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Games for Health 2010 - Game Related Illnesses and Injuries

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Games for Health 2010
Game Related Illnesses and Injuries

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  • http://www.escapistmagazine.com/articles/view/issues/issue_205/6143-Designing-Religion
  • Still playing some of the same games No longer “playing” Farmville
  • http://www.pewinternet.org/~/media//Files/Reports/2008/PIP_Adult_gaming_memo.pdf In the United States: 25% under 18, 49% 18-49, 26% 50+ according to ESA Essential Facts 2008. Virtual world: 11% of teens, 6% of adults MMO: 21% of teens, 9% of adults * No 2010 update YET
  • China imposes online gaming curbs (BBC News 2005) Lawsuit Claims Microsoft Xbox Sparked Fire That Killed Baby (Information Week 2007) Detox For Video Game Addiction? Experts Say Gaming Can Be A Compulsion As Strong As Gambling (CBS News 2006) Wii Fit Death (The Sun 2009) New Video Game Tied To Rash of Head Explosions (The Onion 2008) Guitar hero? Pitcher hurt playing video games (MSNBC 2006)
  • Infrequently updated, but more on the way with MS and Sony controllers out soon?
  • McCowan, T. C. Space Invaders Wrist. N Engl J Med. 1981 May 28;304(22):1368. (letter to the editor, too old to find online) http://www.bmj.com/cgi/content/full/331/7509/122 (Mark Griffiths article online) http://www.working-well.org/articles/games.html (some more online resources) http://openurl.ingenta.com/content/nlm?genre=article&issn=1476-0320&volume=17&issue=1&spage=55&aulast=Sparks
  • Update PubMed numbers for 2010
  • PubMed doesn’t like the term “videogame” (without the space). I updated this 3/17/2010
  • http://www.xbox.com/en-US/support/familysettings/healthygamingguide.htm http://www.nintendo.com/consumer/manuals/index.jsp http://www.us.playstation.com/Support/Manuals/PS3 Mindwire v5 – the controller that shocks you; not what that “shock” warning is about
  • PubMed says 8 hits, but those are mostly burn recovery, or burn-related training Toshiba (?) had a battery overheating problem, had to issue a recall
  • Rajani R, Kumar A, et al. Cardiac pacemakers and Wii BMJ 2008;337:a3103 [BMJ letter] http://americanheart.mediaroom.com/index.php?s=43&item=543
  • Thaker JP, Patel MB, et al. Electromagnetic interference with pacemakers caused by portable media players. Heart Rhythm. 2008 Apr;5(4):538-44. Bassen, H. Low frequency magnetic emissions and resulting induced voltages in a pacemaker by iPod portable music players. Biomed Eng Online. 2008 Feb 1;7:7. Chiu CC, Huh J, et al. A prospective pediatric clinical trial of digital music players: do they interfere with pacemakers? J Cardiovasc Electrophysiol. 2009 Jan;20(1):44-9. http://www.nytimes.com/2008/04/08/health/08real.html Nagatomo T, Abe H, et al. Electromagnetic interference with a bipolar pacemaker by an induction heating (IH) rice cooker. Int Heart J. 2009 Jan;50(1):133-7. Wii uses bluetooth
  • PubMed say 6 hits for “guitar hand injury” but includes stuff like “Modification of a hand splint to permit playing of the guitar.” PubMed says 13 hits for “guitar injury” and 126 for “guitar” Google says 87,600 hits for “guitar hand injury” “ Endless Set List” is a Rock Band thing “ Iron Bladder” is RB2, which is endless set list w/o pausing
  • Acute Wiiitis. N Engl J Med 356;23 Jayanthi N., Sallay P., et al. Skill-level related injuries in recreational competition tennis players. Med Sci Tennis 2005. 10:12–15. Struijs, PA, Kerkhoffs, GM, Assendelft, WJ, Van Dijk, CN. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. Am J Sports Med 2004; 32:462. Wii sales numbers from NPD? Seems to be most commonly cited “Wii” injury Bhangu A, Lwin M, et al. Wimbledon or bust: Nintendo Wii related rupture of the extensor pollicis longus tendon. J Hand Surg Eur Vol. 2009 Jun;34(3):399-400.
  • (3RD Space Gaming Vest) http://tngames.com/ “ Waggle” is a technical term. 
  • http://www.healthfinder.gov/newsletters/pain020810.aspx http://content.nejm.org/cgi/content/short/362/5/473 (letter to the editor)
  • Ip J, Robaei D, et al. Prevalence of Eye Disorders in Young Children With Eyestrain Complaints. American Journal of Ophthalmology 2006;142(3):495-497. (not gaming article) Misawa T, Shigeta S, et al. [Effects of video games on visual function in children] Nippon Eiseigaku Zasshi. 1991 Feb;45(6):1029-34. (article in Japanese)
  • 2% of all epilepsy cases in Great Britain (1995), up to 5.7% if only looking at 7-19 year olds. J. A. Quirk, D. R. Fish, et al. Incidence of photosensitive epilepsy: a prospective national study. Electroencephalography and Clinical Neurophysiology. 1995;95(4):260-267
  • http://www.loonygames.com/content/1.2/feat/index6.php has some old links (mostly dead) http://www.hitl.washington.edu/publications/r-96-3/ http://www.hqda.army.mil/ari/pdf/RR%201832.pdf
  • Look up on PubMed if movies causes stress
  • http://www.dangerousdecibels.org/hearingloss.cfm
  • 2007 APA debate “ The fact that some people play video games excessively is not in dispute, but defining the point at which the behaviour becomes problematic is far from clear.” – (Wood 2002) “ The evidence so far suggests that genuinely excessive players are likely to have other underlying problems, and/or have inadequate time management skills. Excessive video game playing is therefore likely to be a symptom and not the cause of their problem.” – (Wood 2002) Wood, R. Problems with the Concept of Video Game "Addiction": Some Case Study Examples. Int J Ment Health Addiction (2008) 6:169–178. http://www.ama-assn.org/ama/no-index/about-ama/17694.shtml
  • S Korea child 'starves as parents raise virtual baby' (March 5, 2010) http://news.bbc.co.uk/2/hi/8551122.stm
  • http://www.olganon.org Fife, C., Smith, L., et al. Dying to Play Video Games: Carbon Monoxide Poisoning From Electrical Generators Used After Hurricane Ike. Pediatrics 2009;123;e1035-e1038.
  • Transcript

    • 1. Game Related Illnesses and Injuries The accused, documented and related Alan Au – May 27, 2010 Games for Health 2010
    • 2. Who Am I?
      • Graduate student at the Univ. of Wash.
        • Medical Education and Biomedical Informatics
        • Looking for a job soon?
      • Game industry freelance writer
      • NOT a medical doctor
      • NOT a movie industry art director
    • 3. What Am I Playing?
    • 4. This talk is about:
      • Physical injuries
      • (e.g. repetitive stress injury)
      • Physiological reactions
      • (e.g. motion sickness)
    • 5. People Are Getting Hurt (?)
    • 6. Why Should We Care?
      • 97% of teens play games (in U.S.)
        • Younger gamers prefer consoles, online play
      • 53% of all adults play games (in U.S.)
        • Older gamers prefer PCs, offline play
      • Among gamers (in the U.S)
        • 25% under age 18
        • 49% between 18-49
        • 26% over age 50
      • Numbers for Europe, Japan harder to find
      http://www.theesa.com/facts/pdfs/ESA_EF_2009.pdf http://www.pewinternet.org/~/media//Files/Reports/2008/PIP_Teens_Games_and_Civics_Report_FINAL.pdf.pdf http://www.pewinternet.org/~/media//Files/Reports/2008/PIP_Adult_gaming_memo.pdf.pdf
    • 7. Some Recent Headlines
      • “ Doctors Warn: Wii Puts 10 In Hospital a Week” (Fox News 2008)
      • “ Compulsive Video Gaming: Addiction or Vice?” (National Public Radio 2007)
      • “ A Wii Workout: When Videogames Hurt” (Wall Street Journal 2006)
    • 8. Blogs and Websites
      • “ Wii Damage Toll: TVs Suffering The Most Abuse” (http://www.wiiinjury.com 2007)
      • “ Denmark Destruction” (http://www.wiihaveaproblem.com 2007)
    • 9. A Long Tradition
      • Space Invaders’ Wrist (NEJM 1981)
      • Video games and health (BMJ 2005)
      • Wii have a problem: a review of self-reported Wii related injuries (Inform Prim Care 2009)
      McCowan, T. C. Space Invaders Wrist. N Engl J Med. 1981 May 28;304(22):1368. Griffiths, M. Video games and health. BMJ 2005;331:122-123. Sparks D, Chase D, et al. Wii have a problem: a review of self-reported Wii related injuries. Inform Prim Care. 2009;17(1):55-7.
    • 10. What’s in PubMed?
      • “injury” (753232)
      • “fall risk” (7737)
      • “thumb injury” (3251)
      • “gambling addiction” (2715)
      • “motion sickness” (2633)
      • “photosensitive epilepsy” (1519)
      • “tennis elbow” (1205)
      • “repetitive stress injury” (475)
    • 11. Checking PubMed (t+1 year)
      • “ video game” 1506 (1312) +14.8%
      • “ game injury” 824 (760) + 8.4%
      • “ video game playing” 427 (367) +16.3%
      • “ video game health” 388 (327) +18.7%
      • “ video game therapy” 362 (314) +15.3%
      • “ video game violence” 129 (108) +19.4%
      • “ video game rehabilitation” 105 (88) +19.3%
      • “ video game injury” 89 (75) +18.7%
      • “ video game addiction” 90 (71) +26.8%
      • “ videogame”* 70 (65) + 7.7%
    • 12. Console Safety Manuals http://www.nintendo.com/consumer/manuals/index.jsp
    • 13. Highlights From the Manuals
      • Musculoskeletal stress injury
      • Motion sickness
      • Seizures
      • Pacemaker interference
      • Property damage
      • Electric shock
      • Laser and radiation hazard
      • Battery leakage
      i.e. “Don’t open up your console.” http://www.xbox.com/en-US/support/familysettings/healthygamingguide.htm http://www.nintendo.com/consumer/manuals/index.jsp http://www.us.playstation.com/Support/Manuals/PS3
    • 14. Topics
      • Hardware Problems (burns, electrical interference)
      • Repetitive Stress Injury
      • Lateral epicondylitis (tennis elbow)
      • Rashes and sores
      • Bruises and bumps
      • Foot injury and fall risk
      • Eyestrain and photosensitive epilepsy
      • Motion sickness (simulation sickness)
      • Addiction/Overuse and its side-effects
      • Physiological stress
      • Hearing loss
    • 15. Burns
      • “ Lawsuit Claims Microsoft Xbox Sparked Fire That Killed Baby” (Information Week 2007)
      • Xbox power-supply overheating
        • Device problem, not activity problem
        • Microsoft issued a recall but didn’t fix design
      • PubMed says 8 hits, but mostly burn recovery, or burn-related training
    • 16. Radio Interference
      • BMJ 2008: “Wii seems safe with pacemakers”
        • Wii-mote uses Bluetooth (2.4 GHz RF)
        • Nintendo advises >9 inches
        • Pacemaker companies say minimum of 2-9 inches
      • American Heart Association warns about headphones but not devices or Bluetooth transmissions
        • Xbox 360 uses proprietary 2.4 GHz RF
        • PS3 controllers use Bluetooth
      Rajani R, Kumar A, et al. Cardiac Pacemakers and Wii BMJ 2008;337:a3103 http://americanheart.mediaroom.com/index.php?s=43&item=543
    • 17. Electromagnetic Interference
      • PubMed: iPod pacemaker (5)
        • 2007 study says avoid < 2 inches
        • 2008 and 2009 study say no risk
      • Headphones seem to be a bigger problem because of the magnets
        • Int. Heart J: “Electromagnetic interference with a bipolar pacemaker by an induction heating rice cooker.”
      Thaker JP, Patel MB, et al. Electromagnetic interference with pacemakers caused by portable media players. Heart Rhythm. 2008 Apr;5(4):538-44. Bassen, H. Low frequency magnetic emissions and resulting induced voltages in a pacemaker by iPod portable music players. Biomed Eng Online. 2008 Feb 1;7:7. Chiu CC, Huh J, et al. A prospective pediatric clinical trial of digital music players: do they interfere with pacemakers? J Cardiovasc Electrophysiol. 2009 Jan;20(1):44-9. Nagatomo T, Abe H, et al. Electromagnetic interference with a bipolar pacemaker by an induction heating (IH) rice cooker. Int Heart J. 2009 Jan;50(1):133-7.
    • 18. Repetitive Stress Injury
      • ‘ Nintendo Thumb’ Points to RSI (Wired 1998)
      • PubMed: repetitive stress injury (475)
      • U.S. Bureau of Labor Statistics 2008
        • “ Injuries from repetitive motion continue to be the event with the highest median days away from work for all private industries and service-providing industries.”
      http://www.bls.gov/news.release/osh2.nr0.htm
    • 19. Fake Plastic Guitar vs. Real Guitar
      • “ Guitar hero? Pitcher hurt playing video game” (msnbc.com 2006)
        • Joel Zumaya of the Detroit Tigers
      • “ Endless Set List” achievement
        • Play everything in one session?!
        • Iron Bladder (don’t pause either)
      • What about real guitar-playing?
        • PubMed: “guitar hand injury” (6)
        • Google: “guitar hand injury” (87,600)
    • 20. Lateral Epicondylitis
      • PubMed: tennis elbow (1205)
      • Dubbed “Wii-itis” in NEJM letter to editor
      • “ Yet another result of Wii Tennis” (http://www.wiiinjury.com 2007)
      • Elbow is tennis players’ most injured joint
      • Also called “cell phone elbow”
      Jayanthi N., Sallay P., et al. Skill-level related injuries in recreational competition tennis players. Med Sci Tennis 2005. 10:12–15. Struijs, PA, Kerkhoffs, GM, et al. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. Am J Sports Med 2004; 32:462.
    • 21. Rashes and Sores
      • PlayStation palmar hidradenitis
        • Holding controller tightly
        • Lots of button-pressing
      • The “How!” sign
        • Rubbing controller against palm
      Kasraee B, Masouyé I, Piguet V (April 2009). &quot;PlayStation palmar hidradenitis&quot;. Br. J. Dermatol. 160 (4): 892–4. Wood, J. The &quot;How!&quot; sign—a central palmar blister induced by overplaying on a Nintendo console. Arch Dis Child. 2001 April; 84(4):288.
    • 22. Bruises and Bumps
      • Wii manual
      • Blogs and websites
      • Microsoft (Natal) and Sony (Move) controllers
      • “ Impact” vests?!
    • 23. Foot Injury
      • New England Journal of Medicine
      • “ A radiograph showed a small fracture of the base of the fifth metatarsal. … The fracture probably resulted from the pull of the peroneus brevis muscle during inversion of the ankle.”
      • Response (HealthDay)
      • “ Robert Gotlin, director of the Sports Rehabilitation department at Beth Israel Medical Center in New York City, concurred with Eley's sense that while the risk for injury due to Wii gaming is real, it is not a cause for alarm.”
      Eley, K. A Wii Fracture. N Engl J Med. 2010 Feb 4;362:473-474. (letter to the editor) 2010
    • 24. Fall Risk
      • Most references talk about Wii being used to improve balance and reduce fall risk
    • 25. Eyestrain
      • PubMed: eyestrain (759)
      • PubMed: video game eyestrain (5)
      • 1991 Japanese study
        • Shorter viewing distance while gaming (vs. TV)
        • More complaints after gaming >120 min.
        • Games use more rapid eye motion (vs. VDT work)
        • Clinically, games and word processing are similar
      Misawa T, Shigeta S, et al. [Effects of video games on visual function in children] Nippon Eiseigaku Zasshi. 1991 Feb;45(6):1029-34. (in Japanese)
    • 26. Photosensitive Epilepsy
      • Pokemon TV show 1997
        • Over-reported cases due to media coverage
      • Primarily a childhood disorder
      • 5.7% of teenage epilepsy in U.K. 1995
      • PubMed: photosensitive epilepsy (1519)
      Quirk J., Fish D., et al. Incidence of photosensitive epilepsy: a prospective national study. Electroencephalography and Clinical Neurophysiology. 1995;95(4):260-267
    • 27. Motion Sickness
      • Not a new problem
        • Flight simulators
        • Since 1950s (Army report)
      • Causes?
        • Sensory conflict theory
        • Postural instability theory
      • Solutions?
        • Adaptation
        • No same-day flying
        • 2%-3% cannot adapt
      http://www.hqda.army.mil/ari/pdf/RR%201832.pdf
    • 28. Physiological Stress
      • Cortisol (“stress” hormone)
        • Increased blood pressure
        • Cardiovascular activity
        • Gastric secretion
      • Music in games can increase stress
      • Wii “Vitality Sensor”
        • Pulse oximeter
        • Games for relaxation
      Hebert S., Beland R. et al. Physiological stress response to video-game playing: the contribution of built-in music. Life Sciences 76 (2005) 2371–2380.
    • 29. Hearing Loss
      • Noise-induced hearing loss
      • Affects ~10 millions Americans a year
      • >85 dB over a period of time (8 hrs)
      • Associated with firearm use (veterans)
      • 12%-15% of all children
      Harrison, R. Noise-induced hearing loss in children: A ‘less than silent’ environmental danger. Paediatr Child Health. 2008 May; 13(5): 377–382. 2010
    • 30. Medical Addiction
      • PubMed: video game addiction (71)
      • PubMed: gambling addiction (2715)
      • 2009 AMA ruling says not “addiction”
      • 2008 article in Int J Ment Health Addiction
        • “ The evidence so far suggests that genuinely excessive players are likely to have other underlying problems, and/or have inadequate time management skills. Excessive video game playing is therefore likely to be a symptom and not the cause of their problem.”
      Wood, R. Problems with the Concept of Video Game &quot;Addiction&quot;: Some Case Study Examples. Int J Ment Health Addiction (2008) 6:169–178.
    • 31. Addiction vs. Overuse
      • AMA notes that “overuse” still problematic
      • Treatment programs and support groups
    • 32. Sleep Deprivation
      • Teen sleep deprivation a “growing” issue
        • Studies & reports are growing
        • Often cite gaming and other technologies
      • Self-reported “addicts” suffer more
        • ~13% self-report rate
        • Remember, 98% of kids play games
        • Sleep deprivation a side-effect of overuse
      Woolems, A.G., Peszka, J.J., Mastin, D.F. The Effect of Console/Computer Game Play on Sleepiness and Sleep Hygiene. Sleep 2009;32:A415. Oka Y, Suzuki S, Inoue Y. Bedtime activities, sleep environment, and sleep/wake patterns of Japanese elementary school children. Behav Sleep Med. 2008;6(4):220-33. Jan Van den Bulck. Television Viewing, Computer Game Playing, and Internet Use and Self-Reported Time to Bed and Time out of Bed in Secondary-School Children. Sleep 2004;27(1):101-4. 2010
    • 33. Other Side-effects?
      • Google: &quot;carbon monoxide poisoning&quot; &quot;video games“ (30,200)
      • Almost all hits refer to a single article
        • “5 incidents in which video games were being powered [during Hurricane Ike] accounted for 75% (15 of 20) of the pediatric poisonings.”
      Fife, C., Smith, L., et al. Dying to Play Video Games: Carbon Monoxide Poisoning From Electrical Generators Used After Hurricane Ike. Pediatrics 2009;123;e1035-e1038.
    • 34. Summary
      • Growing media coverage
      • Some scientific literature, but not much
      • More people play games than exercise
      • Games becoming more like exercise
      • Most game injuries caused by overuse
        • The old complaint used to be inactivity
        • The emerging problem is overactivity
    • 35. Thank You!
      • Special Thanks
        • Ben Sawyer
        • Freddy “Dr. Gamer” Chen, M.D.
        • Ching-Ping Lin (UW)
      • Work in progress!
      • Questions? Comments?
      “ How to win at Wii tennis…” aau uw.edu @

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