I am at the Games for Health 2005 conference, at the University of Maryland School of Medicine in Baltimore. As with my previous coverage of Education Arcade (1, 2), the Serious Games Summit, Games for Health 2004 (1, 2), and the Advertising in Games Summit I am happy to report that the conference has wifi, and so I will be live blogging the event to the best of my ability. There's no power at the seats, so I may have to go offline or cover selectively to make it through the whole day.

Click through for coverage of the sessions from day one. I'll be back for day two tomorrow (Friday, 9/23).

Update: My wrap-up is now available via Gamasutra.

Stephen J. Downs
Sr. Program Officer, Robert Wood Johnson Foundation

Why did the foundation invest in videogames? The "pioneer portfolio" looks for innovative projects that might be influential 5 - 10 years hence. RWJ research has shown that it takes 17 years for a new finding to make its way into widespread practice, and we have to start now to accelerate that progression.

Dr. Bruce Jarrell
University of Maryland School of Medicine

The dean of the school welcomed attendees, and added that research is the primary focus of the medical school. Jarrell mentioned that the process of teaching medicine is done by lecture and apprenticeship. The electronic age in medicine is limited -- powerpoint, web pages, and a few simple simulations. The effect of the digital revolution has not yet touched medical curricula in a meaningful way. The problem solving goals in medical school needs to e improved.

Jarrell spends time with surgical residents and tries to dig into problems in his students, helping them "repair the holes" in their knowledge. This requires customization based on the students, a wide range of common sense and technical knowledge, and an engaged, interactive address of the students. The practice of medicine currently does not include techniques like this.

Natural language processing and computational linguistics are one technical hurdle to this problem. Funding for these improvements remains hard to find, and it needs to be improved. Content is king at medical school, not just process.

"The Future of Games for Health?"
Ben Sawyer - Serious Games Initiative

There are two sides to games for health: personal treatment and professional pracitce. The former includes treatment, disease management, physical therapy, exergaming, mental health (VR/psychotherapy), cognitive games (like Brain Training for the Nintendo DS) and other applications that people would buy for themselves. The latter includes health messaging, modeling, simulation, and training.

The future of games for health includes virtual reality medicine, commercial, gaming, e-technologies. Ben articulated a concept he called the Personal Health Record, which takes personal information, doctor visits, data recording from various devices, and that produces output that could be tied into or bound to games. One use for this is recording and measurement information.

Ben described a whitepaper the initiative is working on to help individuals evangelize the use of games for health. They will also be taking the initiative on the road, and launching a game contest for games for health, akin to a kind of specific IGF.

Ben then described the "plague" now afflicting World of Warcraft, an infections blood disease which has ravaged the game, being described as an "epidemic." Ben showed a video of the epidemic at work, creating calls to "quarantine the server." It is the first such "outbreak" on record in a game. So, now we need "health for games" in addition to "games for health."

Ben also showed the Brain Training games, which we've discussed previously here on WCG. Ben showed a slide from Iwata's Tokyo Game Show keynote that demonstrated that Brain Training has a very different sales pattern than other games. Most games have a big launch and a steep drop off, but Brain Training has consistent sales over the first 3 - 4 months of sales. Brain Training is above the other DS games, including Nintendogs, as a driver of DS hardware adoption. The player demographics are very different as well, with at least 25% of Brain Training players above 45.

Ben also showed the new Revolution controller, demonstrating that the method of play in these games also includes a health game: a dental surgery game using the new controller. Finally, Ben argued that there is no dividing line between commercial game innovation and games for health, and health games can be healthy for the games industry.

Ben's Game
Eric Johnston - Lucas Arts / Make a Wish Foundation

Ben Deskin submitted a wish to Make-a-Wish to make a game about fighting cancer. Eric showed the game, Ben's Game in which the player player controls a child on a kind of board ... the games take place on cells, and the player's goal is to combat the cancer (we've discussed Ben's Game here on WCG in the past).

The game took 6 months to make. Ben and Eric worked one evening a week and Eric continued on weekends. The game has been downloaded 172,000 times. The traffic on the Make-a-Wish foundation increased from 100 visitors to 60,000 visitors per day after the game was launched.

The game was hard to take on as a company, because of the time required to commit to the game. The first step was to acquire funding, a step Eric skipped :). Eric's first game was 1 person in 10 weeks (Pipe Dream, a classic puzzle game). The scale of gaming has increased considerably. Eric used this opportunity as an excuse to get back to that approach. The project budget included a USB flash drive, to allow Ben to take the game home after every meeting, and 16 liters of limeade. Eric was surprised and impressed by how Ben's involvement and guidance.

The second step was to ask permission, which Eric also skipped. He just started making the game... it could be made at home in the worse case. After getting some traction, LucasArts allowed after hour use of the office, including the sound studio which was a huge help to the development. Legal and PR helped to allow the game to be released for free, and the company also facilitated a tour of Skywalker Ranch and the archives (a place Eric has never been himself).

A problem: how to design a game about cancer? Clearly the player can't lose or die, and they wanted siblings and friends to fight on your side. The two decided to focus on distraction and entertainment for kids undergoing cancer treatment. Distraction is a big part of pediatric medicine, and there's very little you can do in treatment.

Every Tuesday at 5 Eric and Ben worked on the game (except one week when Ben was grounded). Eric showed photos of the two working on the game, demonstrating Ben's detailed involvement in the design as a primary driver. Eric shared his experience watching Ben play the game, which he cited as a tremendous help in the iterative design process.

The game started with the concept of a field of cells. They wanted the game to be abstract and stylized. The field has mutating cells that grow like the game Life by John Conway. They represented health with a shield (to protect side effects), health, ammo, and attitude. When attitude runs out, you keep fighting, going beyond what the level says you can.

Mutating cells aren't very understandable, and kids don't see those: they see the nasty side effects of treatment. So, in the game you fight monsters as a manifestation of seven side effects (fire for fever, q-ball for hair loss, ro-barf for vomit, vampire for bleeding, the tornado for rash, snow monster for colds, and the evil chicken for chicken pox). The game allowed the player to choose a number of characters, and kids can also create their own character to use in the game.

Eric also showed a screen full of names of people who helped with the project, of which there were many, from Mac ports to tests to translators.

Next Generation Healthcare Learning Platform
Dr. Claudia Johnston, TAMUCC
Douglas Whatley, Breakaway
Timothy Holt, Oregon State University

Dr. Johnston talked about Pulse, a virtual learning space project. The project is developing a virtual health care learning system to model dynamic changes in care environments. The idea is that an immersive, persistent environment for responsive medical training would be a valuable adaptive learning environment. The project focuses on high-fidelity graphics and an immersive environment.

Pulse is conceived asa "virtual clinical learning lab" that provides a persistent healthcare world with patient simulation. Challenges include the technical and the programmatic representation of medical treatment.

The game would be first used by the military health care team, then the health care delivery system (nursing and medicine, certification, etc.) and higher education degree programs. Games allow rehearsals for life and offer the promise of improved learning.

Substance Abuse Treatment with Game Technologies
Ro Nemeth, NIDA
Darion Rapoza, Entertainment Science

The gaming community has a perception that NIH doesn't have an interest, because few grants seem to be awarded. However, VR was once in the same situation, and now it is a major funding outlet for NIH and NIDA. Gaming will eventually grow into a similar funding outlet. SBIR solicitations are common and opportunities will become more plentiful even in the near-term. Nemeth encouraged people to talk to her to find the right NIDA or NIH contact for their ideas to help make them fundable.

Rapoza presented on the game itself, which promises to offer more preventative intervention than any other drug abuse related materials could afford. Videogames are especially good at reaching the poor: according the a study Nemeth cited, 100% of urban and rural poor play games daily, have internet access, and (as a projection) 100% of the fathers of urban and rural poor would play games with their kids once a week or more.

Videogames are thus demographically appropriate for the problem of drug addiction education. Videogames are cost effective compared to other preventative interventions.

The game itself is an action/adventure RPG, akin to Deus Ex. Action/adventure have a high proportion of male/female players, and they are the best platform for the translation of evidence-based approaches to drug intervention, according the Rapoza. The game was created in the Unreal engine. Feedback suggested that more advanced technology was needed to engage players. Rapoza showed an Unreal 3 screenshot and argued that this was the target to meet.

Rapoza took a number of attributes to map to drug abuse, including short-term memroy, long-term memory, emotional, focus, problem solving, and so forth. These were mapped to game play attributes, such as friend/foe identification, hacking, conversation, dialogue trees, impulsivity, aim, movement, and skill enhancement. Skill enhancement is based on a hierarchy of achievements. Power-ups for activities in the game include coffee and amphetamines, which players can use to study for exams in the game and do better, giving the player a reason to explore them. Cravings are represented as pop-ups during gameplay, and can be dismissed with "auto" responders (e.g. auto-smoke) which models the actual addiction process. During severe addiction, the player may lose control of the character who will use the drugs without permission of the player. Some players experimented with saving the game in a "pure" drug free state, then experimenting with drugs, then going back to the saved game.

Video Games: Just What the Doctor Ordered
Anuradha Patel, UMDNJ - New Jersey Medical School

Dr. Patel talked about using existing games to treat pre-operative anxiety in children. Most children experience anxiety before surgical procedures, and the most severe distress is experienced when anaesthesia is introduced. Research shows that certain maladaptive behaviors seem to be exhibited after surgery, even as much as a year after the surgery itself (e.g. bad dreams, disobedience, separation anxiety, tantrums, bed wetting). These behaviors would not have been expressed before the operation itself. The cumulative effect of these exposures are unknown.

Behavioral preparation programs, incuding coping skills training, have traditionally been used, but they are time consuming, expensive, and not necessarily successful (more information can lead to more anxiety). Behavioral therapy such as distraction with toys, stoyrtelling, hyponosis, and so forth has also been used. Other researchers have tried environmental modification. Medications also produce delayed recovery and more agitation, and parents are concerned about "drugging" their children.

Videogames can help focus attention, increase dopamine neurotransmission, and absorption. In the study, Dr. Patel's group used a Gameboy to try active distraction. It' sportable and can be played during the introduction of anaesthetic. Based on a Yale Prop Anxiety Scale (a standard measurement method in the field), the group determined that the anxiety of children playing videogames were lower than those with parents present but no additional anxiety drugs and parents present with the introduction of anxiety reducing drugs. 71% of the participants in the Gameboy group had no change in anxiety during the study. Interestingly, parental presence alone is associated with the most increase in anxiety. Moreover, the study suggested a possible improvement in post-surgery behavior, rather than an introduction of new negative behaviors.

Taking Games for Health Mobile
Charles P. Schultz - Motorola

Games can provide players with a sense of mastery over their condition. Schultz used the example of YuGiOh as evidence that kids can learn large bodies of information about arcane topics, and this can be applied to health instead of fantasy. At Motorola, they tried to extend existing internal products and initiatives. At the same time, they wanted to avoid using mobile technology as a nag.

WellWorld is an internal MMORPG built on Torque, started in October 04 and funded through 2005. The goal of the game is to help players manage an acute lifestyle health condition like diabetes or heart disease. In the game, the player gets token rewards for doing things to support their health condition. The purpose is to help kids (or adults) understand and feel more confident in managing their own conditions.

Motorola has a project called "seamless mobility" -- the ability to access what you want when you want it wherever you are. The new iTunes phone is an example of this initiative. Other kinds of mobility are content, experience, brands, information, social experience, device independence, and demographics. So, specific content can be transmitted based on the purposes of the game. Specific content from different domains could then be delivered to the game world. These additional materials could be pushed to a phone. The game world could also move between devices (PC to mobile), and demographically, the parent and child should both be able to engage the experience.

So far in WellWorld, LifeScan and the American Hearth Association branding elements that they replace in the game. The videos in the game are accessible through the game or on the phone. In terms of demographics, the parents want age-appropriate themes and Motorola wants a "happy shiny look." With respect to device mobility, the phone clients are possible but may have limited features.

The justification for an MMORPG was based on research showing that social support helps people engage in positive health behaviors. Higher values of the social contract index are associated with increased odds of health behaviors. Conceptual buy in has been positive.

FreeDive
Brian Morrison - Believe in Tomorrow Foundation
Lyn Dahlquist - University of Maryland

FreeDive is a scuba diving sim created by BreakAway that Dahlquist is using as a pain distraction tool for kids during particularly uncomfortable treatments. The idea behind the game is to distract kids from pain, which requires actual cognitive attention. In Dahlquist's studies, pain tolerance increased more than two-fold among kids in a controlled experiment using a hand submerged in ice as the pain stimulus.