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Videogames
                       a “serious” health
                          technology
                                            Stuart Smith

Monday, 11 July 2011
Background


                       Games for fall prevention



                              Games for stroke rehabilitation


                                          Building an Australian Serious
GameTech 2011
                                          Games for Health industry
Monday, 11 July 2011
But before all of that......

                            Video games have often received
                            bad press with respect to health

                           increased aggression and violence
                                 addiction to gameplay
                             increased sedentary behaviour
                                   epileptic seizures
                       Wii knee, haemothorax and ruptured tendons
GameTech 2011
Monday, 11 July 2011
However.....          games can be seriously considered




GameTech 2011
Monday, 11 July 2011
Exergames for neuroplasticity




GameTech 2011
Monday, 11 July 2011
spinal cord rehabilitation




GameTech 2011
Monday, 11 July 2011
Ethnography




                                                                Cognitive



                                                                             Social
                                                 Falls
                                                         Technology Platform


                                Technology Research for Independent Living
            Develop technology for in-home monitoring of factors associated
            with falls, cognitive function and social connectivity in older adults
GameTech 2011
Monday, 11 July 2011
Use of technology for monitoring health and
                          promoting independent living in older adults.

                                Regional, rural and remote areas
             Australian
               TRIL




GameTech 2011
Monday, 11 July 2011
Can existing technology
                       facilitate independent living in
                                 older adults?




GameTech 2011
Monday, 11 July 2011
Television most familiar of all.



                           Everyday objects are digital




GameTech 2011
Monday, 11 July 2011
Can we use the television to facilitate
                               independent living?




GameTech 2011
Monday, 11 July 2011
Here’s a significant health issue
                                                        Falls are a major factor
                                                      for reduced independence
                                                             in older adults

                                                       1/3 community dwelling
                                                      older adults fall each year

                                                      Total health cost to NSW
                  !"#$%&'()#&'#$*&)$+,-.$,/$
          0*11-$%&2345$67,&8$91)#4$:#,;1#$
                                           $
                                           $
                                                      alone in 2006/2007 $553M
             (&$<#=$>,3."$?*1#-$@AABCADE

                                                    $18,454 per hospital admission
                           !"#$%&'("(&")*+",$-.(/




GameTech 2011
Monday, 11 July 2011
exercise programs that differ greatly in their aims a
  Health and School of Public Health, University of Sydney, Sydney, Australia;

  We know fall risk can be
  w
    Falls and Balance Research Group, Prince of Wales Medical Research      tent. Meta-analysis should therefore involvein the
                                                                                Interventions for preventing falls in older people living explor
  Institute, University of New South Wales, Sydney, Australia; §Clinical Age                        community (Review)
                                                                            whether these factors ‘‘explain’’ (are associated w
  reduced by exercise
  Research Unit, Kings College Hospital, London, United Kingdom; and
  k
    Department of Geriatric Medicine, Prince of Wales Hospital, Sydney,          Gillespie
                                                                                           the effect of exercise Gates S, Cumming 7,8
                                                                            mates ofLD, Robertson MC, Gillespie WJ, Lamb SE, programs.RG, Rowe BH
  Australia.                                                                      A Cochrane review of fall prevention strategi
  Address correspondence to Dr. Catherine Sherrington, The George Institute ducted separate meta-analyses on different forms
  for International Health, PO Box M201, Missenden Road, Sydney NSW         cise and concluded that some exercise programs can
  2050, Australia. E-mail: csherrington@george.org.au of Falls: A Systematic Review
  Effective Exercise for the Prevention                                     falls in community dwellers (e.g., home exercise pro
  and Meta-Analysis
  DOI: 10.1111/j.1532-5415.2008.02014.x                                     balance and strength training, a Tai Chi group progr
   Catherine Sherrington, PhD,Ã wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w
   Robert D. Herbert, PhD,Ã Robert G. Cumming, PhD, z and Jacqueline C. T. Close, MDw k
  JAGS 56:2234–2243, 2008
  r 2008, Copyright the Authors
  Journal compilation r 2008, The American Geriatrics Society                                                                                                                                                                                0002-8614
  OBJECTIVES: To determine the effects of exercise on falls        Key words: falls; exercise; meta-analysis
  prevention in older people and establish whether particular
  trial characteristics or components of exercise programs are
  associated with larger reductions in falls.

       High dosage of exercise is required (eg > 50 hrs or twice/week for 25 weeks).
  DESIGN: Systematic review with meta-analysis. Random-
  ized controlled trials that compared fall rates in older peo-                                                            This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
  ple who undertook exercise programs with fall rates in                                                                   2009, Issue 4
  those who did not exercise were included.
  SETTING: Older people.                                           T     he development and implementation of effective and
                                                                         cost-efficient strategies to prevent falls in older people
                                                                   is an urgent global health challenge. In developed countries,
                                                                                                                                                                              http://www.thecochranelibrary.com



  PARTICIPANTS: General community and residential care.

                      Video games might offer a way to ensure
                                                                   life expectancy for people aged 65 years old is approxi-
  MEASUREMENTS: Fall rates.                                        mately 17 years for men and 21 years for women. At least
  RESULTS: The pooled estimate of the effect of exercise           one-third of people aged 65 and older fall at least once

                             compliance with exercise
  was that it reduced the rate of falling by 17% (44 trials with   annually,1 and falls account for more than half of the injury-
  9,603 participants, rate ratio (RR) 5 0.83, 95% confidence        related hospitalizations for older people.2 Fall rates in the
  interval (CI) 5 0.75–0.91, Po.001, I2 5 62%). The great-
GameTech 2011 of exercise on fall rates (RR 5 0.58, 95%
  est relative effects
                                                                   general older population are reported Interventions1.2The Cochrane Collaboration. Publishedthe community & Sons, Ltd.
                                                                                 3
                                                                                                              to be for preventing falls in older people living in by John Wiley (Review)
                                                                                                              Copyright © 2009
                                                                                                                               falls per
                                                                   person year.
  CI 5 0.48–0.69, 68% of between-study variability ex-
Monday, 11 July 2011
Will older adults play video games?

                       Brand (2009)   “Interactive Australia 2009”
                         National survey of 1614 households


         1034 individuals aged 36-50, 58% play video games

                       912 aged 51-65 52% play video games

                                 221 aged 65+, 51% play video games




GameTech 2011
Monday, 11 July 2011
like Dance Dance Revolution




GameTech 2011
Monday, 11 July 2011
Dance Dance Revolution to
           reduce fall risk and increase
                physical activity




GameTech 2011
Monday, 11 July 2011
Use DDR to measure                 Mrs Smith, it looks like you have

        fall risk over time               been a bit unsteady on your feet
                                           lately. Is there anything we can
                                                       do for you?




                              Fall risk
        Provide health
   information feedback to
    older person and their
                                          Date
       support network


       Videogames as a
    telehealth technology
GameTech 2011
Monday, 11 July 2011
Where to from here?

      Instructor




during quiet stance is
 the feet (normalized
d is shown to be a
ers.33 Subjects were
 ossible, for 1 minute
e data from the force
uter with a sampling
 ute the COP in the
ns, respectively.


 detect outliers and
ted for baseline and
sttest using 1-way
  GameTech 2011
 as found, pairwise
 ed using the July 2011
  Monday, 11 Tukey
Video Games for Independent
  Living: An NBN Technology

    Older adults/ people with
                                                               DDR
          health issuesCognitive
       Physical




                                            ViGIL:ANT
                                   Social
                                                        strategy, memory logic
                                                                games




          Videogame designers/
          developers/publishers
                                                        casual, online games
GameTech 2011
Monday, 11 July 2011
A recent example

        Upper limb function following
        stroke is a major barrier to
        independence




GameTech 2011
Monday, 11 July 2011
How do we build a Games for Health industry?

                          WTF?                blah blah
                                                 blah




         Game
                                                             Health
       developers
                                                          researchers
GameTech 2011
Monday, 11 July 2011
Market size
                       The number of people in NSW alone aged 65
                       and older is estimated to be just over 931,000

                       Every year more than 60,000
                       Australians have a stroke,

                       The cost of strokes to the Australian economy
                       is in excess of $2 billion per annum

  Distribution?                                              Revenue model?

                               Certification?
GameTech 2011
Monday, 11 July 2011
Thank you
                                              for hanging
                                               on till the
                       s.smith@neura.edu.au   bitter end.
GameTech 2011
Monday, 11 July 2011

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GameTech

  • 1. Videogames a “serious” health technology Stuart Smith Monday, 11 July 2011
  • 2. Background Games for fall prevention Games for stroke rehabilitation Building an Australian Serious GameTech 2011 Games for Health industry Monday, 11 July 2011
  • 3. But before all of that...... Video games have often received bad press with respect to health increased aggression and violence addiction to gameplay increased sedentary behaviour epileptic seizures Wii knee, haemothorax and ruptured tendons GameTech 2011 Monday, 11 July 2011
  • 4. However..... games can be seriously considered GameTech 2011 Monday, 11 July 2011
  • 5. Exergames for neuroplasticity GameTech 2011 Monday, 11 July 2011
  • 6. spinal cord rehabilitation GameTech 2011 Monday, 11 July 2011
  • 7. Ethnography Cognitive Social Falls Technology Platform Technology Research for Independent Living Develop technology for in-home monitoring of factors associated with falls, cognitive function and social connectivity in older adults GameTech 2011 Monday, 11 July 2011
  • 8. Use of technology for monitoring health and promoting independent living in older adults. Regional, rural and remote areas Australian TRIL GameTech 2011 Monday, 11 July 2011
  • 9. Can existing technology facilitate independent living in older adults? GameTech 2011 Monday, 11 July 2011
  • 10. Television most familiar of all. Everyday objects are digital GameTech 2011 Monday, 11 July 2011
  • 11. Can we use the television to facilitate independent living? GameTech 2011 Monday, 11 July 2011
  • 12. Here’s a significant health issue Falls are a major factor for reduced independence in older adults 1/3 community dwelling older adults fall each year Total health cost to NSW !"#$%&'()#&'#$*&)$+,-.$,/$ 0*11-$%&2345$67,&8$91)#4$:#,;1#$ $ $ alone in 2006/2007 $553M (&$<#=$>,3."$?*1#-$@AABCADE $18,454 per hospital admission !"#$%&'("(&")*+",$-.(/ GameTech 2011 Monday, 11 July 2011
  • 13. exercise programs that differ greatly in their aims a Health and School of Public Health, University of Sydney, Sydney, Australia; We know fall risk can be w Falls and Balance Research Group, Prince of Wales Medical Research tent. Meta-analysis should therefore involvein the Interventions for preventing falls in older people living explor Institute, University of New South Wales, Sydney, Australia; §Clinical Age community (Review) whether these factors ‘‘explain’’ (are associated w reduced by exercise Research Unit, Kings College Hospital, London, United Kingdom; and k Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Gillespie the effect of exercise Gates S, Cumming 7,8 mates ofLD, Robertson MC, Gillespie WJ, Lamb SE, programs.RG, Rowe BH Australia. A Cochrane review of fall prevention strategi Address correspondence to Dr. Catherine Sherrington, The George Institute ducted separate meta-analyses on different forms for International Health, PO Box M201, Missenden Road, Sydney NSW cise and concluded that some exercise programs can 2050, Australia. E-mail: csherrington@george.org.au of Falls: A Systematic Review Effective Exercise for the Prevention falls in community dwellers (e.g., home exercise pro and Meta-Analysis DOI: 10.1111/j.1532-5415.2008.02014.x balance and strength training, a Tai Chi group progr Catherine Sherrington, PhD,Ã wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w Robert D. Herbert, PhD,Ã Robert G. Cumming, PhD, z and Jacqueline C. T. Close, MDw k JAGS 56:2234–2243, 2008 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614 OBJECTIVES: To determine the effects of exercise on falls Key words: falls; exercise; meta-analysis prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls. High dosage of exercise is required (eg > 50 hrs or twice/week for 25 weeks). DESIGN: Systematic review with meta-analysis. Random- ized controlled trials that compared fall rates in older peo- This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library ple who undertook exercise programs with fall rates in 2009, Issue 4 those who did not exercise were included. SETTING: Older people. T he development and implementation of effective and cost-efficient strategies to prevent falls in older people is an urgent global health challenge. In developed countries, http://www.thecochranelibrary.com PARTICIPANTS: General community and residential care. Video games might offer a way to ensure life expectancy for people aged 65 years old is approxi- MEASUREMENTS: Fall rates. mately 17 years for men and 21 years for women. At least RESULTS: The pooled estimate of the effect of exercise one-third of people aged 65 and older fall at least once compliance with exercise was that it reduced the rate of falling by 17% (44 trials with annually,1 and falls account for more than half of the injury- 9,603 participants, rate ratio (RR) 5 0.83, 95% confidence related hospitalizations for older people.2 Fall rates in the interval (CI) 5 0.75–0.91, Po.001, I2 5 62%). The great- GameTech 2011 of exercise on fall rates (RR 5 0.58, 95% est relative effects general older population are reported Interventions1.2The Cochrane Collaboration. Publishedthe community & Sons, Ltd. 3 to be for preventing falls in older people living in by John Wiley (Review) Copyright © 2009 falls per person year. CI 5 0.48–0.69, 68% of between-study variability ex- Monday, 11 July 2011
  • 14. Will older adults play video games? Brand (2009) “Interactive Australia 2009” National survey of 1614 households 1034 individuals aged 36-50, 58% play video games 912 aged 51-65 52% play video games 221 aged 65+, 51% play video games GameTech 2011 Monday, 11 July 2011
  • 15. like Dance Dance Revolution GameTech 2011 Monday, 11 July 2011
  • 16. Dance Dance Revolution to reduce fall risk and increase physical activity GameTech 2011 Monday, 11 July 2011
  • 17. Use DDR to measure Mrs Smith, it looks like you have fall risk over time been a bit unsteady on your feet lately. Is there anything we can do for you? Fall risk Provide health information feedback to older person and their Date support network Videogames as a telehealth technology GameTech 2011 Monday, 11 July 2011
  • 18. Where to from here? Instructor during quiet stance is the feet (normalized d is shown to be a ers.33 Subjects were ossible, for 1 minute e data from the force uter with a sampling ute the COP in the ns, respectively. detect outliers and ted for baseline and sttest using 1-way GameTech 2011 as found, pairwise ed using the July 2011 Monday, 11 Tukey
  • 19. Video Games for Independent Living: An NBN Technology Older adults/ people with DDR health issuesCognitive Physical ViGIL:ANT Social strategy, memory logic games Videogame designers/ developers/publishers casual, online games GameTech 2011 Monday, 11 July 2011
  • 20. A recent example Upper limb function following stroke is a major barrier to independence GameTech 2011 Monday, 11 July 2011
  • 21. How do we build a Games for Health industry? WTF? blah blah blah Game Health developers researchers GameTech 2011 Monday, 11 July 2011
  • 22. Market size The number of people in NSW alone aged 65 and older is estimated to be just over 931,000 Every year more than 60,000 Australians have a stroke, The cost of strokes to the Australian economy is in excess of $2 billion per annum Distribution? Revenue model? Certification? GameTech 2011 Monday, 11 July 2011
  • 23. Thank you for hanging on till the s.smith@neura.edu.au bitter end. GameTech 2011 Monday, 11 July 2011