The game is very simple to play, and very young children can participate with no trouble. However, the exercise is used by many professional improv troupes to encourage spontaneity, listening skills, and narrative competence. The game manages to succeed in both a professional atmosphere and a children's playroom because of its very simple and wide-open structure. Maintaining grammaticality can be very difficult if a player is not allowing his or her mind to be open and flexible to change, and the results are often entertaining. The professional improv troupe plays much differently, however.
Punctuation becomes a key element of the game.
Top players also use morphemes in place of a full word to modify the story. Here, the story is now not about a sick man, but perhaps a man who is changing residences. Aside from the more technical aspects of the game, there is the general problem of maintaining a coherent story. While an audience might laugh for a while at a grammatically correct, but meaningless, narrative, that novelty quickly wears off. One answer is that improvisers rely very heavily on the principle of reincorporation.