I am a Game Designer / Project lead who spent the last 2 years building brain trauma rehabilitation software for Norway's largest specialist hospital. AMA :>

Submitted by EzekielNOR t3_yzgtyq in IAmA

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Edit: Thank you everyone that has attended, read and sent me heart-warming messages. It's been a blast to do AMA here. I hope that my replies inspire or gave food for thought!

Until Next time :) Feel free to add me / DM on https://twitter.com/eztheory if you want to have a chat or got a question :)

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I am Ezekiel Hauge , a game designer from Norway.

For the last 2-3 years I've pitched, planned and executed plan to create a brain trauma rehabilitation VR software for patients. We've tested it on over 25 brain stroke patients with various degrees of severity. "Sunnaas Specialist Hospital" has been our partner in the project together with "LHL Hjerneslag" and "Dam Foundation" who funded it.

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I am the deputy chairperson to NONEDA - an interest organisation for game development companies in Norway. And I am currently working on a free graphic stress test tool that's available on Steam (Ezbench Benchmark).

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I will be answering this AMA tonight from 22:00CET to 24:00 (19th November) - And for the next two days to the best of my ability.

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Also ask me about:

Brain Trauma Rehabilitation

Games, Accessibility and ethics

Games industry

Industry Challenges

Benchmarking software

(and more!)

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Proof:

Ezekiel Hauge (@eztheory) / Twitter

Imgur: The magic of the Internet

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Comments

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balderdash9 t1_iwzuam2 wrote

What are the pros and cons of VR software over more traditional methods of brain trauma rehabilitation?

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EzekielNOR OP t1_ix00kp2 wrote

With our VR Games / Software we pull the users out of hospitals and onto a tropical resort - we mimic movement and exercises that are beneficial to patients through fun activities. Our patients report that it's exciting, and that they forget that they are in a hospital - every one of our 25 patients reported it didn't feel like rehabilitation.

In short - they had fun. :)

Hour to Hour - initial VR research shows the same results as normal training, however we see a much lower drop-off rate from rehabilitation using games vs traditional methods. (Upwards 200% better engagement in some cases).

There is still a lot of research to be done and peer reviewed in general on VR - but it is a promising avenue - and the patients love it.

VR also has a painkilling effect, most likely related to the immersion that it brings. "Most" people forget their location awareness after 30-60 seconds.

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Unlucky_Win_7349 t1_ix0mbny wrote

How do you deal with taking them out of that vr-environment? I assume there's a method to it but I can't imagine how you'd execute that. How do you go about that and why?

Not part of my question, but I study learning and development and digital solutions are very interesting to me, so this is very inspiring. I appreciate you for the work you do and I hope that I can at one point be part of something similar.

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EzekielNOR OP t1_ix0n26t wrote

Re-adjustment to "real life" is rather quick - some patients may be disoriented for a few seconds (adjusting to light, space) but nothing serious. Out of our 25 patients we had no one suffer dizziness or falling during or after gameplay.

Most patients are helped with donning the VR kit, and also helped with taking it off. There is always a therapist within arm's reach in case of any issues. Many patients also play seated, while other prefer standing.

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Dragon_yum t1_ix1gkn5 wrote

Not much to add but this is really awesome.

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MasterpieceFit6715 t1_iwzxcr4 wrote

This a more open-ended question but Where do you see this technology going in the future? Say 50 or so years.

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EzekielNOR OP t1_ix01gz0 wrote

I am reluctant to even predict 5-10 years into the future at this point - but if I had a wild and somewhat dystopian guess, it would be something along the lines of this:

(Remember, 50 years is a LONG time.)

Full body immersion with a neural interface. Hopefully not hackable.This may be the way we'll make user friction low enough for people to live in virtual worlds - as dystopian as that may be.

Current VR tech and "immersive" experiences has a too steep barrier of entry for mainstream B2C use - for people to adapt such a tech it needs to be almost as simple as using a remote control. Neural interfaces would fix that.

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MasterpieceFit6715 t1_ix0389i wrote

interesting how everyone jumps to a dystopian conclusion in these sorts of situations. I imagine there would be a time when people will be skeptical of this new tech that some huge monopoly of a company is offering for obvious personal gains but depending on marketing and government action and regulations they will start to be widely accepted like the internet when it first came online. This would result in a situation where sort of like today, big companies will get us to doomscroll their services and keep us glued to their products so we evolve a natural dependency on them and slowly humanity dissolves into the puddle of stupidity all because of corporate greed :(

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EzekielNOR OP t1_ix049lu wrote

Hah,
I think my generation (born in the 80s) grew up with all these tech horror movies - Terminator and Skynet, Matrix and so on. We might be a bit environmentally challenged :>

I think that in order to sell a virtual reality, it has to be better than our own. And I don't know how the future will be in 50 years - it might be amazing, but also not so amazing.

We know that loneliness is on the rise - perhaps 8 hours of relaxing on a virtual beach that you perceive to be completely real isn't the worst idea after logging of your work computer then :) Or who knows - bring you entire family to Disney World after dinner!

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MasterpieceFit6715 t1_ix0504r wrote

Well, the future 50 years from now is just as uncertain as it was 50 years in the past when no one could have predicted technology.

I appreciate your answer as a professional on this topic. Thank you

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EzekielNOR OP t1_ix05phv wrote

Exciting question - feel free to poke about more topics :)

Thanks for being here!

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overreflectingmuch t1_ix3b7jy wrote

This is super interesting!!! Thank you for sharing and a your hard work and time on this project.

I'm curious about how/if vr could assist nueral rewiring for ppl w relational trauma or cptsd where in some cases being able to rewire their brain relieve their triggers/stress and others w their pain of addiction...?

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EzekielNOR OP t1_ix3bixb wrote

It is outside my field but I do know research is being done on similar things. I think visual and audio stimulation can be powerful tools in combination with traditional therapeutic methods. It is important to note that we aim to supplement and not replace anyone.

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Thelango99 t1_ix3c5q8 wrote

50 years ago, the first video game console released (1972). The Magnavox odyssey.

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Thelango99 t1_ix3cinp wrote

Had they been more persistent, Magnavox could have been a major player in the industry.

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sabouleux t1_ix2d0r6 wrote

You don’t need to jump to brain-machine interfaces to get dystopia. We can get to ugly places with what we already have in high-end hardware.

Meta is intending to place itself as the leader in VR technology — it has by far the most capital, talent, and intellectual property invested in the domain, of all players in the industry. Meta is an advertisement company — it makes its income by selling targeted advertisements, and by knowing its audience eerily well. Meta will certainly want to (and already is starting to) include eye-tracking hardware in its headsets. We already know they quantify the time spent on individual posts while scrolling through timelines to measure interest and engagement — but eye tracking data is the ultimate measurement of attention. Imagine having advertising clients automatically bet in real-time for milliseconds of your gaze time. Imagine how disgustingly exploitative and overbearing an advertisement system that optimizes gaze heat maps would get. Meta absolutely wants this — and they want the monopoly on VR because this means complete dominance in the advertising word, if VR becomes a significant part of our lives in our future — which us Meta’s bet. They will want to enforce a closed ecosystem that strips us of our ability to watch unwatched. Their ability to sell our attention will be unmatched.

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driverofracecars t1_ix1fj7i wrote

I shudder at the thought of getting stuck on the loading screen while linking my neural interface and being stuck for what feels like years even though it’s only been minutes in the outside world.

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EzekielNOR OP t1_ix2uq66 wrote

Imagine being stuck on an advert with "Last Christmas" on loop. That'd be my fear.

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TheBaddestPatsy t1_ix09rml wrote

Could you make games that help with depression, PTSD and other things going wrong with the brain?

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EzekielNOR OP t1_ix0aoq6 wrote

There are games that focuses on these topics as well, our didn't but - given funding and time it would be an interesting venue to explore. Especially PTSD which some military forces already do VR experiments with.

I think that stories and narrative experiences can be powerful tools for people to identify with and process experiences with.

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twasjc t1_ix25jkq wrote

If you have ideas and desire for this kind of stuff but lack funding reach out to me and I'll see what I can do. PTSD specifically has better options for neural net collapse and reset but if you think theres positive things in a similar vein to work on.. reach out

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overreflectingmuch t1_ix3bpym wrote

Yeah im really curious on this one too. Esp since brain rewiring can be done! Since you seem informed on it what do you think about the connection, relational component? In reestablishing safety esp through relationship, could vr be the place where folks practice new relational skills...does it have to be a human? Suuuuper interesting stuff, and thankful for all the good folks doin the work.

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Quantum_Kitties t1_ix3spy7 wrote

They already use non-human relationships in PTSD treatment, think animal assisted therapy! Using animals has proven to be incredibly effective in improving PTSD symptoms.

There’s even a robot that provides emotional support for people with dementia and alzheimers (though there are ethical concerns about that, saying a robot “only provides the illusion of a relationship”).

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EzekielNOR OP t1_ix4jc46 wrote

I feel pretty confident in that it could be used in training relation skills. I don't see it much different than roleplaying in that sense.

I also think that VR experiences can be bonding experiences for people that are lonely - either through shared simultaneous experience, but also as a topic of conversations (i.e., home for elderly)

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twasjc t1_ixaplcy wrote

I think it's basically like defragging a hard drive and changes the routing to different folders.

Mushrooms collapse and rebuild the architecture to be more efficient

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EzekielNOR OP t1_ix4ip2u wrote

Will keep that in mind, feel free to add me on LinkedIn as well: https://www.linkedin.com/in/ezha/

We are currently working on a slightly different project that focuses on energy and efficiency, benchmarking. But nothing is set in stone. :)

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bartpieters t1_ix08ojv wrote

How do the VR simulations and exercises aid with recovering from brain trauma?

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EzekielNOR OP t1_ix0b5er wrote

I touched a bit on this earlier but:

Patients reports enjoying training through games. They experience it as something fun rather than "rehabilitation" - making them engage more with training, which in turn can increase the recovery rate. You can also bring games with you home.

Our software mimics real life movements and gives incentives for doing movement patterns that we provoke through gameplay. Especially more unnatural movements that are beneficial to general mobility/movement.

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bartpieters t1_ix0ekvm wrote

So through the exercises they retrain the brain functions they lost and relearn them?

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EzekielNOR OP t1_ix0f7sj wrote

That is the goal. Increased mobility and perhaps regaining some lost function in hand/arms/legs. :)

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bartpieters t1_ix0jt10 wrote

And because they are having fun, they keep going at it, the training becomes more intense and the training is more successful?

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EzekielNOR OP t1_ix0lpcx wrote

When they get better - they can opt in for harder difficulties, or increase the speed of the games :) Leader boards with dates and times help encourage the progression.

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bartpieters t1_ix0opru wrote

Gamification and serious gaming in a medical healing setting, very interesting!

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TheSOB88 t1_ix2heqd wrote

Oh jesus I hope you don't have intrusive popups for those like many modern games

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EzekielNOR OP t1_ix2usj3 wrote

Zero Pop-ups, we mimic real life. Everything has a physical, touchable place in the world.

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TheSOB88 t1_ix5jipu wrote

Interesting! I'd love to see video. It's probably somewhere else in the thread but i'm too neurotic to ever go look for it

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EzekielNOR OP t1_ix5jrm3 wrote

Very early iteration from back in 2019. https://youtu.be/RG2JmztWGhY

Sadly I am unable to show newer things due to patient confidentiality and some other things. But it gives an idea of the graphics level and scenery at least.

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PeanutSalsa t1_iwzyu24 wrote

Do you think video game graphics will look so real at some point that people won't be able to tell the difference between them and real life?

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EzekielNOR OP t1_iwzzlvz wrote

I will start a bit early with answering - may it give some ideas for questions :)

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I think that it's closing in on that point in some cases. If you take a look at Megascans assets - you need to take a real hard look to realise it is computer graphics.

It may take some time to get at that level in your "average game" - but I am confident it will happen.

Another interesting thing with things like VR: "Most" people lose a sense of where they are within 30-60 seconds. Users experience a very high degree of immersion using VR. No one will forget that they have a VR headset on them, but it does show us that we can trick the brain relatively easily. In fact - we see a very real, and relatively powerful painkilling effect using VR on patients with chronic, or even acute pain.

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bmt0075 t1_ix0rzd8 wrote

I’ve experienced this in VR. I was playing a very obviously unrealistic game but somehow my brain thought I could set my VR controllers on the table in the game.

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EzekielNOR OP t1_ix0s3zy wrote

I have around 6000 hours in VR - and still I can make silly mistakes like this from time to time. :D

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Lexx2k t1_ix18ck1 wrote

I feel like a part of this is that we want it to work. We really want this table to be physical, etc. but sadly it is not.

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WanderDrift t1_ix0tssx wrote

Can you tell me more about the accessibility aspects of your VR project?

I’m an assistive technologist who dabbles with accessible gaming but more in the aspect of playability with accessible controllers, switches, etc. I’m new to understanding VR and what accessibility features or supplemental devices are available/needed. I understand that this is a developing field and would love to hear what your project learned. It’s great to see accessibility as a focal point.

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EzekielNOR OP t1_ix0ur9d wrote

Aye, one of the reasons we were accepted by Sunnaas Specialist hospital is that we had the accessibility first mindset.

We designed all of our games to be playable seated or standing - and with only one arm (minus one game). We've got a few variations of the controller scheme - some include hold-to-grab, auto-grab and click to release, or click to grab and click to release.
We also allow for the use of rebinding actions to Microsoft Adaptive Controller if needed.

We spent a lot of time designing the world: We wanted relatively high fidelity (https://youtu.be/RG2JmztWGhY This was a very early concept but gets the point across). We also took care to choose colours that aren't distracting.

The importance of not cluttering the world with too many items, while still making it believable was a difficult but important balancing point too.

Sound and audio adjustments, avoiding distracting or uncomfortable sounds. Voice over on every button and menu, including descriptions for the games.

We also have a menu to adjust more weird settings like hue, contrast. But we do not recommend anyone to use these unless there are specific reasons for it.

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[deleted] t1_iwzz8rm wrote

[deleted]

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EzekielNOR OP t1_ix04mg1 wrote

I am afraid I don't consider myself qualified enough to offer advice on this.

However, from what I understand - memory research is a constant field of development that has continues progression as we understand more and more about our brains.

I hope that in time you will be able to recover some lost memory - and even if not - get the chance to create new and wonderful ones.

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onlycrazypeoplesmile t1_ix09hmv wrote

What video game do you think is the most therapeutic?

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EzekielNOR OP t1_ix09xsc wrote

Commercially available for general brain trauma rehabilitation - assuming that the patient has the abilities to play it (with or without assists like one handed, no fail etc) I think that Beat Sabre is a genius piece of software. Great hand/eye coordination, balance and reaction speed training.

Software like the one we made is a bit more specialized and tries to do more specific things and movements - great for institutional use, especially due to special accessibility features.

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onlycrazypeoplesmile t1_ix0anui wrote

Ooh nice! What about for the impaired? I feel one-handed click and move type games might be highly beneficial too

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EzekielNOR OP t1_ix0bl0p wrote

We've seen patients with only one-armed mobility play Beat Sabre, and all our mini games (minus one) is made to be played both standing, sitting and with just one arm/side.

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Point and click games can be a great tool for spacial awareness and memory perhaps? I don't know of any specific research on this particular form - but it sounds interesting.

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onlycrazypeoplesmile t1_ix0bp4x wrote

I so want to try out your software now lol I'd happily play a beat saber style game sitting down 🤣

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EzekielNOR OP t1_ix0c059 wrote

Turning on no-fail and enabling one-handed mode inside Beat Sabre has been rather well received among users in our experience. You still get to play and have fun - without having the experience ruined by things they cannot interact with.

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brodymulligan t1_ix0vs1t wrote

Hello. I am always curious about music in the use of the brain's functions. Are sounds / music incorporated into your work? What have you learned so far about how music interacts with the brain in terms of the healing process?

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EzekielNOR OP t1_ix0wucx wrote

We don't specifically track this - but we make sure to avoid things that may be disconcerting to the users. (Loud noises, tinnitus like sounds and other distracting things).

There are research papers on music and therapy however that could be interesting to read.

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VRgoddess t1_ix19t0z wrote

Sick ama! Any reason why Unreal over Unity? I always thought unity was the go to software for vr applications

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EzekielNOR OP t1_ix1cgiw wrote

Always used Unreal Engine. Easier to quickly prototype with high fidelity:) Megascans.

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heLLoLyou t1_ix04rcv wrote

Is this technology bringing good for physical brain trauma only or a psychological trauma too?

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EzekielNOR OP t1_ix05fte wrote

It's an interesting question. Our software that we developed in particular doesn't focus on psychological trauma - However:

There are software projects that focus on PTSD and crisis handling in combination with traditional therapy, there are some Army projects doing this.

Other venues of VR usage are phobia through exposure therapy. Also in combination with qualified personnel.

From a personal standpoint - I could see use cases that involves preparing and easing in people that are transitioning to self-living after being in institutions. (Digital twins of soon-to-be-homes and training daily tasks for example).

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Lbj1212 t1_ix2dkek wrote

Does Ez or anyone else know more about getting involved with helping develop this type of software? Thank you.

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EzekielNOR OP t1_ix4kn99 wrote

I would try going directly to interest orgs that focuses on this and talk to them. They probably know where to look, or whom to contact.

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zoinkability t1_ix0xeqq wrote

Several people I know have had to severely limit their screen time during brain injury recovery. How do you make sure that rehabilitation that uses screens does not cause problems for these types of people? Is there any tech being created expressly to help those with visual processing issues post TBI?

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EzekielNOR OP t1_ix0zlbf wrote

Our world is built up around reducing distracting colours, not having a cluttered -but easily readable world. We try to not overwhelm the senses of our users despite being in VR. So on the software side there is "tech" - but not anything specific on the hardware side.

We generally limit sessions to 15 to 20min or so, but we some patients may prefer longer sessions depending on their abilities.

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SquidCheese39 t1_ix1g574 wrote

I've had a traumatic brain injury 9 years ago, so this is really interesting to me!

My question for you is what is your best success story(s)?

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EzekielNOR OP t1_ix2vb5z wrote

It's always hard to quantify without longer studies, but we had one patient in particular whom had suffered an extremely severe stroke - paralysis of left side (very limited hand movement), and reduced mobility on right side on top of some mental disabilities.

It was the kind of patient that you'd sit on eggshells to see how would react, expecting that they would gain nothing, be frustrated and quit.

They didn't. They loved it. Despite extreme challenges, including taping a controller to the left hand - they laughed so hard and had so much fun that I had tears of joy in my eyes. That kind of thing made all the hours we donated worth it.

The patients we had with the heaviest disabilities were the ones that came with the most positive feedback. I guess this goes to show how much a little bit of fun can mean for someone.

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SquidCheese39 t1_ix3y7mt wrote

This warms my heart so much. Thank you for doing this, and thank you for replying ❤️

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Modulus16 t1_ix1p3ni wrote

Does your VR game work with people who have homonymous hemianopsia after a stroke in the occipital lobe of the brain? I’ve been hesitant to try VR games since I can’t process one entire half of my visual field.

Has any of your research been focused on 1) accommodating people with visual field defects or 2) helping people with recent strokes restore even some of their lost vision due to stroke damage in the brain (who have otherwise fully functioning eyes)?

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EzekielNOR OP t1_ix2w998 wrote

There shouldn't be any issues using it with mono-vision, but of course depth perception will be limited as in real life. It will be significantly harder, but not any different from real life.

A small note that we didn't write research papers on this but developed it through workshops and clinical use. User and hospital feedback combined with iterations and in conjunction with qualified medical personnel. Continued clinical use is planned.

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Alterscapes t1_ix0kfsn wrote

Can you describe the nature of the games and their benefits?

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EzekielNOR OP t1_ix0lgpf wrote

Absolutely!

We've got a few different games in our "Tropical Island hub" where you can walk around freely in VR:

Bowling (with a twist) that helps users develop underhand movement and coordination.

Bow Game that helps users with sequential movement, aimed to increase general mobility and arm/eye coordination while aiming at targets. There is also a component of reaction speed as targets go up and down. Speed can be adjusted.

We've got a volleyball style game which promotes overhead movement/boxing. Occupational therapist seems to love this one in particular because of the moment it promotes.

Other games include free hand tower building and something that is similar to beat sabre, but with colour switching on the sword. The latter one in particular is very well received by those with a bit more function - but can be played by everyone.

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overreflectingmuch t1_ix3cfqw wrote

Oh! This makes me think about people who are born w lessened ability in their hands/arms like palsy vs those who endured an injury? Are there any differences in play, outcomes, etc?

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EzekielNOR OP t1_ix3cknt wrote

Outcomes are very hard to quantify without extensive trials, however we know that exercise and rehab is important for these groups as well.

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blackboard_sx t1_ix48xng wrote

This sounds awesome. Hopefully you get it released commercially (and in different languages) so more of us that could use it can try it out. Subscribed to your YT just in case :)

I always imagined many of the obnoxious vestibular and visual therapy exercises could be gamified to VR. Which could be huge for moderate/severe TBI, but even for mild concussion/PCS and vestibular patients, which would open up a far wider audience and potentially help lots of folks by having an engaging, fun, and safe way to rehab.

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EzekielNOR OP t1_ix4kguy wrote

If funding was found - creating a more universal rehab platform would be awesome. These things are incredibly costly though. Millions.

But I think it is possible, and beneficial to mankind. Not least because of the option to bring it with you home after rehab - instead of being stuck doing nothing - you can keep on progressing.

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vetlemakt t1_ix0orp7 wrote

What hospital are you working with?

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EzekielNOR OP t1_ix0ouau wrote

We worked with Sunnaas Specialist Hospital during the project :)

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vetlemakt t1_ix0s2jw wrote

Ah, yes, you said earlier. Good stuff!

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EzekielNOR OP t1_ix0s796 wrote

They've been amazing partners in the project, same with LHL Hjerneslag and the Dam Foundation :)

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some__other__guy t1_ix0u745 wrote

This is really cool, thanks for sharing!

How did you end up working on this project? Where did the idea and motivation come from? Is there anyone with a history of brain trauma on the development team?

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EzekielNOR OP t1_ix0vdid wrote

I was inspired after a friend of mine suffered a brain stroke in his 40s. He was rather severely afflicted and sits in a wheelchair now - but he never gave up. Always thought. He even bought a belted wheelchair and mounted his gun on it - still goes moose hunting.

I spent a lot of time with him talking about rehab and he told me how extremely boring some of the stuff was, and how Wii games were cool but some were very hard for him. And that kinda started it all.

We spent about 2000 volunteer hours on the project. But making the life of just one patient better was worth it. And we know we did. It's a great blessing to be able to help someone in this way.

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ThePinkKraken t1_ix108co wrote

Hello! This may be a bit of an odd question, but: I'm currently 30 years old and looking for a career change. I'd love to so something to help other people, my dream was to create some VR software for elderly people so that they can visit various places, either fantastical or real world. I'm also super curious about building special wheelchairs or prophetic limbs and doing research in those fields. I have no idea how to get started. Studying may not be possible since I also need an income, but with no futher knowledge I can't offer much help, but I'm super willing to learn. Any tips what I could do to get starting? Either way keep being awsome, I'm happy to see people doing good things in this world :)

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EzekielNOR OP t1_ix10nmz wrote

If you want to experiment with something - I would look at software for loneliness and isolation. Scenery, locations in VR that could be brought to home for elderly to give them an experience and vacation to an exotic and exciting place. I think this would be well received and be a topic for discussion among the elderly that tries said experience.

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ThePinkKraken t1_ix1sdwy wrote

Thank you, I'll look into such software :) appreciate your reply!

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Ashimowa t1_ix1dum3 wrote

It was always my dream to combine games/VR technology with medicine, helping people. What's a good way to get started? I mean finding people, organizations or hospitals, specialists to work with?

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EzekielNOR OP t1_ix2vmwd wrote

You'll need a lot of initiative. I contacted the general secretary of the largest interest group in Norway directly. Got the chance to do a 2min pitch and he liked it.

I was somewhat lucky that got his number from a tech lead at the company - he told me to go for it.

After that we approached the Dam Foundation for funding application and approached the largest specialist hospital in Norway. They liked our idea, and we developed the application together. It got declined the first time and we applied a second time in which it was accepted. :)

I don't think there is any set way to do this, but getting powerful players in on your idea early is very important.

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Xaroin t1_ix2pj15 wrote

Do you know how Tetris effects the human brain and what it does to change it through extensive play?

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EzekielNOR OP t1_ix2vfli wrote

I don't know the specifics. But I know that it's been used in treatment of addictions (probably as a distraction). Even some research on post traumatic injury to see how it can maintain synapse function. I do not know what the end result was- but it's very interesting to see games being used this way.

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TheDwilightZone t1_ix0shiz wrote

Are you excited that Kaizers Orchestra is coming back?

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EzekielNOR OP t1_ix0stmi wrote

Hah,

I heard they sold out 80,000 tickets in one hour - so I guess someone is excited for them at least.

Last concert I went to was Black Sabbath back God-knows-When :)

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HuskyDread t1_ix0tvng wrote

How did you get into the virtual reality industry? I'm currently a college student and I want to work with VR in the future, but there's not a lot of programs to get started with it.

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EzekielNOR OP t1_ix0vnvw wrote

Inspiration after a friend of mine had a brain stroke. Combined with being a indie developer/hobbyist for mange years using Unreal Engine.

I don't know what the best way into the games industry these days is- it can be very hard. But starting off small, doing your own projects and getting noticed, building a portfolio with VR things is always a good way to go about it I believe.

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Chaosbuggy t1_ix0xs2i wrote

I really appreciate your transparency with the limits of what the games do, and the extent of your medical knowledge. I bet that a lot of people in tech are interested in helping in the medical field, but don't feel they have the right expertise for that. I feel that way, at least.

I hope your AMA inspires other people to reconsider how their skillsets could help in other fields; it has certainly inspired me!

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EzekielNOR OP t1_ix0ybry wrote

Thank you for the kind words. If I inspire one person -that is mission complete for me. <3

It can be daunting to start projects like these. We didn't have extensive medical knowledge outside a keen interest in the topics - but that is why we allied ourselves with a good hospital - to weigh up for our own limitations.

If you feel limited in anything you do - find people that compliment you! :)

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HuskyDread t1_ix0wj8i wrote

Thanks for the response! I also have a question that's a bit off topic, but do you how the VR industry is in Norway? I currently live in America but I want to move to a different country and currently Norway is my top choice, but I don't know much about the industries there.

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EzekielNOR OP t1_ix0wz2l wrote

We have a few studios working with VR I believe. And within digital twins, training I believe the market will grow rapidly.

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snertwith2ls t1_ix1g1tu wrote

Any chance of being able to apply any of your work to tinnitus?

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EzekielNOR OP t1_ix2uyvb wrote

Masking sounds could be a potential avenue - but I don't know enough about tinnitus. We teamed up with a hospital to deal with the medical side of our project.

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snertwith2ls t1_ix3e1d3 wrote

Thanks for your response. I was hoping for some brain retraining exercises, I heard that works better than masking but haven't been able to find anything yet. Years ago there were some options on youtube but ever since the "misinformation" purge it's been harder to find those kinds of things.

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AXLplosion t1_ix0wtkr wrote

What inspired you to start working on this? Is this something you've wanted to do for a long time, and what's it been like to transition from (I'm assuming) traditional game development?

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EzekielNOR OP t1_ix0xic8 wrote

>I was inspired after a friend of mine suffered a brain stroke in his 40s. He was rather severely afflicted and sits in a wheelchair now - but he never gave up. Always thought. He even bought a belted wheelchair and mounted his gun on it - still goes moose hunting.
>
>I spent a lot of time with him talking about rehab and he told me how extremely boring some of the stuff was, and how Wii games were cool but some were very hard for him. And that kinda started it all.

I was inspired after a friend of mine suffered a brain stroke in his 40s. He was rather severely afflicted and sits in a wheelchair now - but he never gave up. Always thought. He even bought a belted wheelchair and mounted his gun on it - still goes moose hunting.

I spent a lot of time with him talking about rehab and he told me how extremely boring some of the stuff was, and how Wii games were cool but some were very hard for him. And that kinda started it all.

From before I was in the games industry as an indie/hobbyist using Unreal Engine.

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omega4relay t1_ix0ydxq wrote

Do you apply neuroscience or psychological concepts at all when designing games for rehabilitation or games in general? How much is there a difference? What's your opinion on what makes good game design? Have you ever been stuck on a design problem? Did you or did you not solve it? How or why not?

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EzekielNOR OP t1_ix105lw wrote

Game design in general takes a lot from psychological concepts, and even some neuroscience in the way we design for accessibility. We don't specifically deep dive into it - but build our software based on feedback from our patients through workshops and our game design knowledge.

I don't think I've been stuck on a game design problem - it usually leads to trying different approaches that are more creative, or work arounds. If there is a will there is a way - it is just a question of how much smoke and mirrors you want to use. :)

I think that the most important aspect of any product or game design is where possible reducing user friction. Make it as easy and intuitive to pick up as if it was walking. Drop in and play/use. (That does not mean it cannot be challenging! Dark Souls is amazing, minus accessibility!).

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Ojoho t1_ix0yyiu wrote

Is this software available for private use? Would you say that a physical therapist's presence is required to get full use out of it? Will there be more widespread trials at any point? (My brother suffered a stroke some years ago, he has an oculus rift, but we're a long way from Norway)

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EzekielNOR OP t1_ix0z7y4 wrote

We are looking for commercialization partners for the project currently - currently it is available at Sunnaas Hospital and for home use with their patients. But it is not publicly available other places yet. More widespread trials would be a logical next step.

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Terranical01 t1_ix172kw wrote

What and where did you learn the skills to get to your position?

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EzekielNOR OP t1_ix17f62 wrote

I had been a hobbyist in Unreal Engine and UDK2.5 since 2004. Modding, level design - and entered the indie development scene a few years before coming up with the brain trauma rehabilitation idea.

My skills are in project management, debugging, optimization and product / game design. The project management skills came naturally as a part of the journey getting here.

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imatt3690 t1_ix1lutr wrote

What was your journey through programming and frameworks? What tools worked, what didn't?

Bonus: What's your favorite text editor?

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EzekielNOR OP t1_ix2vt0q wrote

We were always set on using Unreal Engine as we had a lot of experience with that. I have a dedicated programmer - he prefers Rider IDE since it's very Unreal Engine friendly.

You don't want me to write code unless you love spaghetti, and not the Italian kind. :)

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imatt3690 t1_ix4bel0 wrote

Seems reasonable. No such thing as the perfect code. Everything is spaghetti but if the code runs and you can read it. It's good enough. Formatting and organization are always helpful but end of the day you have to make it work more than make it pretty. Have a feeling others would fight me on that.

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EzekielNOR OP t1_ix4i7ay wrote

Hah.

We've used a mixture of Blueprint and C++, now we mainly use C++ in our new projects.

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jafinch78 t1_ix1n1w3 wrote

Any patients that you can discuss that have been impacted by the "mild traumatic brain injuries" or other injuries related to concealed wireless assault weapons that beam form sound or other what appears to be thermal elastic expansion and contraction pulsed RF/microwave effects that deliberately can maim or cause serious bodily harm?

Excellent work read like. Definitely seems like an area of opportunity for the future where might be better audit trail and qualitative and quantitative metrics of and for the diagnosis and treatment.

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EzekielNOR OP t1_ix2w0tw wrote

Our workshop/test group was limited to Brain stroke patients due to project requirements. But we consider everything we did to be applicable to rehabilitation of TBI.

Sadly, I do not know a lot about such weapon and harm, so I wouldn't be qualified to answer that.

&#x200B;

One of the things we do is quantify patient results through leader boards. This helps doctors track daily performance and or long term improvements.

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jafinch78 t1_ix5xtgf wrote

Awesome, thanks for the reply!

I see, sure best to focus on one group at a time.

Similarly, has been a challenging experience being a victim and advocating situational awareness of systems many deny exist... yet in the U.S. our own government has confirmed "non-lethal" weapons that are wireless and can be lethal if used outside of design non-lethal thresholds. Very politically challenging due to the not well disclosed uses of such devices for more than intelligence gathering. However, I've been trying to get the topic and situation more main stream, slowly but surely again as seems like there had been a hiatus on reporting about since the 80-90's.

Yeah, not sure how is in Norway, though in the U.S. we have systems like Epic EMR systems and others that are great relational database systems where is very helpful the dimensions of information that can be linked together along with potential tools to mine or process the data. Sad though how some of the basic information records systems get bogged down and bloated with GUI aesthetic... my guess hardware resource demanding for more sales aspects.

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Hyperwerk t1_ix2au9l wrote

Your name sounds familiar, a Metroid fan by any chance?

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EzekielNOR OP t1_ix2wcym wrote

Kekumanshoyu hype!

And yes - I know who you are :>

Nice to see you mate!

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tnkirk t1_ix2hdl5 wrote

What did your verification and validation protocols look like for this kind of software?

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EzekielNOR OP t1_ix2wiii wrote

Everything we did was ran through medical professionals and the users for feedback and adjustments. We had user workshops to get detailed feedback and see real life use cases outside the clinical usage at the VR Lab.

Continued clinical usage is planned.

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nklsoe t1_ix3e6vq wrote

isnt a software like this a class III medical device? are you planning on doing the full conformity assessment process if it qualifies as such?

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EzekielNOR OP t1_ix3emre wrote

It isn’t much different from software like Beat Saber and similar when it comes to requirements. However, we’ve gone through conformity assessments in a ROS analysis to make sure patient data is sufficiently protected.

If the software was to be developed further it would be sensible to start extended clinical trials.

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hiyayakkokin t1_ix2i4jt wrote

Can you link the project pages and if there are any published research papers? I work in IT healthcare and specifically interest in physical and mental wellbeing. I haven't done brain rehab but I would be really interested in looking at what you've been doing.

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Hazo_Rackman t1_ix2n3di wrote

Any chance you're looking for a remote hire? Lol I'm at the end of my Game Development & Design BS. This industry has been tough to get a foot in so far lol

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EzekielNOR OP t1_ix2wm4e wrote

We've remote a lot due to Covid. But we are not hiring atm. Sorry :)

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Vuguroth t1_ix2pixs wrote

So this is a lot about coordination. Have you heard anything about brain fatigue treatment? Like CFS/ME and other conditions where you're limited to low intensity activities.

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EzekielNOR OP t1_ix2wqoy wrote

We've had a few patients with CFS/ME like symptoms, but it is hard to quantify results like this without extensive research programs and clinical trials.

Based on the feedback we can say they enjoyed the games though.

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PrecursorNL t1_ix2vvoa wrote

How do I get into the gaming field as an audio professional? Bonus points, I have a back ground in neuroscience and pharmaceutical research so I'm missing the right network.. but I'm a producer for 12 years and have been classically trained since the age of 5

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EzekielNOR OP t1_ix2x432 wrote

That's an awesome combo. I think getting into the industry as "just" an audio designer can be difficult these days - but with background in neuroscience and pharmaceutical research you will have an advantage.

I would reach out to research clusters and ask if they know someone working on gamification/audio in research and development and try to build something from there.

Other than that, portfolio is always important in the games industry. Implementation skills are also very important.

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MNGirlinKY t1_ix35dbw wrote

Question

How bad is anesthesia for brain issues and would this help with those issues?

Follow up, when it’s unavoidable I’ll get it but if I can’t what can I do to stop the foggy brain from increasing? I’ve had 14+ surgeries, longest was 13 hours. Messed me up

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EzekielNOR OP t1_ix35ybb wrote

I am afraid I am not qualified to answer that. I would try to ask your specialist about treatments and alternative anaesthesia if you feel that the current ones might be detrimental.

I am sorry to hear of your woes - and hope that you find something that works better for you. Stay strong friend. <3

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MNGirlinKY t1_ix368ug wrote

Thanks for your quick response I wasn’t sure it it was related and in your area so took a chance!

Take care and thank you again.

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BronnOP t1_ix3ar9s wrote

What methodology did you use and why?

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EzekielNOR OP t1_ix3b8pc wrote

We largely developed our own methods based on feedback from hospital and user feedback. I have touched on some of the specifics on how we solve several challenges in some of the questions as well. :)

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AgentArachnid t1_ix3fivd wrote

I'm a game designer as well, fresh into the field. This sounds amazing and what I entered the industry looking for. I did my final year project at university on using game based learning to train technical skills, but I haven't been able to find many companies that do that sort of thing.

How did manage to build a company based around this? Anything I should keep in mind about how to do it myself?

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EzekielNOR OP t1_ix4mbsw wrote

Getting into contact with interest groups, find a problem that you want to solve and start working on a solution for it.

I was inspired by my friend who had a stroke, and that lead me to contact with the largest interest group in Norway - which in turn applied with me to a Foundation that offers funding to medical projects.

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dancinginspace t1_ix3hlzy wrote

I'm late here but hopefully you see this! What was the severity level of stroke patients? My mother (in her 50s) is mostly incapacitated, she can understand us but can't really verbally respond. Really only can speak names. Amazingly, she CAN sing songs when they are sung to her or being played on a speaker. Anyway, do you think with people with her level of injury would have some positive impact with the VR?

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EzekielNOR OP t1_ix3huw8 wrote

I think so. Some of the severely afflicted patients were the ones that gave us the highest praise. Every patient is unique - so testing it is the only real way of telling though.

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dancinginspace t1_ix3i6g7 wrote

That's great to hear! Any chance this could become GA soon? And, would it only be accessible via rehab centers? Also, thank you for your time and hard work on this, it definitely gives us hope!

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EzekielNOR OP t1_ix3idy4 wrote

It is only available in Norway currently. We are looking to sell the project for further development and internationalization now. But hopefully that can happen :)

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captainbarbell t1_ix3r559 wrote

Is psychological therapy part of brain trauma rehabilitation? I know a guy from Norway who specializes on that.

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EzekielNOR OP t1_ix41nks wrote

It can be, it is more on the hospital side than the software side though. But I am sure software can be used to help!

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Chubbstock t1_ix3ribg wrote

What games are you playing now or looking forward to in the future?

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EzekielNOR OP t1_ix41izk wrote

I do not have that much time to play, but World of Tanks. Looking forward to Baldurs Gate 3 :)

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iamtenacity t1_ix42eax wrote

What should be my starting point to het into game design?

No prior knowledge in this space

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EzekielNOR OP t1_ix4lylv wrote

Game design is somewhat difficult to get into - Less than 2-3% of games industry jobs are in this category.

"There are many ways to Rome" but, if I started anew, I would do something like this:

Build your portfolio, attend game jams, create your games - build systems that people notice, solve problems that people haven't found good solutions to. Specialize in a field (accessibility? :)). Building an understanding of other disciplines and tying them together.

Game development is rather hard and involves a lot of risk. I think that it is very important to have fun while working in the industry. If you stop having fun, that can be scary.

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georgikhi t1_ix4pskr wrote

Are you aware of anybody working towards using VR/AR for children with Cerebral Palsy? Old school tricks like mirrors on top of a less connected limb help in many cases as for the first 2 years kids are experimenting a lot with their bodies. Audio and visual stimuli during the first few years when children experiment is proven to be extraordinarily effective.

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EzekielNOR OP t1_ix4q67z wrote

That's very interesting. I am not aware of this, but - one of the things we wanted to "modernize" was mirror training with boxes for mobility/eye-hand- coordination.

Sounds like something worth exploring.

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NickLickSickDickWick t1_ix0ye6l wrote

what is your salary?

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EzekielNOR OP t1_ix0yvcz wrote

Currently working on a new project. I own the company, so my salary varies.
I try to not take a salary that is bigger than the rest of the team.

Depending on where you live you can earn from 65K to 150K USD per year with my skills. Sometimes more. (Unreal Engine generalist, game designer with 5-10 years' experience).

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NickLickSickDickWick t1_ix159hg wrote

That is a nice money. Did you eventually thought of making the project opensource, so less fortunate people can use it too?

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EzekielNOR OP t1_ix15l7y wrote

The original reply to my answer has been changed.

He went on a rant about Norwegians not working and spending thousands of dollars of weekend vacations, comiting a line of code or two, before being exhausted. And complaining about Norwegians being depressed.

My reply to this was "Thankfully that's not how it works" - and in turn he changed his reply to "That is a nice money. Did you eventually thought of making the project opensource, so less fortunate people can use it too?"

&#x200B;

Not sure what's up with that but. Clarification for the masses.

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