Games for Health 2009 - Game Related Illness and Injuries

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Games for Health 2009
Game Related Illness and Injuries

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Games for Health 2009 - Game Related Illness and Injuries

  1. 1. Game Related Illness and Injuries A review of articles, rhetoric, and realities Alan Au – June 12, 2009 Games for Health 2009
  2. 2. Who Am I? <ul><li>Graduate student at the Univ. of Wash. </li></ul><ul><ul><li>Medical Education and Biomedical Informatics </li></ul></ul><ul><ul><li>Looking for a job soon? </li></ul></ul><ul><li>Game industry freelance writer </li></ul><ul><li>NOT a medical doctor </li></ul><ul><li>NOT a movie industry art director </li></ul>
  3. 3. What Am I Playing?
  4. 4. This talk is about: <ul><li>Physical injuries </li></ul><ul><li>(e.g. repetitive stress injury) </li></ul><ul><li>Physiological reactions </li></ul><ul><li>(e.g. motion sickness) </li></ul>
  5. 5. People Are Getting Hurt (?)
  6. 6. Why Should We Care? <ul><li>97% of teens play games (in U.S.) </li></ul><ul><ul><li>Younger gamers prefer consoles, online play </li></ul></ul><ul><li>53% of all adults play games (in U.S.) </li></ul><ul><ul><li>Older gamers prefer PCs, offline play </li></ul></ul><ul><li>Among gamers (in the U.S) </li></ul><ul><ul><li>25% under age 18 </li></ul></ul><ul><ul><li>49% between 18-49 </li></ul></ul><ul><ul><li>26% over age 50 </li></ul></ul><ul><li>Numbers for Europe, Japan harder to find </li></ul>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. 7. Some Recent Headlines <ul><li>“Doctors Warn: Wii Puts 10 In Hospital a Week” (Fox News 2008) </li></ul><ul><li>“Compulsive Video Gaming: Addiction or Vice?” (National Public Radio 2007) </li></ul><ul><li>“A Wii Workout: When Videogames Hurt” (Wall Street Journal 2006) </li></ul>
  8. 8. Blogs and Websites <ul><li>“ Wii Damage Toll: TVs Suffering The Most Abuse” (http://www.wiiinjury.com 2007) </li></ul><ul><li>“ Denmark Destruction” (http://www.wiihaveaproblem.com 2007) </li></ul>
  9. 9. Console Safety Manuals http://www.nintendo.com/consumer/manuals/index.jsp
  10. 10. Highlights From the Manuals <ul><li>Musculoskeletal stress injury </li></ul><ul><li>Motion sickness </li></ul><ul><li>Seizures </li></ul><ul><li>Pacemaker interference </li></ul><ul><li>Property damage </li></ul><ul><li>Electric shock </li></ul><ul><li>Laser and radiation hazard </li></ul><ul><li>Battery leakage </li></ul>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
  11. 11. Checking PubMed <ul><li>“ video game” (1312) </li></ul><ul><li>“ game injury” (760) </li></ul><ul><li>“ video game playing” (367) </li></ul><ul><li>“ video game health” (327) </li></ul><ul><li>“ video game therapy” (314) </li></ul><ul><li>“ video game violence” (108) </li></ul><ul><li>“ video game rehabilitation” (88) </li></ul><ul><li>“ video game injury” (75) </li></ul><ul><li>“ video game addiction” (71) </li></ul><ul><li>“ videogame” (65) </li></ul>
  12. 12. What Else Is In PubMed? <ul><li>“injury” (753232) </li></ul><ul><li>“fall risk” (7737) </li></ul><ul><li>“thumb injury” (3251) </li></ul><ul><li>“gambling addiction” (2715) </li></ul><ul><li>“motion sickness” (2633) </li></ul><ul><li>“photosensitive epilepsy” (1519) </li></ul><ul><li>“tennis elbow” (1205) </li></ul><ul><li>“repetitive stress injury” (475) </li></ul>
  13. 13. Topics <ul><li>Repetitive Stress Injury </li></ul><ul><li>Lateral epicondylitis (tennis elbow) </li></ul><ul><li>Rashes and sores </li></ul><ul><li>Bruises and bumps </li></ul><ul><li>Fall risk </li></ul><ul><li>Burns </li></ul><ul><li>Eyestrain </li></ul><ul><li>Photosensitive epilepsy </li></ul><ul><li>Motion sickness (simulation sickness) </li></ul><ul><li>Addiction </li></ul><ul><li>Physiological stress </li></ul>
  14. 14. A Long Tradition <ul><li>Space Invaders’ Wrist (NEJM 1981) </li></ul><ul><li>Video games and health (BMJ 2005) </li></ul><ul><li>Wii have a problem: a review of self-reported Wii related injuries (Inform Prim Care 2009) </li></ul>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.
  15. 15. Repetitive Stress Injury <ul><li>‘ Nintendo Thumb’ Points to RSI (Wired 1998) </li></ul><ul><li>PubMed: repetitive stress injury (475) </li></ul><ul><li>U.S. Bureau of Labor Statistics 2008 </li></ul><ul><ul><li>“ 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.” </li></ul></ul>http://www.bls.gov/news.release/osh2.nr0.htm
  16. 16. Fake Plastic Guitar vs. Real Guitar <ul><li>“ Guitar hero? Pitcher hurt playing video game” (msnbc.com 2006) </li></ul><ul><ul><li>Joel Zumaya of the Detroit Tigers </li></ul></ul><ul><li>“ Endless Set List” achievement </li></ul><ul><ul><li>Play everything in one session?! </li></ul></ul><ul><ul><li>Iron Bladder </li></ul></ul><ul><li>What about real guitar-playing? </li></ul><ul><ul><li>PubMed: “guitar hand injury” (6) </li></ul></ul><ul><ul><li>Google: “guitar hand injury” (87,600) </li></ul></ul>
  17. 17. Lateral Epicondylitis <ul><li>PubMed: tennis elbow (1205) </li></ul><ul><li>Dubbed “Wii-itis” in NEJM letter to editor </li></ul><ul><li>“ Yet another result of Wii Tennis” (http://www.wiiinjury.com 2007) </li></ul><ul><li>Elbow is tennis players’ most injured joint </li></ul><ul><li>Also called “cell phone elbow” </li></ul>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.
  18. 18. Rashes and Sores <ul><li>PlayStation palmar hidradenitis </li></ul><ul><ul><li>Holding controller tightly </li></ul></ul><ul><ul><li>Lots of button-pressing </li></ul></ul><ul><li>The “How!” sign </li></ul><ul><ul><li>Rubbing controller against palm </li></ul></ul>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.
  19. 19. Bruises and Bumps <ul><li>Wii manual </li></ul><ul><li>Blogs and websites </li></ul><ul><li>Microsoft and Sony have waggle controllers in the works </li></ul><ul><li>“ Impact” vests </li></ul>
  20. 20. Fall Risk <ul><li>Most references talk about Wii being used to improve balance and reduce fall risk </li></ul>
  21. 21. Burns <ul><li>“ Lawsuit Claims Microsoft Xbox Sparked Fire That Killed Baby” (Information Week 2007) </li></ul><ul><li>Xbox power-supply overheating </li></ul><ul><ul><li>Device problem, not activity problem </li></ul></ul><ul><ul><li>Microsoft issued a recall but didn’t fix design </li></ul></ul><ul><li>PubMed says 8 hits, but mostly burn recovery, or burn-related training </li></ul>
  22. 22. Eyestrain <ul><li>PubMed: eyestrain (759) </li></ul><ul><li>PubMed: video game eyestrain (5) </li></ul><ul><li>1991 Japanese study </li></ul><ul><ul><li>Shorter viewing distance while gaming (vs. TV) </li></ul></ul><ul><ul><li>More complaints after gaming >120 min. </li></ul></ul><ul><ul><li>Games use more rapid eye motion (vs. VDT work) </li></ul></ul><ul><ul><li>Clinically, games and word processing are similar </li></ul></ul>
  23. 23. Photosensitive Epilepsy <ul><li>Pokemon TV show 1997 </li></ul><ul><ul><li>Over-reported cases due to media coverage </li></ul></ul><ul><li>Primarily a childhood disorder </li></ul><ul><li>5.7% of teenage epilepsy in U.K. 1995 </li></ul><ul><li>PubMed: photosensitive epilepsy (1519) </li></ul>Quirk J., Fish D., et al. Incidence of photosensitive epilepsy: a prospective national study. Electroencephalography and Clinical Neurophysiology. 1995;95(4):260-267
  24. 24. Motion Sickness <ul><li>Not a new problem </li></ul><ul><ul><li>Flight simulators </li></ul></ul><ul><ul><li>Since 1950s (Army report) </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Sensory conflict theory </li></ul></ul><ul><ul><li>Postural instability theory </li></ul></ul><ul><li>Solutions? </li></ul><ul><ul><li>Adaptation </li></ul></ul><ul><ul><li>No same-day flying </li></ul></ul><ul><ul><li>2%-3% cannot adapt </li></ul></ul>http://www.hqda.army.mil/ari/pdf/RR%201832.pdf
  25. 25. Medical Addiction <ul><li>PubMed: video game addiction (71) </li></ul><ul><li>PubMed: gambling addiction (2715) </li></ul><ul><li>2009 AMA ruling says not “addiction” </li></ul><ul><li>2008 article in Int J Ment Health Addiction </li></ul><ul><ul><li>“ 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.” </li></ul></ul>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.
  26. 26. Addiction vs. Overuse <ul><li>AMA notes that “overuse” still problematic </li></ul><ul><li>Treatment programs and support groups </li></ul>
  27. 27. Carbon Monoxide Poisoning <ul><li>Google: &quot;carbon monoxide poisoning&quot; &quot;video games“ (30,200) </li></ul><ul><li>Almost all hits refer to a single article </li></ul><ul><ul><li>“5 incidents in which video games were being powered [during Hurricane Ike] accounted for 75% (15 of 20) of the pediatric poisonings.” </li></ul></ul>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.
  28. 28. Wireless Interference <ul><li>BMJ 2008: “Wii seems safe with pacemakers” </li></ul><ul><ul><li>Wii-mote uses Bluetooth (2.4 GHz RF) </li></ul></ul><ul><ul><li>Nintendo advises >9 inches </li></ul></ul><ul><ul><li>Pacemaker companies say minimum of 2-9 inches </li></ul></ul><ul><li>American Heart Association warns about headphones but not devices or Bluetooth transmissions </li></ul><ul><ul><li>Xbox 360 uses proprietary 2.4 GHz RF </li></ul></ul><ul><ul><li>PS3 controllers use Bluetooth </li></ul></ul>Rajani R, Kumar A, et al. Cardiac Pacemakers and Wii BMJ 2008;337:a3103 http://americanheart.mediaroom.com/index.php?s=43&item=543
  29. 29. Electrical Interference <ul><li>PubMed: iPod pacemaker (5) </li></ul><ul><ul><li>2007 study says avoid < 2 inches </li></ul></ul><ul><ul><li>2008 and 2009 study say no risk </li></ul></ul><ul><li>Headphones seem to be a bigger problem because of the magnets </li></ul><ul><ul><li>Int. Heart J: “Electromagnetic interference with a bipolar pacemaker by an induction heating rice cooker.” </li></ul></ul>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.
  30. 30. Physiological Stress <ul><li>Cortisol (“stress” hormone) </li></ul><ul><ul><li>Increased blood pressure </li></ul></ul><ul><ul><li>Cardiovascular activity </li></ul></ul><ul><ul><li>Gastric secretion </li></ul></ul><ul><li>Music in games can increase stress </li></ul><ul><li>Wii “Vitality Sensor” </li></ul><ul><ul><li>Pulse oximeter </li></ul></ul><ul><ul><li>Games for relaxation </li></ul></ul>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.
  31. 31. Summary <ul><li>Growing media coverage </li></ul><ul><li>Some scientific literature, but not much </li></ul><ul><li>More people play games than exercise </li></ul><ul><li>Games becoming more like exercise </li></ul><ul><li>Most game injuries caused by overuse </li></ul><ul><ul><li>The old complaint used to be inactivity </li></ul></ul><ul><ul><li>The emerging problem is overactivity </li></ul></ul>
  32. 32. Work in Progress! <ul><li>Acknowledgements </li></ul><ul><ul><li>Ben Sawyer </li></ul></ul><ul><ul><li>Freddy “Dr. Gamer” Chen, M.D. </li></ul></ul><ul><ul><li>Ching-Ping Lin (UW) </li></ul></ul><ul><li>Work in progress! </li></ul><ul><li>Questions? Comments? </li></ul>“How to win at Wii tennis…” aau@u washington edu

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