Clinical Trial of a Rehabilitation Game - SuperBetter
Condition: Concussion; Mild Traumatic Brain Injury; Moderate Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Brain Concussion; Wounds and Injuries
Study type: Interventional

Summary: 
      Today's hospitals need innovative solutions to help patients transition from our care to
      self-management at home. The vast majority of the patients seen in Dodd Rehabilitation
      Hospital and associated clinics leave our care with persistent and life-altering challenges -
      behavioral, cognitive, emotional and/or physical. The period of time immediately following
      discharge is an under-addressed stage within the continuum of care. The investigators are
      researching solutions to help patients in this transition to self-care and believe that
      multiplayer gaming paradigms may be a promising innovation to facilitate this transition.

      The investigators believe that Dr. Jane McGonigal's SuperBetter, and positive play games like
      it, are promising novel interventions that could make a positive difference in the ability of
      our patients to successfully transition to self care after discharge from therapeutic care.

      Specifically, the investigators will evaluate feasibility of use of such a game by mild to
      moderate brain injured individuals and to record pilot data to help us plan a clinical
      effectiveness follow up study. Our goal is to finish this study with an intervention tailored
      for use within the clinical continuum of care and sufficient pilot data to prepare for a
      randomized clinical control trial of this intervention.
    

Detailed description: 
      Today's hospitals need innovative solutions to help patients transition from our care to
      self-management at home. The vast majority of the patients seen in Dodd Rehabilitation
      Hospital and associated clinics leave our care with persistent and life-altering challenges -
      behavioral, cognitive, emotional and/or physical. The period of time immediately following
      discharge is an under-addressed stage within the continuum of care. The investigators are
      researching solutions to help patients in this transition to self-care and believe that
      multiplayer gaming paradigms may be a promising innovation to facilitate this transition for
      several reasons:

        1. Games can bring the power of social networks and alternate reality to bear on the real
           world work of post-injury self-management.

        2. Games can use a digital platform, enabling quantification of performance in ways that
           could provide clinically-relevant documentation for post-discharge follow up efforts
           including tele-rehabilitation.

        3. Today's youth are gamers. The investigators aim to tailor our rehabilitative approaches
           to leverage the existing ability of our youth in this paradigm. In addition, Dr. Jane
           McGonigal reports in her book, Reality is Broken, that within another decade the
           majority of the world's population will likely be gamers. The investigators aim to
           anticipate this shift and be ready for it.

        4. Affordable games have the potential to be cost-effective aids and improvements over
           standard medical care protocols.

      Despite the promise of games to facilitate transitions from hospital care to self care, no
      clinical studies have been done to establish best practices for applying gaming for
      rehabilitative purposes within the specific window of time in which discharge from standard
      care happens. While some commercially available games exist for those interested in health
      self-improvement, through companies such as That Game Company, Nintendo, Xbox, only the
      Nintendo Wii system has undergone clinical testing to demonstrate feasibility of use within
      the hospital-based model of patient care. Without more such evidence, the investigators are
      unable to confidently offer such novel interventions for our patients.

      A new game, SuperBetter (SuperBetter, LLC, Sausilito, CA), has been developed to employ both
      social networking and alternate reality theory to achieve rehabilitative goals. SuperBetter
      is most similar to Facebook or Twitter in that users, or "gamers", create an account, invite
      others to be within their network, and post short status update messages. There are two major
      differences between SuperBetter and Twitter or Facebook, however. One difference is that this
      rehabilitation game will not offer a public option. The only people who can see a user's
      posts and status updates will have been specifically invited by that gamer; people outside
      the invited network will have no ability to "friend" a gamer, meaning there is no way to
      request to become part of a user's network - you must be invited by the account holder. The
      second difference is that SuperBetter assigns points to a gamer for attaining health goals
      such as: remembering to take medications each day; avoiding circumstances that exacerbate
      symptoms; checking in with someone within your trusted network (i.e. reaching out to your
      loved ones for support). Points are also assigned for "epic wins" which are defined by the
      patient and amount to things he or she cannot do today but want to be able to do tomorrow;
      this includes short term wins like hanging out with friends/loved ones or long term wins like
      getting back to playing sports.

      The investigators believe that McGonigal's SuperBetter, and positive play games like it, are
      promising novel interventions that could make a positive difference in the ability of our
      patients to successfully transition to self care after discharge from therapeutic care. The
      investigators are conducting Phase I clinical testing (feasibility) to determine whether such
      a rehabilitation game is appropriate for use with: mild traumatic brain injured children and
      teens.

      Specifically, the investigators will evaluate feasibility of use of such a game by mild
      traumatic brain injured individuals and to record pilot data to help us plan a clinical
      effectiveness follow up study. Our goal is to finish this study with an intervention tailored
      for use within the clinical continuum of care and sufficient pilot data to prepare for a
      randomized clinical control trial of this intervention.
    

Intervention name(s): SuperBetter play
Intervention type(s): Behavioral
Intervention description(s): average 10 min of game play per day for 6 week period
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: TBI; concussion; brain injury