Gamification in Rehabilitation: Finding the “Just-Right-Challenge”

Gamification in Rehabilitation: Finding the “Just-Right-Challenge”

Rachel Proffitt (University of Southern California, USA)
DOI: 10.4018/978-1-4666-9522-1.ch007


Rehabilitation is complex. It involves an ever-changing interaction of the rehabilitation patient with different clinical environments and healthcare providers. Gamification for rehabilitation goes beyond simply creating a “fun” and “exciting” application or environment in which to complete rehabilitation exercises and interventions. A delicate balance of the demands of the task and the patient's abilities must be achieved. High-cost and commercially available systems are limited in their applications to gamification for rehabilitation. Furthermore, the created game and system must be usable across treatment settings and at different phases in the recovery process. Insurance companies are also requiring more data from rehabilitation therapists and therapists have minimal time to be able to learn and use a game. Pairing low-cost devices with customized games will allow for better “fit” with each patient, provide appropriate data to therapists and insurance companies, and eventually lead to effective games for rehabilitation.
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Healthcare, and specifically rehabilitation, entails complex interactions between multiple persons (doctor, patient, caregiver), multiple settings (hospitals, clinics, the home), and varying stages of diseases (preventive, acute, chronic). The rehabilitation therapist (occupational, physical, and speech) must take the patient’s medical history, current diagnosis, social support, insurance coverage, and a myriad of other factors into consideration when determining the plan of care. “Client-centered care” has been the backbone of therapy professions for decades and the concept is becoming more common in medicine and nursing. The idea of individualized medicine and patients taking a more active role in their health care is critical to rehabilitation. The sense of autonomy, or the capacity to make an informed decision, lies not only as a moral obligation in healthcare, but a driving force of a sound game (Sheldon & Filak, 2008). Gamification of rehabilitation means capitalizing on the concept of autonomy, as well as other aspects of engagement and motivation. This chapter is structured into four sections. The first section will provide Background literature and definitions to guide the discussion of gamification in rehabilitation. Building on the literature, the second section will present various issues, controversies and problems surrounding the current state of gamification in rehabilitation healthcare. The third section will provide a discussion of potential solutions to the barriers and issues in the field. The fourth section and final section will build on the solution and provide specific recommendations for healthcare providers, rehabilitation healthcare services consumers, and game designers/programmers/engineers. The objectives of the chapter are to:

  • 1.

    Review of the current state of gamification in rehabilitation healthcare.

  • 2.

    Define common terminology used in the fields of rehabilitation healthcare and game design/learning and discuss concepts that support gamification in rehabilitation healthcare.

  • 3.

    Discuss the challenges and limitations of gamification in rehabilitation healthcare.

  • 4.

    Explore future opportunities for gamification in rehabilitation, including recommendations for healthcare providers, rehabilitation consumers, and game designers/programmers/engineers.

Key Terms in this Chapter

Tele-Rehabilitation: Rehabilitation interventions delivered across a virtual medium and involves the interaction of one or more rehabilitation healthcare professionals with a rehabilitation consumer and/or their social support.

Just-Right-Challenge: The dynamic nature of an experience that creates an appropriate challenge level of the task that is suitably matched with the skill level of the individual. The level of challenge can be graded up and down as the performance of the individual changes over time.

Engagement: Made up of four concepts including flow, absorption, presence, and immersion. For a game or activity to be truly engaging, it must provide an aspect of each concept. The level of engagement of an individual will vary depending on their tendencies towards each concept.

Rehabilitation: A complex process with the goal of returning a patient to the highest level of function, well-being, and quality of life possible.

Measurement of Performance: An objective assessment of one or more aspects of skill and function within a specific context. This is required in order to validate rehabilitation services for payment and progress a patient through rehabilitation interventions.

Flow: A state of being when the challenge of the task is suitably matched with the skill level of the individual. Being in a flow state means that perceptions of reality are distorted and the individual has focused most attention to the task at hand.

Gamification: Creating a totally engaging experience for a player by matching the task demands to the level of ability of the player with appropriate feedback and interactive elements.

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