How games conquer our world and range from mere entertainment to rehabilitation measures

In the past, gamers were considered geeks and nerds who sit in front of their computer screens all day and hardly ever leave their rooms. But today, gamers are right on trend and hip. Video games have lost their corny and immature image a long time ago. And that’s a good thing because aside from being incredibly entertaining, they also have tremendous social potential. In times of online multiplayer modes and TeamSpeak, people from all walks of life come together and try to solve tricky missions and puzzles. Meanwhile, the fields of rehabilitation and therapy also increasingly rely on the playfulness of young and old.

In the summer of 2017, the German Association of Interactive Entertainment Software (BIU- Bundesverband Interaktive Unterhaltungssoftware) announced that total sales of computer games, gaming peripherals, portable game consoles and games for smartphones and tablets have increased to over one billion Euros in Germany in the first half-year. This was a sales increase of eleven percent compared to the same period last year. Worldwide sales in 2016 totaled 91 billion US dollars. Sales are likely to crack the 100 billion US dollar mark by the end of 2017. In doing so, video games have officially taken their place in mainstream society. In our December We Asked interview, Felix Falk, the Managing Director of the BIU also confirmed that "half of Germany’s population plays computer and video games."

Despite the fact that half of the German population likes to play games on occasion, not everyone is able to play along. Even a suitable alternative for a game controller is hard to find for quadriplegics like Dennis Winkens for instance. His QuadStick is a custom-made product as it were. Because this device is far from being a mass-produced item, the multifunctional mouse, which is mouth-operated via sipping and puffing motions costs around 400 US dollars. In addition to this mouth-operated joystick, there are also programmable foot pedals or gaming mouse pads with an integrated, programmable keyboard. For those, who have a difficult time hitting individual, small keys, there are also external control modules with large buttons or foot pedals. Those are not the only examples that show that people with disabilities who want to play games have to take many matters into their own hands. Or they turn to organizations like AbleGamers for assistance. The www.ablegamers.org website supports people with disabilities to find custom gaming solutions – tailor-made for their disability- and also helps with financing the purchase. Yet despite all of the creativity people show in creating alternative control systems, the major video game console manufacturers throw a monkey wrench into these plans by generally only allowing the use of original accessories.

Even if you are able to operate the controller with your hands, it doesn't automatically mean you can play every game. Even though individually adjustable options pertaining to button assignment, color contrast, volume or subtitles have found their way into the games, not every manufacturer has embraced these features yet. Even so, playability has improved for people with disabilities, as blogger Melanie Eilert is also able to attest. Back in 2016, she not only wrote in her contribution for gamescom but also on her blog about modding controllers for Minecraft and how she managed to move around the 3D world using just mouse commands.  Needless to say, it’s not just physically impaired gamers like Winkens or occasional gamers like Eilert, who have difficulties playing video games.

Games are (nearly) unplayable, especially for deaf or blind people. For example, sound effects are the hallmark of horror video games, while other games have terrible menus for visually impaired persons or have features that are practically indiscernible for people with red-green color blindness. But it doesn't have to be this way. Games like the Kickstarter-funded horror adventure game BlindSide, which is audio-based show another way. Many gamers with programmer skills take charge with MODs, that being programmed modifications of the original game to make games playable via voice output for example. What's more, websites like www.audiogames.net that are specialized in recommending games that primarily focus on soundscapes versus visual perception are also helpful.

In general, there are many websites that can assist people with disabilities in finding games that are playable and that suit their needs. The best example of this is the www.unstoppablegamer.com website. The page of the AbleGamers Community features numerous game reviews. Not only are games assessed based on their graphics, story, and sound, they are also rated in terms of their playability as it pertains to various accessibility factors. There are also websites that specifically target video game developers. After all, it is actually not all that difficult to ensure the accessibility of video games if it would simply be factored in during the programming process. Having said that, it’s typically indie game developers who focus on making games accessible by modification. That’s why www.includification.com gives software developers and game designers pointers and basic requirements and provides plenty of studies and essays on accessibility. 

Oftentimes, it's not intentional that developers make the games inaccessible but simply speaks to a lack of knowledge and awareness. That's something Dennis Winkens has also experienced along the way and reveals in our interview: "Once you get in touch with developers, they are usually very interested and willing to make changes to ensure more accessibility." That’s another reason why a Game Accessibility Special Interest Group (GASIG) was set up within the International Game Developers Association (IGDA), to make video games accessible to all. The website www.igda-gasig.org aims to connect people with disabilities and game developers.

Over the past years, the video game industry has certainly facilitated more accessibility, though in other ways it has not. It's a well-known fact that accessibility doesn't just benefit people with disabilities. After all, today's gamers are getting older, too. "At the moment, the fastest growing target audience is people over 50. That's why accessibility will also be an important issue in the future," says Felix Falk, who also identified another important area where games can be applied. "Games can be utilized in another important field: namely medicine. Today, dementia prevention programs or therapeutic training can be supported by computer and video games. Senior citizens can use games to boost their mental and physical health. Respective pilot projects are already being implemented in senior citizen centers."

By now, various concepts have made their way into the medical industry and games are now used to address many different aspects. This runs the gamut from pure gamification, meaning the use of e.g. bonus points to translate a playful stimulus an existing application, all the way to health games, which can be further sectioned into exergames (a term that combines "exercise" and "games") or brain games. They all fall into the main category of serious games. Their purpose is not just incentive-based. Instead, they are fully developed games that are designed to be fun but also pursue a serious objective.

A lack of motivation is often a barrier to treatment success, especially when it comes to children's therapy. Video games that were designed for medical rehabilitation purposes can motivate children to repeat monotonous exercises. The Zurich University of the Arts (Zürcher Hochschule der Künste) has developed "Gabarello - Game based rehabilitation for Lokomat". The ZHdK researchers have developed different game concepts to make therapy with the Lokomat – a powered gait machine that automatically guides the legs of patients with mobility impairments on a treadmill – more entertaining, thereby increasing the success rate by giving the young patients an incentive to repeat certain movements without the intervention of a therapist.

But health games don't have to be solely aimed at exercise and movement. So-called brain games can also improve memory and thus train people with a so-called "mild cognitive impairment", a precursor of dementia to boost their memory skills.

Health games can be used to improve both physical and cognitive abilities. Whether they are used to perform different movements for training or rehabilitation purposes or implemented in an attempt to imprint movement patterns into consciousness or to relearn them, health games clearly have a broad range of applications. "The most obvious advantage is that games are fun. The game contents and mechanisms boost motivation and improve the effectiveness of training," says D.Eng. Stefan Göbel, Head of Serious Gaming at the Technical University of Darmstadt. Our article on this subject highlights the benefits of exergames and describes their primary applications.

Meanwhile, the field of education has already emphasized playful teaching and learning for quite some time. This runs the gamut from educational games for children to educational games used in job training and education. For example, firefighters also use simulation training to create a training environment that offers a high level of realism in firefighting operations without actually putting any people at risk.

At this point, games are played in many areas of life, whether the intent is to reduce stress or promote training or exercise objectives. Man’s play instinct is distinctive and deeply rooted in his being. The virtual world definitely provides many opportunities, they just have to be made equally accessible to all people. But unlike reality, it would be easier to break down barriers in the virtual world and focus less on physical and mental disabilities and let the actual person take center stage instead. That's when games could also foster and encourage more inclusion in both the recreational or healthcare realm.