Development of a Health Game to Promote Self-Management Skills                                     Among Adolescents and Y...
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Development of a Health Game to Promote Self-Management Skills Among Adolescents and Young Adult Males with Spinal Cord Injury (SCI)


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Authors: Michelle Meade, Sean Petty, Joseph Hornyak, Josh Marshbanks, Drew Clayborn, Douglas Rakoski, & Eric Maslowski
Physical Medicine & Rehabilitation • School of Medicine
• UM 3D Lab
• Library System
University of Michigan, Ann Arbor, Michigan

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Development of a Health Game to Promote Self-Management Skills Among Adolescents and Young Adult Males with Spinal Cord Injury (SCI)

  1. 1. Development of a Health Game to Promote Self-Management Skills Among Adolescents and Young Adult Males with Spinal Cord Injury (SCI) Authors: Michelle Meade, Sean Petty, Joseph Hornyak, Josh Marshbanks, Drew Clayborn, Douglas Rakoski, & Eric Maslowski Physical Medicine & Rehabilitation • School of Medicine • UM 3D Lab• Library System University of Michigan • Ann Arbor, Michigan Table 1: Health Metrics and Required Behaviors Issue to How to manage How to monitor For Planning Consequence manage Skin Pressure reliefs (every 30 min)  Timer Recognize that pressure  Skin break down reliefs have to be done at  Decreased health regular intervals Art Team Programming Team continuously throughout the Stephen Bizer Sean Petty game Austin Cascarelli Sean Sheehan Background Bowel Bowel program • Timer  Need to be home/ HQ • Bowel accident Stephanie O’Malley Michael Skrzynski Traumatic SCI (1x / day) • Stink clouds  May need help • Stink cloud Scott Spangler Alejandro Guerrero* • Decreased health Andrew Bobo* • Affects about 259,000 individuals in the U.S., with nearly 12,000 new injuries each year1 Andrew Smith* • Embarrassment / increased stress • Mean age is 40.2 years old 1 but about half of new injuries happen to those between the ages of 16 to 29 • Impaired communication Michael Theodore* years old2 * indicates individuals who are not • Younger patients: Bladder Cathing  Timer • Need correct supplies  Bladder accident Results actively working on the project • Are overwhelmingly male (every 4 hours)  Urine trails • Need privacy  Stink cloud  Researchers in the Department of Physical Medicine • Often need serious medical care for the first time in their lives Impaired communication  Impact heath and Rehabilitation are collaborating with programmers • Are likely to be single (never-married) and have a high-school education or less Fitness  Eat healthy things • Remember • Can bring meals from • Change in body type and artists at the University of Michigan 3D Lab to • There is a subset injured through participation in high-risk behaviors / violence  Drink enough water behaviors home • Impact stamina and health • with lower education and literacy levels and fewer resources  Avoid unhealthy food • Check POS • Can purchase meals create the health game based on self-management • many are from ethnic and racial minority backgrounds3  Exercise • Go to PT to exercise skills, as articulated in the Health Mechanics program. • Have a high degree of technical sophistication which can be leveraged to Advisory Board members provide critical input and Stress  Monitor stress levels POS • Regularly monitor • Decrease attention / concentration promote the transfer of knowledge and self-management skills  Make time for stress- • Take time for stress- • Decline in navigation ability feedback about game appearance, accessibility, relieving activities (yoga, relieving exercises relevance and enjoyment. A range of issues continue to The Millenial or Net Generation deep breathing)  Enhance cognitive resilience arise during development and adaptation of the self- • Born between 1980 and 2000 • Comfortable with technology and have learning styles adapted for management program, including the accessibility and this medium – specifically active and visual learning styles.4 Cognitive  Enhance problem-solving, POS Plan to work on cognitive • Impacts health play-ability of the game to individuals with tetraplegia, Flexibility / attention, memory tasks with Dr. Schyrnk • Impacts resistance to Chillex 3000 • Prefer information in short, direct, focused segments4,5 Resilience development of dialogue that is understandable and • Can deal with a lot of information relevant to target population, and the creation of • Have a high ability to multi-task Health  Perform all health behaviors POS • Impacts stress characters and a story line that players can relate to. • Characterized by shorter attention spans, a low threshold for boredom, and resistance to memorization  Improve fitness • Impacts stamina and busy work  Decrease stress • Impacts ability to accomplish tasks • Want and expect high interactivity, fast pacing and high impact images 6  Increase Cognitive Resilience Conclusions Health games have the potential to promote Secondary Conditions after SCI: Energy / • Fitness POS Optimize all behaviors • Impacts navigation • Often not direct nor necessary consequences of SCI7 skill development and behavior change; Fatigue • Stress • Influences ability to accomplish • Can be prevented or minimized with appropriate management – including performance of health • Health tasks however, before this can occur, they have to maintenance behaviors and compensatory strategies7, 8 • Practice / therapy be accessible and engaging to the target • However, research has demonstrated that education alone is seldom sufficient to produce behavior group. We are currently in the alpha stage of change or induce adherence with medical recommendations.9 the development of a health game to promote • Effective interventions need to be based around techniques that have been proven effective in Considerations for Accessibility & Engagement self-management skills among the changing behaviors. Limited or no arm functioning Age Cost population of adolescents and young adult • See Table 1 for required behaviors Slowed physical functioning Cost Humor males with SCI. Our poster presentation will Self-Management: Flow of Story Graphics Engagement articulate relevant design issues and be • Refers to the ability of an individual with a chronic condition to manage their health and its physical & Expectations Playability Pace supplemented by the availability of iPod psychosocial consequences 10 Touch and iPad devices, so that audience • Requires the ability to make decisions and lifestyle choices that will optimize functioning and allow for Levels members can view and play the current greater participation in family, social, community and vocational roles and environments11 Next Steps version of the game. • An evidence-based approach to managing chronic illness that provides education and skill-building Level 1: Brave New World - Player wakes up in the hospital and learns that they have a SCI •Continued development of levels related to self-monitoring, communication, problem-solving and relaxation • Proven to be effective for improving health status and health behaviors, increasing self-efficacy, •Alpha Continued - Meet with health care providers and learns how to function improving compliance with medication regimens, decreasing pain, and lowering health-care costs 9,12-21 •Alpha Stage Evaluation - Return home (parent’s home) and must organize their space • Protocols have been effectively tailored to meet the needs and concerns of minority populations22-28 •Beta Stage • Health Mechanics program created by M. Meade, specifically for individuals with SCI Level 2: Helping Hands •Beta Stage Evaluation • Skills include - Meet and learn to work with assistant •Evaluating efficacy - Attitude - Self-Monitoring - Problem-Solving - Return to hospital for outpatient follow-up •Marketing / outreach - Communication - Organization - Stress-management - Need to monitor their health statistics, including stamina, stress and overall health., and perform •Adapt for other populations required behaviors - Party at Home REFERENCES 1. NSCISC. Spinal Cord Injury Facts and Figures at a Glance. 2011. Accessed September 4, 2009. - Key Skills: Communication, Organization 2. SCI-Info-Pages: Quadriplegic, Paraplegic & Caregiver Resources. 2009; Accessed December 30, 2009. About Serious games: 3. Burnett DM, Kolakowsky-Hayner SA, White JM, Cifu DX. Impact of minority status following traumatic spinal cord injury. NeuroRehabilitation. 2002;17(3):187-194. • As used in the computer gaming industry, a serious game is Level 3: Independence Day 4. 5. Oblinger DG, Oblinger JL. Educating the Net Generation. In: Oblinger DG, Oblinger JL, eds2005: Accessed January 2, 2010. Thietje R, Giese R, Pouw M, et al. How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients. Spinal Cord. 2011;49:43-48. “a game designed for a primary purpose other than pure - Learn to drive 6. Litten A, Lindsay B. Teaching and learning from generation Y2001. entertainment”29 - DVM and get van 7. 8. Krause JS. Secondary Conditions and spinal cord injury: A model for prediction and prevention. Topics in Spinal Cord Injury Rehabilitation. 1996;2(2):58-70. Lammertse D. Maintaining health long-term with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2001;6(3):1-21. • Serious games based on development of self-management - Meet friends at club 9. Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns. Sep 2003;51(1):5-15. skills have been developed for asthma, diabetes, surgery 10. - Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: A review. Patient Educ Couns. 2002;48:177-187. preparation, safe sex negotiation, and promoting nutrition - Skill: Problem-solving 11. Creer TL, Holroyd KA. Self-management of chronic conditions: the legacy of Sir William Osler. Chronic Illness. 2006;2:7-14. 12. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. Nov 20 2002;288(19):2469-2475. and physical activities. Level 4: Viva La Resistance 13. 14. Lorig KR. Arthritis self-management: a patient education program. Rehabil Nurs. Jul-Aug 1982;7(4):16-20. Lorig KR, Sobel DS, Stewart AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a • Found to be effective in improving self-care, reducing - Recruited into the Underground Resistance 15. randomized trial. Med Care. Jan 1999;37(1):5-14. Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. Nov-Dec 2001;4(6):256-262. symptoms, minimizing secondary conditions, reducing 16. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. Aug 2003;26(1):1-7. - Gain a secret identity / live a double life 17. Lorig K. Self-management education: more than a nice extra. Med Care. Jun 2003;41(6):699-701. emergency room visits and decreasing health care costs30 18. Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. May-Jun 2004;119(3):239-243. - Training and missions 19. Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care. Nov 2006;44(11):964-971. 20. Lorig K, Ritter PL, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educ. Jul-Aug 2009;35(4):641-651.Objectives: - Skill: Multi-tasking 21. Newman S, Steed L, Mulligan K. Self-management interventions for chronic illness. Lancet. Oct 23-29 2004;364(9444):1523-1537. 22. von Goeler DS, Rosal MC, Ockene JK, Scavron J, De Torrijos F. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educ. Jul-Aug• To develop an electronic game for an iPod Touch or similar device that will teach and / or Level 5: The Big Stink 23. 2003;29(4):663-672. Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. Jun 2005;29(3):225-235. promote the use of key skills necessary for managing a spinal cord injury (SCI). - Final level is the final confrontation with Dr. Schyrnk 24. Carbone ET, Rosal MC, Torres MI, Goins KV, Bermudez OI. Diabetes self-management: perspectives of Latino patients and their health care providers. Patient Educ Couns. May 2007;66(2):202-210.• Ultimately, we hope that playing the game will increase knowledge and confidence, normalize - You have to unravel his complex plot and defeat him. 25. Vincent D, Clark L, Zimmer LM, Sanchez J. Using focus groups to develop a culturally competent diabetes self-management program for Mexican Americans. Diabetes Educ. Jan-Feb 2006;32(1):89-97. and promote self-management behaviors, and reduce secondary conditions and health care - Once you do, you can continue to access any of the areas of the world, this time using the 26. Lorig KR, Ritter PL, Gonzalez VM. Hispanic chronic disease self-management: a randomized community-based outcome trial. Nurs Res. Nov-Dec 2003;52(6):361-369. 27. Lorig KR, Ritter PL, Jacquez A. Outcomes of border health Spanish/English chronic disease self-management programs. Diabetes Educ. May-Jun 2005;31(3):401-409. costs additional equipment and skills you have gained along the way. 28. Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care. Mar 2008;31(3):408-414.• This game application is based on the self-management principles and specifically on the - Skill: Continue to manage health while save the world… 29. Wikepedia. Serious Games. 2009; <>. Accessed 1/29/2009. 30. Lieberman DA. Management of Chronic Pediatric Diseases with Interactive Health Games: Theory and Research Findings. Journal of Ambulatory Care Management. Health Mechanics program 2001;24(1):26-38. University of Michigan