Maritza's dream: Games that make therapy fun

By Megan Jones

It started with her brother. Maritza Basaran remembers sitting with him years ago, playing video games. Jaimie, who has autism, loved to hang out in the living room and fool around on his Nintendo. But without strong literacy and fine-motor skills, he couldn’t always play the games he wanted to. He couldn’t read the onscreen text, and sometimes wasn’t able to move fast enough to advance through the levels. So Maritza and her mother would plug in a second controller and play alongside him, doing most of the in-game work themselves.

The strategy worked for a while, but as Jaimie grew older, he caught on. Realizing that he wasn’t actually playing the game upset him, and he steadily lost interest in the activity.

“It was sad to see him give up on something that had once made him happy,” Maritza says.

Years later, in 2012, Maritza began work as a nanny for a toddler with cerebral palsy. She noticed the child tried to move and interact with the animated characters she saw onscreen while watching TV or movies. But, like Maritza’s sibling, it was hard to find media that she could fully engage with.

“She and my brother weren’t able to interact with the platforms the same way as other kids could,” Maritza says. “Not necessarily because of their disabilities, but because the media that was available didn’t suit their needs.”

Maritza knew the situation was avoidable, and began to think about how to make video games and other media that could be accessible for children with a wide range of abilities. “No kid should pick up a video game and think, ‘Oh, I have to work harder,’” she says. “No, you should have fun just like any other kid.”

Today, Maritza, 26, is applying her training in psychology and media design to a project at Holland Bloorview. Along with scientist Elaine Biddiss, Maritza, a research assistant and child media specialist, is working to develop a game that can double as physical therapy for children with CP.

Using the Kinect, a webcam-style add-on for Xbox, the game tracks players’ movements—that is, the motions they make in real life are reflected onscreen. The focus of the game will be on encouraging kids to perform therapy movements—such as reach and grasp—while completing different in-game tasks.

While the project is still in its early stages, some details are set. The game follows the story of Botley, a hapless but well-meaning painter robot who dreams of becoming an inventor. To help him with his painting, Botley invents a minion called a bootle. Happy with his creation, Botley tries to replicate his bootle. But when his plan goes awry, and he accidentally unleashes an army of minions, who begin to run amok, it’s up to the player to assist Botley in getting the bootle population under control.

“Our philosophy is that the kids are part of the show,” Maritza says. “You, as the player, are helping Botley. It’s kind of empowering.”

Gaming systems that use motion-tracking cameras for therapy purposes do already exist but they can be expensive and “kind of boring.” Maritza describes a typical therapy game where, for example, kids are instructed to follow an onscreen fish in a figure-eight motion in order to practice broad arm movements.

While the existing games might seem more appealing than floor exercises when a child is in clinic, they don’t pass muster at home. “The second it’s competing with television and other toys it’s rarely touched.”

By building plot, characters and reward-based incentives into the game—the things that make mainstream video games so much fun—the researchers hope to overcome some of these issues. 

And the games are designed to include players with different abilities.

“First, the actual navigation and controls of the game are much simpler to use,”  Maritza says. “We use a scanning system, so each menu option is highlighted one at a time and the child simply raises their hand or presses a single button to make a selection. Mainstream games often use navigation menus that require precise movements and targeting to make a selection and require several choices to continue with the game. Also, our menus and game instructions are seen in text and heard via narration so children can learn the rules even if they can't read.”

In addition, “the games are matched to the abilities of each player, making it much easier for kids like my brother to play. At the beginning there's a calibration where the system records how far the player can move their arms on the screen and how fast they can hit a target. For example, if a child can't reach the top right side of the screen, the system will record that and no in-game objects will appear in that location. And the difficulty settings, like speed of game objects, are adjusted to the ability of the player.”

In multiplayer games there will be a “skills match”  so that everyone is playing to the best of their ability with equal chances of winning.

Maritza says her own experience with difference has informed her thinking while working on the Botley game. In addition to growing up alongside a brother with autism and caring for a toddler with CP, Maritza herself was born with a cleft lip and palate, and was teased as a child. She believes this has helped her to develop an empathetic approach to her projects. She also spent time as a camp counselor for children with autism and Down syndrome. Working with children with a variety of conditions has allowed her to see disability as something multi-faceted, and to better understand the range of needs each individual may have.

Ultimately, the researchers hope the gaming system will accomplish two main goals: first, they would like the software to function as a fun way for children with cerebral palsy to reap therapeutic benefits. The ideal would be to see evidence that the game actually improves children’s range of motion.

The second aim is to provide inclusive, social play. “I think back to my brother and the exclusion he felt not being able to participate,” Maritza says. “We probably all dream of children having the opportunity to compete with friends and family members on an equal playing field.”

Elaine and Maritza have begun working with kids and families through Holland Bloorview's Children’s advisory council to test the game and they hope to repeat the experience soon.

At the end of the day, Maritza and Elaine hope that kids will find the technology fun. “It’s funny, we’re trying to get kids addicted to video games,” Maritza says. “To us, they’re beneficial. Other people may feel video games are bad, but we think they’re great.”