Authors: Michelle Meade, Sean Petty, Joseph Hornyak, Josh Marshbanks, Drew Clayborn, Douglas Rakoski, & Eric Maslowski Physical Medicine & Rehabilitation • School of Medicine • UM 3D Lab • Library System University of Michigan, Ann Arbor, Michigan

1. Development of a Health Game to Promote Self-Management Skills
Among Adolescents and Young Adult Males with Spinal Cord Injury (SCI)
Authors: Michelle Meade, Sean Petty, Joseph Hornyak, Josh Marshbanks, Drew Clayborn, Douglas Rakoski, & Eric Maslowski
Physical Medicine & Rehabilitation • School of Medicine • UM 3D Lab• Library System
University of Michigan • Ann Arbor, Michigan
Table 1: Health Metrics and Required Behaviors
Issue to How to manage How to monitor For Planning Consequence
manage
Skin Pressure reliefs (every 30 min)  Timer Recognize that pressure  Skin break down
reliefs have to be done at  Decreased health
regular intervals Art Team Programming Team
continuously throughout the Stephen Bizer Sean Petty
game Austin Cascarelli Sean Sheehan
Background Bowel Bowel program • Timer  Need to be home/ HQ • Bowel accident Stephanie O’Malley Michael Skrzynski
Traumatic SCI (1x / day) • Stink clouds  May need help • Stink cloud Scott Spangler Alejandro Guerrero*
• Decreased health Andrew Bobo*
• Affects about 259,000 individuals in the U.S., with nearly 12,000 new injuries each year1 Andrew Smith*
• Embarrassment / increased stress
• Mean age is 40.2 years old 1 but about half of new injuries happen to those between the ages of 16 to 29 • Impaired communication Michael Theodore*
years old2 * indicates individuals who are not
• Younger patients: Bladder Cathing  Timer • Need correct supplies  Bladder accident Results actively working on the project
• Are overwhelmingly male (every 4 hours)  Urine trails • Need privacy  Stink cloud

Researchers in the Department of Physical Medicine
• Often need serious medical care for the first time in their lives Impaired communication
 Impact heath and Rehabilitation are collaborating with programmers
• Are likely to be single (never-married) and have a high-school education or less
Fitness  Eat healthy things • Remember • Can bring meals from • Change in body type and artists at the University of Michigan 3D Lab to
• There is a subset injured through participation in high-risk behaviors / violence  Drink enough water behaviors home • Impact stamina and health
• with lower education and literacy levels and fewer resources  Avoid unhealthy food • Check POS • Can purchase meals
create the health game based on self-management
• many are from ethnic and racial minority backgrounds3  Exercise • Go to PT to exercise skills, as articulated in the Health Mechanics program.
• Have a high degree of technical sophistication which can be leveraged to Advisory Board members provide critical input and
Stress  Monitor stress levels POS • Regularly monitor • Decrease attention / concentration
promote the transfer of knowledge and self-management skills  Make time for stress- • Take time for stress- • Decline in navigation ability feedback about game appearance, accessibility,
relieving activities (yoga, relieving exercises relevance and enjoyment. A range of issues continue to
The Millenial or Net Generation deep breathing)
 Enhance cognitive resilience
arise during development and adaptation of the self-
• Born between 1980 and 2000
• Comfortable with technology and have learning styles adapted for management program, including the accessibility and
this medium – specifically active and visual learning styles.4 Cognitive  Enhance problem-solving, POS Plan to work on cognitive • Impacts health play-ability of the game to individuals with tetraplegia,
Flexibility / attention, memory tasks with Dr. Schyrnk • Impacts resistance to Chillex 3000
• Prefer information in short, direct, focused segments4,5 Resilience
development of dialogue that is understandable and
• Can deal with a lot of information relevant to target population, and the creation of
• Have a high ability to multi-task Health  Perform all health behaviors POS • Impacts stress characters and a story line that players can relate to.
• Characterized by shorter attention spans, a low threshold for boredom, and resistance to memorization  Improve fitness • Impacts stamina
and busy work  Decrease stress • Impacts ability to accomplish tasks
• Want and expect high interactivity, fast pacing and high impact images 6  Increase Cognitive Resilience
Conclusions
Health games have the potential to promote
Secondary Conditions after SCI: Energy / • Fitness POS Optimize all behaviors • Impacts navigation
• Often not direct nor necessary consequences of SCI7
skill development and behavior change;
Fatigue • Stress • Influences ability to accomplish
• Can be prevented or minimized with appropriate management – including performance of health • Health tasks however, before this can occur, they have to
maintenance behaviors and compensatory strategies7, 8 • Practice / therapy be accessible and engaging to the target
• However, research has demonstrated that education alone is seldom sufficient to produce behavior group. We are currently in the alpha stage of
change or induce adherence with medical recommendations.9 the development of a health game to promote
• Effective interventions need to be based around techniques that have been proven effective in Considerations for Accessibility & Engagement self-management skills among the
changing behaviors. Limited or no arm functioning Age Cost population of adolescents and young adult
• See Table 1 for required behaviors
Slowed physical functioning Cost Humor males with SCI. Our poster presentation will
Self-Management: Flow of Story Graphics Engagement articulate relevant design issues and be
• Refers to the ability of an individual with a chronic condition to manage their health and its physical & Expectations Playability Pace supplemented by the availability of iPod
psychosocial consequences 10 Touch and iPad devices, so that audience
• Requires the ability to make decisions and lifestyle choices that will optimize functioning and allow for Levels members can view and play the current
greater participation in family, social, community and vocational roles and environments11 Next Steps version of the game.
• An evidence-based approach to managing chronic illness that provides education and skill-building Level 1: Brave New World
- Player wakes up in the hospital and learns that they have a SCI •Continued development of levels
related to self-monitoring, communication, problem-solving and relaxation
• Proven to be effective for improving health status and health behaviors, increasing self-efficacy, •Alpha Continued
- Meet with health care providers and learns how to function
improving compliance with medication regimens, decreasing pain, and lowering health-care costs 9,12-21 •Alpha Stage Evaluation
- Return home (parent’s home) and must organize their space
• Protocols have been effectively tailored to meet the needs and concerns of minority populations22-28 •Beta Stage
• Health Mechanics program created by M. Meade, specifically for individuals with SCI Level 2: Helping Hands •Beta Stage Evaluation
• Skills include - Meet and learn to work with assistant •Evaluating efficacy
- Attitude - Self-Monitoring - Problem-Solving - Return to hospital for outpatient follow-up •Marketing / outreach
- Communication - Organization - Stress-management
- Need to monitor their health statistics, including stamina, stress and overall health., and perform •Adapt for other populations
required behaviors
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