VA embraces gaming as therapy for injured vets

Gaming is becoming an official therapy tool for the Department of Veterans Affairs.

The VA plans to offer gaming sessions as an alternative form of therapy, assist in mental and physical rehabilitation, and improve socialization for veterans with limited mobility through a partnership with Microsoft.

Microsoft announced the partnership involving its Xbox adaptive controllers designed for and with gamers with limited mobility in April. The tech giant donated 170 of the controllers to be used by 22 VA facilities, including the Washington, D.C., VA Medical Center, along with Xbox One S consoles, games and other equipment, including PDP one-handed joysticks, buttons and switches. Reporters were invited to join Microsoft CEO Satya Nadella's Oct. 7 visit to the facility to meet with veterans using the equipment and clinicians who incorporate gaming into their care.

“In the past you would think of all of this as assistive technology which is just for a market that is outside the mainstream," Nadella (center) told reporters, stressing the need for broad cultural change when it comes to inclusive design. "Everyone will need help at some point in terms of assistive technology. So what if we took that to the heart of inclusive design and build all our products -- whether it’s Windows whether it’s Xbox whether it’s Office -- with that spirit and designing ethos.”

Colleen Virzi, a VA recreational therapist who coordinates all the adaptive sports therapies, said having different options, such as large, 6-inch wide buttons on the controllers, foot pedals and joysticks, allow gamers to customize their experience -- which will hopefully yield favorable health outcomes.

"It's a unique piece of equipment because no matter what type of disability you have, you can adjust it to work for you," she said, adding that gaming can help with fine motor skills, improve competitiveness and socialization.

The plan, Virzi said, is to have a weekly outpatient clinic for about two hours. Veterans will get fitted for their controllers and compete against other veterans.

"Once they're all set up we teach them how to play the game and kind of let them go and compete against their fellow veterans that are in the clinic with the ultimate goal of going home and playing with their families and friends," she said.

Roger Brannon, 48, spent 28 years in the Marine Corps as active duty and in the reserves before he was diagnosed with amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, in 2016. And while Brannon said he was always into computers and games like World of Warcraft, the ALS diagnosis made gaming a bigger part of his life.

"I haven't played a lot of games in a long time because I was busy working. But now that I'm retired, I try to find things to do with my son and he wants to play video games," he said, laughing.

"When you can only play 15 minutes, for him, that's level 1. He wants to go for an hour or two."

Brannon, (right) a former master gunnery sergeant and communications chief, said he can use a standard Xbox controller for only a few minutes before reaching his limit. With the adaptive controllers, foot pedals and joystick, he can play Star Wars and Minecraft with his 13-year-old son for more than an hour.

Brannon has requested adaptive controllers to improve his home gaming and said such controls will help as ALS progresses and patients become more "locked in your body."

Matthew Wade, 31, on the other hand, is a dedicated gamer, who played as a kid and during the four years he was enlisted in the Navy as a master at arms, petty officer third class. Now, he uses gaming to connect with family and as a form of pain management.

Wade (left) became quadriplegic after suffering a cervical spine injury, said gaming is a welcome distraction from chronic pain.

"It's definitely something I'm interested in to be able to have something easier to use, something that I don't have struggle to get set up for," Wade said of incorporating adaptive gaming to his therapies. "If it's something as simple as pressing these buttons -- it's right there for me to use -- then I'm happy to use it."

Wade, who uses a standard controller on an adjustable table at home, used the adaptive controllers for the first time and said the controls would surely help with driving games. But joked that it might not be enough to get him to enter the VA's inaugural e-gaming competition.

The National Veterans Wheelchair Games will introduce competitive e-gaming in 2020 for the first time, said Leif Nelson, the director of the National Veterans Sports Program.

Gaming data

The Veterans Health Administration plans to collect data on veterans gaming and how adaptive controllers affect patient outcomes, particularly regarding spinal cord injuries and conditions.

"It's really early in the collection of data and the efficacy of the controllers on clinical outcomes," said Larry Connell, chief of staff for the Veterans Health Administration.

The VHA is also focused on suicide prevention and how gaming could help through increasing comradery with fellow veterans. "One of the things we've found is that sense of belonging or lack of belonging in soldiers and sailors and airmen that come out of the military is they lose that camaraderie. We think that's one of the indicators that if we could fix that, we think we can move the needle on suicides," Connell said.

Connell said that theory is unproven, but that a timeline is being developed for the data-tracking effort, in which information will be shared between the controllers, VA, and Microsoft. 

Usability and security concerns remain, however. Michael Heimall, director of the VA Medical Center in Washington, D.C., said that while he wants to make the deluge of patient data usable, he's also tuned into data privacy concerns.

"I worry all the time with electronic health records," Heimall said. "The way we communicate is based on that electronic health record and if you don't read the one note that has the pertinent piece of information that you need, you've got an opportunity to have a bad outcome. How do you use artificial intelligence and machine learning to really add value to what's in those databases."

The 2018 VA Mission Act allows the department to share information with non-VA providers and requires veterans to opt out of the data-sharing starting Oct. 1 rather than opting in.

"There's a tremendous amount of anxiety among the veteran population," Heimall said, "so people are very sensitive to how their personal information -- not just their health information" is shared.