B. Dan
Feb 4, 2022
Citations
0
Influential Citations
1
Citations
Journal
Developmental Medicine & Child Neurology
Abstract
The crucial role of play in development has long been recognized, with emphasis on experiment and planning, pleasure and control, and emotion and participation. Play is an engaging, demanding activity which, while contributing to learning skills and socialization, is typically undertaken for its own sake rather than being strictly goal oriented. However, play is now increasingly integrated into school settings as an educational tool, specifically to enhance children’s learning, competences, and performance. This contradicts the supposed polarity between work and play. In opposition to Aristotle’s view in the Nicomachean Ethics that ‘serious things are better than laughable things and those connected with amusement’, serious gaming has an array of applications in education, politics, economics, military and disaster control, and health. The pleasure of being challenged in a non-threatening environment, and the prospect of winning, translate well to purposeful activities. Therapy is thus increasingly presented playfully to disabled children and adults, or inserted as a meaningful part within a play context. The hope is to increase people’s motivation to engage in therapy. The willingness, even compulsion to play can attract individuals to participate in games in the context of activities that may otherwise not be pleasant to them. Such an effect is often assumed but has not been thoroughly documented, though there is some evidence that including social and indeed game elements within therapy has positive impacts on patient experience and motivation for treatment. Support from health professionals, family, and peers is likely a determining factor for enjoyment as it is for freely chosen leisure activities. The development of computer gaming technology, including relatively low-cost off-the-shelf devices, has led to many applications in rehabilitation with mounting evidence of efficacy on selected outcomes such as balance, hand, visual-perceptual or social skills, and pain management. Many systems provide an interactive interface for various task-oriented scenarios. Most can be used at home, though this may require additional incentives to maintain compliance – some games include motivational features, such as awards, bonuses, and opportunities for social connection. A few games are designed to meet therapeutic objectives, whereas others are used in their commercial version or customized to abilities, needs, and goals. In this process, it is ethically important to preserve the patients’ agency. But patients and therapists commonly complain about the limited entertainment and content diversity offered by existing games, and cost may be prohibitive. Therapists can surely make the most of gaming opportunities in creative and promising ways. One must be aware that different motor characteristics should be expected in a virtual gaming environment than in a conventional therapy space or in real life. This bears relevance to transfer of skills and tasks as well as environmental modifications from the virtual environment to the real world. We need to clarify how we can tailor programmes individually and how reliable and effective these would be. How would serious gaming support and complement therapy? How can motivation and enjoyment be further promoted and maintained? Major challenges remain to be addressed, including cost, space, and obsolescence. But usage at home, in a familiar and private sphere, may lead to reduced travel expenses and commuting time, and lower costs for services. Gamification of therapy can bring in fun, one of the core F-words that have been suggested as a focus in (childhood) disability, and could thus make therapeutic interventions more meaningful. But special care must be taken to avoid collapsing work and leisure with specific expectations for performance. It is pleasant for both therapist and patient (and of potential benefit to both) to make interventions seem more like a game, even when they are not inherently so, but one must be aware of the risk of forcing leisure time to become productive.