What is the topic of your research?

I am interested in the use and integration of new technologies in rehabilitation. This is a broad and emerging field. I am focusing on the use of commercial and specially developped video games. There are many ways to integrate the games in the conventional revalidation. We choose to work only with widely available and low cost material. Therefore the solutions that we are currently developing will be as accessible as possible for patients and clinicians. We are mainly working with the “Kinect” camera and the force plate Balance Board that have been developed by the video game industry. They are thus produced on a large scale and at reasonable cost (approximately one hundred euro for each device). One part of my thesis was to validate the use of this equipment to perform functional assessments of patients during rehabilitation exercises. Despite the low price of these devices, we get very satisfactory results in comparison to “gold standard” devices used in laboratory. We are currently working on a feedback system that corrects in real time the movements performed by the patient during the rehabilitation exercises, therefore there are sure to do them correctly. All the motion performed by the patients are recorded and reports are sent to the therapist to monitor the evolution of the patients during the full rehabilitation process.

What is the added value of serious
games in the treatment?

There are several positive aspects related to the integration of serious games in the conventional treatment. The first point is that it allows more possibility in the treatment and more exercises for both patients and clinicians. The exercises that the patients
have to perform in the games are the same as the one the patients have to perform during conventional rehabilitation exercises. Butthe fact to perform those exercises in games provides new opportunities. From a motivational point of view it is obvious that games
are a nice and positive solution to stimulate the patients. All studies agree on this positive effect. Another positive point is the fact that when patients are playing, they are less focusing on the movements they need to perform and can therefore performed more repetitions before getting tired of the exercises. Studies have shown that patients perform on average 10 times more repetitions within video games than during conventional rehabilitation. In rehabilitation it is well known that the number of repetitions is directly related to patient outcome (especially in neurological rehabilitation), we can easily understand the possibilities of this kind of intervention. But in order to be effective the exercises must be performed correctly. The use of video game coupled to a motion analysis system is also and added value. Clinician could check that patients are really performing their exercises at home but most important is that they can control if the motions are performed correctly! A last positive point is the fact that these games are close to double-task training. We know that this kind of exercises is a good way of developing new connections in the brain. Studies using functional MRI showed changes in the cerebral cortex before and after training using video game.

Some will argue that with this type of intervention (serious-gaming) the physiotherapist risks to loose their
kwow-how. What would you answer to them?

Paradoxically, while we are living surrounded and helped by technology, some people are still reluctant and fearful about to use of new technology in their profession, especially in the healthcare system. In a way it is natural to have this sense of protectionism and to say and think that machines will never replace the know-how and human skills. Although I am convinced that it will happen one day, and it is in fact already the case in many domains, the debate is not there. The technology is definitely not an enemy but a precious help. If we take a look at the evolution of medicine over the last thirty years, it is clear that medical doctors are using more and more technology to provide precise diagnosis and improve the quality of patient’s care. I think that nobody complains about the fact that we can obtain perfect pictures of coronary vessels in a few milliseconds without any risk for the patients, to perform most of the abdominal surgery using laparoscopic techniques or that it is possible to remove brain tumors without surgery… Technology is already used and will be more and more used in the future. Rehabilitation follows, slowly, and will follow this movement. Of course this does not mean that the clinician will lose their know-hows and knowledges. I think exactly the opposite! In fact, the new data coming from such kind of system must be interpreted and well understood by the clinicians. This will enable him to adapt the treatment based on those results but also based on his expertise, knowledges and clinical perceptions when he is working and performing exercises with the patient. It is also clear that the final decision of treatment will always be taken by the clinician, not by technology. Clinician is charge of the patients, technology is a help and a precious support to help clinician, he is free to do what he wants with this help!