AJSLP Viewpoint Enhancing the Therapy Experience Using Principles of Video Game Design John Wm. Folkins,a Tim Brackenbury,a Miriam Krause,a and Allison Havilanda Purpose: This article considers the potential benefits that emotion or cognitive connection. The discovery principle applying design principles from contemporary video games promotes indirect learning in focused environments. The risk- may have on enhancing therapy experiences. taking principle addresses the uncertainties clients face when Method: Six principles of video game design are presented, attempting newly learned skills in novel situations. The and their relevance for enriching clinical experiences is generalization principle encourages multiple opportunities for discussed. skill transfer. The reward system principle directly relates to Results: The motivational and learning benefits of each the scaffolding of frequent and varied feedback in treatment. design principle have been discussed in the education Last, the identity principle can assist clients in using their newly literature as having positive impacts on student motivation learned communication skills to redefine self-perceptions. and learning and are related here to aspects of clinical Conclusion: These principles highlight areas for research practice. The essential experience principle suggests and interventions that may be used to reinforce or advance connecting all aspects of the experience around a central current practice. ideo games are captivating. Around the world, for a number of years, both at school and at our clinic. people spend more than three billion hours a week Martin typically showed low levels of engagement in both V playing them (Knewton Inc., 2014), with the average environments despite multiple attempts to make sessions gamer playing 8 hr per week (Entertainment Software interesting and enjoyable. Although some treatment proto- Association, 2014). Contemporary video games are success- cols include statements related to client motivation and ful because they are personally meaningful, experiential, and engagement, we were unable to find any research in the social (Shaffer, Squire, Halverson, & Gee, 2005). Players speech and language literature that directly examined specific are highly engaged: They concentrate hard, they stay on task, strategies (outside of the technique of motivational inter- and they often find it hard to put the game down even viewing; e.g., Behrman, 2006). Textbooks and consultations when mentally fatigued (Beck & Wade, 2004). Can the same with colleagues yielded interesting but unsupported ideas. things be said for clients receiving intervention from speech- This article considers how the design principles of language pathologists? Are there lessons we can learn from contemporary video games, independent of the games video games that might enhance client engagement and themselves, may provide meaningful guidance for clinicians motivation in therapy? looking to increase their clients’ engagement and motivation. An example of a client who might benefit from in- It was inspired by clients like Martin as well as recent dis- creased engagement of this type is Martin, a 12-year-old cussions in the education literature about improving student with specific language impairment who was recently seen motivation and learning through the design principles 1 in our clinic. Although we were able to quickly determine an of video games (Gee, 2005, 2007a, 2007b; Kapp, 2012; evidence-based intervention approach to facilitate Martin’s McGonigal, 2011). The following discussion presents and language development, we were concerned about his moti- analyzes six principles of contemporary video game design: vation and participation in therapy. He had been in therapy essential experience, discovery, risk taking, generalization, reward systems, and identity. A summary of these princi- ples is provided in Table 1. If design features such as aBowling Green State University, OH Correspondence to John Wm. Folkins: [email protected] 1The name Martin is a pseudonym. His case is a fictional account Editor: Krista Wilkinson that is loosely based on a client with whom one of us worked. All Associate Editor: Erinn Finke descriptions of Martin are used for illustrative purposes only and do Received April 21, 2014 not depict a full case study. Revision received August 27, 2014 Accepted September 13, 2015 Disclosure: The authors have declared that no competing interests existed at the time DOI: 10.1044/2015_AJSLP-14-0059 of publication. American Journal of Speech-Language Pathology • Vol. 25 • 111–121 • February 2016 • Copyright © 2016 American Speech-Language-Hearing Association 111 Downloaded From: http://ajslp.pubs.asha.org/ by Bowling Green State University, Karen Brackenbury on 02/24/2016 Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx Table 1. Six principles of contemporary video game design that increase player engagement. Principle Description Essential experience Fundamental themes that evoke targeted emotional and mental responses immerse players in the world of the game. Discovery Learning through exploration and experimentation promotes active attention and creative problem solving. Risk taking Risky challenges that are commensurate with players’ skills encourage exploration and increase enjoyment. Generalization Connecting skills acquired early in the game to later challenges reinforces their development and increases their application to new circumstances. Reward systems Incorporating multiple forms of reinforcement and punishment signifies achievement, enhances skill development, and entertains. Identify Complex characters, whose motivations and skills vary, encourage players to take and act from perspectives that may be different from their own. these can be used to facilitate learning in nongame contexts, outside of gaming. Some, for example, use video games to they may also increase engagement and motivation, and crowdsource solutions to difficult problems (e.g., Cooper thereby learning, in clinical intervention. et al., 2010; Kapp, 2012), whereas others use them as simu- lations to teach particular concepts or skills (e.g., Moore, Current Therapy Design in 2008; Shaffer et al., 2005). A third general approach, and the one emphasized in this article, is gamification, de- Speech-Language Pathology fined as “using game-based mechanics, aesthetics, and Speech-language pathologists have many factors to game thinking to engage people, motivate action, pro- consider when creating clinical experiences for their clients. mote learning, and solve problems” (Kapp, 2012, p. 10). They select long-term and short-term goals and objectives, Gamification is more than simply adding individual as- choose or create therapy activities, and develop ways of pects of video games, such as points and badges, to other tracking progress, often in cooperation with the client and experiences or incorporating games into learning envi- his or her family. Such decisions have long been guided by ronments (see Egenfeldt-Nielsen, 2006, for a review of many different theoretical perspectives (e.g., psychological, such applications). Gamification involves understanding educational, and cognitive). A clinician setting out to design the principles that make video games so engaging and therapy typically begins with some theoretical understanding applying them to other contexts. Gee (2007a), for example, of a disorder and how to modify it. For example, stuttering discussed how 36 learning principles inherent in video therapy might be guided by principles of stuttering modifi- games can be applied to education. Kapp (2012) cited ex- cation, fluency shaping, or acceptance. Likewise, a clinician’s amples of recent interest in applying gamification to aid theoretical understanding of specific language impairment business and industry in innovation, marketing, training, or auditory processing may influence the design of receptive employee satisfaction, employee performance, health, and language therapy for a child. social change. As stated by Shaffer et al. (2005), “The Behavioral objectives for therapy are developed from question is this: How can we use the power of video these underlying theoretical models of disorders, and their games as a constructive force in schools, homes, and work- implementation is typically embedded in broader theories of places?” (p. 3). learning and development, such as operant learning theory Aldrich (2009) highlighted that video game design or social learning theory (Fey, 1986). The treatment approach principles used to enhance educational activities are aimed selected may be clinician directed, client centered, or a at procedural learning. Students are taught not only facts hybrid of the two (Roth & Paul, 2002). Principles such but also how to analyze and act in the situation; that is, as modeling (Burns, 2011), scaffolding (Bellon, Ogletree, & how to perform as a skilled participant or professional Harn, 2000), or distributed practice (Maas et al., 2008) (Schön, 1983, 1990; Shaffer et al., 2005; Shulman, 2005). may be considered. Procedural factors are also important; This is relevant to the field of communication disorders for example, as Roth and Worthington (2015) noted regarding in two ways. First, speech-language pathologists and audi- efficiency, “Every session should be efficiently designed to ologists need to know not only information about disorders provide a client with the maximum number of opportunities and clinical activities but also how to perform