MND Australia

Why videogames matter for MND these holidays

With the end of year fast approaching, many of us are looking forward to time spent resting, celebrating with family and friends, and, for some, enjoying one of the most popular and pixelated recreational activities in recent years: videogames.1

There are many reasons why people love videogames. Videogames offer a virtual escape, can encourage problem solving, are an interactive form of storytelling and, simply, are fun to play.2 Videogames may develop skills with technology, too. Recent survey work by the Motor Neurone Disease (MND) Association of Victoria in Australia found that playing videogames was a common reason for people living with motor neurone disease (MND) to use iPads.3

Increasingly, videogames are also an important social activity. It is through gaming that many friendships form and are maintained despite people being separated by physical distance. More than the act of playing together, a distinct gaming culture has emerged where gamers collaboratively strategise and discuss the lore of the worlds they are exploring. Videogames can be great activities to share with family and loved ones, too.

But as fun and engaging videogames may be, especially during the holidays, not everyone finds it easy to switch on the computer or console, and roam through their favourite digital world.

Some people, like those living with motor neurone disease (MND), face great challenges to using videogame technology, by themselves or with others.4, 5 MND can make pressing buttons, holding controllers and other basic parts of operating consoles and computers very difficult. Fatigue from MND can make it hard to keep playing as well.

The barriers are unfortunate. Many people living with MND who could enjoy videogames may not be able to use them for pleasure, socialising with others or for just having a break during a tough time.

As we learned here at MND Australia, however, there are great ways that videogames, and how they're developed, can change.

We asked a team of researchers from four different Australian universities about a unique project they are working on that explores how to make it easier for people living with MND to play videogames.

About the research team

Dr Kirsten Harley is a sociologist who lives with MND and writes regularly about her experience and use of communication technology. Kirsten is an Honorary Lecturer at the Centre for Disability Research and Policy, The University of Sydney, and is also a Board member of MND NSW. 

Typically working with a younger audience, Dr Matthew Harrison explores the affordances of digital games-based learning for creating more inclusive school communities at the University of Melbourne. Through his past research, Matt has established ways of using cooperative videogames as spaces for developing social capabilities in children on the autism spectrum, and has developed an understanding of the importance of accessible game design and input devices. This work has positive ramifications for also supporting players living with MND so that they can keep playing with their friends and family.

Also working in the digital education space is Dr Natasha Dwyer, based at Victoria University. Natasha is a user experience (UX) design researcher exploring the dynamics of digital trust, an area she worked in as Research Fellow at British Telecom.

Dr Ben O’Mara is the Information Resources Manager at MND Australia and an Adjunct Research Fellow at Swinburne University. As part of Ben's work in research and practice he explores ways of making health and information technology more inclusive, including for people living with MND.

What is your project?


We want to explore how gaming can be made more inclusive for people living with MND. The first part of this project is exploring the current state of research into how videogames are being used for people with similar needs to the MND community.

To do this we are conducting a scoping review of the literature. This involves systematically exploring the breadth of literature available around inclusive gaming.

By identifying not just the available academic research, but also the 'grey literature' including from peak bodies and grass roots advocacy groups, we can gain a richer understanding of what is known. We hope to build from this to co-design and test programs that connect players with MND with other gamers to maintain social connections and build new friendships.


All I'd like to add to Matt's words is that we are also investigating how we can inform and influence commercial game developers to design projects with a wide set of audience needs in mind.


Yes, I think Matt and Tash have described the project really well. We're creating a really useful "map" of the evidence, so that it's easy to see what kinds of research and practice can best make videogames easier to play with MND. And I'm hoping that it will shape the way commercial game developers work, make it easier for them to meet the needs of people living with MND.


And by identifying what helps and hinders access to fun, easy games and communication technology we can contribute to the policy conversation.

What excites you about researching MND and videogames?


It excites me to consider how the wider user experience of technology design can be improved to assist people living with MND.


Videogames have become part of our cultural fabric, appealing to a broad cross section of society within Australia and around the world. Shared gaming experiences connect people and bring them closer, something that we know is important for people living with MND and their families. 

What is exciting is that this project can allow people to once more do something they love and to share this experience with their friends and families.


I know from personal experience how MND makes playing games increasingly difficult, yet there are solutions that mean this can remain an enjoyable leisure activity.


I really love how this research is about finding ways to help more people living with MND enjoy that sense of play and connection. To have a break with games either alone or with others, because MND can make things hard.

I also think it's an opportunity to create memories with family and loved ones. Interactive technology can do some amazing things when it comes to recording and sharing stories and experiences. With videogames, when they're accessible, they can be an enjoyable way to share memories.

What have you found so far?


We have found that while there are a wide range of areas requiring further exploration, there is also a clear recognition in the literature that social connection is important and that games offer a valid and potentially transformative space for these connections to develop over time.

While the identified research has largely focused on the ways people living with MND can interface with the games, we have also found that there is no single solution that will work for everyone. The key is to provide choice and agency in how people play.


To again add to Matt's excellent summary... There are exciting areas of technology and design development in particular contexts that could be applied to different scenarios. 


The only other thing I would add to our initial findings is that, so far, evidence suggests enhanced or different kinds of support through community programs, training and the National Disability Insurance Scheme (NDIS), and for using assistive technology as part of playing videogames, could be important. Not everyone has the same level of financial and social support to make it easy to access devices and equipment for videogames.


[Kirsten suggested linking to the group's recent video presentation delivered at the Games for Change Asia Pacific festival]

Making Videogames More Inclusive for People Living with MND

Based on your research, what are some things people with MND and their loved ones could try if they wanted to play videogames? 


Try experimenting with the Microsoft Adaptive Controller and slower paced games. To be cost effective, use Xbox Games Pass to sample a range of games rather than buying titles outright as every gamer will have their own preferences for genre and input options.


Ask people if they have an Xbox and what they play. Interesting stories will follow. 


I think asking your friends and family and having a look at some videogames on the Xbox are a great start. Learning about games on other platforms could help too, including those that play at a reasonable speed and are affordable or available for free. The Australian Centre for the Moving Image is a handy source of information for videogames in general.

I also think it can really help to have a chat with an MND Advisor, your health care team or an occupational therapist about what may work best with videogames and MND.

An occupational therapist in particular might be able to learn from you about your preferences with technology and how a console or computer could best be set up in your home to make them easy to play.


You can also start with whatever communications technology you currently use. For example, I play games on my iPhone using a NeuroNode and the inbuilt switch control.

There are so many different games available, from scrabble and chess to the epic adventures of Lord of The Rings and Star Wars. For people with MND and their loved ones who might not have thought about playing videogames before, but are interested in trying them, how could they get started?


I think it’s great that there is so much variety. Video games can be a way for those of us with MND to continue past interests, whether it’s a card game, word or number puzzles, sports or adventures. Videogames are also chance to play with your kids or grandkids.


Start with turn-based strategy, click and point adventure games or puzzle games, such as the Civilisation series, Thimbleweed Park or Monument Valley. All of these games allow time and space for users of augmented controllers to adjust to a new input device without the pressure of a time limit.


Consider re-visiting old favourites / classics. It's likely that their digital re-invention is a very pleasurable experience with interesting twists. As a 'gen xer', I'm constantly surprised by way games I loved have changed in their digital versions and the communities and resources associated with those games.

For instance, there are videos on Youtube describing the thought processes of excellent chess players while they progress, such as the 3 or 4 next moves they have in mind. The culture has changed so it is easier to find resources that are not sexist and thus not off putting.

Hive is a newish game that is like chess but arguably more creative. Boggle and Scrabble... there are excellent online versions of those too.


I agree with everything above suggested by my awesome team! There is a great variety of videogames. Videogames can help to continue past interests, and many of them are turn based and can give players plenty of time to interact and use their technology.

I'm similar to Tash, in that you might be pleasantly surprised by re-visiting games you grew up with, or classics and that have now been updated. It's great to see that The Secret of Monkey Island, Myst and other older point and click puzzle games are still available to play.

I also think there's a nice connection between turn based videogames and board games. Some board games have gone digital and are available as apps on smartphones and tablets, like Ticket to Ride, Catan and Trivial Pursuit.

If there was one thing that you could change to help more people in the MND community to not just play games, but surf the internet, listen to music, chat with their loved ones and other activities involving technology, what would that be?


The one thing I would change centres on the notion of 'inclusive gaming' - I would increase the degree of acceptance and welcoming within our gaming communities of people who play differently. There are many ways to play and what really matters is that everyone feels like they belong.


More integration of eye-control functionality into technology.


Much greater government and broader social support for people living with MND and their carers, and through funding to carer programs and services, and those relevant to technology. I think it's really important to recognise and better support the relationship between people living with MND and carers, loved ones and others who provide support. That relationship is very important for helping to enjoy recreational activities like videogames, and using other forms of communication technology.


Funding through the NDIS and for over 65s that recognises and supports access to communication, leisure and social connection as a legitimate priority for people with MND.

Kirsten, Matt, Natasha and Ben are working towards the submission for publication of their scoping review about MND and videogames in the first half of 2022, as well as its presentation. The protocol paper for their research was recently published in the first issue of the Games for Change Asia-Pacific journal.