Gamifying Rehabilitation: How Virtual Games Are Transforming the Lives of the Unwell and the Elderly

It wasn’t long ago that gaming was viewed as nothing more than an exercise to kill time. To non-gamers, gamers were ‘no-hopers’ and ‘time wasters’ who lived in their parents’ basement, ate only Cheetos and drank only soda, and sponged off of others to get their fix in the virtual world.

How wrong we were. Not only are top-level gamers taking home seven figure earnings, but slowly we are all coming around to the benefits of gaming for sharpening the mind, reconnecting with others (despite what many say) and even improving mobility.

Some game designers have even gone as far as to use their talents to help improve the lives of those suffering from dire illnesses.

SuperBetter: Gamifying Mental Resilience for the Unwell

Take US game designer Jane McGonigal who’s become a familiar face on the TED stage. Her three TED talks — all centred on the rehabilitative benefits of gaming — have received close to 13 million views.

When Jane found herself bedridden and suicidal following a severe concussion, her doctor explained that in order to heal her brain she needed to rest it. This meant no reading, no writing, no work email, no running, no alcohol… no a lot of things.

Suffering from headaches, nausea, vertigo and memory loss, and crippled by the notion of not being able to distract herself, Jane describes, “My brain started telling me, Jane, you want to die. It said, you’re never going to get better. It said, the pain will never end. And these voices became so persistent and so evasive that I literally began to fear for my life”.

During this time Jane came to the conclusion that she had two choices. Either she could end her life or she could play a game. Studying the psychology of game design for over a decade, she understood well that games could play a key role in improving creativity, determination and optimism. She also understood that games made people more likely to reach out for help and that this played a big part in the healing process.


After some consideration Jane decided to create a role playing game called ‘Jane the Concussion Slayer’. She recruited her twin sister and husband to join in on the game and they played together.

The game involved battling the bad guys, which was anything that could trigger her symptoms — bright lights, crowded spaces etc — and collecting and activating power-ups, which was anything she could use to make herself feel better on her worst days — cuddling her dog, walking around the block etc.

Within just a couple of days, Jane explains that the fog of depression and anxiety began to disappear. “It wasn’t a miracle cure for the headaches and cognitive symptoms. That lasted for more than a year and it was the hardest year of my life” she explains. “But even when I still had the symptoms and was still in pain, I stopped suffering”.

Later she evolved the framework of the game and renamed it Superbetter to make it more universally appropriate to people suffering from conditions beyond just concussion.

Superbetter involves completing missions proven to help people build physical, mental, emotional and social resilience. These, after all, are the cornerstones of an individuals ability to bounce back.

Within the game physical resilience exercises include things such as standing up and walking a few paces or making your hands into fists and raising them as high as possible above your head for 5 seconds. These simple movements improve blood flow and the health of the heart.

Mental resilience exercises include things such as snapping your fingers 50 times or counting backward from 100. Jane explains this “improves focus, determination and willpower”.

Emotional resilience exercises include things like looking out of a window or googling pictures of your favourite baby animals. These activities improve positive psychology, proven to play a big part in the healing process.

Social resilience exercises include things like shaking someone’s hand for 6 seconds or sending someone a quick thank you by text or email. Jane explains, “Physical touch increases the level of oxytocin in the bloodstream, which primes us to like and want to help one another… and gratitude improves our positive mindset”.

After making the game publicly available Jane wrote some blog posts to spread the word and before long she was hearing from people all over the world who were recruiting their own allies (friends and family) and going into battle to combat illnesses such as cancer, chronic pain, depression, crohn’s disease, and even terminal diagnoses like ALS.

Jane describes that people from all over the world began reaching out to her. They felt braver and stronger. They felt better understood by their friends and family. They even talked about feeling happier, even though they were in pain and tackling the toughest challenges of their lives.

What Jane later discovered was that the reason the game was working so well was because of what scientist’s call post-traumatic growth, whereby trauma can be used as a springboard to unleash an individual’s full potential.

According to SANE Australia, “Since the mid 90’s researchers have studied [post-traumatic growth] and have found that somewhere between 50 and 70% of people who survive a traumatic event report positive changes”.

Jane explains that post-traumatic growth can often arise after a traumatic event because an individual often better understands who they are, has a better appreciation for what they have and gains a stronger sense of purpose and meaning.

SuperBetter has so far helped nearly half a million people achieve personal growth and tackle real-life challenges. Jane even wrote a book, SuperBetter: The Power of Living Gamefully, to provide more information to those wanting to take a deeper dive on her journey.

SilverFit: Gamifying Physical Therapy for Seniors

Virtual games are not just helping with mental resilience. They are also being used for physical rehabilitation. A great example of this is the Dutch company SilverFit, which designs video games to help elderly individuals improve physical mobility in a fun engaging way.

SilverFit offers several products, which help improve motor skills, strength, cognitive function, and even necessary survival actions like relearning to swallow.

SilverFit’s flagship product is SilverFit 3D. Similar in concept to Wii, the virtual system tracks a users’ motions as they interact with an on-screen game. Users are tasked with making movements — often from a seated position — that help them with rehabilitation. The highly customisable games can be adapted to different physical and cognitive abilities.

Pictured: A case study explaining how senior, Den Hollander, used SilverFit 3D so she could function independently at home again. Source: SilverFit

The SilverFit company was formed in the Netherlands by former colleagues, Joris Wiersinga and Maaike Dekkers-Duijts. Maaike had always been interested in improving the lives of elderly individuals. Joris, on the other hand, had a background in technology and gaming. During one of their many conversations, they hit upon an idea: what if they partnered together to create games for seniors?

They met with various physiotherapists to get their thoughts on the subject and one said, “You shouldn’t just make games, you should make games that let people exercise and move, because we’ve seen that if we [add] exercise in the form of games, we get so many more people who participate. However, all the stuff that’s on the market at the moment [like Wii Fit and Wii Sports] is made for young people. It’s way too difficult for most of the elderly population, and it doesn’t provide the right exercises.”

That comment led to the creation of SilverFit in 2008. Since then, the company’s grown tremendously. Although it arose from humble beginnings, today SilverFit’s products are in 22 countries throughout the world in Asia, Europe and North America.

The very first SilverFit product ever created was the SilverFit 3D. It was developed using exercise protocols that are typically given to geriatric patients or those rehabilitating from a fall, stroke or Parkinson’s disease.

Joris describes how a bingo game, for example, can help a stroke victim practice important skills like standing up and sitting down. He explains, “[With bingo], what happens is a numbered ball is drawn. If the number is on your chart, you have to stand up, instead of just scratching it. What happens is, people start enjoying the exercise they’re getting.

“They are actually playing a game and they forget that they have just stood up and sat down five times, eight times, twenty times. Without the game, a therapist can often spend most of their time trying to motivate the person to do that particular exercise.”

As it’s turned out, patients have enjoyed SilverFit 3D so much that it quickly made its way outside of the physiotherapist’s office. In its new location, the elderly began exercising much more often than they were previously.

Joris explains, “People typically receive half an hour or one hour of physiotherapy a day. When we put SilverFit in the common area, patients were able to train with the SilverFit with a family member, nurse or assistant during the time that the physiotherapist was unavailable.

“We saw that people went from exercising just once a day with a physiotherapist to twice a day and on the weekends by doing this. That was great because it has been proven that the more you exercise, the better the outcome.”

Based on the success of SilverFit 3D, the company created a home version — SilverFit Compact — which can be placed anywhere within a rehabilitation facility or in a person’s home.

Additionally, the company has also created SilverFit Mile, which allows people to bike or use a treadmill while viewing real-life motion videos, depicting outdoor scenes. This simulates exercising outdoors, making the experience more interactive and enjoyable for patients.

Pictured: A video showing SilverFit Mile in action. Source: SilverFit

There have been plenty of scientific studies concluding that SilverFit products work. Joris says, “We did a study in an elderly home where we looked at how much more time people are training independently. I think they went from zero people training twice a day to 60% of people training twice a day and the weekends.

“We also looked at how many people in an elderly home trained with SilverFit Mile. We found that people showed up about twice as often and they trained about twice as long, so in total about 4 times, 3.8 times I think, more use of that particular bike.”

Perhaps even better, participants’ motivation to use SilverFit products doesn’t appear to wane over time. Joris explains, “We also showed if you followed people over a longer period of time that if they have the games, they keep motivated. Whereas if you do not have the game, then every week you will see the motivation of people drop. Even if they are still participating, their motivation drops from week to week. So, these kinds of things are quite nice to see.

“We’ve also done some studies looking at, for instance, people re-training their balance by measuring the balance skills of people before and after doing the exercises. There’s a definite trend toward better balance after doing the exercises. But you need to measure 100 to 200 people to show that and we normally don’t get more than 5 or 10 or so,” Joris explains.

But even without the evidence confirmed it’s easy to see the individuals whose lives are being transformed by SilverFit. Joris recalls one elderly man, a stroke victim with limited mobility who was extremely discouraged at the thought of engaging in physical therapy. Initially he was resistant to using SilverFit 3D because he didn’t believe he’d be able to. However with a bit of encouragement he tried the game and within minutes he acted as though he’d been playing the game his entire life.

Joris reports, “He was enjoying it tremendously and then his therapist said, ‘You’re extremely good at this’. The guy just stood up and became like a couple of centimetres bigger and said, ‘Yes, well it’s great that there’s something I can still do well’.”

With technology playing an increasing part in all of our lives, I think we can all agree that virtual games are set to play a bigger and bigger role in the treatment of many ailments and illnesses. After all, one of the greatest challenges of patient engagement is keeping people motivated between doctor visits. Something games might just be the answer to.

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