NeuroGaming Theraputic Functions

May 2, 2013, Neuro-Gaming Conference, San Francisco—The gaming industry could have important effects for brain illnesses like memory loss, attention, and emotional issues. The panel moderator was Casey Lynch from NeuroInsights. Panel members were Sheryl Flynn from Blue Marble Game Company, Andrew Faulkner from Personal Neuro Devices, Evian Gordon from Brain Resources, and Henry Mahncke from Posit Science.

Flynn described the system as a table-top display with embedded games. The system captures metrics and provides reports for evaluations. Eventually they will export the data to electronic health records. The games include self-assessment through play, using standard assessment scales.
Faulkner talked about an inconspicuous portable EEG like a phone earpiece. The device can monitor 24-hours a day to detect mental issues like depression. Integrated neural feedback can provide recommendations for personal self control and monitoring. The hardware teaches changes for ADHD, meditation, and other neurological metrics.
Gordon is working on a database for all modalities (www.brainnet.net ) to discern key facets of thinking and self-regulation. They post their research results after 20 sets of game play to provide standard data for developing control groups and other metrics.
Mahncke addressed cognitive training. Their site www.brainhq.com is looking at validation, efficacy and use for training. Results show that tier games are better than crossword puzzles. The intent is to make the training more fun. More like “Call of Duty” or a soccer simulation than “Angry Birds”.

Efficacy established?
Flynn responded that efficacy is essential and critical but with limited funding not easy. They are getting into testing after the games are developed. They have added hooks for other functions and metric acquisition. The science is critical, but you need money and partners to do the science. You also need partners for entertainment pacts.

FDA regulations and efficacy?
Faulkner plans to establish efficacy with help from universities and the Canadian government. They will help to evaluate comparable electrodes. They are not registering with the FDA because the devices are non-invasive and are considered neurological supplies.

Skepticism of efficacy?
Gordon noted that the missing information is precisely what the FDA is looking for—a protocol, plans for testing, and a submission of results to the FDA showing the ability to predict and treat depression. This process is just basic science, but will cost $20M and take 2 years to prove a level of efficacy.
Mahncke commented that they are in trials now. Software developers fear the FDA, but clearance is not that difficult. You just need a good study. The FDA has the authority, but doesn’t have the time, resources, or expertise to regulate all the software.

Engagement and tricks?
Flynn responded that entertainment and fun are a part of the game design. The games have dynamic difficulty adjustments to maintain interest and challenge. They work with clinicians and patients at early design levels to get the components working right. Without engagement there is no value and any efforts are not maintained. They integrate existing guidelines into the games.
Faulkner commented that their device changes levels and keeps scores. They have unlimited potential to grow.
Gordon mentioned viral marketing as one facet of the expansion. Their deep brain model has no push, but new discoveries keep appearing. They add personalization and dynamics to the game.
Mahncke wants a more serious focus. Having fun is not the issue, but training is more important. The game has to generate applicable metrics and data while still being “pretty”. No game is right for all people, so the industry needs a diversity of games. the deeper commonality is brain training. We have to change the definition of fun, a hard problem.
Faulkner disagreed, if you add fun, you get better results. You need different reward systems. Many types of games are needed with different colors and actions.
Flynn chimed in that fun experiences lead to better results due to more activity and compliance. The results are really self-deterministic for issues like control, success, autonomy. You need to add fun, and be able to share successes in a social environment.
Mahncke debated the context. If something is framed as a game the “fun” is not as good as a “real” game.

Choose games and change popular games?
Flynn noticed that off the shelf games level up quickly and have overly complex graphics. If these games can work, then use them, but there is no data showing any value. The industry needs to generate lots of new data, since current data are not specific enough.
Faulkner offered that commercial games can be easy and portable. Simple games give rapid responses.
Gordon commented that boredom is one aspect of ADHD, so existing games are possible. The issue is to balance engagement and distraction. Gamifying depression treatments can be negative to pointless. The treatments have to be faithful to biology first then you can transfer the intent into a standard game.

Need to meet FDA standard protocols, with the levels of inspection going up.
Faulkner acknowledged that this is a difficult protocol proportional to the asymmetry with elements. You just have to look for a negative ground state. The patient still needs to see a doctor and get medicines. The games are a supplement.

Is the issue not the FDA but insurance?
Gordon agreed that you have to sell the idea to the large insurance companies like Aetna. The FDA is not a scare tactic and you avoid the issue are your own peril. Insurance companies are more interested in the ROI.
Manhcke agreed that insurance is important. The FDA is not the same as the insurance companies. In many cases, using a game is much less expensive than a neurological practitioner at less than $1k per year. Payers are easier than MDs and the FDA because they understand the changes result in saving money.
Faulkner commented that payers are not interested with FDA issues. They are looking for low cost therapies.
Flynn suggested getting medical side and payer discussions. Get pilots rolling for an evidence-based program. For example, software and sensor fall prevention. The payers are interested because it will reduce costs.