Press Play to Heal: Reshaping Occupational Therapy for Generations to Come

Transcript

Speaker 1: 0:01

This podcast is for educational purposes only, does not constitute legal advice and does not create an attorney-client relationship. If you need legal assistance about a legal problem, contact an attorney. Welcome back to Know your Regulator the podcast that inspires you to engage. I’m your host, simone Murphy, and today we’re diving into something that blends regulation, innovation and heart. We’re joined by Major Eric Johnson, a retired Army occupational therapist. Whether it’s through his work with adaptive technology or advocacy, eric’s commitment to making therapy more accessible and inclusive has had a real, lasting impact on the field. Eric, welcome to the show.

Speaker 2: 0:40

Thank you so much. I’m so excited to be here and can’t wait to get chatting about all things gaming and all that stuff. So thank, you Absolutely.

Speaker 1: 0:51

Your journey is incredible and from military service to working with Xbox on the Xbox Adaptive Controller let’s kind of start at the beginning you got to see the power of therapy in really the most intense setting combat zones. What did those experiences teach you about occupational therapy?

Speaker 2: 1:12

Yeah, you know, it’s interesting because if you think about like kind of the therapeutic uses and benefits of video games in general, like I could even take it back way more than when I was actually going through the therapeutic process with occupational therapy. And so my story begins as a young private in the army when I was burned really bad while I was overseas, and so you can kind of see I have burn scars on my arms and legs and but I remember in that moment there we were recovering down in San Antonio at a burn center and I was teamed up with another kid who was going through cancer treatment and we kind of lived together but neither of us could really go outside because the sensitivity of the sun and my burns did not really match really well. And then also with his cancer treatments, his chemo, like he was very sick, and so one of the things that really kind of brought us together was the ability to escape that real world, or that the real world, into this fictional world. And we played Final Fantasy VII and he was such a he would play and I would watch and we just spent hours in a different land with bodies that weren’t damaged, you know, and so it was like this very kind of therapeutic eye opening moment, that psychosocial component of gaming. And so fast forward. You know we go into Afghanistan.

Speaker 2: 2:37

I mean, of course, you know I ended up recovering, staying in the military, going to OT school, and then ended up recovering, staying in the military, going to OT school, and then had been an OT for a few years at this point, and the Office of the Surgeon General gave me a call and said hey, we’re trying to set up a brain injury program in Afghanistan and we’d like you to kind of head it up. It’s a pilot and we’re hoping that what we can get from it is being able to treat people in the theater of battle, of operations and being able to keep them there. And so when I got there, I remember I was in like, like literally, I probably had five, a five by five foot space maybe, and and I started doing some treatment out of that little closet and that expanded a bit to a tent. I got a full tent and they said you could put whatever you want in here. And you know, when you’re working with a small amount of space, you have to get pretty creative, and so one of the things that I knew very well was gaming, and I knew that gaming had some really good benefits in different ways.

Speaker 2: 3:51

So I did a lot of research on cognition, executive function and how I could kind of pull gaming into the mix and use it on this generationally relevant population, right. So it’s, like you know, 18 to 35-year-old humans, right, and so what are they going to want? To play Video games, right, and what a great way to do it in a space that I’m trying to see some recovery but also keep them engaged. And so that’s where it really kind of started, kind of taking off. And that therapeutic component was huge because there was buy-in.

Speaker 2: 4:26

Every time that I did it they’re like oh yeah, you want me to play DJ Hero or get on the balance board and work on my balance and weight shift, or do you want me to work on my vertigo? Or maybe my thinking is a little slow, I can work on stimulating that cognition. So that’s kind of where it was. It was pretty cool and I thought it was really innovative at the time. I didn’t see a lot of people doing that. So you know it was pretty cool. You know I thought it was something fun, you know obviously.

Speaker 1: 4:53

That’s awesome. No, it really does kind of reframe the work that you’re doing with your therapy and making it something more enjoyable, more fun, and gives you that kind of community, like you said, that, that psychosocial component of things, and that’s huge in healing. What’s the kind of impact that you’ve seen through this?

Speaker 2: 5:18

I get two different approaches from it. Like half of the people will be like, oh, it’s silly, it’s just video games, and the other half is, oh my gosh, what a smart idea. You know, because as we, as we get older, our, our world is growing older, younger, if you will like.

Speaker 2: 5:37

So our 50 year olds are kind of 30 year olds and our you know, 30 year olds are like 20 year olds and you know our 30 year olds are like 20 year olds and you know our 70 year olds are like 50 year olds. And so if you think about kind of where our world is going, just in general, technology is inevitable, right. So we are moving forward, and we are moving forward quickly in a space that says, like, when I am now in the hospital or in a nursing home or skilled nursing facility, as a 70, 80-year-old, I’m going to want some form of technology in my hands, whether that be for leisure or for connection or for therapy, you know. And so I have the writings on the wall and if people aren’t really adopting it, like they’re going to be behind, you know the curve when it all comes.

Speaker 2: 6:27

Right now, if you go to a skilled nursing facility, typically you’ll see older adults who want to read the newspaper, do some gardening, and those are like those activities that they are that are true to them. But if we think about in 20, 30 years, true to them is going to be. I want to talk to my family. I want to play chess with my dad, but he’s in a skilled nursing facility and I can play online with them a lot more than I you know can. And then and also again that, like I mean, I’ll be 50 next year and in 20, 30 years I better be playing video games as my therapy right.

Speaker 2: 7:03

So, and I think that there’s going to be a move to really you’re going to see that happen more and more, because the gamification of therapeutic practices, you know it’s powerful, it really is.

Speaker 1: 7:16

Yeah, absolutely no. That’s such a great point, and I also hope that there will be some games in whatever facility I’m in. So I think too, you know, there’s two things that I was kind of want to piggyback off of. One is when, when we think about how we’ve integrated technology into schools, you know it was something that we were very, a lot of people were really adamant. Let’s, you know, we don’t want to do that, but look at where we’re at now. We’ve got Chromebooks, I, chromebooks, I mean that’s, like you said, just where the future is going, and if you’re not on board, you’ll be left behind. And you know, I think that it’s the, the component of having those video games being available and just digital technology being available.

Speaker 1: 8:04

Um, in those homes, I mean, there’s I think there’s a, a grandma gamer, I think, yeah yeah um, and they talk about all the time, just how uh the cognitive, um the the positive cognitive, uh I can’t find the word that I’m thinking of.

Speaker 2: 8:24

Yeah, effects of gaming.

Speaker 1: 8:25

Yeah, exactly that. It keeps you sharper, you know, and so I would hope that we’ve got tools that are keeping us sharper as we continue to move forward, especially with technology. So you were part of the team that was behind the Xbox Adaptive Controller. Can you talk to us about how you got involved with that project?

Speaker 2: 8:46

Yeah, you know, it’s interesting because it’s one of those things where your intentional actions have unintentional benefits. Yeah, and in this space. So I come back from Afghanistan and I am named the Chief of Occupational Therapy at at the amputee center at Walter Reed up in DC. It’s like the biggest you know body of amputees, probably in the world. You know, especially at the time of war that we were in, I think we had 200 amputees, all from blast injuries and and everything.

Speaker 2: 9:26

And so when we came back, so like one of the, the part of the process for occupational therapy is you do an initial evaluation and then interventions and you know, and all this stuff, but part of your, your evaluation, is an occupational profile. So we’re trying to get a very good idea of the human, the who the human is that we’re working with, and so it always.

Speaker 2: 9:48

I always ask them like so tell me about some of the things that you feel like you’ve lost and you wanna make sure that we work on during therapy while you’re here. And the top two answers were always like I wanna be able to play video games and I wanna have sex.

Speaker 2: 10:04

So you know like fair enough fair enough for both of those, right and great. The cool thing is OT was really is is really designed to be able to do both of those, but in this particular situation, the the gaming stuff was always kind of coming up, coming up. The gaming stuff was always kind of coming up, coming up and so I started to do a lot of adaptive gaming kind of like, by myself, and it was just like making splints so they could hold a controller a traditional.

Speaker 2: 10:35

so, like your traditional controller looks like this, right? So you have, you know, two hands buttons, joysticks, and so to be able to hold a controller like that, you obviously have to have two hands. If I’m missing a hand all of a sudden, it gets a lot more tricky because I’m trying to push all these buttons with one hand. And even more challenging is, even if I could do it, I have to hold it somehow.

Speaker 2: 10:58

So I would start making splints for the residual limb that would just hold the controller while you can do all the other motions, right. So that was like kind of that first step and then I would. I started researching a lot of different types of controllers. In general, if you’re familiar with Dance Dance Revolution, it’s a bunch of buttons on the ground and they’re just buttons, and so you could really just use those buttons as just big buttons. So if I lost a hand, maybe I can use one of those buttons as a foot, you know. And so I started looking at all these different adaptive type of ways to be able to play. And at one point in time an engineer came in and he started talking about you know, what are you guys doing over there? And I was like I’m trying to get this guy to be able to play. And he’s like, well, why don’t you just take this, you know this button and then you can just put, you know, like, these buttons over on this side? And then you know, put this over here. And just, and I was like you know, like I’m not an engineer, I can’t do that stuff. And so he and I teamed up to start doing some of this stuff, and so what he would do is he would actually like rip rip apart one of these controllers. He would wire, solder, like buttons that would come out, big buttons, and so then you’d be able to like hit buttons around that were linked directly to the, you know, the boards of the controller. And so we started making these little adaptive devices. We’d make these big rigs and we’d put the buttons kind of connected to the controller, out and um, and sip and puff controls, all kinds of different things, and um anyway. So we created a, uh, our nonprofit, which is warfighter engaged, and we basically were like, let’s do something where we can do this service for free for service members, veterans and families, and um, and then we would, you know, you know, get donations, money to be able to contribute to that Right.

Speaker 2: 12:53

And so at one point in time Microsoft gave us, like they saw what we were doing. Xbox was like hey, we love what you guys are doing. Would you mind coming to Redmond, washington, which is right outside of Seattle, to you know Xbox headquarters and talk to some of our developers, xbox headquarters and talk to some of our developers? And so we said we got connected with the team out there and started talking about possible options where you know, hey, what if we did this kind of adaptive controller, like a hub where we can put all these buttons in, you know? And so instead of having to, you know, reinvent the wheel and and solder things together, we can just plug things in and it’ll just work.

Speaker 2: 13:35

And so there was this hackathon. They came up with this concept, and it was the first time any hackathon had produced a winner. That was hardware, and this was the hardware. And so that was the beginning of the journey for the Xbox Adaptive Controller. And of course, you know, if you look at it, it’s you know, this is it right? So we take the traditional controller, that is, you know, this one, and we make it into that. And so the big key component was, like, we have to have all the switches that are on a controller be able to plug into a controller, and so what you see back here is 19 different inputs, and then you have some on the sides for joysticks, and they can be completely customizable, adaptable and um, and you get this beautiful kind of system where you can plug and play in game as it’s happening, and so that’s that’s kind of how it started. You know, that’s uh, it was crazy because when we got the call they were like hey, would you come out to Microsoft and Xbox? We’re like, yes, 100%.

Speaker 1: 14:39

No questions asked.

Speaker 2: 14:41

Yeah it was so cool. It was such a neat thing.

Speaker 1: 14:45

That is so awesome and I’m sure has just been so instrumental in healing and continuous healing. You know, I mean I’m sure that you do your therapy sessions and some people are in OT, I would imagine, for life and that can really have such a profound effect on just the healing journey itself. So that’s so awesome. I know that you also worked on representation in Halo as well, which is so cool. That is amazing. And you, what was that like? How did that come about?

Speaker 2: 15:26

You know it’s again. I didn’t ask to go to Microsoft. I was doing the right thing for humans and I had an opportunity and Halo was similar. I had been working with Xbox a little bit and, of course, 343 is under the Microsoft family and 343 is the company that makes Halo, company that makes Halo, and and so they were like, hey, we got your name from, you know so, and so, who knows, you’re a military OT and we would love to like have a conversation with you about our next game, because we are going to include amputees and we want to make sure we do it right, because if we don’t do it right, then you know we’re going to be heavily criticized and it’s going to be.

Speaker 2: 16:24

You know, all these things could potentially happen and they ask interesting questions. Like you know, if you have a, you know a hundred amputees running at you at the same time, is it going to be weird. You know, like they would ask me all these different things, but but one of the biggest things that that I contributed was to to, to, to label them correctly. They’re like we want to make sure that we’re very intentional with how we call amputees amputeeses and we want to see, like, what type of amputation they have. So when I first got to them they were like, okay, this is a upper um, like uh, above elbow amputee was at the shoulder, below elbow amputee was at the elbow, um, and same thing with the legs. And I was like, okay, well, first of all, let’s call it the right. So if you’re going to do a below elbow amputation, let’s say, call it trans radial amputation, because that’s what it’s called, and if we do above elbow, it’s called a trans humeral amputation.

Speaker 2: 17:27

So so now, if you go into the game, that’s how they’re called. They call them the right thing. They, you know, they made sure that they’re representing them the proper way, and so they have, like, wrist disarticulation, they have, you know, the arms, they have the legs and so you can go do transfemoral, trans tibial, like all those things are correctly, you know, identified in the game. And before it was launched, the Halo team, the researcher that I was working with, she was sharing some of these things to the you know world and she came up with, she showed, the layout of how you can customize your player to be that type of amputee and she tagged me on it. It was like this is your work, eric and I was like oh my gosh, like.

Speaker 2: 18:21

Halo team recognized me Like it was so cool and what a gift to be able to have that. And you got to represent such a community that was so dear to you, you know. So it was super cool.

Speaker 1: 18:36

That’s awesome. Not only did you get to represent that community, you educated those you know with Halo on how to properly represent the community, how to properly refer to different. You know amputations, so that’s really awesome.

Speaker 2: 18:53

Yeah, you know real quick before we move.

Speaker 2: 18:55

I just want to say one other thing On that note. You know, we, when we first went to Microsoft, like they didn’t know what occupational therapy was. You know, almost nobody had heard of any and so, like it was like my life’s work to like go in there and just jam it in their face as much as possible Occupational therapy, occupational therapy. And to the point where, as we were working with them, they saw they not only saw the value in OT coming out of it, they hired one of my students to work for Microsoft as an occupational therapist and to this day she’s still worked. She’s been working for them, I think, since like 2017, 2016, something like that, and so she so, um, so, and, and she’s now one of their senior accessibility, uh, specialists and everything, and she’s still on our team at warfighter and so it’s so cool that they would see like not only do we see the importance of OT, we want to bring one on. Yeah, what a, what a perfect situation, you know totally.

Speaker 1: 20:06

That’s great, though, for them to take it, for them to listen and and take action and then continue to implement that into their business. It’s fantastic, that’s awesome. So, when I get back to licensed professionals here in Texas, what are some of the regulatory considerations that occupational therapists should keep in mind when they’re considering integrating these non-traditional tools like gaming into therapy?

Speaker 2: 20:36

Yeah. So this is tricky. So you know, if we think about regulation, a lot of times we go to documentation because documentation is going to fuel reimbursement. It’s going to fuel, you know, like all the things that potentially could go wrong. Right. And so, again, when I spoke earlier about if for some reason, I talked about gaming, I’ll either get one or two responses One that’s really cool and what a what a valuable tool. The other one is this is garbage, it’s a toy you can’t even like.

Speaker 2: 21:11

How do you say video games is therapy, right? So this is how I put it in perspective in general. First of all, whenever I do documentation again, this is where I’m going to go is documentation, because it’s so important. Whenever I look at documentation, I’m never documenting. I’m never getting reimbursed for the task. I’m getting reimbursed for the task. I’m getting reimbursed for the therapy that’s happening, right.

Speaker 2: 21:33

So tons of us will value certain different occupations in different ways. For example, the OT community. We so highly regard gardening. We think gardening is the king or the queen of occupations. It is the best way to do therapy. Nobody’s ever going to question it because it is gardening, you know. But if we look at statistics and actually and I don’t have them in front of me, but statistically there are almost twice as many gamers in America than there are gardeners, and and so is arguably way more important to the patient more of the population than gardening is, and so why do we devalue that? So if I were to look like, if I’m using gaming in a clinical setting, the most important things is I’m not going to be writing any goals that revolve around gaming. You know, it’s not going to say like patient will use his score in Halo from. It’s not going to say like patient will use his score in Halo from. It’s not going to be like that, right. So unless that’s their job, maybe if it’s a job that they have to compete, that’s different. But what I am going to do is I’m going to look at the things that I’m working on potentially standing tolerance, energy conservation, maybe we’re working on balance, all these different things. I can definitely look at opportunities to use gaming.

Speaker 2: 23:00

So, for example, I’ll give you one example that we had. So one of my patients at one point had gotten in a car accident or something like motorcycle accident or something. He had kind of shattered the left side of his body and, big guy, but probably in his 50s, loved video games and as we were working on therapies, we were really trying to get him to stand more and to have more activity tolerance, and so we put him up at a high table and just had him engage in something, some kind of activity basically. And this one particular one was like building a puzzle, right, we were trying to distract him by building the puzzle. He would stay up and he would be kind of motivated to kind of engage with his activity, right. So he stood up for about a minute and a half, right, and he was like oh my gosh, I can’t stand up anymore. I like hurts too much, like it’s too much the next day.

Speaker 2: 24:03

And so we started talking about it and I was like you know, I’m going to try something else. We’re going to stand him using, we’re going to, we’re going to play video games, and what I’m going to do is I’m going to take the adaptive controller and I’m not going to use it for accessibility, I’m going to use it for therapy. So just like I can make buttons go out for people with accessibility, I can bring buttons out and make them further away from somebody. So if I want to like have him extend his arm or work on balance moving left and right, I can put these buttons out here, right, and so I made this whole thing. Where his joystick was over here, there’s buttons over here and he would have to kind of weight shift to get to the other ones. And the next day he went from going a minute and a half from working on a puzzle to 17 minutes just playing video game, and I mean it’s as simple as being intentional with the human that you’re working with.

Speaker 2: 24:58

right, it’s not the answer for every single patient.

Speaker 2: 25:02

It isn’t, but here’s the thing. So now, how do I document that? Do I say patient played video games today for 17 minutes? No, but what I do want to say is that when I’m writing goals, I’m writing goals for activity, tolerance, balance, all those things. And so what I would say is patient, was patient engaged in activity today designed to increase standing tolerance and balance? Patient engaged for 17 minutes while standing at high, high, low table. And then I would put supplement that this is what we did. We, you know, we played video games, or with the, with the adaptive gaming setup or something like that.

Speaker 2: 25:43

Because the regulators are looking that you have skilled therapy in your practice. It’s not necessarily what you did. Like they’re not going to say, well, he played puzzle, that’s skilled today, and then if he played video games tomorrow, it’s not skilled. They want to see what are you working on? I’m working on standing tolerance. I’m working on, you know, balance. I’m working on all these things crossing midline. I work with stroke patients, with stuff like this as well, you know, like maybe they have a neglect and so I set up buttons so they have to, like, attend to one side, you know. So things like that give me the ability to challenge them in different ways, and so you know. So that is so. So the biggest issue again with regulation people will. How can I bill for gaming?

Speaker 2: 26:27

You know well you don’t bill for gaming, you bill for therapy. And one of the things that I think one of my dreams is to build a clinic that is, a gaming clinic. And and in the gaming clinic, you know, we would have all kinds of populations kids, obviously, but adults or whoever wants to come in there and you know people would say, look, how do you get reimbursed? It’s like, well, I’m not reimbursing for playing, you know, Xbox, I’m being reimbursed for skilled therapies. So that’s, I think, regulation-wise, like that’s the biggest kind of thing to consider is like, how am I documenting for gaming? Yeah, how?

Speaker 1: 27:05

are you showing the therapeutic benefits of, of everything going on, yeah and and and backing it up. No, that’s super, that’s crucial. You know. Like you said in, documentation is just, that’s your records. That’s definitely a stickler for regulators, for sure, and I think, like you said, it also demonstrates the effectiveness of the type of therapy that you’re using. And, again, so cool that you can kind of break these things down or just take a different look, engineer a different way to make therapy fun, make it engaging and, you know, make it really beneficial. I mean three, not three minutes. You said one like a minute.

Speaker 2: 27:48

a minute and a half yeah it’s just 17 minutes.

Speaker 1: 27:51

That’s wild, and I mean, there’s your proof in the pudding right there.

Speaker 2: 27:55

So yeah, yeah, well, and I and I do think, like, as as we go forward and as we start getting you know more and more, um, kind of research and evidence behind it, it’ll look a lot more duh type thing, like, oh, you know, because, uh, that’s what happens. You know, you, you put something out there, you do research and then you provide evidence to support it.

Speaker 1: 28:22

Yeah, well, for other OTs that are listening, how can they lead change responsibly? Any advice that you would have for them?

Speaker 2: 28:33

Yeah, absolutely, you know, here’s the thing in general. So you have again we’ve talked about technology is moving forward, right, and gaming isn’t necessarily the only you know means of therapeutic technology. There is so much other stuff out there. Roots we love the traditional kind of OT spaces that we were born in and now, 100 years later, still thrive in, but if we’re not staying generationally relevant and we’re not kind of moving forward with what the current trends in occupations are, then we’re going to be again left in the past, and that’s something that we’ve always fought for our identity and we need to continue to fight for what that looks like moving forward.

Speaker 2: 29:23

And if occupation is our foundation, what is the current occupations of this world? What is the current occupations of you know, humans I mean you and I are on a podcast right now using technology in a way that we couldn’t have done 20 years ago. You know this would not have happened like this, and so we have to kind of understand like we harness it or we let it pass us by. And so, for all these OTs, I really, really encourage you to look at small ways, simple things that you can incorporate in practice, Even using a cell phone, to to like guide therapeutic intervention at home. Like you, can, you know, for lack of a better term prescribe or do a treatment plan for them to go home and work on cognitive type situations on their phones? You know, set up schedules all those things happen. You know in a digital space that you can really help facilitate a forward movement for your clients.

Speaker 1: 30:22

Yeah, very well said, it’s awesome. Well, thank you, eric, so much for joining me today. Your story is incredible. I’m very grateful for your time For our listeners. If this sparked ideas, questions or even career shifts, that’s the kind of inspiration that we’re here for To learn more about Eric’s work, check out the links in the episode description below. Be sure to follow, like. Subscribe to Know your Regulator so you can stay up to date with your professional industry and, until next time, stay inspired and continue engaging with your regulatory agency. Know your Regulator the podcast that inspires you to engage.