Can video games treat diseases?
Do you prefer a pill or playing a video game?
This may become a not so weird question you’ll heard from your doctor in the near future.
Indeed, at least for children with ADHD (attention deficit and hyperactivity disorders), Akili Interactive developed and validated through randomized controlled trials a potential prescription treatment. It is known as “Project: EVO” or, more technically, AKL-T01.
This is a sort of video game to be prescribed for 30 minutes a day which is currently under evaluation by FDA, the U.S. regulatory agency.
Gamification is not a new concept in the health arena. It helps making behaviour change easier and more fun, like in company-promoted steps challenges. Gamified DTx are “just” at a higher level. Let’s see how they work.
Update: On 15th June 2020 the FDA has granted clearance for EndeavorRxTM (the commercial name chosen for AKL-T01), so this is the first prescription treatment delivered through a video game
How video games work as digital therapies?
“Project: EVO” consists in navigating a character through a range of levels, using both the touchscreen and tilting the tablet to respond to the environment. Continuing through the levels, difficulty increases and distractions are added.
It relies on high-quality graphics and reward loops designed to be engaging for children. So, the look and feel is that of interactive action video games but this digital therapy is designed to target cognitive deficits at the specific sources in the brain to improve cognitive function
“Project: EVO” is designed to deploy sensory and motor stimuli to target and activate the prefrontal cortex, the area of the brain known to play a key role in cognitive function.
These digital medicines are also extremely personalized. Monitoring user’s progress it’s possible to adjusts the “dosage”/difficulty. The intervention mentioned above embeds algorithms that continuously adapt to cognitive control ability and provide feedback on progress and compliance.
Therapeutic adherence is not just for drugs
Gamification techniques help better engaging patients, which is mandatory for therapeutic success. Indeed, even if we’d develop a DTx that assures 100% improvement in clinical outcome X, if patients become bored and stop using it, it becomes worthless.
Adherence to treatment/compliance is a topic already stressed in healthcare… But users’ engagement importance is an hot topic in game development too. Some well-known ways to boost engagement (outside DTx) are the following:
- Points collection
- Displaying progresses
- Badges and stickers collection
- Challenges (with rewards)
- Competition / leaderboards / ranking
- Disclosing features progressively
- Levels to be completed/unlocked
- Missions (ever tried games with daily missions? And the obligation sense, especially if you have to maintain a completion streak…)
- Collection of (virtual) goods
- Constraints / deadlines (such as with time-limited offers)
- Storytelling (let users immerse themselves in the game)
- Give choices
- Engagement with peers, joining efforts towards a shared goal (players can encourage each other)
- Loss avoidance (as with Pact, a healthcare game which encourages exercising and eating healthy, and charges you a predetermined amount if you missed daily goals. Note that this is not, yet at least, a DTx)
Probably not all together, maybe not all of these, but I bet this tips from previous experiences of commercial game designers will be useful with gamified digital therapeutics too.
AKL-T01 is not alone, other therapeutic games will arrive
This isn’t the only game willing to become a digital therapy. Akili Interactive itself, indeed, is developing also other “therapeutic games” aimed to treat autism spectrum disorder in children (1 small, active-controlled clinical study conducted so far), cognitive deficiency in adult patients with Major Depressive Disorder (AKL-T03 is currently undergoing Phase II clinical studies, AKL-T04 is in feasibility phase).
In addition, AKL-T03 is being evaluated as a potential DTx to address cognitive impairment in patients with multiple sclerosis (feasibility study completed).
And I bet other companies will join in exploring this new, and fun, frontier of medicine.