Authors: Michelle Meade, Sean Petty, Joseph Hornyak, Josh Marshbanks, Drew Clayborn, Douglas Rakoski, & Eric Maslowski
Physical Medicine & Rehabilitation • School of Medicine • UM 3D Lab• Library System
University of Michigan • Ann Arbor, Michigan
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Conclusions
Health games have the potential to promote
skill development and behavior change;
however, before this can occur, they have to
be accessible and engaging to the target
group. We are currently in the alpha stage of
the development of a health game to promote
self-management skills among the
population of adolescents and young adult
males with SCI. Our poster presentation will
articulate relevant design issues and be
supplemented by the availability of iPod
Touch and iPad devices, so that audience
members can view and play the current
version of the game.
Background
Traumatic SCI
• Affects about 259,000 individuals in the U.S., with nearly 12,000 new injuries each year1
• Mean age is 40.2 years old 1 but about half of new injuries happen to those between the ages of 16 to 29
years old2
• Younger patients:
• Are overwhelmingly male
• Often need serious medical care for the first time in their lives
• Are likely to be single (never-married) and have a high-school education or less
• There is a subset injured through participation in high-risk behaviors / violence
• with lower education and literacy levels and fewer resources
• many are from ethnic and racial minority backgrounds3
• Have a high degree of technical sophistication which can be leveraged to
promote the transfer of knowledge and self-management skills
The Millenial or Net Generation
• Born between 1980 and 2000
• Comfortable with technology and have learning styles adapted for
this medium – specifically active and visual learning styles.4
• Prefer information in short, direct, focused segments4,5
• Can deal with a lot of information
• Have a high ability to multi-task
• Characterized by shorter attention spans, a low threshold for boredom, and resistance to memorization
and busy work
• Want and expect high interactivity, fast pacing and high impact images 6
Secondary Conditions after SCI:
• Often not direct nor necessary consequences of SCI7
• Can be prevented or minimized with appropriate management – including performance of health
maintenance behaviors and compensatory strategies7, 8
• However, research has demonstrated that education alone is seldom sufficient to produce behavior
change or induce adherence with medical recommendations.9
• Effective interventions need to be based around techniques that have been proven effective in
changing behaviors.
• See Table 1 for required behaviors
Self-Management:
• Refers to the ability of an individual with a chronic condition to manage their health and its physical &
psychosocial consequences 10
• Requires the ability to make decisions and lifestyle choices that will optimize functioning and allow for
greater participation in family, social, community and vocational roles and environments11
• An evidence-based approach to managing chronic illness that provides education and skill-building
related to self-monitoring, communication, problem-solving and relaxation
• Proven to be effective for improving health status and health behaviors, increasing self-efficacy,
improving compliance with medication regimens, decreasing pain, and lowering health-care costs 9,12-21
• Protocols have been effectively tailored to meet the needs and concerns of minority populations22-28
• Health Mechanics program created by M. Meade, specifically for individuals with SCI
• Skills include
- Attitude - Self-Monitoring - Problem-Solving
- Communication - Organization - Stress-management
Levels Level 1: Brave New World
- Player wakes up in the hospital and learns that they have a SCI
- Meet with health care providers and learns how to function
- Return home (parent’s home) and must organize their space
Level 2: Helping Hands
- Meet and learn to work with assistant
- Return to hospital for outpatient follow-up
- Need to monitor their health statistics, including stamina, stress and overall health., and perform
required behaviors
- Party at Home
- Key Skills: Communication, Organization
Level 3: Independence Day - Learn to drive
- DVM and get van
- Meet friends at club
- Skill: Problem-solving
Level 4: Viva La Resistance
- Recruited into the Underground Resistance
- Gain a secret identity / live a double life
- Training and missions
- Skill: Multi-tasking
Level 5: The Big Stink
- Final level is the final confrontation with Dr. Schyrnk
- You have to unravel his complex plot and defeat him.
- Once you do, you can continue to access any of the areas of the world, this time using the
additional equipment and skills you have gained along the way.
- Skill: Continue to manage health while save the world…
University of Michigan
Development of a Health Game to Promote Self-Management Skills
Among Adolescents and Young Adult Males with Spinal Cord Injury (SCI)
Issue to
manage
How to manage How to monitor For Planning Consequence
Skin Pressure reliefs (every 30 min) Timer
Recognize that pressure
reliefs have to be done at
regular intervals
continuously throughout the
game
Skin break down
Decreased health
Bowel Bowel program
(1x / day)
• Timer
• Stink clouds
Need to be home/ HQ
May need help
• Bowel accident
• Stink cloud
• Decreased health
• Embarrassment / increased stress
• Impaired communication
Bladder Cathing
(every 4 hours)
Timer
Urine trails
• Need correct supplies
• Need privacy
Bladder accident
Stink cloud
Impaired communication
Impact heath
Fitness Eat healthy things
Drink enough water
Avoid unhealthy food
Exercise
• Remember
behaviors
• Check POS
• Can bring meals from
home
• Can purchase meals
• Go to PT to exercise
• Change in body type
• Impact stamina and health
Stress
Monitor stress levels
Make time for stress-
relieving activities (yoga,
deep breathing)
Enhance cognitive resilience
POS • Regularly monitor
• Take time for stress-
relieving exercises
• Decrease attention / concentration
• Decline in navigation ability
Cognitive
Flexibility /
Resilience
Enhance problem-solving,
attention, memory
POS Plan to work on cognitive
tasks with Dr. Schyrnk
• Impacts health
• Impacts resistance to Chillex 3000
Health Perform all health behaviors
Improve fitness
Decrease stress
Increase Cognitive Resilience
POS • Impacts stress
• Impacts stamina
• Impacts ability to accomplish tasks
Energy /
Fatigue
• Fitness
• Stress
• Health
• Practice / therapy
POS Optimize all behaviors • Impacts navigation
• Influences ability to accomplish
tasks
Table 1: Health Metrics and Required Behaviors
Considerations for Accessibility & Engagement Limited or no arm functioning Age Cost
Slowed physical functioning Cost Humor
Flow of Story Graphics Engagement
Expectations Playability Pace
REFERENCES 1. NSCISC. Spinal Cord Injury Facts and Figures at a Glance. 2011. www.uab.edu/NSCISC. Accessed September 4, 2009.
2. SCI-Info-Pages: Quadriplegic, Paraplegic & Caregiver Resources. 2009; http://www.ohsu.edu/oidd/cca/oodh/projects/HL/index.cfm. Accessed December 30, 2009.
3. Burnett DM, Kolakowsky-Hayner SA, White JM, Cifu DX. Impact of minority status following traumatic spinal cord injury. NeuroRehabilitation. 2002;17(3):187-194.
4. Oblinger DG, Oblinger JL. Educating the Net Generation. In: Oblinger DG, Oblinger JL, eds2005: www.educause.edu/educatingthenetgen. Accessed January 2, 2010.
5. Thietje R, Giese R, Pouw M, et al. How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in
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9. Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus.
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13. Lorig KR. Arthritis self-management: a patient education program. Rehabil Nurs. Jul-Aug 1982;7(4):16-20.
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Objectives: • To develop an electronic game for an iPod Touch or similar device that will teach and / or
promote the use of key skills necessary for managing a spinal cord injury (SCI).
• Ultimately, we hope that playing the game will increase knowledge and confidence, normalize
and promote self-management behaviors, and reduce secondary conditions and health care
costs
• This game application is based on the self-management principles and specifically on the
Health Mechanics program
Results Researchers in the Department of Physical Medicine
and Rehabilitation are collaborating with programmers
and artists at the University of Michigan 3D Lab to
create the health game based on self-management
skills, as articulated in the Health Mechanics program.
Advisory Board members provide critical input and
feedback about game appearance, accessibility,
relevance and enjoyment. A range of issues continue to
arise during development and adaptation of the self-
management program, including the accessibility and
play-ability of the game to individuals with tetraplegia,
development of dialogue that is understandable and
relevant to target population, and the creation of
characters and a story line that players can relate to.
Next Steps •Continued development of levels
•Alpha Continued •Alpha Stage Evaluation
•Beta Stage •Beta Stage Evaluation
•Evaluating efficacy •Marketing / outreach •Adapt for other populations
About Serious games:
• As used in the computer gaming industry, a serious game is
“a game designed for a primary purpose other than pure
entertainment”29
• Serious games based on development of self-management
skills have been developed for asthma, diabetes, surgery
preparation, safe sex negotiation, and promoting nutrition
and physical activities.
• Found to be effective in improving self-care, reducing
symptoms, minimizing secondary conditions, reducing
emergency room visits and decreasing health care costs30
Art Team Programming Team
Stephen Bizer Sean Petty
Austin Cascarelli Sean Sheehan
Stephanie O’Malley Michael Skrzynski
Scott Spangler Alejandro Guerrero*
Andrew Bobo*
Andrew Smith*
Michael Theodore*
* indicates individuals who are not
actively working on the project
