MemoreBox by RetroBrain: Where rehabilitation meets fun

Doing something good for your health in a playful and fun way – that sums up the concept of health games. "It does not have to be grueling, boring and dreadful to maintain or regain your health," says Manouchehr Shamsrizi. Together with five colleagues, he co-founded RetroBrain and developed the MemoreBox – an easy-to-use gaming console for aging adults, designed to keep them physically and mentally healthy and fit.

RetroBrain CEO Adalbert Pakura as well as creative mind and co-founder Manouchehr Shamsrizi  sat down with REHACARE.com to talk about the success of their startup company, describe their philosophy and reveal what’s next for MemoreBox.

Mr. Shamsrizi, from innovative idea to the now market-ready product: Can you briefly summarize the development of the MemoreBox since 2014 for us?

Manouchehr Shamsrizi: Six of us co-founded our startup company RetroBrain while we were EXIST scholarship holders at the Humboldt-Universität zu Berlin, which also included alumni of the Ludwig Maximilian University of Munich and the Zeppelin University. In a way, the idea for RetroBrain originated in the networking and the unique community within the university.

One of the aspects that I distinctly remember from this early stage is the discrepancy between the idea of man held by the healthcare economy and the idea of man my generation grew up with and has come to know. This is reflected by computer games being the dominant entertainment medium of my generation. On the one hand, we have the often mentioned Homo Ludens – that is to say, a dynamic, socially interactive and included man, the player. On the other hand is the patient as defined by health economics, who must be "subjected to" prevention, rehabilitation or therapy. In other words, the patient is often controlled by an external source, which tends to be driven by short-term economic incentives and is typically represented by a doctor or a health insurance company telling a patient what to do. There is a huge discrepancy here, which is actually quite unnecessary once you merely scratch the surface. It does not have to be grueling, boring and dreadful to maintain or regain your health - quite the contrary, it is more sustainable, productive and ethically desirable when staying healthy is fun.

Once the gamelab of the Humboldt Universität zu Berlin has come to realize this, we started to form applicable partnerships. We are certain that gesture-based video games with innovative control systems can be made up of drug-free, therapeutic, preventive and rehabilitative elements.

In a strictly regulated and highly politicized public health sector, you need a good and broad stakeholder network if you want to make this type of social innovation available on a larger scale for as many people and organizations as possible who are affected by this situation. Our venture is a social business, which is also why we have been supported since an early stage by Ashoka (an international US-based non-profit organization that promotes social entrepreneurship) and Malteser International. To this effect, the business venture is ultimately a vehicle for us to make this type of social innovation available on a broad and sustainable scale. Needless to say, German health insurance companies are also among the main stakeholders that help us achieve this goal.

What opened the door to their world for us was the German Prevention Act, which has been in effect since the summer of 2015. The need for this law indicates how diametrically opposed the two poles of "having fun" and "getting/being healthy" were at the time. The legislator is aware of this and created this law to motivate the health insurance industry to invest more money in prevention. Given that it generally takes fewer resources and is simultaneously more promising to keep someone healthy versus trying to heal him/her after they have taken ill, which takes more effort and has far lower chances of success, the legislator designed the Prevention Act to obligate health insurance companies to allocate sufficient funds to promote meaningful prevention.

The fact that this approach is important and right is also reflected in us now collaborating with the BARMER insurance company, the Diakonie Germany (Editor’s note: a nationwide charitable organization) and the Humboldt-Universität zu Berlin in implementing the new Prevention Act for the first time. We already have the first results, and we are very excited about rolling out our joint pilot program nationwide during a second phase. Even more exhilarating is that the Deutsche Fernsehlotterie (Editor’s note: Germany’s leading provider of state-licensed lotteries) has likewise deemed our solution worthy of its sponsorship - as the first-ever digital project.

A video game console is typically not something one would expect to see in a nursing home or rehabilitation center. Yet everyone from stroke survivors to dementia patients to healthy senior citizens without any impairments can use the MemoreBox. How do you get everyone to overcome any skepticism and play video games?

Adalbert Pakura: It’s fascinating to see that it’s usually those who generally hold a critical view of digitization in healthcare who are skeptical. Meanwhile, we are putting our players at the center of all our efforts in development, design and our social enterprise business model. That’s why our approach to overcome prevailing skepticism is a simple one: with our supportive partners by our side, we prove that this concept works. As a game, as an intervention that promotes health, as a pilot project for the digital transformation in the healthcare sector, and ultimately as an option for a new – and actually very old – idea of man, which we aim to promote: namely, the self-determined Homo Ludens.

How can gamification support issues such as fall prevention or dementia treatment?

Pakura: In addition to the general motivational and psychological aspects mentioned earlier, we can now answer this question based on the following experiences gleaned from our pilot project, which studied the health-promoting effects regular gaming has on the social, physical and cognitive resources of senior citizens: Compared to the non-gamers, gamers showed significant improvements in cognitive performance, gait stability, motor skills, stamina and coordination. There are also moderate improvements as it pertains to the health-related quality of life, the extent of which is practically significant. However, it still needs to be shown on a larger number of participating senior citizens during the second pilot phase whether these improvements are also of statistical significance. There were positive trends in the subjective experience of pain, which was reduced by regular gaming. Assessments using H.I.L.DE. (Editor’s note: The Heidelberg Instrument for Accessing Quality of Life in Dementia Sufferers offered by the Institute of Gerontology at the University of Heidelberg) also suggest an improvement in social inclusion, interaction, and communication.

We are now planning a continuing study of these results as part of a nationwide study to further explore other issues.

What does inclusion mean to you?

Shamsrizi: Ultimately, inclusion is a fundamental characteristic of democracies, which is why we believe it far exceeds the meaning it has in colloquial language. It is also a term that should be understood less as it relates to problems and more as it refers to opportunities. From a media archaeology perspective, every new era and every new cultural technique - whether it was the printing press or the telephone or now the Internet and digital technology - was the prelude to a more inclusive society. For us, inclusion denotes these opportunities of (re-) connecting people beyond spatial, generational and health constraints and boundaries.

By the way, if you consider the time in which the concept of Homo Ludens was coined and note Schiller, who said, "Man only plays when he is in the fullest sense of the word a human being, and he is only fully a human being when he plays", then the aforementioned separate sectors - health in a comprehensive sense and play as a design principle or cultural technique, respectively – are seen as an entity aimed at the concept of inclusion. Bearing in mind that Oliver Wendell Holmes, the past Dean of the Harvard Medical School said, "We do not stop playing because we get old – We get old because we stop playing", we were actually quite close in our understanding of the cultural technique of play as being inclusive.

For us, this understanding of what inclusion is in practice also means that we regularly challenge ourselves and our partners from science and practice to make our ideas easier and more accessible for an even broader range of people with a variety of impairments. We expressly emphasize this in our BMBF funded project "EXGAVINE: Motion Play in Virtual Reality as a Therapy for Neurological Diseases"