Ideas, Ideas, Ideas

The last couple of weeks brought a huge wave of brainstorming, sketching, creating, and discussion with Jason and the team.  As of last Friday, I have spoken to 48 different patients, still keeping up a wide age range.  The more I spoke with patients, the bigger the game world within the Neuromotion platform grew in my head.  What world should they encounter?  What sort of problems?   The original plan was to have the player go to different cities around the world during the game, but I kept thinking that the metagame could be a great opportunity to imbue something more engaging and creative, while still keeping the experience cohesive.

When I brought up this thought to Jason, he thought of how aside from the biofeedback component, helping children with emotional regulation often means teaching them necessary executive functions.  After a thoughtful pause, he pondered, “What if each place the character could go to could teach different executive functions?  It could be a good chance to teach some psychotherapy in the game.”

I ruminated on this thought for a few seconds, but the cams and cranks in Jason’s brain were already flickering a small light of inspiration.  Without missing a beat, he slid over to his computer and e-mailed me an article about this subject, simply called Executive Functions by Adele Diamond, a professor from the University of British Columbia and BC Children’s Hospital, Vancouver.  She wrote:

Executive functions are “a collection of top-down control processes used when going on automatic or relying on instinct or intuition would be ill-advised, insufficient, or impossible.

For her, there were three core executive functions and an additional minor one. Jason’s current idea is that the mini-games could be categorized accordingly into each function:  Cognitive Flexibility, Inhibitory Control, Working Memory, and Fluid Intelligence.  That way, the games could be more organized and this would provide a bit more cohesion.  Of course, play-testing would be the ultimate judge of this idea, but it’s a start!

To provide more brief definitions of these terms, I wrote up bullets for my own notes and for the rest of the team:  Executive Functions

Sketch— Inhibitory Control: giving into external lures, handling impulses.  Lack of:  Characters with chronic hoarding issues?

Though this metagame idea is farther down the road for the team, it’s important to think of the proceeding steps since the start-up constantly changes.  Jason had me start thinking of how these worlds could look, and that we can talk through their accuracy and accessibility.   I have to say, it made those hyper-conceptual RISD assignments have come to good use.  Project tasks like “Please Illustrate De Ja Vu” and “Create a 12-dimensional self-portrait with gouache” actually DO resurface in the non-RISD world.  This gives me hope, albeit a lasting migraine to wrap my head around these concepts while also keeping themes and illustrations understandable.

Sketch—Working Memory:  Holding information in mind and mentally working with it.  Lack of:  Some form of negligence.  Purposely getting lost and not caring?

Aside from this brainstorming around the metagame, we came to the conclusion that there should be an avatar character that the child can play as.  I would say pretty much all of the kids feel relatability and customization would be crucial to this game to connect them to the game (as well as having a large world of possibility to explore).  If the avatar could have natural dialogue with the friend (coach) as well as with other characters, the experience can play out as a story and less as a one-way teaching tool.  I think we can learn a lot when situations play out in front of us;  for some reason, we can reflect better in the third person.

So in a sense, now friend character will become secondary to this avatar character.  We’re now questioning how much the friend should intervene, and how much we can use this narrative framework to instill independence for our users.  Jason and I had a brief discussion, and he thought that at this point, the avatar becomes the main character of this game.  Thus, when I started to create final splash screens and home screen backgrounds, I questioned whether to represent an avatar as an independent traveler or have them accompanied by their friend.

Progress—Splash Screen and Home Screens.  Show mid-travel spots.  Keeping it vague, but inviting.

Progress:  Avatar customization.  Dr. Alex Rotenberg suggested that this could be an opportunity to use a VAS scale (visual analog scale) where a child can choose an expression that feels represents them.  He asked whether that could give insight into “an inherent problem” that the child perceives themselves in a certain way.

Also the team has been helping to create other opportunities to introduce the avatar and friend into the beta game.  We have a tutorial or “emotional warm-up” where players have to raise and then lower their heart-rate on the screen as well as a game-over screen where the friend, when appropriate or occasionally, could appear with advice.

It’s Not Your Fault

So it’s production mode until the end.  With one more week left, I still plan to see more patients.  I think this last week would be a valuable opportunity to ask some final big thinking questions.  For some of the patients I met, I asked, “What would be something that we should definitely do in this game?” Then followed by, “What is definitely something we shouldn’t do?”  One older boy thought that there should be a main lesson in the end, so there’s a working goal.  A couple of 7 year-old girls both said that it would be important to have your character travel around and help other characters because that would help them feel better about themselves.

If I can share one response that resonated with me these past couple of weeks, it would be one experience in the Inpatient Unit with a teenage boy.  He was the only person I interviewed that afternoon, mostly because I had to leave early to see another patient in the Outpatient Clinic.

“The g-game should teach you how to…get better…and …get out of the hospital.” I noticed the “Welcome to the [Inpatient Unit Name]” notebook on the table in front of him.  He also said that the character you play as has to have a motivation, an ultimate goal to reach at the end of this game.  “Also teach…skills, like coping…skills.”

He was a very soft-spoken person, but his face was very physically scarred and his eyes very tired.  He was also shaking the entire time.  Each time he had to stop to cough, he apologized.  A couple of times, he was shaking so  violently that he couldn’t verbalize his thought.

During a particularly strong episode, he tumbled through his words. “I’m s-sorry…it’s my med-medication tha-that’s…ma-making me…shake”

“It’s okay, it’s okay.”  At that moment, his quivering head slowly turned towards me, and I knew I had to look him square in the eye.  It’s not your fault, I thought to myself.  It’s not your fault.  In a weird way, I thought he could hear me.  I let him speak for about 40 minutes until I had to leave.  Each time he coughed, I waited.  Each time he needed to collect his thoughts, I waited more.   In the beginning, I contemplated whether or not I should have turned to one of the nurses there to see if they needed to help him.  But after those first couple of minutes of speaking with him, I realized that this boy was trying so so hard to get his thoughts across. He was very thoughtful, gave great critical feedback, and really valued the importance of having a character give you advice during the game, not a disembodied voice.

Very politely, he shook my hand at the end of the interview.  “G-good luck.”  I think he smiled a bit.

I smiled back.  “Thank you so much.  G-have a good day.”  I nodded my head, thanked the nurse, and walked out with another nurse.

Should I have said ‘good luck’ back?  Should I have even said ‘have a good day’ even?  These phrases are so casual in day-to-day life, but in an inpatient unit, it’s just irony.  I thought about this on my way to the Outpatient floor where I realized my patient cancelled and I had another hour or so until my next expected patient.

Progress—launcher screen

Not to get too philosophical here, but it’s moments like these where it’s important to separate the body from the mind.  Though this boy had little control of his actions, his sharp, serious expression exclaimed his presence.  It takes a little longer and a bit more patience to really see it, but it’s there.  I had to give him time to speak and not impose anything which has been a constant anxiety for me when talking to patients.  In a way, this experience has become less about finding information about what motivates these children, but more-so learning to present myself as an active listener and empathetic  speaker.  How can you really hold a conversation with a child, any child, and have them know that an adult is taking them seriously?  Though I may be dressed in business casual and have a fancy hospital ID around my neck, I still want to get down to their level, which really becomes the task for any pediatric clinician at BCH. And there’s a lot more nuances than people think. Some kids have been easier to reach than others, but again, it’s part of the learning.  I didn’t study any of these techniques or terminology; at that moment I can only reach them through small questions, a bit of joking, and a handful of writing and doodling.

But sometimes simplicity is the answer I suppose?