Tomorrow, Today - Video Game Therapy with Dr. Rachel Proffitt

Episode Date: April 11, 2022

With the development of more and more realistic video games and technologies, especially around the space of virtual reality, how can these technologies offer real benefits for society as a whole? In this episode, we're joined by Dr. Rachel Proffitt, Assistant Professor at the University of Missouri and Principal Investigator at the VR Augmented Rehab Lab. We chat about the many applications of virtual reality, from physical therapy to utilization as a tool for supporting neurodivergence.  You can learn more about the resources the VR Augmented Rehab lab is building by visiting their website here: https://healthprofessions.missouri.edu/proffitt-vr-ar-lab/ The research we discuss can be found on Google Scholar here: https://scholar.google.com/citations?user=FreXC9IAAAAJ&hl=en&oi=ao

Welcome to Tomorrow Today, the podcast where we talk about tomorrow, but today. Dant-da-da. My name is Nashville, and I'm joined, as always, by my favorite co-host. Your only co-host. My only co-host. Oh, I was really promised additional ones. Sorry. It's just me.

It's Andy. Hi, Andy. How are you? I'm lovely. Are you? I'm looking forward to this conversation. Me too. Today we are talking about.

video games as therapy, which I'm very pro. Are you pro video games? I'm actually not very, well, I'm not not pro video games. I'm just not a video game er. Okay, so what's your favorite video game? Yeah. Not even like a Mario Kart? Yeah, I'm trying to think.

I feel like Mario Kart's like kitsy and cool now, so like saying that makes you just sound like a dumb hipster versus like. You can't like Mario Kart because it's too mainstream. Well, you know what I mean. Like, it's, it's not what it used to be back in the day. Oh, my God. You were worried just liking it was going to make you a hipster, not that, like, you liked it before it was cool?

Yeah, I definitely liked it before it was cool. First off, sure, sure, sure. Second off, I don't know, as fun as that game was, it can't be the best game I've ever played. That's putting a lot of weight on that game. Like, I don't know if I can really, like, emotionally attach myself to Mario Kart 64 like that. Okay, but you did also say that you weren't a huge gamer.

I'm not. But now it's like an identity thing. Got it. Got it. Your reputation is on the line. I get it. I understand. Yeah, maybe like Maniac Mansion.

That's a throwback. Okay. Wow. Okay. I don't. I mean, I was going to go with Mind Sweeper, but now I feel silly. Do you remember that that game in like the 90s where you just like walked through hallways with a gun? Do you remember this?

Doom, right? Doom. Doom. I thought you were going to totally different direction. I was like. I think that's the first video game I remember, but I do think it's funny that the millennial generation started off with what like Mind Sweeper and Doom. And we all wonder why we have like generalized anxiety disorders. What was wrong with that?

Like it's just you could die around any corner. That was basically our high school too. Is that one? Anyway, this is a totally different episode. We're not really talking about video games, although we are. sort of talking about video games. I got to sit down with the very, very fantastic Dr. Rachel Prophet, who is at the University of Missouri, and she is an occupational therapist and a researcher, which was just

fucking fantastic. But that has to lead you to the question, what is occupational therapy? No, you really weren't going to come in on that one, huh? No, I was going to say, what does that have to do with video games? But all right, let's talk about occupational therapy. Okay, so I am- -therapies me. Therapeutize you.

I am not an expert in this. That will be very clear from the moment I start talking about it. Also, so this is just a very brief and very unscientific history of occupational therapy. Hang out of your butts. This one is wild. It's not. You just call people's butts wild wild butts. That's what we're here for tomorrow today.

Just butts. Buts gone wild. Miami, you know what I mean? It's fine. We're fine. I'm fine. So occupational therapy. It's called O.T.

You'll hear us say O.T. a lot in the interview. It is a bunch of mysterious origin points. But here is the main takeaway. You can go all the way back on this one. I can? Personally, you can. What does that mean? Like that?

No, I didn't mean like back in, what? Is that a dance move? It's like the back in time music. Oh, okay. I didn't. It wasn't quite. Is that better? I think that's less good.

Anyway, we can go to the Greeks and the Romans, which was all the way back on this one. Also known as the Gromans. You are out of control this episode. Anyway, the Greeks and the Romans tended to treat people with physical or mental challenges as people, and so they used a series of, you know,

occupations, bathing, music, exercise, those things, to treat people with certain disorders and diseases. That was their starting point. From the Greeks and the Romans, though, you're never going to believe when we get back to occupational therapy. Take a stab at how long it takes us to treat the mentally ill as people. I'm going to have to guess like the 70s.

Okay, so you're in the ballpark, right? It does take us to the 20th century. So we go from ancient times to like yesterday, essentially, in terms of treating people like people. Thank you capitalism. I know that's not entirely your fault. But you sure as hell tried. But you really committed to the bit, you know what I mean?

The primary uses of OT these days for neurodivergent children to get them into social programming, to get them into self-care, for sports injuries. So if like, do you play sports at all? Do I look like I play sports at all? I'm not going to answer that. Anyway, so if you hurt yourself... Well, and I'm casually chopping down a tree. Just, yeah.

You're sort of your, you're outdoors, you know, I guess it's not formal sports, but it is sports for you, you know, forest rehabilitation. So if you hurt yourself doing that, or as we will talk about in this particular interview, using occupational therapy as a way to help people with mental status challenges. So anybody's had a stroke recently in any of tourism, anything like that, where they have affected extremities. OT is your business. So in the 20th century, We have a mother and a father of OTI, if you're curious. So Eleanor Clark Slagel with solid name. You're never going to forget that one.

So she opens in 1915. So like get the Kegles with Slagel. I'm sorry it took me that long to come up with that. I was going to say, wow, you know, you really had to think about that one. Which is funny because you didn't do anything with your face as I was looking at you and you were like literally focusing. I was like, there's something there. I need to find it. Use that occupational therapy to like dig in.

No. Anyway, in 1915, she opens this training program in Chicago called the Hull House. And basically, she starts using OT. That sounds like a sorority house. Yes, it does. Yes, it does. I'm sure there were some crazy moments. So basically, she starts using OT to train professionals in how to treat those with

mental health changes or conditions. So she, with this dude called William Rush Denton, these are real names. Totally not made up. Just to clarify that. They create the National Society for the promotion of occupational therapy. regretfully called end spot. Anyway. Oh, man.

They really were fucking visionaries. They have to hand it to them. They really were. Okay, anyway, that later becomes the American Occupation Therapy Association. Oh, it became an occupation. So it gets better. It's aota now. Just what you want.

But basically, OT, just to sum that shit up for you, is an early modern medicine approach to incorporating like holistic treatment. So Denton is credited as the father primarily because he really focuses on the definitions of occupation and how purpose and occupations can help you get better or just work with you to help you engage in social activities, etc. And the American Occupational Therapy Association still exists today. Anyway, so I interviewed Dr. Rachel Prophet for the interview that you're about to listen to. We talked about video games and stroke victims. And those are two things that I would have never, ever probably lumped together in my life.

What do you think? What was the likelihood that you were going to... No, I definitely wouldn't have said stroke victims should play more video games if that's what you're saying. Yeah, that is what I'm saying. It wasn't something I would connect at all. But it actually makes a lot of sense listening to her talk about it, right? I haven't listened to her talk about it, so not yet.

I will believe you. I think you're a... A truth teller. You are a person that tells things. Yes. And they sound like they make sense. So tell me how they make sense. Nash.

Nash. So basically, stroke victims often lose access to one of their arms during or after the stroke. And it can be hard for them to regain mobility or strength in that extremity. So the team created this video game where you're, you know, canoeing down a river, I believe. Sounds lovely. Doesn't it sound? Actually, this is the kind of video game I think you would really enjoy because it's very calm. It's like got big.

Ron Swanson vibes about it. Yeah, I feel like I should be wearing flannel to play this game. Yeah, I agree. But basically, it's more fun and engaging than regular occupational therapy, because now we're incorporating some kind of game element, right? And the game itself is really dope. I bet that's a pretty relative term, pretty dope. Well, sure.

I mean... But it does sound dope, right? It sounds better than alternatives, but probably not. for most people. Okay. For the reasons you'd have to use it, I suppose those are not dope, right? But playing the video game itself

sounds really dope. That's where I'm landing on that one. Okay, let's go with that. Yes. So they use this video game as a way to get people more engaged with their therapies, and it sort of covers this economic access to healthcare problem, because they can serve a lot more people because of telehealth and this being a video game

than they can if you have to physically drive to the location. So just for clarification, we're talking about like a 3D, like you got the virtual glasses on, or is this just like you got the little... Oh, no, you're in it. You're in it? You're in it to win it? Yep.

That was Rowan. So you guys didn't see that, but this was a very animated paddling action by Nash. I keep forgetting that this is a voice thing. Yeah, so if you guys are wondering, that's what it sounds like when she's kayaking. Yeah, which I'm also not good at. Thank God we're on a lake and nobody can hear me. wait. Oh wait, sound travels. Oh, wait. Sound travels over water. Mmm. That sound right there.

This is becoming bullying. It's okay. You signed up for this. I didn't. I didn't really. Can we just get to the interview now? I think we should just get to the interview. Okay. So wrap this up. What else do we need to know? You're going in it now. Kayaking or the day interview? Oh, I mean, you could do whatever you want. I don't know. I'm not going to judge you if you kayak can't listen to this episode. Okay. So Dr. Rachel Profit is an assistant professor in the Department

of Occupational Therapy at the University of Missouri, and we are sitting down today to talk about her work in OT and video games. So tell us a little bit about you, what drew you to OT, and specifically what drew you to the recovery of those impacted by stroke and traumatic brain injuries. So I was originally headed for medical school when I was an undergraduate. I knew I wanted to do something in health care. And I worked at a camp for individuals with disabilities, sort of a respite camp for, you know, caregivers and family members who just need to take a week or two off. And so we were then the caregivers for these individuals, both adults and children. And I loved it. I loved the interactions that I had, the friendships that I

made with the campers and the staff there. And I realized that if I was going to go to med school, I wasn't going to have those interactions. And I really enjoyed, you know, working with individuals with a variety of disabilities. And so then I came back to undergrad and had to find a new career path, albeit a related one. And I stumbled upon occupational therapy and realized that this is a good bit for me,

a combination of biology and dance as my undergrad majors. So science, arts, you know, science and creativity, which is really what makes up occupational therapy. It's bringing the science in, but then also doing the problem solving, being creative and coming up with ways to help our clients live their life to the fullest. And I'm really glad I went into this field. And then when I was in graduate school, learning to become an OT, I started working in a research lab and working with individuals who had experienced the stroke.

And hearing their stories and interacting with them was just so very powerful to me. and I wanted to do something. We were learning about a bunch of different interventions, ways to help them use their arms and legs and participate in daily life. And everything seems so boring to me. And I said, well, I'm like, there's got to be something, the way to do this to make it more fun. And a woman from the computer science department, this was at Washington University in St. Louis, where I was going to grad school, came to our lab and said, hey, I have these new approaches using pretty much off the shelf video games, but I want to do this for good, if you will, as she said. And I happened to be in the lab working that day,

and I turned to my mentor and I said, can I do this? This sounds like kind of that missing piece to what I want to do to work with and help these individuals who've had a stroke. And he said, sure. And so it kind of took off from there. And I realized I really liked the research side of it, being able to, you know, bring things then to clinical practice that are fun or exciting, but still also have, you know, I like doing clinical research. I like being able to interact with, you know, with my study participants and hear how it does impact their daily lives. So that's kind of how I fell into this area. And it's evolved over time. I went from more of the development side to now going out and actually running the research studies doing the testing and now that

things are more developed and ready to use. But it's been a really exciting journey and really excited to see where it goes from here for me. The reason I know OT is my daughter's autistic, so they use OT in a variety of settings for her. And I was sort of surprised to run across it in this, you know, thinking about it like using it almost like a PT approach to get back some of those skills, you know, because it seems to me in my life so autism focused. Yeah, and that's the wonderful thing about OT and PT, you know, speech therapy in general, is that the practice settings, the populations, the diagnoses that we, we work with are so varied. You know, I have colleagues that would work with someone like your daughter.

I have those that work in nursing homes. I have individuals that do work in what we call like work hardening places for employees trying to get back to their job. Individuals that work in psychiatric, you know, acute psychiatric mental health facilities. It really spans the gamut. And that's the one thing I love about OT is that it is so diverse. And so this is sort of one area that I've chosen to take my career and individuals that I've just. found a real passion for helping. Yeah, that's wonderful. So your article that came out earlier this year, actually, about the vigorous. So it focuses on the use of virtual gaming systems as a

self-directed sort of physical therapy for these outpatient stroke victims. So is this something you were already sort of thinking about prior to these COVID shutdowns, or is this practice as a result of these sudden needed increases in these telehealth appointments and working with these folks from home? So this is something that's been ongoing for a number of years. This was the The full study was my colleague, Lynn Gauthier, she was at the Ohio State University, now is at University of Massachusetts Lowell. She was the principal investigator for the study. It was a multi-site study. So she had investigators at different places around the country and was struggling with recruitment at one of the sites. So she reached out to me, knowing that I was in a similar field, you know, knew the research and the background.

We had interacted at, you know, conferences prior to this and said, you know, hey, would you be able to recruit some participants and I said, yeah, I think so. We have a good relationship with our neurological clinics here. We have a registry of individuals that have experienced a stroke that we can reach out to. And I, you know, personally, I want to see this kind of stuff be successful. So I said, sure. And this was 2018, 2019. So pre-COVID, we actually wrapped up, I believe, in December 2019, So just a few months before, everything started shutting down, which I'm very grateful for. So we were able to recruit people and not have to deal with, you know, scheduling issues, what have you. And so the telehealth piece of it had, you know, she had, I think she had the forethought to bring this in.

And it's something that I, you know, I thought, well, yeah, this is going to work, especially given that, you know, here in Missouri, I'm in Columbia, Missouri. And so we're kind of like the center of the state. We serve up to a two-hour radius away from the city because we are the closest thing for a lot of people living in our rural areas. And I recognize this when she reached out to me that this could potentially have a really nice impact on those that are limited in terms of their access to services. They'll take a whole day to come into Columbia just to receive health care. And so that's, you know, time spent away from work, caregiver time spent away from work, driving, you know, travel, the fact that they may have one appointment at 9 a.m., then another one at noon, so now they're just sitting and waiting. And so to do something like telehealth, I think, can address a lot of those access barriers. That being said, rural Missouri does have its challenges in terms of internet availability, like a lot of the rural areas of our country. But it's getting better. And even to have, you know, a phone call based telehealth is better than requiring them to drive in to, you know, come to a visit that could be done over the phone. There are something where you want to see them in person and, you know, do assessments.

But a lot of what we do can be done via the phone. So, yes, we were thinking about this before COVID. And I think COVID has kind of accelerated the need for things like this in individuals post stroke as well as many other. diagnoses. And we saw that, oh, this is something that really can be useful and helpful. It's lower costs. It's less of a burden on the individuals that we serve on their caregivers. You know, I think about, you know, yourself as a parent, the time that you then have to spend organizing and coordinating and, you know, going then to visits and driving, you know, organizing childcare, all of that, to be able to just hop on a quick video conference wherever you

are, it's a whole lot easier. And for a lot of individuals post-stroke, they don't, can't, won't drive. So they're relying on someone else to do that. It was kind of fortuitous that we started exploring this before, before COVID. And, you know, we saw some great results from that, particularly from the arm that included telehealth. I imagine that the feeling for you guys in March of 2020 was like, thank God this is done now. You know, we can just start applying it unilaterally, which is definitely what you want in the pandemic, you know? Yes. I, you know, I had a number of my other projects.

You know, we had to halt study recruitment and, you know, any in-person interactions that were part of the research study. And then, you know, kind of bring those back in. It was probably about June or July when things at least here in the middle of the country started opening up a little bit more. I, you know, I've heard from some of my colleagues that are in more metropolitan. and the coast that it's it is still a challenge for them. So to have something like this approach that has a telehealth piece allows for being able to recruit and include individuals in our

research studies versus those that require in-person visits. Right. Can you talk a little bit about the science itself in very layman's terms? Because I'm not a scientist and you will lose me immediately. But just about how the study was done sort of what you were looking for, if any of the results surprised you at all? Sure. So like I said, this study was something that had come from a couple of, I'd say several years worth of research on my colleague's part and then she pulled me into this. So really her goal was to look at a video game based approach for stroke rehabilitation. For individuals post-stroke, at least over 60% have difficulty using their more affected arm in everyday tasks. Like they struggle to, reach forward to open up a door knob or, you know, pull up in their fridge to get a snack out,

make a cup of coffee, you know, all those things that we take for granted in our everyday life they may struggle with because if this is the type of stroke they experience, it impacts the movement on one side of their body called hemiparesis. It can affect the arm and the leg, just the leg, just the arm. And there's also then other effects from other types affecting in speech, memory, attention, those things. We focus more on the motor-based effects of the ability to use the arm and then the leg in everyday life. And so there's an approach that has been studied over the past several years called Constrain-induced Movement Therapy, or C-I-M-T. And the goal with that one is that you constrain your more or less good side, so the side that was not affected by the stroke,

Because most people, if you, you know, we're going to find the most, as humans, we're going to find the most efficient way to do something. And so with one side of your body doesn't work as well, you're going to use the side that works a lot better to accomplish the task. It's lower frustration. It's just easier to do, right? But with constraint and just movement therapy, you then constrain that good side that has been doing everything and essentially force the individual to use their more effective side after a stroke.

It can be really challenging and really frustrating for a lot of people because that side has not worked as well after their stroke. But by doing that sort of, you know, high intensity movement, making them use that side and even just little fine motor task, having them incorporate that into their everyday routine. So saying, hey, when you go to turn all your light switches on and off in your house at the end of the day, use your more effective side. And sometimes we even put like a mitt over their hand to kind of restrict them from using that side and say, all right, you know, try and use your arm in pulling open that cap. cabinet, in fleshing the toilet, you know, trying to see if you can pick up the dog food bowl

with your more affected side. And, you know, then in the clinic, we do lots of repetitive paths to get them to, you know, get better at using that side. So there's a lot of good evidence to support that approach. What the video game does is essentially the same sort of approach, but without using the real-world objects, you're now playing a video game. So the game makes you use your more affected side to navigate this little sort of kayak or canoe down a rapids. So the game is called recovery rapids. So you use your arm to sort of paddle to scoop up floating debris in the water. So you're helping the environment batting away spiders and bats that fly over you, using your arm moving it left and right to steer. But rather than, you know, thinking about picking up these,

you know, little beans or whatever in the clinic 20 times, you're playing a game. And so now your focus is no longer on you using your arm, but are you playing the game successfully? It's a lot more fun. But you're still getting that high intensity, high repetitive number of movement and forcing the individual to use that arm. We use the connect sensor. So it can say we can tell it only the white arm is the one that's able to control the game. And that's their more affected side. If they try and use their better side, it won't work. So it's a natural constraint through playing the game. And so that's the game that Dr. Gauthier had created. And she wanted to see, does this lead to improvement? So in science, if we were to just have everybody play the game and everybody got better, people would go,

well, was it because of the game? Or was it because everybody just naturally got better? You know, did everybody have, were there other things in their life that, what we call confounders, that impacted the results of that? So in science, what you have to do is compare what you want to see, you know, does it help people get better to other things that are comparable? So we're now comparing the video game to the standard constraint-induced movement therapy. Again, both of those they have the same type of approach. You're forcing the individual to use that arm. It's just one's in person and one's a video game. So now we can say, Both groups get better. It's likely because that approach just works overall. If the video game group

gets better than the constraint and use movement therapy group, we can say yes, because it is the approach and because the video games likely more fun, more engaging, all of that, which is a little bit of what we saw on our findings. We added a couple other what we call study arms in here. So we compare the video game, the standard constrainages movement therapy. We then had a video game with added telehealth sessions to it. We realized that just having the individual play the game, it relied on them making their own schedule and being consistent with playing the game. I mean, I'm a person that when I've done some physical therapy in the past, I haven't always been the most consistent in following my exercise programs. And a lot of people aren't, and we know this as therapists.

So adding in the telehealth calls had these additional check-ins with a therapist to say, hey, how's it going? You know, they could see how much the individual was playing the game. They could then say, here's some things to think about doing in your everyday life now that your arm is starting to get a little bit better, you know, do some problem solving, some strategy training with them. And so that was the little like plus piece to one of the other study arms. And then our fourth comparison arms, we had four study arms here.

the last one was just sort of what we call sort of standard occupational therapy. Unfortunately, a lot of individuals in terms of healthcare coverage only get one, maybe two visits a week. And typically only for, you know, eight to 10 weeks, Medicare, I believe, covers up to about 26 visits a year in outpatient therapy, if you've had a stroke. That's it. Wow. And it's not a lot, no. And so that was. was our fourth arm comparison based, basically to compare to what a standard care look like. Some places are starting to incorporate the constraint to do with movement therapy, but most it's just one hour a week. And, you know, that's it honestly during that hour.

Most of what we're trying to do is talk with them through, you know, how's it going? How are you using your arm? Giving them some strategies, talking with the caregiver, doing some assessments to see how they're doing. But our time is really limited with them. We can't get in that high intensity practice that we, we see with contraining movement therapy. So those were the forearms, and we saw some really nice results. Most of them did better than the standard therapy, which is to be expected, because you're doing a whole lot more movement in those other three arms than you are in standard therapy.

So that did not surprise us. One of the things we did find was that the arm that had those added telehealth visits saw a greater improvement, and that was really, really nice to show that you still need those little bit of check-ins with the therapist to keep people on track and to help them then figure out how can they use their arm in their everyday life. They start using their arm more in their everyday life. They then get better at playing the game. They then play the game more. They start getting improvement. They then get better in everyday life. And it's like the cyclical process that happens leading to greater improvement rather than just relying on people to manage their own

schedule and play the game on their own. So did folks have access to the game just in general and they could play it whenever or did they have these like sort of structure times where they could only access it during those meetings or whatever they could so they got the they got a whole computer and um the connect sent home with them if an if an individual didn't have a you know a tv or a monitor to hook into we provided one for them and so they could play whenever they wanted um we had people that had gone back to work so they were only able to play before or after um some individuals we had a lot of people that were kind of like our late morning, you know, you finish your coffee and all of that. And then they was down and play the game at, you know, 10 or 11 a.m. We had some people that were the evening people.

They like to do it later on, somewhere afternoon. It's really dependent on how it fit into their schedule. And so they could play ideally as much as they wanted to. We gave them a, you know, here's sort of what you should be doing as a prescription, so to speak, but we don't prescribe, prescribe an OT, but here's sort of what you're supposed to do. And then we could check in and see how they're doing. That game was connected up to their Wi-Fi or internet, so we could check in with them. So this game was like basically created to target some of these things. Because I was originally thinking that we're playing like World of Warcraft or something. And I, that seemed really hard. I don't think I could do that. Now this, this game, yeah, it was, it was created specifically for

stroke rehabilitation. That makes way more sense than how I'd had originally. envisioned it. So any other applications of this technology that you'd like to see implemented? Like, what do you think the future of this, like, gaming system and OT sort of looks like? I know you talked a little bit about it a little bit earlier, but I was thinking as soon as I started coming across it, this is what really help get, you know, people in rural areas more access to this kind of care. Yeah.

You know, the nice thing is with the game, you know, they could choose when to do it. And then with the telehealth piece in it, they're doing it. they're doing everything in their home. And with the game, because we use the Microsoft Connect, that sensor is able to essentially track the whole body moving in space without having to put any markers or headsets or hold controllers or anything. You just literally sit or stand in front of it. It knows where your head and your shoulders and your elbows and your hands are in

three-dimensional space. It also knows how close or how far away from the sensor you are. And all those data are recorded by the computer. And so we've built this into the game. And so the therapist can go back in and look and check and see not only how much did the individual play the game, but how well are they doing? How much are they moving their arm? How much are they able to bend their elbow or bring their shoulder up over their head? And a lot of times we're not able to do those assessments in traditional practice until we see the person in our clinic.

So this connect is kind of like our, you know, our eyes in the home to see how is this person doing and progressing in, you know, playing the game and essentially in progressing in their therapy. So that's additional data that we previously haven't had. And that helps then inform us as clinician to then make some decisions as to what sort of things we want to recommend for the individual to do and change our treatment plan for them. So the more frequent assessment really helps us as, as clinician. So, you know, this is sort of like one of those next steps into how do we use, you know, health data from things like sensors or wearable devices or mobile phones.

You know, this is sort of like the next phase of what I would call precision rehabilitation, you know, precision health care, precision medicine. So using data that come from the individual to help us then guide and customize treatment. Like I said, we've only been able to do this in the clinic using our standard assessment. but now we can have people wear or have things in their homes that give us a whole lot more data than we ever have had before. I imagine that's been helpful sort of in circumventing some of these insurance built parameters. You know, if they only can go 26 times, but they're a stroke victim and now they have to go back to work and everything, sort of having this technology allows us, I imagine, some extra hours to actually cater a lot of what they actually need.

Exactly. Yeah. And it's something where, you know, as a. as a clinician, as an OT, to then take the time out to do, you know, a one-hour session with the individual. This is now time that I can take just a little bit of time to look at their data, make some recommendations. We can have a short, you know, telehealth call with them. That's maybe only 15, 30 minutes. I can now serve a larger number of people by this availability of telehealth and data from, you know, different types of sensor system, video games, those kinds of thing. And, you know, ideally, then we also see improved outcomes for the individuals that we serve. So individuals post-stroke.

And I think there's other applications, other populations. I'm currently working with older adults with disabilities living in our rural area, individuals with multiple sclerosis, ALS, Parkinson's. I like the neurological populations. It's a passion for me. You know, but then even orthopedic conditions, they may have to go in more frequently to, you know, have a cast. or something looked at, you know, and assessed in person, but still to be able to have that done via telehealth, to get them further, faster, and you recover earlier, you know, is one of

things that we want to see as clinicians and then be able to, like I said, serve more individuals and help them maybe reach a higher level of recovery than they might have before and sooner than they might have before. Yeah, it's absolutely fantastic. I'm, like, so astonished by this work being done. So do you play video games? I guess that's my next question. I do. I do some. I play more now, I think, than I did before. I have a six-year-old who has recently gotten into Minecraft. I don't play with him, but I hear all about Minecraft. We play a lot of the Lego games together. You know, we have a switch that we do Mario Kart racing, some of the other Mario games. Those are a lot of fun.

I think for me, just the making it fun and taking the attention for the individual off of them and their body and focusing it elsewhere, it really does lead to better recovery. There's all kinds of literature in the motor control, motor learning area that supports that what we call external locus of control. So you're focused on other success and other in tasks, not necessarily. on success and how far can I move my arm, but can I reach that cabinet that's overhead? So it takes the focus off the individual and onto the out in the environment. And so playing the game takes your focus off of you and puts it into how well am I doing

in the game. Am I able to go down the river faster and steer around the rocks and pick up all the bottles out of the water? And you forget that you're now using your arm to play that game and the focus is off of your body and onto the game itself. It does lead to faster and better recovery. I imagine. I mean, I'm from the generation. I think that our parents were like, all the video games are making you violent, whatever. But I'm a parent now. I have a six-year-old. She's nonverbal autistic, but she does use Minecraft and that's how we get a picture of her world. You know, she learns to use her fingers a little bit better. We understand when she's having bad days by how often she's bombing her villagers. You know, we're interpreting a lot just from that. So I'm

very, very pro video game. I'm very bad at them, but we're very pro video games in this house. Yeah, I think they're fun. And, you know, my, my husband, he does all kinds of racing games, the, the Forza games and whatnot. And we have, we have now a steering wheel with the pedals and everything, and my son will use that. And, you know, everybody's like, oh, he's going to, you know, be such a bad driver because he's crashing into walls and everything. And I'm like, actually, he's quite good at using the steering wheel. Yeah, there's time when like he has fun and it's playful and he'll drive over trees and whatever. But I've watched him play Mario Kart, whatever. He is steering and drifting on that track. He picked that up way faster than I did. So the control that he

gets from that, you know, I think will translate to him being a pretty good driver. My husband actually drives for Lyft and Uber, did ballet parking. He is a phenomenal driver. And he grew up, you know, for the elder millennials. He grew up playing a lot of those games as well. And he's a fantastic driver. I imagine he probably did the same thing as my son and drove over trees and into walls. But it's, you know, you're learning sort of what can you do and what can you not do. But you're still getting a lot of those, your body's response and the motor control,

the visual processing that I didn't, I didn't play those games growing up. So, you know, my visual processing, it probably isn't quite as fast as them. I think there's a lot to be said for using, you know, video games, computer games as a, you know, a medium or mode for delivery. These games have, that I'm working with, they have a purpose. You know, we see just off-the-shelf game being used for kiddos with autism and, you know, other diagnoses to then get them to be able to be able to maybe verbalize a few things to, have some of those social interactions with their peers to, again, sort of communicate in a nonverbal way what's going on. So I think there's a lot of great applications for video game for all the populations we serve as OT's. Yeah, I mean, I agree. I'm an elder millennial,

so I grew up playing Mario Kart, the original, and I loved the Rainbow Road. And I've never once driven off a real road. So I think that's, you know, just adding to the thesis. Thank you so much for being here and for chatting with us today. So where can our listeners find more of your work. So there's the article that's out there. Honestly, because I am at a public university, University of Missouri. If you type my name in University of Missouri, you'll be able to come across my faculty webpage.

I do have a Twitter, so games and then the number four rehab OT. Okay. And sometimes we'll post a number of things. A lot of times some of my articles and science are shared on there. I am on LinkedIn for other professionals that would like to connect. And the, again, for the game itself, if you Google Recovery Rapids, you'll come across the game itself and the website, and you can learn a little bit more about that. It's exciting where we're going with this research and what we've been able to show works. And I'm always open to, you know, emails and connections from individuals that we serve, professionals, clinicians.

I like to just get all this out here so that it can make its way into practice sooner rather than later. Yeah. Like we were talking about before we hopped on here, that, you know, there is this huge gap between when we publish things and when things actually get implemented in practice. So anything to help narrow that gap is extremely helpful. So I'm very grateful that you all are doing this podcast. It was absolutely great time with you. I hope that we help you narrow that gap in some way. Thank you. Thank you so much for doing this. We really appreciate it.

Thank you.