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Getting better is a (digital) game. What gamification means for patients

Can playing a videogame replace a pill? As gamification enters the health sectors, digital therapies promise to change the way we heal. And the role of patients in the process.

To understand how gamification is entering the world of e-health you have to imagine a scene. A little girl takes a selfie: a crown, a touch of lipstick and she is transformed into a princess. Meanwhile, her little brother is practicing with a lightsaber: Watà, the strongest ninja in the world, is teaching him how to use it.

When gaming is not just fun

But the space in which all this happens is the waiting room of one of 600 dental offices, 3 hospitals and 8 Italian dental clinics where the kids have stopped thinking about the drill. But the App they use (called Super Powers) is not provided just for entertainment. The game, in fact, has been designed to prevent the fear from affecting correct intervention; and to ensure that the prescribed therapy is practiced thoroughly at home.

Gamification has entered the health sector

Gamification is the transposition of logics that belong to the gaming world in the production of non-gaming services. That is: enigmas, level crossings, competition to get to a reward that become methods to make people do specific activities in the most diverse sectors. From management training to school activities, gamification has established itself progressively over the years. But only now it has literally exploded also in the health sector, the last one to be touched by the digital disruption. And last November, Research N Reports market research firm calculated that by 2022 the gamification business in healthcare will grow by 55.1%.

Italy is part of this “game”

In the process of gamification of healthcare, Italy is present. For example, the start up Brave Potions is based in Cagliari: and it invented, financed and produced the App Super Poteri. «It reduces fear in 88% of the children being treated by dentists and its allows safer and faster treatments», explains managing director Alberto Piras. And so, after the results of the validation tests, the game will soon be exported to the United States. Italians are also the creators of Tommi, a digital game based on VR that helps young cancer patients (300,000 a year) to positively face their long path of care.


When it comes to digital therapies, we are at ground zero

However, the real new frontier are digital therapies and here we are at ground zero. These are apps and videogames that not only support the patient. For example, psychologically, in physical rehabilitation or by actively engaging in the management of often complex therapies. Because digital therapies act like real medicines. The promise of health gamification is: we will recover from some diseases by playing.

An App, rather than a pill?

But can an app really have an effect similar of that of a drug? How far can health gamification take us? «It’s possible, of course, especially in some areas of medicine such as neurology or physical rehabilitation», says Stefano Vitta, partner and expert in digital strategies at Healthware International. one of the largest independent agencies in the healthcare world. «But the sector is still in its infancy. Only a few months ago, tests confirmed the effectiveness of an American video game for the treatment of attention deficit and hyperactivity disorder (ADHD). The next step to officially turn it into a “drug” is the OK of the Food and Drug Administration, with a path that will begin shortly».

Patien Innovation. The experience of OpenDot in Milan, a fab lab that works with disabled children and their families

What deseases can videogames cure?

Vitta refers to Akili, an action videogame that activates, in a selective and self-reprogrammable way, cognitive neurological systems that are deficient due to some diseases. Like the aforementioned attention deficit and hyperactivity disorders. But also the major depressive disorder, the autism spectrum problems and even multiple sclerosis, for which the validity tests will begin shortly. Regarding the latter condition, the Italian Multiple Sclerosis Foundation and 12 Italian neurological centers participated in a dedicated gamification project. That is, the implementation of Ms-Fit by Roche, a video game that allows sufferers of multiple sclerosis to perform movements to improve posture, balance and breathing.

Listening to music that restores our listening

In Europe, on the other hand, a digital treatment to cure tinnitus has already been approved. Tinnitus is the auditory disorder that causes continuous whistling or background noises to be perceived. It is called Tinnitracks and it reprograms the patient’s playlist by emphasizing certain frequencies to activate the natural ability of the nervous system to change. Using it for one hour a day for six months leads to recovery and for this the German health care system reimburses it.

More high tech equals less pills?

Is the gamification of the health sector the beginning of a new era, with less drugs and more high-tech methods but all in all natural? «Surely. But we are still in its infancy because the pharmaceutical sector has just been touched by the digital transformation », continues Vitta. «Until recently it was a closed system, difficult to attack from start-ups due to strict regulations and length of development projects. Because we talk about 10-15 years for the approval of a drug. What has changed today, is consumers. The push from below is fundamental ».

Patient innovation and design of digital therapies

Stefano Maffei, professor at the Design Department of the Milan Polytechnic, agrees: «New technologies have changed the relationship between people and care. Patient innovation, the therapeutic drive promoted by those who are sick, has a real impact». Maffei is also the scientific director of the Make To Care platform, 120 cases of patients-innovators, independent and non-independent researchers, new entrepreneurs and start-ups, makers and Fab Lab active in e-health. It is to this ecosystem that now the large pharmaceutical groups – in this case Sanofi – look to face digital health care. «Those who need personalized care have realized that thanks to Apps and digital manufacturing they can have them at low cost. And there are those who have started to design solutions for situations in which the National Health System is underperforming. That is those of long rehabilitation or disability. That often follow generic protocols while requiring personalized care».

Gamification and strokes

Francesca Fedeli and Roberto D’Angelo with their association Fight The Stroke are also patient innovators. They produced MirrorAble, a digital game that teaches children affected by stroke, like their 6-year-old son Mario, to become conjurers. Imitating the magician on the screen and interacting with other children who are doing the same path, the little ones train mirror neurons to compensate for brain damage.

IV Walk by Alissa Rees

The importance of an eco-system

If patins have a key role in innovation, it is clear that connecting all those who participate in the digital development of healthcare becomes fundamental. This is why, alongside the Italian Make To Care, there is the international mapping of the Digital Therapeutic Alliance. This also includes Italian Healthware International, which unites the forces of digital therapy producers, facilitating their development, approval and use within national health systems. Because the solutions already ready to download and use are many. Look for them on click on the part of the body to be treated and the app with the descriptions appear. But without concertation of validation processes, it will take years before gamification-based therapies are accepted (and reimbursed) as traditional drugs.

The need to start from the patients’ real needs

The regulatory one is not the only question mark in terms of digital health and gamification. «Digital therapies can help the sick. But it would be a disaster if they were privileged over the human relationship», says Alissa Rees, a 26-year-old Dutch designer, and a former cancer patient. Rees designed a backpack that contains the drip and allows you to move freely during the therapy (we saw it at Fuorisalone, see here). And now he is developing a video game to be projected on the ceiling, so that bed-bound patients can play tennis, do karate or swim, moving selected parts of the body. “It is important for gamification to consider the primary needs of the patient. Healing is not enough, it is also necessary not to alienate one’s own body from the surrounding world ».

Good game design as an anti-alienation recipe

Fabio Viola, 38 years old, game designer with an archaeologist’s training, is second in the Gamification Gurus Power 100 ranking. (Viola is also co-author of Super Poteri and of the award-winning game Father & Son for the Archaeological Museum of Naples that we talked about here) . «When games are designed with an old-fashioned thinking, the result can be alienation: just like when TV is used as a baby sitter». A bad design is also due to the other problem linked to the gamification of healthcare: abandonment. «Games for non-entertainment purposes are often ignored because they do not arouse attention and motivation», Viola continues.

Game design recipes: from storytelling to storydoing

«A game made only of commands and interfaces, people who shoot and take points, clearly underlies the point of view of those who played in the eighties», continues Fabio Viola. «Today the games that work have to be like movies or novels. They involve people because they turn them into directors and writers. This is the future: no complicated puzzles, but the possibility of designing the story as protagonists. Those who design digital therapies should focus on the art of involvement, on storydoing as an evolution of storytelling». So healing by playing – and having fun – can be more than a promise.

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