Video Games – therapy of the future? Parents know too much time on screens increases the risk of obesity, diabetes and musculoskeletal disorders, but what if gaming could actually double up as physical therapy? And how accessible are current gaming consoles for children with hemiplegia? We investigated… Given that most kids would choose video games over ‘normal’ physio, it’s unsurprising that research into gaming as therapy started in the 1990s. It even has a name: ‘exer-gaming’. Canadian researcher Dr Elaine Biddiss has developed therapy games for children with CP and brain injury using the Microsoft Kinect. Others have invented new hardware to bypass accessibility problems and encourage bi-manual play, such as the Australian OrBIT system. Sadly, research results so far are not as conclusive as children would like! Video games are not physically challenging enough to build muscle strength or stamina. However they can help dexterity, for example wrist extension, motor skills and balance. They can also encourage two-handed play and practice of complex motor activities. The repetitive movements and enjoyment gained can promote positive neuroplastic changes in the brain. Often, the most notable outcome was increased motivation to do the exercises! Therapy aside, parents often ask which console is most accessible for a child with hemi. Obviously a lot depends on the individual. Special Effect is a UK charity which provides free bespoke adaptations. Its GameAccess online database can be searched by gaming platform or control device, but also by ‘single hand’ to find user-friendly products and adaptations. Special Effect (and Able Gamers in the US) worked with Microsoft on the 2018 Xbox Adaptive Controller. This ‘unified hub’ has two extra-large buttons which can be operated by hands, elbows or feet, plus 19 ports for additional accessibility switches, buttons or thumbsticks, allowing full personalisation. Microsoft’s Kinect motion sensor for Xbox and the Nintendo Wii have historically been popular consoles for accessible gaming. However, the Kinect has been discontinued and the Nintendo console of the moment is the Switch. The Washington Post recently published a beginner’s guide to gaming and recommended the Switch for disabled gamers. Rather than playing the handheld console, try slotting detached Switch JoyCon controllers into their holder. JoyCon controls are also customisable, and official accessories – steering wheel, motion control Poké Ball Plus or the Pro Controller – can also make gameplay easier. An engineer created a one-handed Joycon adapter for his gamer friend Rami, who has hemi and makes YouTube videos (in French with subtitles). The design is available as a free download or they can be bought online, ready-made. Top of Form While access to gaming is a mainstream topic, an August 2019 study by Curry’s PC World found disabled representation within games is still poor. There are few disabled characters; physical disabilities are most likely to be portrayed; and 47% of them are ‘fixed’ by the end of the game. Accessibility expert Ian Hamilton commented: “This notion that people with disabilities are broken and need to be fixed was rejected and abandoned in the 1970s, yet still persists in games, often through the trope of medical conditions being replaced by superhuman powers or prosthetics. Moreover, games are often guilty of furthering the myth that a disability is rare, with all the impact that has on broader prejudice and discrimination.” Read more about disabled representation here. Finally, the charity One Switch campaigns for accessible gaming and provides gaming industry contact details.