Gaming and Friendships After Injury

Gaming has become an integral part of everyday life for vast numbers of children and young adults. A significant proportion of research has focused on the potential harm related to violence, depression, and addiction that overexposure to gaming can cause. Whilst there may be some legitimacy in these concerns, modern research has introduced some balance by exploring the positive impacts gaming can have.

The developments in gameplay and quality of content have changed the gaming landscape and introduced a far greater selection of games to a wider audience. Many are now more complex, diverse, realistic, and social in nature and can play a valuable role in the rehabilitation of children and young people following a catastrophic injury.

Setting goals is an important element in any rehabilitation programme and for children these need to align with the fun, carefree existence of childhood whilst delivering the therapeutic benefits required to regain a better quality of life. Gaming can act as a strong focus for goal setting, whether it’s adapting to using a new controller following limb loss or playing new games to help with memory and concentration following a head injury. Online gaming also helps people connect and opens opportunities for children to form and build lasting friendships.

Benefits of gaming in child rehabilitation

Children can become isolated following a catastrophic injury and find themselves having to endure lengthy recovery periods in hospital or at home. This can lead to depression and mental health challenges that can undermine any physical progression, so gaming can be central to achieving a child’s psychological therapy goals. Gaming enables children to interact with each other, forming bonds based on a shared interest in particular games and allowing them to be included on an equal footing with other gamers.

The variety of switch access controls available gives children access to an increasing range of games and can help in different ways. Consoles and controllers can help develop fine motor skills and improve cognitive impairment. Eye-gaze technology uses a special camera that follows eye movement to provide a way of accessing computers, tablets or communication aids using a mouse that you control with your eyes. These controls require the development of different coordination and concentration skills that can help children achieve occupational therapy (OT) and speech and language therapy (SALT) goals.

Games focused on sports help improve movement, core body strength and gross motor skills and make a valuable contribution to specific treatment pathways. Nintendo Wii and Switch/DS consoles in particular offer a range of games that require active participation that increases the heart rate and provides a beneficial cardiovascular workout.

Improving understanding and access

Gaming brings children together and provides a platform for social interaction, but the nature of the injury experienced can present different challenges in maintaining friendships. If the child has an acquired brain injury (ABI), they may present changes in their personality and behaviour that are difficult to predict and manage. Children with frontal lobe ABI often lose their inhibitions and ability to show empathy, which can be confusing and upsetting for other children, particularly if interacting remotely or if a friendship is new.

Organisations like the Child Brain Injury Trust (CBIT) play an important role in helping educate children and adults on brain injuries and the impacts they have. Visiting schools to share information helps create a better understanding among peers and teachers and allows them to prepare and respond appropriately to post-injury changes in personality and behaviour a child might display. They can also provide additional support to case managers and families.

SpecialEffect is a charity that seeks to use gaming as a mechanism for introducing fun and inclusion into the lives of physically disabled people and allow them to build friendships. Donna Newman is a case manager at Bush & Co and a paediatric nurse who has experience working with the charity:

“SpecialEffect use innovative technologies to give children the best interactive experience available to suit their ability. They use a huge variety of games from video games to desktop robots and eye-gaze. They also have a new resource to help developers make games more motor accessible and create a wider choice available to children with physical or cognitive disabilities”.

 The Able Gamers charity provides 1:1 peer counselling and guidance to assess player needs to enable and optimise access to games. The charity uses adaptive technology and initiatives to build a support network to help the broader gaming community become more inclusive and accessible. This work includes gamers as well as industry professionals and game developers.

Gaming and friendships - the role of case managers

The sheer volume of diversity in gaming technology makes it a valuable tool in rehabilitation and one that case managers and healthcare professionals engaged in working with children need to be familiar with. This will allow them to connect with the most appropriate support network and tools.

Awareness among Augmentative and Alternative Communication (AAC) and SALT therapists, for example, will ensure that, after assessment, children are assessed to identify fine motor skill and communication difficulties and referred to specialist providers that can provide the right switch access to let them start or return to gaming. Case managers will coordinate the OT and SALT in completing the necessary referral forms and may introduce assistive technology experts or specialist charities as part of the rehabilitation programme.

Donna Newman shares her experience of working with a young adult who had suffered an early neonatal injury causing deafness and dyskinetic cerebral palsy, which is characterised by impaired muscle tone regulation, coordination, and movement control.

“The goals around gaming and friendships were to access more games using different switch access methods, be able to play games in the family environment and not just his bedroom, and to be able to play with other people.

Following an assessment by a SALT and OT to identify the current gaming set-up, the family was moved to a larger home with improved access to technology in communal areas and reduced risk of scoliosis, which was a legitimate risk with how games were played previously.

We made a referral to SpecialEffect, who conducted a joint visit with the SALT and subsequently provided different switches to enable access to more games and greater access to social interactions.

A further referral was made to Environmental Control Service for North Thames (RECES), which provides assessment provision and follow-up support to patients with physical disabilities who have difficulty operating computer technology. A standing wheelchair has been ordered for better positioning when accessing games to reduce the risk of pressure sores and improve circulation.

The changes made significantly reduce the risk of additional physical injury from gaming, but also provide far greater access to gaming and to friendships that would perhaps otherwise not be available. This has had a huge impact on the quality of life of this young man and his family”.