Making Rehab Rewarding: The gamification of post-stroke recovery

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Hot air balloon

Making Rehab Rewarding: The gamification of post-stroke recovery

Whew – what a week! You’ve been challenging yourself everyday and now you want to end your week doing something fun.  So, you fire-up your Motus Nova® Home Rehab System and start playing!

“Hold on, did you just say start playing?”

Yes, you heard me right – Motus Nova® has developed an interactive game-like system that makes physical rehabilitation fun.  By gamifying traditional rehabilitation exercises (e.g. by incorporating the immediate feedback of your progress and the reception of rewards when you succeed), it is possible to make rehabilitation something you want to do, not just something you have to do.  The more you want to rehabilitate, the more you are motivated to do your exercises.  And the more exercises you do, the quicker you re-gain limb function.

Gamification and Biofeedback

Gamification is the process of “enhancing services with [rewards], in order to invoke gameful experiences and further behavioral outcomes” (1).  In the case of the Motus Nova Home Rehab System®, the service being enhanced is physical rehabilitation. 

Motus Nova Home Rehab System® comes with a robotic exo-skeleton (either the Hand Mentor® or Foot Mentor®) and monitor to display your gamified rehab exercises.  Whether it’s a balloon ride, golf, digital ping pong, or any other of the ten games Motus Nova® (2), the Home Rehab System® continuously monitors your movement and rewards you when you achieve your goals. 

Cartoon Thermometer
Warm up with this activity before you get started on the more challenging games. Adjust the temperature to get hotter or colder as indicated by the thermometer.
Hot air balloon
Float through the air in paradise on your personal hot air balloon. But watch out! Navigate around birds, airplanes, and other objects to avoid crashing and popping your balloon.
Golf Course
Get a hole-in-one with this game while improving movement of your hand/foot! Adjust the power and angle at which you hit the ball to reach your goal.

Each time you achieve a goal, the rewarding feeling that follows feels good because a chemical messenger called dopamine fires in your brain (19).  To create that feel-good dopamine response, three crucial components of reward must be met. Motus Nova® makes sure to incorporate each of these components into their games:

(1) Immediacy

The reward must be immediate, or, delivered in real time (3)(9).  Motus Nova® makes immediacy possible because the artificial intelligence that powers the Hand and Foot Mentor®, senses user movement and offers biofeedback.  Biofeedback is “feedback about how the body is functioning” (5).  Each time the user makes the correct movements in order to achieve a goal, the object in the game corresponds in real time eliciting a rewarding dopamine response. Research (3)(6)(7)(8) has found that if the reward does not arrive immediately, there is “decrease in [dopamine] firing” once the reward is received. Therefore the more immediate the feedback, the more effective and motivating the reward.

Motus Nova® takes biofeedback a step further by delivering progress reports after each sessionThese reports include weekly active time summary, range of motions, and number of repetitions from the previous session (10).  With this constant feedback, you are continuously being motivated to reach your next therapy goal.

Motus Nova Reports

(2) Expectancy

Secondly, the reward must be expected by the user (3).  The more the user learns to expect a reward (i.e. a dopaminergic effect) after repeating a particular action, the more motivated they become to initiate the action.  The more this process is consistently repeated (i.e. expect reward–enact necessary movement–receive reward), research (3) shows that “the dopamine response shifts to occur immediately following the reward-predicting [movement] instead of the reward” (3).  In other words, the more you use your Motus Nova Home Rehab System® and expect rewards as you play each game, the more the act of playing (i.e. the act of rehab) becomes rewarding on its own.

(3) Voluntary

Thirdly, the reward must arrive only as a result of voluntary movement by the user (4).  Not only does using the Motus Nova Home Rehab System® require voluntary movement by the user, but because it is an at-home system, it gives the user a feeling of independence they likely wouldn’t get in a clinic-based setting.  This independence can make reaching new therapy goals feel increasingly rewarding. 

These three ways of eliciting the rewarding dopamine response makes the Motus Nova Home Rehab System® more than just a rehabilitation experience – it makes it a gameful experience.

Gamification and Motivation

If you thought the fun stopped at “dopamine response”, you’re in for a treat!

After dopamine is released in the brain, an enzyme called dopamine β-hydroxylase converts dopamine into a chemical called norepinephrine, or what you likely know as adrenaline (11)(12).  Adrenaline is usually associated with feeling motivated since its effect on the body includes increased heart rate, elevated blood pressure, and increased energy supplies (13).  To get a sense of this invigorating feeling, just think back to a time when you felt an adrenaline-rush – how did you feel during that rush?  Possibly energized and excited? Well, as you use your Motus Nova Home Rehab System®, the adrenaline rush you create while playing the games will motivate you to create more of that rush, and therefore continue using the system.

When gamification makes rehabilitation feel rewarding, you as the user are not necessarily focused on rehabilitation, but more so on playing the game; when your impaired limb is exercised as a result of playing the game, rehabilitation becomes fun and intrinsically motivating.

Gamification and Repetitions

When rehabilitation becomes intrinsically motivating, you tend to make more time to do it. More rehabilitation means more repetitions of exercises, and that means quicker recovery.

The reason repetition is vital to recovery is because, “repetition induces [neural] plasticity” (14).  According to a 2008 paper written by Kleim and Jones, neural plasticity is “the mechanism by which the damaged brain relearns lost behavior in response to rehabilitation” (14).  That said, when stroke survivors become intrinsically motivated to use Motus Nova’s Home Rehab System®, they can re-gain limb function at a quicker rate.

According to landmark research by Nudo et. al., regaining limb function requires 400 – 600 repetitions, daily (15).  To compare, the average number of repetitions in outpatient therapy is 53 (16), whereas the average number of repetitions by Motus Nova® users is 159 (17).  It is apparent that Motus Nova’s® gamified rehab system has the potential to increase user repetitions by 3x per session.

Are you ready to "up" your rehab game?

When you start using the Motus Nova’s Home Rehab System®, the rewarding gameful experience will keep you coming back for more.  By strengthening the association between rehab exercises and desirable outcomes, you can condition yourself to desire and therefore repeat usage (18).

If you’re ready to take your rehab game to the next level with the Motus Nova Home Rehab System®, fill out the form hereAnd don’t forget you can save 10% off your purchase by using the *discount code ELLA10 at checkout!

Article written by Ella Sofia, MA – a freelance writer, habit coach, and content creator at http://www.retrainyourbrain.ca

 

 

                                                                              

 Resources:

(1) J. Hamari, J. Koivisto and H. Sarsa, “Does Gamification Work? — A Literature Review of Empirical Studies on Gamification,” 2014 47th Hawaii International Conference on System Sciences, Waikoloa, HI, 2014, pp. 3025-3034, doi: 10.1109/HICSS.2014.377. https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=6758978

(2) Stroke Recovery Robots for Tele-Rehabilitation. (2020, October 22). Retrieved October 25, 2020, from https://motusnova.com/exercises-2

(3) Foerde, K., & Shohamy, D. (2011). The role of the basal ganglia in learning and memory: Insight from Parkinson’s disease. Neurobiology of Learning and Memory, 96(4), 624-636. doi:10.1016/j.nlm.2011.08.006

(4) K. Huotari, and J. Hamari, “Defining gamification: a service marketing perspective”, In Proceedings of the 16th International Academic MindTrek Conference, October 3-5, 2012, Tampere, Finland, ACM, pp. 17-22. Doi: 10.1145/2393132.2393137

(5) The Difference Between Biofeedback and Neurofeedback. (2018, September 06). Retrieved October 25, 2020, from https://serincenter.com/the-difference-between-biofeedback-and-neurofeedback/

(6) Fiorillo CD, Tobler PN, Schultz W. Discrete coding of reward probability and uncertainty by dopamine neurons. Science. 2003;299(5614):1898–1902.

(7) Schultz W, Apicella P, Ljungberg T. Responses of monkey dopamine neurons to reward and conditioned stimuli during successive steps of learning a delayed response task. Journal of Neuroscience. 1993;13(3):900–913.

(8) Waelti P, Dickinson A, Schultz W. Dopamine responses comply with basic assumptions of formal learning theory. Nature. 2001;412(6842):43–48.

(9) Mathiowetz, V., Nelson, D. M., & Gillen, G. (sept 13 2020). Chapter 3: Task-Oriented Approach to Stroke Rehabilitation. In 1007489459 776086681 G. Gillen (Author), Stroke Rehabilitation – E-Book: A Function-Based Approach. Elsevier Health Sciences. Retrieved October 25, 2020.

(10) Motus Nova Stroke Rehabilitation Technology Designed for At Home Use. (2020, October 01). Retrieved October 25, 2020, from https://motusnova.com/technology/

(11) Rice CAAM – Norepinephrine. (n.d.). Rice University – Computational and Applied Mathematics. Retrieved October 25, 2020, from https://www.caam.rice.edu/~cox/wrap/norepinephrine.pdf

(12) Aminoff, M., & Daroff, R. (2003). Norepinephrine. In Encyclopedia of the neurological sciences (p. 628). Elsevier Science (USA). Retrieved October 25, 2020, from https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B0122268709013976/first-page-pdf

(13) Chronic stress puts your health at risk. (2019, March 19). Retrieved October 25, 2020, from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037

(14) Kleim, J. A., & Jones, T. A. (2008). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. Journal of Speech, Language, and Hearing Research, 51(1). doi:10.1044/1092-4388(2008/018)

(15)Nudo et al 1996. Nudo, R. J., Wise, B. M., SiFuentes, F., & Milliken, G. W. (1996). Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science, 272(5269), 1791-1794

(16) Lang et al, 2009. Lang, C. E., MacDonald, J. R., Reisman, D. S., Boyd, L., Kimberley, T. J., Schindler-Ivens, S. M., … & Scheets, P. L. (2009). Observation of amounts of movement practice provided during stroke rehabilitation. Archives of physical medicine and rehabilitation, 90(10), 1692-1698

(17) Housely et al 2016. “Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors.” 

(18) Asher, T., Figures by Wierbowski, B. (2017, February 03). Brain training: The future of psychiatric treatment? Retrieved October 25, 2020, from http://sitn.hms.harvard.edu/flash/2017/brain-training-future-psychiatric-treatment/

(19) Pietrangelo, A. (2019, November 05). How Does Dopamine Affect the Body? (1008842338 776913345 T. J. Legg Ph.D. CNRP, Ed.). Retrieved October 25, 2020, from https://www.healthline.com/health/dopamine-effects

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