Spy Game to Help Rehabilitate Veterans Suffering From Brain Injuries

By Grace V. Jean
The signature wound of the Iraq and Afghanistan wars — traumatic brain injury — continues to plague thousands of troops long after they have returned from the battlefield. Many suffer from cognitive impairments including memory loss, reduced attention and concentration and slow central auditory processing speed.  

Repairing the damage is possible, neuro-psychologists say. As in physical therapy, cognitive rehabilitation is best accomplished through daily sessions over a long-term period of weeks and months. During that time, clinicians assign exercises to help treat brain injury patients. Many are computer-based drills that include memory games involving playing cards and attention tasks that, for example, require players to hit the space bar whenever the letter “A” appears in a series.

But those cognitive skill exercises do not cut it for combat veterans who grew up playing Microsoft Xbox and Sony PlayStation video games.

“It’s really hard to get them to buy into a video game that doesn’t have a cool story line and graphics involved,” said Kirk Little, a clinical psychologist who owns a practice in northern Kentucky. Available exercises on the Internet also lack the entertainment factor of console games and become so boring and tedious to use over time that troops eventually lose interest altogether. “It’s too much of a chore, like folding your socks,” Little said. Without the repeated practice, cognitive functions do not improve, neuroscientists say.

To appeal to the gaming generation, researchers are developing a trainer designed to rehabilitate brain injury patients at Walter Reed Army Medical Center through adaptive scenarios that engage them in audio and visual exercises.

“Our goal was not only to develop a tool that could be used at home, but also to help folks stick with rehabilitation,” said Alexandra Geyer, senior cognitive scientist at Aptima Inc., the Woburn, Mass.-based firm that is producing the game.

The training tool, called adaptive gaming for auditory training and evaluation, or AGATE, takes participants through a series of puzzles and exercises with a spy-adventure twist to them.

“They feel like they’re playing a video game,” said Jason Sidman, a cognitive scientist who leads the instructional and training technologies team at the company.

In the initial phase of AGATE, a player might approach a briefcase with a keypad lock on it. A code is verbally given to him through an earpiece and he has to remember the sequence and punch it in to open the briefcase. “What’s under the hood is a digit task that assesses memory — how many digits they can actually remember and enter into the keypad,” said Sidman.

To train patients on the speed of processing, players will control a robot and follow verbal directions as they maneuver through a maze of underground pipes. “You have to make those decisions in time in order to correctly navigate the pipes,” said Sidman.  

Beneath the entertainment exterior, the game runs algorithms that adapt and tailor the exercises to the specific cognitive needs of each individual. When patients sit down to play for the first time, they complete a series of tasks that assess their cognitive abilities. Based upon the results, the game sets up challenges and levels appropriate for the player, and then continuously assesses his cognitive skills.

“We wanted to make sure that the skills that are being rehabilitated are the skills that actually need to be rehabilitated,” said Geyer.

The game records the player’s performance and progress, and directs him to subsequent levels of difficulty to allow for additional practice on the skills he needs to hone, Sidman added.

“We know if people will work on these tasks, it can make a meaningful difference in their rehabilitation,” said Little. He cited a study conducted on London taxi drivers that showed the brain is capable of growing through repeated practice over a long period. English cab drivers before becoming licensed must proceed through a two-year internship learning the complicated city streets. Brain scans taken before and after the program revealed that the part of the brain responsible for visual and spatial memory had doubled in size.

“With repeated practice, we can get people to regrow parts of their brains that are damaged. We just have to get them to practice and stick with it,” said Little. In his own clinic treating brain injury patients, he can typically persuade them to keep at the cognitive skills exercises for about two to three weeks. But then they peter out quickly because the games aren’t very motivating.

His hope for AGATE is that patients will play the game a few hours a week at the beginning and become hooked on it, so that they stay at it for an extended period. Their skills will continue to improve depending on how often and for how long they keep practicing. It is no different than how concert pianists or professional football players hone and maintain their abilities, clinicians pointed out.

Aptima officials said it would take a minimum of 20 to 40 cumulative hours of playing the game before patients will start seeing meaningful impact and benefits to their cognitive functioning and everyday life.

“It doesn’t eliminate the need for a clinician or doctors or rehabilitation professionals. It’s an added tool that the patient can utilize,” said Little, who is one of two consultants on AGATE.
Aptima scientists are integrating a feature that will allow patients to print out a summary of their playing time and performance. The report can be taken to their next appointment so that the clinician can chart progress and make recommendations for further rehabilitation.

The game is scheduled for delivery next year to Walter Reed Army Medical Center. Company officials are considering using Xbox as the game platform, with AGATE distributed on a disc. Developers also would like to make it compatible for smart phones to allow patients to play on the go.

Aptima officials intend to create an online community where players can communicate, share hints and insights and discuss their gaming and rehabilitation experiences.

“We feel strongly it’s going to help them, so we’re putting a lot of time and effort into making sure that the experience is going to be enjoyable,” said Sidman.                   

Topics: Simulation Modeling Wargaming and Training, ComputerBased Training, Videogames

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