In the midst of a hectic, crowded, and noisy E3 2013, there was a quieter (albeit only slightly) corner of the show floor. Out of curiosity and after being dazzled by the lights and bombast of the larger booths, I decided to wend my way through the smaller set-ups in this calmer section of the expo. I was approached by a representative of Blue Marble Games, a relatively new developer that focuses on creating games that are both fun and will hopefully help people with brain injuries, especially returning veterans.
I was introduced to Nina Withrington, a physical therapist who works with the programmers and artists to help create Blue Marble’s games. At E3, Blue Marble was showing off a collection of games called RESeT, which collects information about performance that therapists will be able to use to identify problems with patient cognition like memory or attention span. I was able to chat with Nina about RESeT, Blue Marble, their other upcoming game Treasure of Bell Island, and their crowd-funding attempt, Zoezi Park.
Jack Gardner: Why don’t you start at the beginning?
Nina Withrington: To start from the beginning, this is a suite of games called RESeT. It basically has two parts: An assessment section and an intervention section. These games were made with funding from the Department of Defense for mild traumatic brain injury for the soldiers and veterans returning from Iraq and Afghanistan to serve them, because [brain injuries are] a big issue in that population. So, what we’ve done, we have a research team in-house, which I am a part of. I am a physical therapist. Bonnie here is an occupational therapist with a PhD in metrics and math and the owner of the company is a physical therapist and has a PhD in neural science.
Garnder: Wow, so you’re a bunch of smart cookies!
Withrington: [Laughs] We’re doing all right, we’re doing all right. Yeah, between us we have 75 years of clinical experience. It is really great that we get to work with a team of game designers, programmers, and artists to build these games from the ground up with clinical input in mind. So, going to the literature [and seeing] the current clinical guidelines, the evidence, what clinicians are using, and then inputting that into the game. That’s the whole idea behind this.
[Gesturing to the table-sized touchscreen computer on which RESeT is running, Withrington begins flicking through the menus, showing me different features.]
So, this is the assessive portion. You can see that it challenges different things that can be impaired in brain injuries: visual perception, visual-spatial inattention, memory, attention, executive function, which is organization and planning, coordination, and patient recorded outcomes. So, the game I’m going to show you here is called Asteroid Adventures and this is an assessment of executive function. It is our gamified version of a common test used in the clinic called 'the trail-making test.'
[I took a couple seconds to look the game over. It appeared to consist of identifying the patter and order of numbers and letters in the sand and pressing them in the right order. As I am playing, matching the correct pattern, Withrington continues to talk.]
The traditional test is done on paper with circles and a pencil. That’s the difference. Running in the background of all these games is a database that tracks every tap that is made on the screen. From that we can figure out what someone’s response time was, where they made an error, and what they did after they made an error. Did they keep tapping that same thing? Did they pause and make the same error? Did they pause and then make the right choice? That can tell us a lot about what is going on while they are doing an assessment. Another thing, on a big table like this we also know where you touched.
[Withrington pulls out her laptop and shows me a map of the Asteroid Adventures. The image is identical to the game I just played, but there are red marks across the left side of the screen, while the right side is relatively clear.]
This is actually some data from a person with a brain injury who played this in our offices and what you can see is that all of his mistakes were made on the left side of the screen. What that tells us is that he has some inattention to that side, which is common in brain injury, not necessarily in mild traumatic brain injury, but more severe brain injuries. We can collect that data, which is kind of neat. Let me show you one more thing… We’ll do the same test one more time, but a different version of it…. Just so you know, this suite of games is going to be at the clinical trials at Cedars-Saini* this summer. So, it will be a validation study of the assessment portion. Which is very exciting for us. Another thing about our games is that they are levelled, so that someone who is healthy can play these games and have just as much fun as someone with impairments. So, they level up and then they level down to a lower level. So, that way, if someone is going through the rehabilitation process their family can play with them, and they can play with their friends and they have something to talk about besides their injury. Which I think is really awesome, personally. I am going to show you one more evaluation. This is the same thing, but in this one, there is a line being drawn.
Gardner: So, same kind of deal as before.
Withrington: Yep, it is the same thing. The major difference being that you are getting this additional queue, right, so you know where you’ve been. Then I can show you the data and show you why that is interesting.
[In the interest of time, Withrington does the level herself, performing admirably despite the level being upside down from her point of view, and once more pulls out her laptop to show me data.]
This is what I wanted to show you. This blue line is the sandbox one, where you get this queue of where you’ve been, the line. This red one here is the one where you don’t get that queue. This was done with the same player with brain injury. You can see when he has the queue, he goes really fast in the sandbox. When he doesn’t have the queue, it takes him 3-4 times as long. That is a memory issue, where was I last? Trials B, where you switch between number and letter, he does about the same on both, which tells us he primary problem is memory, not flexible thinking. That’s the kind of granular data that you can glean from something that is on a platform like this and gives you data in the background. All of our games port to tablets and they play on the PC as well, so there are lots of platforms for them.
We also have another game called Treasure of Bell Island, which is a strategic adventure game, and what happens is- I don’t have a tablet right now, but the player has a cast of characters and they have to solve the mystery of an island. They have to explore the island, they have to hunt to feed their crew, they have to keep their crew sheltered, and all of these things as they go along solving this mystery and collecting golden bells. Each of the mini-games challenges a different aspect of cognition, memory, attention, and executive function. So, there is a whole narrative, you have a purpose, and it is real-life, you have to think about others, not just yourself. So, that is a really great, fun game that we are doing as well.
Gardner: Over time do these kinds of games improve that kind of mental cognition?
Withrington: That’s a great question. These were literally just built.
Gardner: So, we don’t know yet.
Withrington: So, we don’t know yet, that’s the answer. But, we have taken the evidence from the literature and I can say they do challenge all of the impairments, but whether that will translate into real world will take lots of studies to figure out over years. In the meantime, this is what we’ve got and it can be used, in my estimation. Especially when you consider that therapists are taking games off the shelf and trying to make those work. Saying, ‘well, at least I am getting this challenged a little bit.’ You know, they are looking at it from a task analysis perspective and saying, ‘what is being challenged here and can I make that work?’
Gardner: Is this available now?
Withrington: It will be available soon. Very, very soon.
Gardner: And people would just be able to buy this on the Apple App Store, or…?
Withrington: They could buy it from our website. That will be the first place you will be able to buy it. We’re not quite on iPad yet. We are working hard to get there, we have a preliminary build, but hopefully we will be. That’s the plan. But it can be played on PC if someone wanted to play on PC.
Gardner: What is this going to cost? Will it be free?
Withrington: No, that’s a great question. I am not the business person for Blue Marble, but I do know that we are committed to making these affordable. It will never cost more than an off-the-shelf game or what you would spend on a regular app. What would probably cost more would be if you wanted to know the data all the time. That takes a lot more maintenance on our end. But certainly, just to buy the game would be, you know, an average priced game, even though it has so much more going into it, like actual research.
Gardner: When someone buys the game, how do they access the data?
Withrington: The data is online. They can log in and see it there.
Gardner: Would therapists be prescribing these games?
Withrington: What’s great about our model here is that it could just be used by someone picking it up and wanting to use it or you can work with a therapist if you have impairments. The way I see these cognitive games is that they could be used as brain games too, because they level so high. But if you do have impairments, you probably should work with a therapist so they can help you through the game and develop strategies for you. In this game we have lots of mini-games as you go up in levels that challenge certain things specifically, so if a therapist has assessed someone, they can say, ‘you know, focus on these challenges, and don’t worry so much about these.’
Gardner: Are you working with other physical therapists not associated with the development?
Withrington: Yes, all throughout our design process. It is what we call user-centered design. We go out and do focus groups with all of our end-users. That is clinicians, people with disabilities, caregivers, and family members. We get everybody’s input: What would be fun, what doesn’t work here, does this mechanic really disturb your vision, etc. We have to consider things like that. There are certain mechanics that we can’t do in games here. Is the art too complicated? These are things that are all barriers for [people with brain injuries to enjoy] entertainment games.
Gardner: Can you tell me a little bit about how Blue Marble started?
Withrington: Yes, absolutely. Dr. Sheryl Flynn is our CEO. She is a physical therapist and has a PhD in neural Science. She won a grant from the Department of Defense to make the Treasure of Bell Island game, which was our first game.
Gardner: Treasure of Bell Island is out right now?
Withrington: Almost. We just redid the art. So, probably in a month or two, that game will be out.
Gardner: Also on the same platforms as RESeT?
Withrington: Yes, on tablet and PC, working on the [iOS] process. So, anyway, she won the grant from the government to make that one and then we got a grant to make RESeT and we had gotten another small grant to create a prototype for a game that helps prevent falls in older adults, and that small grant enabled us to create a very basic prototype with just one or two exercises in it, but we want to put in a whole suite of exercises from the Otago exercise program, which has been shown to prevent falls in older adults by 35%. We would love to get the generations playing together and doing that. We are doing crowd funding to raise money to hopefully be able to build out that game. It is Whenyouwish.com and the game is called Zoezi Park and Zoezi is Swahili for exercise. Because you have to train balance to maintain balance and I know as our population ages it is a very big public health issue and just a caring-about-our-seniors issue.
I think that what Blue Marble Games is trying to do is pretty great, and not something that we see very often in the video game industry. Check out their products and their stuff if you want to see something unique in the industry.
For more information on RESeT go here.
*Cedars-Saini is a non-profit hospital that also functions as an academic center for health science.