Ron Kuran is no stranger to playing games.
He could hold his own on a basketball court in high school, and he played volleyball as a young man at the division I college level.
So when he suffered a devastating stroke four years ago — a brain bleed complication of a procedure he’d undergone to deal with a separate clotting disorder — it seemed a natural fit that games were incorporated into his recovery, along with traditional physical and occupational therapy, at West Orange, New Jersey-based Kessler Institute for Rehabilitation. Now 50 and a father of four living in Jackson, New Jersey, Kuran says having a background as an athlete made his rehab “easier” (at least relatively speaking anyway, accounting for the inherently arduous nature of stroke rehab) because he already knew how to make adjustments to reach a goal.
In fact, throwing a football was made part of his therapy so he could do that with his sons, which was one of his recovery goals. And he eventually picked up a basketball as well, dribbling around as he sought in so many ways to regain what he lost from a stroke. But it wasn’t just sports. Games of all kinds — that made him think and recall and look and walk — featured prominently in his remarkable recovery, which saw Kuran return to work six months after his stroke in February 2014.
For each person who survives a stroke, rehab varies considerably, but frequently it includes physical, occupational and speech therapy, with regular input from clinicians who closely monitor progress. Often it’s a long, tough road. So while not aiming to replace traditional rehab, frequently stroke recovery programs now incorporate playing games — from low tech board and card games, and the block-stacking game Jenga, to video games (like sports-themed ones) on the Wii and Xbox Kinect that require really putting your whole body into it, to virtual reality. These are integrated into the recovery process to make it fun and keep patients engaged to help give them an edge.
[See: 10 Ways to Lower Your Risk of Stroke.]
“I think the biggest thing that we look at in neurologic rehab in general but particularly in stroke rehab is sort of the ability to force the brain to adapt a new environment,” says Arielle Resnick, physical therapist with a clinical specialty in neurologic rehabilitation at Kessler Institute rehab center in Saddle Brook, New Jersey. Considering the concept of neuroplasticity, or the ability for the brain to essentially reform and reorganize its connections, what’s needed to drive that is the repetition of activities that are focused on developing a skill. But that alone isn’t enough. Research on neuroplasticity shows it’s important to choose activities that are salient to the patient, Resnick explains; that is, it needs to be something that captures the patient’s interest and which that person wants to get involved in. “So when you do something like games … a common ground that’s enjoyable to a lot of people, you can focus the games to sort of target what it is that you’re looking to recover — whether that’s a cognitive function, a speech function [or] a mobility function,” she says.
Much of the research finding games to be beneficial in stroke recovery focuses on virtual reality. But experts say games of all kinds seem to make a demonstrable difference, like in Kuran’s case, as a supplement to — not a replacement for — mainstay rehab therapies.
Now a senior project manager in the construction industry, Kuran had his work cut out for him after his stroke to get back to the life he knew. “I was completely paralyzed on the left side of my body,” he recalls – having no movement in his left arm or left leg, as a result of the bleed that impacted the right side of his brain. His field of vision was essentially halved: “I lost vision on my left side.” His memory suffered, and the engineer by trade’s math skills were also undermined. “I noticed that not too long after [the stroke] that simple mathematics was not easy for me, along with just regular conversations, and when you get into detailed conversations — like this, as a matter of fact: Recalling things for me — short-term and long-term — was a struggle initially.”
Since, though, he’s made almost a full recovery, with limited lingering deficits, like to his vision, which is very nearly fully restored, though not 100 percent. “I still have numbness in the left side of my body,” he says. “But I could do all the things that I’d done. Like I walk fine.”
One game-based approach incorporated into his rehab early on involved using a robotic arm — that acted essentially like an extension, in this case of his left arm — to pick up, say, produce in a virtual store represented on a screen in front of him. “You would be able to control this object with your hands, and on the screen you would see that person picking this object up and putting it in the grocery bag,” Kuran says of the technology Armeo by the international firm Hocoma, which makes robotic and sensor-based devices for functional movement therapy. This helped with getting his left hand working again, he says.
[See: Working Can Help You Heal From a Stroke.]
Often low-tech games help advance recovery as well — like hide-and-seek with things. Kuran says physical and occupational therapists at Kessler would hide small objects, like wooden pegs kids might play with, for him to find. At home, his kids even picked up the baton, stashing things like Matchbox cars or dolls at first in the same room, then anywhere on a floor and finally throughout the house, so that he’d have to go up and down stairs. Kuran says playing the game at Kessler and at home “made a huge difference.” It helped with walking; as he regained most of his vision on his left side, the game aided his adjustment to a remaining “sliver” deficit in his field of vision he has to see “around;” and it honed his short-term memory. “I would have to constantly remember, ‘Well, what am I looking for?'”
Like the hide-and-seek game, even classics like checkers can have an impact on stroke recovery, experts say, requiring fine motor movements to put checkers on spaces, which can translate to other tasks for a stroke survivor. “So when they have to grab a pen and write, them having practiced grabbing a small game piece can help them that way,” explains Dr. Monica Verduzco-Gutierrez, medical director of the Brain Injury and Stroke Program at TIRR Memorial Hermann.
If stroke survivors and their advocates want to be proactive about incorporating games into recovery, Verduzco-Gutierrez suggests they should ask their physiatrist, or rehab doctor, and therapist if games are something that can be used to enhance their recovery. “We do not want it to get in the way of the therapy they’re already getting,” she notes. But if games can supplement it, experts say, all the better.
“Games are social, games have rules, games have language, and if you use the right games, you can not only improve cognition, attention, visual processing, but it’s social,” says Jodi Morgan, a speech language pathologist and manager of the Brooks Rehabilitation Aphasia Center in Jacksonville, Florida. “Aphasia is a language disorder following a stroke that affects people’s ability to understand and produce language in all language modalities — so it could be reading, it could be writing, it could be understanding language or speaking,” Morgan explains.
[See: How Hospitals Are Using Technology to Become More Patient-Centered.]
So that may be writing or drawing like with Pictionary, or in Scrabble spelling out words with lettered panels, or in cards, just commenting on a play someone made. Those and many other games can help stroke survivors with aphasia, Morgan says. Given the involved, complex nature of the disorder, as with stroke, it pays to take a dynamic approach to addressing it. And that’s ultimately analogous, experts say, to why games are a good fit for stroke rehab, which is multidimensional by nature. “Sometimes I’m just mesmerized by what people can do when you actually make something fun for them,” Morgan says.
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Playing Games With Stroke Recovery originally appeared on usnews.com
