By Tasfinul Haque
Invented in 1947, the Cathode Ray Tube Amusement Device allowed people to use an oscilloscope to shoot “missiles” at targets on overlaid transparencies. Since then, video games have become a multi-billion dollar industry, with game developers pushing the limits of graphic technology to create hyperrealistic visuals with engaging plots. The meteoric rise in popularity of video games since the late 1970s has prompted researchers to explore the effects that these games have on our neural functions. While the social repercussions of video games are hotly debated, the neural plasticity that video games induce is more objective. Those who play video games have greater cognitive flexibility, faster visual reflexes, and better motor control than those who do not (1). Neuroscientists are using this wealth of information to understand how video games can be used to rehabilitate those with neural pathologies. Even more recently, researchers and game developers have begun to collaborate in order to tailor video games to improve specific neural functions. Although the results of video game therapy are positive, its role in mainstream rehabilitation has been limited. Nevertheless, video games have the potential to reveal and address the neural basis of physical and mental impairments and thus warrant further investigation.
The Neural Basis of Video Games
Video games engage several neural areas on the cortex involved in hand-eye coordination, integration of senses, the ability to adapt quickly, and many other characteristics. In fact, studies have shown that those who frequently play video games have increased gray matter (neuronal cell bodies located in the brain and spinal cord) in areas of the brain essential for spatial navigation, strategic planning, working memory, and motor performance (2). For an inexperienced video gamer, cortical activity increases because several new tasks are being performed by the brain. As the gamer becomes more skilled, cortical activity decreases, requiring fewer neurons to execute the same task (3). This implies that the nervous system is becoming more efficient over time as a person plays video games. The increased efficiency may be assisted by the activity of the ventral striatum. As a person plays video games, the ventral striatum releases dopamine, a neurotransmitter that is significant in reward processing and motivation. Since dopamine secretion increases the desire of a gamer to continue playing (4), the neural circuits involved in executing a specific skill in the process are reinforced. Dopamine signaling also triggers long term potentiation, the mechanism underlying memory formation and learning in neurons (4). As a result, the neural pathways that are activated by game play are strengthened and produce sustained effects. By understanding these implications, video games can be used to help those with neurological damage.
Neural Reorganization and Motor Control
Video games can assist in regaining motor control after a stroke by inducing reorganization of the motor cortex through repeated movements of the affected limb. Strokes are caused by a disruption of blood to the brain and often results in some loss of motor control. Constraint-induced movement therapy (CIMT) is a common method to help patients regain motor function, and involves high repetition movements made by the affected limb without relying on the healthy side (5). Recently, customized video games were developed for use in CIMT, where patients complete motor tasks in the game, such as navigating a boat through obstacles using the affected arm. When the affected side is forced to move, its representation in the cortex increases, which increases activity of the motor cortex area associated with the affected limb (6). This suggests that when damage to the motor cortex occurs during a stroke, CIMT can facilitate the distribution of limb representation among the remaining healthy motor cortex. CIMT is often used in traditional therapy, but there are several other benefits that video games can provide. Caregivers have noticed that patients are more engaged and motivated in therapy when video games are utilized, as it creates a non-clinical environment where patients can feel more relaxed (7). Therefore, stroke patients that have sustained motor control deficits can actively and enthusiastically play games to produce long-term improved motor control.
Memory Processing and Mental Disorders
Researchers have also begun to explore how video games can improve the lives of those with mental and cognitive disorders, such as Alzheimer’s disease. Several studies involving patients with dementia and Alzheimer’s have shown that use of musically based video games can slow or stop the progression of mental decline by reinforcing existing memories and skills (8). Music therapy has proven to be an excellent tool for patients with dementia, as singing or playing instruments have a long range of effects, such as reinforcing speech construction, inducing reminiscence, promoting fine motor control, and decreasing stress hormones (8). Even after dementia patients have lost several cognitive functions, music can still evoke a response until the late stages of dementia (9).
A video game based on music therapy has many of the effects of traditional music therapy, but can be applied to patients with low musical inclinations with minimal training. By reinforcing several neural circuits involved in speech, memory, and motor functions, a patient can gain a sense of control over their dementia. In a study involving the videogame MINWii, patients played music on a virtual keyboard in order to restore self-esteem, a process known as renarcissization (8). Renarcissization improves many behavioral issues, which may otherwise lead to institutionalization. While MINWii may not induce neural reorganization to eliminate dementia, it is able to reinforce many neural circuits that are lost during dementia and prevent its progression.
In an even more remarkable study, researchers found that Tetris was able to interrupt the brain’s process of memory formation, which has elucidated potential methods by which post-traumatic stress disorder (PSTD) can be eliminated before it forms. Tetris, a puzzle game in which falling blocks are rotated onto a board with increasing speed, requires extensive integration of visuospatial data. Visuospatial tasks involve the perception of the spatial relationships between different objects. PTSD is a type of anxiety disorder that develops after a person encounters a traumatic event, and is associated with repeated flashbacks of the traumatic event. Interestingly, the flashbacks associated with PTSD use visuospatial centers in the brain to consolidate these traumatic memories. Because the brain has limited resources, engaging in visuospatial tasks selectively competes for resources to generate mental images (10). The neurobiology of memory formation suggests that there is a six-hour window in which memory consolidation can be disturbed and avoid being processed by the brain.
In order to test the ability of Tetris to diminish memory consolidation, researchers showed a graphic film to volunteers. They were then divided into groups with no assigned tasks and groups that played Tetris 30 minutes after viewing the film. Researchers then monitored the number of flashbacks experienced for each participant and assessed their clinical symptoms. Those who played Tetris after the traumatic viewing had significantly fewer flashbacks and trauma symptoms (10). While this procedure represents a very crude approximation of PTSD, the underlying mechanism of memory formation remains the same. Effective treatment for PTSD exists in the form of drug therapies and cognitive behavior therapy. However, these therapies are successful if the patient can come to terms with the traumatic event, which is often an emotionally painful process. The application of specially designed visuospatial tasks can provide a novel approach to eliminate traumatic memories as they form.
Establishing Video Game Therapy
Despite the promising results of video game therapy on several motor and mental disorders, several factors still prevent its integration into traditional therapy. The most immediate issue is the low number of games being created for the purpose of rehabilitation. While the use of existing consoles, like the Nintendo Wii, is proving useful, tailor-made games can more accurately target a specific issue and remove unintentional aspects of mass marketed games from therapy. Even after a video game therapy is developed, access to the games is often limited. Many video games are located in hospitals or rehabilitation centers, which may prevent or discourage patients from receiving the therapy.
The most significant obstacle that video game therapy faces is the critical lack of research. While the cognitive and motor benefits of video games are well documented, research regarding how specific areas in the nervous system are affected by video games remains scarce. Video games cannot efficiently serve as a neural therapy if the appropriate neural targets are not identified. Research into video game therapy is also limited because it is complex to study. In order to test the effects on the nervous system, the putative component of the game must be studied in isolation, which often proves difficult for mass marketed games (1).
Video game therapy has several obstacles to overcome before it can be integrated into traditional rehabilitation, yet the benefits that it can provide to those with impaired neural capacities should not be overlooked. In particular, the increase in motivation that many patients express for video game rehabilitation may prove therapeutic in itself. Video games have an advantage over other therapies because there is a significant amount of non-clinical interaction with caregivers, family, and other patients. The effects of the added social therapy on self-esteem building and overall well-being should also be explored. In order to provide a therapy where social interaction is valued alongside physiological improvement, research into the neural basis of video games as well as a standard for studying the components of video games must be established. Video game research can provide valuable insight into how motor and mental disorders are processed by the brain, and may provide an innovative method for treating a variety of neural pathologies.
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