Making Rehab Rewarding: The Gamification Of Post-Stroke Recovery
By Ella Sofia 4th Oct, 21 Whew – what a week! You’ve been challenging yourself everyday and now you want to end your week
doing something fun. So, you fire-up your Motus Nova® Home Rehab System and start playing!
“Hold on, did you just say start playing?”
Yes, you heard me right – Motus Nova® has developed an interactive game-like system that makes
physical rehabilitation fun. By gamifying traditional rehabilitation exercises (e.g. by
incorporating the immediate feedback of your progress and the reception of rewards when you
succeed), it is possible to make rehabilitation something you want to do, not just something
you have to do. The more you want to rehabilitate, the more you are motivated to do your exercises.
And the more exercises you do, the quicker you re-gain limb function.
Gamification and Biofeedback
Gamification is the process of “enhancing services with [rewards], in order
to invoke gameful experiences and further behavioral outcomes” (1).
In the case of the Motus Nova Home Rehab System®, the service being enhanced is
physical rehabilitation.
Motus Nova Home Rehab System® comes with a robotic exo-skeleton (either the Hand Mentor® or Foot Mentor®)
and monitor to display your gamified rehab exercises. Whether it’s a balloon ride, golf, digital
ping pong, or any other of the ten games Motus Nova® (2), the Home Rehab System® continuously monitors
your movement and rewards you when you achieve your goals.
Each time you achieve a goal, the rewarding feeling that follows feels good because a chemical messenger
called dopamine fires in your brain (19). To create that feel-good dopamine response, three crucial components
of reward must be met. Motus Nova® makes sure to incorporate each of these components into their games:
1) Immediacy
The reward must be immediate, or, delivered in real time (3)(9). Motus Nova® makes immediacy
possible because the artificial intelligence that powers the Hand and Foot Mentor®, senses user
movement and offers biofeedback. Biofeedback is “feedback about how the body is functioning” (5).
Each time the user makes the correct movements in order to achieve a goal, the object in the game
corresponds in real time eliciting a rewarding dopamine response. Research (3)(6)(7)(8) has found
that if the reward does not arrive immediately, there is “decrease in [dopamine] firing” once the
reward is received. Therefore the more immediate the feedback, the more effective and motivating the
reward.
Motus Nova® takes biofeedback a step further by delivering progress reports after each session.
These reports include weekly active time summary, range of motions, and number of repetitions
from the previous session (10). With this constant feedback, you are continuously being motivated
to reach your next therapy goal.
2) Expectancy
Secondly, the reward must be expected by the user (3). The more the user learns to expect a reward (i.e. a dopaminergic effect) after repeating a particular action, the more motivated they become to initiate the action. The more this process is consistently repeated (i.e. expect reward–enact necessary movement–receive reward), research (3) shows that “the dopamine response shifts to occur immediately following the reward-predicting [movement] instead of the reward” (3). In other words, the more you use your Motus Nova Home Rehab System® and expect rewards as you play each game, the more the act of playing (i.e. the act of rehab) becomes rewarding on its own.
3) Voluntary
Thirdly, the reward must arrive only as a result of voluntary movement by the user (4).
Not only does using the Motus Nova Home Rehab System® require voluntary movement by the user,
but because it is an at-home system, it gives the user a feeling of independence they likely wouldn’t
get in a clinic-based setting. This independence can make reaching new therapy goals feel increasingly
rewarding.
These three ways of eliciting the rewarding dopamine response makes the
Motus Nova Home Rehab System® more than just a rehabilitation experience – it makes it a gameful experience.
Gamification and Motivation
If you thought the fun stopped at “dopamine response”, you’re in for a treat!
After dopamine is released in the brain, an enzyme called dopamine β-hydroxylase converts
dopamine into a chemical called norepinephrine, or what you likely know as adrenaline (11)(12).
Adrenaline is usually associated with feeling motivated since its effect on the body includes increased
heart rate, elevated blood pressure, and increased energy supplies (13). To get a sense of this invigorating
feeling, just think back to a time when you felt an adrenaline-rush – how did you feel during that rush?
Possibly energized and excited? Well, as you use your Motus Nova Home Rehab System®, the adrenaline rush you
create while playing the games will motivate you to create more of that rush, and therefore continue using the
system.
When gamification makes rehabilitation feel rewarding, you as the user are not
necessarily focused on rehabilitation, but more so on playing the game; when your
impaired limb is exercised as a result of playing the game, rehabilitation becomes fun
and intrinsically motivating.
Gamification and Repetitions
When rehabilitation becomes intrinsically motivating, you tend to make more time to do it.
More rehabilitation means more repetitions of exercises, and that means quicker recovery.
The reason repetition is vital to recovery is because, “repetition induces [neural] plasticity” (14).
According to a 2008 paper written by Kleim and Jones, neural plasticity is “the mechanism by which the
damaged brain relearns lost behavior in response to rehabilitation” (14).
That said, when stroke survivors become intrinsically motivated to use Motus Nova’s Home Rehab System®,
they can re-gain limb function at a quicker rate.
According to landmark research by Nudo et. al., regaining limb function requires 400 – 600 repetitions,
daily (15). To compare, the average number of repetitions in outpatient therapy is 53 (16), whereas the
average number of repetitions by Motus Nova® users is 159 (17). It is apparent that Motus Nova’s® gamified rehab
system has the potential to increase user repetitions by 3x per session.
Are You Ready To Up Your Rehabilitation Game?
When you start using the Motus Nova’s Home Rehab System®, the rewarding gameful experience will keep you
coming back for more. By strengthening the association between rehab exercises and desirable outcomes,
you can condition yourself to desire and therefore repeat usage (18).
If you’re ready to take your rehab game to the next level with the Motus Nova Home Rehab System®, fill out the form here.
And don’t forget you can save 10% off your purchase by using the *discount code ELLA10 at checkout!
* This is an affiliate code which means I will receive a small commission off each purchase, at no extra cost to you
Ella Sofia is a freelance writer, habit coach, and content creator at
www.retrainyourbrain.ca
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References
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(2) Stroke Recovery Robots for Tele-Rehabilitation. (2020, October 22).
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