to next level physiatry, eSports medicine. We're all excited for you to be here. My name is Jeremy Roberts. I'm a PGY6 Pediatric Rehab Fellow at Children's Hospital Colorado, and everyone will be introduced along the way. We're excited to have you. I just want to start off this session, my best friend literally texted me earlier. He said, also, what's your presentation on today? I said, presenting on eSports. He said, I wish I could understand even a fraction of what you presented, though. Is this like carpal tunnel? So my hope is that at the end of this session, you will understand that eSports medicine is more than like carpal tunnel. And Noni will come up now. Alright, thank you so much everyone for being here today. I would like to go ahead and introduce our Moderator here. I'm dr. Bartolo. So give me just a second here All righty, so Dr. Katie Bartolo is an assistant professor in the Department of Pimanar at the University of North Carolina Chapel Hill She's board certified in Pimanar and sports medicine and currently serves as a physician advisor to the UNC Chapel Hill eSports team She is also the director and co-founder of eSports Center for performance health at UNC Chapel Hill and dr Bartolo is also an international speaker on eSports on eSports health and has given numerous talks related to eSports health topics to a variety of audience audiences including young gamers as well as Collegiate eSports players and other health care providers including physicians and athletic trainers as well as medical students. So without further ado, dr. Bartolo to be the session director for this innovative session. We were talking a lot about tech so far, a lot of the plenaries, and I feel like this fits in really well. So to start it off, we're gonna start with a poll. So eSports, there's been a lot of controversy on how to spell this appropriately. There is an industry standard, and people in the industry really do care about it. So to start it off, we have a poll here. So there's a QR code, if you guys could take out your phones and give that a quick scan. No? And go ahead and take the poll there and see which way you think. Oh, there we go. Yeah, we already have it. Oh, cool. All right. Nice, done. Okay, awesome. So good job, everybody. There are actually two proper spellings on this one. It was a little bit of a trick. So we have both E and I being correct, so it just depends. So the capital E will happen when it's in a title, or if it's at the beginning of a sentence, otherwise it'll just be all lowercase letters. Awesome. Okay, so our first speaker today will be Dr. Melina Moore, talking about eSports medicine. Dr. Melina Moore is a quadruple board certified physician in physical medicine rehabilitation, sports medicine, brain injury medicine, and lifestyle medicine. She has been a team doctor for the NBA, WNBA, NBA 2K, and consulted for the NFL. She is currently visiting clinical faculty at University of California Davis Health, where she has also served as the head team physician. Dr. Moore is an international trailblazer on health and wellness for gamers and eSports athletes, and advises and collaborates with global organizations, including the International Olympic Committee, the World Health Organization, UNESCO, and the International Telecommunication Union. She has been innovative and instrumental in introducing the new subspecialty of eSports medicine, and is a co-editor for the Handbook of eSports Medicine, the first documented textbook to be published on this field of study. In addition, Dr. Moore is the vice president on the board of the Global eSports Federation, and chair of the Distinguished Health and Wellness Commission. Please join me in welcoming Dr. Moore. Thank you. Happy Physiatry Day, y'all. I like saying that. I didn't say it. You're the first person who said it to me today. Happy Physiatry Day to everyone. I have my timer, so I'm going to start. This is eSports. This is fun. eSports is about having fun. This is not a stuffy lecture, you guys. Disclosures none. Just a little bit of background on you. Thank you very much for the beautiful introduction. My whole career has been in traditional sports, and so starting in 2011 with the Sacramento Kings, myself and Dr. Brandi Waite, who's here from UC Davis, we're the first black female physicians in the NBA, and so we're very proud of that, but that was one year out of my fellowship. My entire career has since followed, starting with the Sacramento Kings and then being the head team physician at UC Davis over the intercollegiate athletic department, and then moving on to Washington, D.C., where I was a team doctor for the WNBA, the NBA G League, and then consulting for the NFL there. So all I know is sports, and traditional sports, I should say. And then in 2019, my hospital volun-told me to take care of this team, Wizards District Gaming. I've never heard of them, had no idea who it was. I got on the phone calls, like, Melita, can you get on the call? Sure. And they were talking about gaming. I knew NBA2K, but I had never heard of esports, or that this was a thing, or that it was a professional league, and so I got off the call and said, why did you all have me on that call? And they said, oh, well, you're going to be their team doctor. I said, for what? They said, we don't know. Just sign your name. You know, they're part of our professional umbrella under Monumental Sports, so they have to have a doctor of record. And I said, what do you all want me to do? And they said, just sign your name. I said, well, that's something I'll never do. So I met with the gamers. I met with the team to say, what would you all need me for? They had no idea. And I didn't know what I needed them for. And then at the time, we were in between our WNBA championship run, and I'm in the locker room, and one of the players said, well, why are you going to take care of them? I said, well, the same reason why I take care of you all. So it's been a very interesting journey from 2019 to now, but these six young men in the middle, that became my new athlete. And I do refer to esports players as athletes, because I think when you start to use that terminology, they themselves start to identify as an athlete, and they like to do all the things that we want them to do to be healthy and well. So I went from NBA, NFL, WNBA, to these six kind of scrawny-looking guys. And that was in 2019. And so at that time, I had to really dig deep and try to do some research, and there was very little out there of what was happening for professional gamers or for esports. And that was early 2019. And so I decided, OK, well, they have problems with this, this, and this. And so we built a very robust medical team, as you see some of us standing beside them. And so we had about 14 people on the medical team taking care of these six young men. I went from the sideline of the football game, the hard court of the NBA game, to now this being my sideline coverage. So inside of an esports arena, taking care, I remember I went to Las Vegas for the very first time. I said, let me see what these guys are actually doing. And it's NBA 2K, so it's on the big jumbotron, we're in the big arena. And I found myself yelling at the screen, pick up the ball, block the shot. I was like, this is not real basketball. This is actually a video game. But that's how interested I got into it, obviously, very early on. But I know one thing that Dr. Waite talked about in her lecture yesterday was just saying yes to an opportunity. And so I said yes to this ball-and-toed opportunity that was presented to me. I just want to show, I hope this works, this is a video. Oh, wait, is there any sound? Hmm. Well, this is a video. Wait, I want to see if there's sound. How's there sound? We don't know. No sound. Well, anyway, you all see this packed arena. You think we're at an NBA game or WNB game somewhere. This is actually at an eSports championship in Rio de Janeiro. It's a CSGO competition. The crowd is bananas. But you look at this, this is eSports. We are now having stadiums that are filling and selling out. We can't sell out, unfortunately, in DC, our Wizards Arena, but we can certainly sell it out when it is time for an eSports championship. So I'm just going to go over a few things. Okay. All right. Sorry, y'all. I shouldn't be pressing all the buttons. eSports and gaming. So what is eSports? eSports technically is organized competitive video gaming. So it's really, it's truly a competitive sport if you are competing on a league or as an individual and you're in competitions. That is truly what eSports is. It's the professional level or now collegiate level here in the U.S. And gaming is kind of everyone else that's a casual gamer. For the purpose of this conversation, we're saying eSports, although we truly are talking about the overall gaming space. And so people, I put this up, they're like, what is Laugh Out Loud? And you know, when we see these things, it's like, well, this is actually League of Legends. And COD, like Call of Duty. So this is, it's learning a new terminology, a new language, it's speaking differently. And so there was a learning curve certainly for me. But when we talk about eSports, these are a lot of the eSports titles that are popular here in the U.S. But there's over 3.7 billion gamers worldwide. There's a lot of varying statistics, but over 3 billion, more than half of the world identifies as gamers. And so I was just telling someone else here before, us as physiatrists, we have the opportunity right now to seize this eSports industry as the leaders in this space and take on something that's a new sport, although we know it's not new, but something that's new around the world and make it our own. So I'm glad that we have this panel here, I'm glad you all put this together, and I'm glad you all are listening. Because for the medical students and the residents, this is for you. I'm old in this space, but eSports is really burgeoning and we have this great opportunity, so we're going to seize it now. This is across the world, about 52% identify as male gamers and 48% female, 20% are under the age of 18, so this young group that's coming up. So more even from the Peds rehab as well. And about the middle, the average age is between 18 and 34. Everybody in America has a console, look at these stats. I don't, but most people in the US have a console in their house or a PC, and they spent a lot of money, $60 million in 2022 in the video gaming industry. And so globally, it's $233 billion, so this is not a small industry. Some of the health concerns, and I am going to kind of speed through this. We all know this, but I think, like you said, is this like carpal tunnel? No, it's not. And I get asked that all the time. It's very infuriating, but people don't know. They haven't been educated on it. That's why we're here today. And so these are things I talk about when I talk about health and wellness for gamers and when we talk about eSports medicine, it is very deep in the things that we do. And so one thing I always like to talk about is vision, because a lot of people don't think about it. It doesn't even come up as part of what would be a health risk or concern for an athlete or an eSports athlete. But it's not just your vision itself. All these things, when you're a gamer, these things matter. Certainly this contrast sensitivity, depending on the type of game that you're playing. That contrast, being able to see just those subtle differences. In eSports, milliseconds count. And so anything you can do to have that advantage above your competitor, you do. And so all of these things from reaction time to accuracy, they're very important depending on the type of game that you're playing. However, we are all living digitally, myself included. And so an average eSports player in the professional level, they're gaming for about 10 to 12 hours a day or grinding. They're practicing, which is bananas. But no one's been here to tell them that they shouldn't be doing that or the detriment to doing that. And so when we talk about computer vision syndrome or digital eye strain, when your eyes get super tired, fatigued, dry eye, that is coming from all that screen time. When you are looking at a screen, you stop blinking as much. And so when you're not blinking, you're not producing that natural tear. And so dry eye becomes a large part of this picture. This blue light toxicity that we know. Blue light has a bad rap. It's not great. But there are some small benefits to blue light. But when we look at the extended exposure during eSports medicine, I mean, during eSports competition, the blue light is really detrimental for sleep as well as for your vision. And so I always give this rule so that everyone can take something away, especially the gamers. When you are talking to gamers and doing your educational talks, we can talk the fancy words, blepharospasm and all these things. But it's like giving them something that they can use in the moment. And so I always leave everyone with the 20, 20, 20 rule. So every 20 minutes, you look 20 feet away for 20 seconds. That really just helps to reset the muscles in the eye. It helps with that fatigue. It produces some tearing. And so if there's one key thing you can take away or teach to a gamer or someone else is the 20, 20, 20 rule. I usually will tell them, mark out 20 feet, put an X on the floor, on the wall, something that you know you can look at. Obviously not during competition. But this is something that they should be doing on a regular basis. I've partnered with Dr. Kaiser Kaderi, who was at UC Davis, which is how I met him. He's now currently the founder and director of the Stanford Human Perception Lab. And they've created something called the Vision Performance Index, or the VPI. And so when I talk about vision and we're talking to esports teams and leagues and organizations, these are some of the tools that can be used in this VPI. I really suggest that you look up this article and look up the Vision Performance Index because it kind of balances lifestyle, physical activity, vision, health, sleep, and the benefits of all of those. It's an overlay to a lot of video games. I saw someone taking a picture. I'm going to put it back up there quickly. These slides are in your app as well. Mental health. We hear the negative things about gaming and mental health. It's social isolating. It's for depressed people, which that has been part of the story. Part of the new story, the new narrative, is all of the positive mental health benefits that it can have. The social connectedness. We're now tackling this epidemic of loneliness. Being able to communicate better. Building a community. Those are some positive things for mental health. Critical thinking. Decision making skills. So the positive parts of mental health when we talk about esports and gaming, those are important also. And when we get to a competitive nature, that sports psychology piece is really very important. And so when I started with my team, that was the only healthcare provider with a sports psychologist. And now with the top tier one teams, they're mostly, they have a sports psychologist and may not have anyone else in the healthcare system. We talk about musculoskeletal. You all know all these things. But from a statistics standpoint, this information has come from out of NYIT with DeFrancisco, Donna Hugh with her research that they've been doing there. And so about 42% of the injuries are neck and back. Upper cross syndrome was something I wasn't quite familiar with. It's more of a physical therapy term. But now with esports, I've become very familiar with it. And then from risks like ECU tendinitis. So professional esports athletes, they can make anywhere from 400 to 600 actions per minute. Movements per minute on a keyboard and mouse, 400 to 600. So a lot of that ulnar deviation motion, you can imagine kind of in the wrist or a lot of the fingers. So on the keyboard, this WASD, which we'll get to. So a lot of these motions can create a lot of wrist tendinopathies that are there. And then for gaming, for the hand, gaming thumb or texting thumb or selfie thumb, whatever name you want to put on it, dacra veins, tenosynovitis, and certainly OA. This is upper cross syndrome. It's from poor posture. I sit like this now sometimes that I'm on my computer so much. But that's really where you are kind of shortened in the front and extended in the back. And so making sure that we are staying aware of upper cross syndrome when we're talking about proper ergonomics, which we'll hear about later in our talk. This is what I was talking about, key binds. This is another terminology word that you need to use. So when you are talking to a gamer, you can say, depending on the type of game that they play, what's your key bind? What's your grip on your mouse? Then you sound cool also. What's your grip on your controller? And so most players who are using a PC-based game, they use that WASD key to move their characters. And so that is a lot of that ulnar deviation motion that can occur there as well. This is one thing that I did not think about when I first started was actually hearing health. I don't know why I didn't think about it. But for competition, for practice, if they are practicing 12 to 18 hours a day, a lot of times they have their headphones on a large part of that. And so I'm now advising and working with the World Health Organization on something called safe listening. The World Health Organization cares about gamers. We didn't take this to them. They brought that to us. Because we know that gaming is such a huge part of how people are living, the World Health Organization has decided to make sure that they are creating some recommendations on safe listening specifically for e-sports and gaming. Substances of abuse. Nobody ever talks about it. It's a big elephant in the room. There was a huge article in the Washington Post in 2020, and it just says, everyone's on it. No one's talking about it. And so this is very prevalent in my team of six, three were not taking any medications that were prescribed for their attention, but three were taking amphetamines, Adderall. And so we look at the nootropics, that is really very, very popular in e-sports and gaming. Unfortunately, a lot is not from a prescription, and so it becomes a drug of abuse. Technically there's not a regulatory body in e-sports, so there's no doping that exists currently. However, I am talking with the World Anti-Doping Agency about education and awareness for this community, but certainly substances of abuse are a big deal, and caffeine. Caffeine is a big sponsor of the e-sports league, and so when you talk about you're on an upper, you keep that caffeine going up, it's now finally time to go to sleep, but you've had so much blue light you can't sleep, then you smoke weed to kind of bring you down. So it's just this terrible circle. So it's one thing just to make sure that you are taking note of. I have one more video, I just wanted to show this. This is from the Olympic e-sports week that just happened in June, the inaugural Olympic e-sports week, but this is using real sport and combining it with gaming to kind of, this is a game called Swift, and so this is actually cycling, but it's an e-sport. And so we're going to start to see more of this active e-sports or virtual e-sports coming into the International Olympic Committee. Sleep, we already talked about, it's a very big deal. We understand you have to have that to be cognitively well, to have concentration in your performance, but also the detriments of not having enough sleep. Nutrition, I put this up here, and we are wrapping up, but I always put this up here because these small things, like I said, make a big difference, and so e-sports nutrition, there's very little information about that. But if you can eat certain foods that are going to make your eyes better or your brain better, because those are the two tools that you do use from an e-sports perspective. So for eyes, I always say vitamin ACE, A-C-E, and for brain, vitamin BED, B-E-D. And just promoting some of the foods that you can snack on, and of course, physical activity. We want to promote physical activity. There has been a very big study that was done with New York Institute of Technology that's showing that a six-minute walk in between a two-hour game play can actually improve your performance. So you always want to promote physical activity. This is a very sedentary sport, but we're working with UNESCO on promoting physical activity along with digital age, and so this is another project that's a global project. UNESCO cares about gamers, and so we always want to make sure that we are promoting physical activity. And so to end, these are kind of all the things that we were talking about from a health and wellness standpoint. So if you have a program or you're thinking about building a program or want to rotate with someone to introduce or educate, this is kind of that circle that I've built about who all needs to be surrounding, and as physiatrists, we do very well as teamwork. And so these are a lot of the specials that you could use to have a robust program. Thirty seconds over. Sorry, guys. Thank you. All right. Who has the raffle folder? Can you bring it up, please? Awesome. If you didn't get a raffle ticket, we're going to do the first raffle. You can grab one after this one. We're going to do our first raffle. While transitioning, I'll put up a new poll. So, for our next poll, we want to know what people prefer to play on. So, this is your preference. If you're new to the session, there's a QR code in the corner that will bring you to the poll everywhere. We're going to be doing periodic polls throughout the session. Awesome. We've got a lot of PC gamers out there. Me too. Okay, cool. So, we're going to do our first raffle, and the first winner is 529037. Come on down. This is for, come on down. This is for a t-shirt or socks. Okay, so Jeremy is going to help you if you want to come back here. All right, so our next speaker is going to be Dr. Andy Wu. He is a Senior Director of Peer Counseling at the AbleGamers Charity. He leads both the peer counseling and engineering research pillars, which are player-focused aimed at helping people with disabilities play potentially as many video games as possible. Before joining AbleGamers, Andy was a professor responsible for research, teaching, and service. Most recently, he was the Founding Chair Director for Developing Occupational Therapy Programs. Andy holds a Master's in Occupational Therapy and a Ph.D. from the University of Kansas. He most enjoys PVP video games and is currently playing a lot of Fortnite. So please join me in welcoming Dr. Andy Wu from AbleGamers. And another raffle all right and second winner is 5 2 9 0 6 1 come on down okay okay all right hello happy to be here thank you for inviting me thank you for the intro as well my name is Andy I'm here to talk about adaptive gaming try to keep on time here okay so again I'm a senior director of peer counseling at the able gamers charity and I do have an OT which they were looking for at the time which is great I ever think I would actually use my OT for video games which is kind of crazy to me but essentially able gamers we're a charity a nonprofit the largest organization in the United States I believe doing this kind of work our work is centered around helping people with disabilities play video games we're really trying to combat social isolation that has really resonated through kovat we changed this mission I think like two or three years ago right around that time but essentially really to get people into video games foster these inclusive communities that we're building out in the United States but some of these people here on the panel as well which is great because we're really focused on people with disabilities all different types I have to start talking about this it's a kind of ground because there's a negative connotation when we talk about video games sometimes that I've encountered even you with my own family my wife just really hates that I've spent so much time playing video games but it's really about player experiences I have a great colleague who did some research back in 2010 dr. Chris power he's up in Canada he actually asked people what what are the kind of experiences that you want to have in video games and what what kind of experience is actually do you actually have in the game so what do you find valuable in video games and what he found with people with disabilities and people without disability these five shared experiences right number one connection we play video games because we're going to connect with people right so you either play video games you know multiplayer games to play with people at the same time or if you play single-player games you probably want to talk to other people about those video games right you're like oh man I just beat this this crazy boss at this level was so hard or you know what whatever not diversion is getting away from the everyday stresses escapism is really about enjoying the actual video game getting immersed in the video game benefit some people actually want to get better right they want to improve at their gameplay over time artistry game developers we work with them all the time and they are so focused on building out the game world the experiences within the game so that you can enjoy that experience so these are the five shared experiences between people with disabilities and people without disability so everybody what is unique though is this sixth experience of enablement people with disabilities identified that they're enabled when they can play video games right and this was this was work done but probably four to six hundred people self-identified with disabilities of all different types upper limb lower limb visual hearing so what have you so essentially this is what happens right people we have we have the player on one side and we have play on the other side disability gets right in the middle it gets in the way right for some reason and so what we find with people with disabilities though when we dig into the psychology of it I've been doing some recent work related to this figuring out how we can better help people people with disabilities they they often rely on people for certain ADLs for ideals different kind of things house management things what we find is that people are not that motivated when they they don't have a sense of autonomy right they don't have this sense that they can choose and do what they want to do in life okay and then competence they need to feel like they're being effective at what they're doing right and then this last one relatedness a sense of belonging or connecting with others is really important and these three things from self-determination theory really drive motivation right so how does this tie it to video games right what we find though is if we can figure out that people with disabilities don't have as many opportunities as possible because society kind of sucks you did the curb cuts or an easy example of things like that that just kind of help people with mobility as far as power chairs and other type of mobility walking or whatnot now if we can if we can enable them to do video games they can run jump fly and I don't think we can all fly but run job and be whoever you want in the video games just like everybody else right so here's some pictures of people some common conditions folks around the United States that we've helped kind of go a little bit in order the top from the top left all the way down to the bottom right we have a girl who's in Pittsburgh with spinal muscular atrophy right and we have the next one who has cerebral palsy her name is Carrie Pippy who had a stroke Jonathan who has muscular dystrophy Isaiah you can't see his hands but he has cerebral palsy Jordan I think he has cerebral palsy Jolie has cerebral palsy Hudson in the yellow he has a limb difference we have Gabe who has cerebral palsy the two kids right there from Craig Hospital they both have spinal cord injury Derek has a spinal cord injury as well and Cody's in Canada who has muscular dystrophy so largely what we do at AbleGamers what I do what I'm in charge of is leading this team to help people get get their gear right so I'm gonna talk really quickly about the more common pieces of equipment you'll see we're talking about adaptive gear largely a lot of the things that we do at AbleGamers so all those conditions that you you heard about because we're a charity we can outright grant this equipment this equipment can get quite expensive depending on what the setup looks like but essentially you when you have a person who cannot okay so all the consoles your Xbox your PlayStation Nintendo switch all come with standard controllers as you see on the screen right the standard controllers you have to hold it with your hands for the most part right you need two hands you need your thumbs for the thumbsticks you need your your other two fingers governed by the median nerve for the triggers and then so and then the other two the older nerve ones you kind of hold with with yeah your pinkie and your ring fingers but all those conditions I mentioned you either have a one-sided paralysis you have a paralysis here that impacts the ability to grip and to move your fingers otherwise we wouldn't need to help people right they would have their standard controllers but that's not the case so what do we do we have the Xbox adaptive controller it's probably the most famous piece of equipment came out in 2018 big old it looks like a Nintendo controller from a long long time ago if you're old enough to remember that one but essentially you have two big buttons but the really the the powerful part of this is all the little ports in the back that enable you to plug in different switches so essentially what we're doing is we're trying to build out a controller for the person for where they have movement all right we have the Logitech G adaptive gaming kit these are a series of switches of different sizes of different force so some and then we have variable triggers as well so you think about driving and the gas pedal the harder you push on it the more gas it goes stuff like that the Hori flex controller is another one I don't have that one with me but essentially it looks a little bit different than that the Xbox one and that has a lot of buttons on top natively right there already has it this one can also accommodate eye gaze technology which is really cool for the for the kids and the people that need a AC devices this can route in that system to the Nintendo switch which is really cool PlayStation access controller we're fortunate to work with PlayStation there's some promotional stuff that you might have seen recently related to this they have a completely different approach I'm gonna say this haven't hope this is not recorded but I think this is a little bit better it comes with the joystick and it comes with the series of buttons so those pieces of equipment there separately are $100 each right $100 for the Xbox thing $100 for the Logitech thing this one is $80 but it comes with joysticks right which Austin dr. Scott here knows it's kind of a pain in the butt right now for us to even manage with joysticks but anyway this is highly configurable the joystick kind of the toppers all can change depending on the person's grip and how they want to handle the joystick this one's really cool this is the one of the coolest things I've encountered since working able gamers now for two years the quad stick this is a mouth controller that uses the head and neck and it's a series of sip and puff switches that activates button pushes so you see the three there's three little holes you sip and puff a sip is one function a puff is one function there's a hard sip and a soft sip and a hard puff and a soft puff so you think about the permutation of all those three little button those little three holes and how much you can control and well I'll show you a different I'll talk about a different person here in just a minute related to that so essentially you grab and you move your head around like that and you sip and puff so it's a lot of there's a lot of hardware in this little device but also it's a pair of very very powerful software you can do a lot of profiling dr. Belita she was talking about key binds so a lot of that you can kind of program macros so you do one sip and it activates a whole series of different functions so it helps a person be able to do that a little more cost-effective now with the 3d printing being a little more you know all over the place as controller adaptations by all means I think this is a great approach as well simply because from an OT perspective you learn how to use the standard controller if you don't have to deviate from that very much the adoption rate for being able to play differently is a lot better right versus like drastically throwing out this controller and taking a whole different approach the learning curve on that is very steep so that's not all the hard the hardware side is one part of it the software side is another part of it right I'd like to point people to this website's called family gaming database essentially has a huge database even with ps5 games which is the news which are the newest games you can kind of you can look through here and figure out what different games offer as far as options because when we recognize people as people they don't just have impairments in their hands they also might have hearing difficulty you might have visual difficulties they might also have diabetes or whatnot right so again this is from fortnight because I'm obsessed lately with fortnight so for example they have an option here we call a second channel so we do interface with the game developer game studio side as well and we're part I think we've done some work with epic games which is the producer of fortnight they have an option called visual sound effects so you think about this second channel if you're if you're having difficulties hearing you you see the reticle in the middle where it has footsteps and gunfire it relocates that audio into a visual right so these are just a whole bunch of different kind of settings all within different games they're not all universal but we are doing a lot of that work kind of getting people educated relates to that I kind of touch a little bit on eSports we don't do a whole lot with it this guy Rocky no hands the guy on the left uses a quad stick solely it's a game he has the Guinness World Record for what is it in fortnight for number of kills I think something like 26 or something just using his mouth and head neck right he's on Lumosity gaming which is a content creator kind of group as well the image on the right we do host in collaboration of Mount Sinai and also adaptive eSports I think this is based on New York but it's a virtual it's an online thing AET are adaptive eSports and we've modeled it somewhat after the Special Olympics a little bit where we have tier 1 tier 2 tier 3 tier 1 being little to no adaptive equipment tier 2 medium and medium equipment and in tier 3 you're looking at quad sticks and stuff like that so a lot of adaptive equipment right and we play Rocket League it happens every year this is our third year now so Logitech really helps us out with all the pricing and everything then I think I'm done these are just some some quotes from people that we've helped they really love it you can see I try to highlight some of the stuff that that we're talking about the experiences which I always want to get back to you right you hear it in the stories you hear it in the testimonials you hear it in the ability to go back and play so thank you all right so as we're getting ready to move on to the second part of the session it's gonna be a Q&A panel with all those seated here and I will introduce Dr. Austin Scott here as well on the end Dr. Scott is currently a fifth-year resident in the combined pediatric rehab program at Cincinnati Children's he has loved video games since first starting with Mario Brothers on NES and during residency he realized he combined could combine one of his favorite hobbies into his career as a physiatrist for the past two years Austin has worked with able gamers and the bridge adaptive sports and recreation to develop a novel adaptive gaming program in Cincinnati that provides monthly events and adaptive evaluations for the community before we move on to that we're gonna do a few more raffles so okay if you don't have a raffle ticket please come up and grab one we don't want you to be left out we are gonna auction off one of the controllers one of the big prizes for this one and the second will be at the end of the session people can fill out the poll everywhere poll in the meantime there's a new poll everywhere up on the screen we just want to know this one's just open answer what do you think are some of the biggest myths that face the field of eSports medicine we want to hear what you think there's more lines I have it All right, this is for a pair of socks. Gamer socks! Yeah, they're Able Gamer socks. They're Able Gamer socks. All right, the winner of a pair of socks goes to 529047. Come on down and get your socks. No? Yeah! No? Maybe they left. All right, next. Oh, multiple ones here. Okay. The socks go to 529066. No? Really? Okay. Okay. And a third try. 529012? Woo! Okay, this is for one of the big prizes. You get to come and pick up which one you want. Look alive, everybody. Look alive. All right. You want to do the honors? Yes, please. Boom. You want to read it? No. Okay. And the winner is 529015. Woo! Yay! All right. And one more for socks or a T-shirt. 529144. Yay! All right. So thanks for filling out the poll. Katie, do you want to address the biggest myths on our field? The biggest myths. The answers to the poll. The answers to the poll. We've got unhealthies on here a few times. It says carpal. I'm imagining that's carpal tunnel. Injuries, depressing, musculoskeletal, thinking that the players maybe are lazy or less active, things like that, it looks like. Overuse injuries. Oh, tunnel ended up over there. Anyway. Interesting. Okay. So we're going to move to our panel here. We do have some set questions that would love to interact with you as well. You can ask a question in two ways. You're welcome to come up in person and use one of the microphones in the center there in the aisle. Alternatively, if you open up the app and go to our session at the top part, if you click on it, it will have a Q&A tab, and you can go ahead and just enter a Q&A in there. I'm happy to answer any questions about eSports medicine, gaming wellness in general, adaptive gaming, things like that. It looks like we have a question already, so go for it. This question may be more for Andy and Austin, but Xbox recently said that they were stopping third-party support for controllers and things. How do you guys see that affecting adaptive equipment in gaming? Let's see how well this comes through. Sorry for my voice. It's been a rough couple days. So as of right now, Xbox is probably the most universal adaptive controller that we have in terms of using third-party joysticks that you can solder yourself and 3D print yourself, and it will immediately work, which is amazing and convenient. The Nintendo Switch Hori Flex is not like that. They actually have some firmware that blocks the software. So it is a little bit concerning. And then the other thought is, too, is Xbox over the last couple of years has been kind of stop manufacturing certain things that work with the XAC. So for example, this little nunchuck thing here is a joystick that they used to manufacture that they have now discontinued, even though it's a very simple and relatively helpful joystick. So it is somewhat concerning, but I think the XAC itself won't change and will continue to be. So, anything that routes into here won't be affected, which is probably not all the solutions. So, you think about quad sticks, a quad stick does need an adapter. The cheaper adapters, Brook Gaming specifically, are from Taiwan. Those have been blocked, and they're working on something of a new patch or a new version of that. There's this other adapter. We are monitoring because we send out sure from our end. But this is something Microsoft, I don't know if they're going to walk back that. I don't know if it's purely about cheating. There might be something related to their Xbox, design for Xbox, kind of a hardware program that they have for other computers. Go ahead. How about using posture reminder trainers for that head forward posture that drives me crazy with everybody using computers and games? Has that been helpful to people? Are they willing to use it? Because my son-in-law has one that's still in the box. I'm just saying. It doesn't work if it's still in the box. It does not work if it's still in the box. Our professional players were resistant to using it, but this has been their career. For an average esports athlete, they are retiring around the age of 22, 24. That's really more a lot from overuse injuries, some diseases that come from being sedentary and poor nutrition, but a lot of it is overuse. I think this younger generation, what we call grassroots gaming or the grassroots community, we can start to implement maybe some of those things, whether it's preventative or postural retraining, but I think earlier on, but I think just like if you were to tell Serena Williams it's time for you to change your grip on your racket, that's not happening. At that higher level, we haven't really seen people be overly receptive, but I think at this younger and more collegiate level in high school, possibly, but I know they have a few, but I haven't seen it used a lot in the space. I haven't seen it. Certainly no one's looked at it from a research perspective, but the example you gave was really good, that they get used to playing in a certain way and the idea that something's going to be distracting them, trying to remind them while they're gaming, might be something that they'll buy into maybe a little bit for practice, but long-term, they're not because at the end of the day, e-sports players care about performance and that really is how you're going to get buy-in on anything. Dr. Moore brought up the example of a walking break during playing, there was another study that came out that was looking at high-intensity interval training for about 20 minutes before playing and they showed increased accuracy and fewer errors and things like that, so you're more likely to get buy-in when you're like, look, if you do this and you do high interval aerobic training, things like this, you're more likely to game better than they're more likely to care, but they don't really see the longevity of if you keep doing this, you're going to end up with neck pain or back pain or things like that. Well maybe we need to do some studies. Yeah, love it, let's do studies, let's do it. Thank you for the information, I just have two thoughts, one, are there any EEG and or EMG-based controllers in the works? And two is, can there be a movement for home-brewed frameworks for software and hardware for non-competitive e-sports gaming, such as the use of Arduinos, Raspberry Pi, and other hardware hacks? Sorry, could you repeat the question real quick? Oh, so first question is, are there any EEG and EMG-based controllers? Are there any EEG or EMG-based controllers? I'm not aware. There are some BCI things, like caps and stuff like that, is that correct? The closest thing that we utilize often are facial... I mean, I'm aware of. Cool idea, though. We were talking about research. Yeah, cool. And then the second one is, are there organizations, perhaps it would be a great organization to spearhead a movement for homebrewed frameworks in both software and hardware, like using the Arduino kits or Raspberry Pis? So we do collaborate with a group in Canada called Maker Making Change. They are a really big organization, part of an even bigger organization that a lot of engineers on that. Sorry. OK, but thank you. Yeah, OK. Hey, guys. Thank you for the informative lecture. I guess my question would just be, what would your advice be for either residents or early career physiatrists who are interested in getting involved with e-sports medicine? It's asking. And so when I was at MedStar, we had a resident, Dr. Lindsay Migliore, which probably a lot of you know as Gamer Doc. She was a fourth year, and I was an attending. And she said, hey, Dr. Moore, I'm into gaming. Can I do an e-sports medicine rotation? And I said, yes. And we created one together. And so I think finding one of your attendings, probably more in the sports medicine or maybe in the PEED space, that would be willing to help you put a program or curriculum together. It's one thing that we talked about bringing to AMSSM, but we didn't do that. But I think finding someone who maybe have an interest, and also from a research perspective, there's a lot in this area that needs to be researched and understood. But I think starting with a rotation, we were hoping that, and there's a few doctors across the country, several here today, at Mayo, at Cleveland Clinic, who actually have an NYIT, who have an e-sports and gaming division or center. And so it's being creative. And seeing if you can either do a wave rotation or creating one for yourself at your home institution. It's not difficult. You just have to find an attending to say yes. And I would say a lot of you have the knowledge base, especially doing a PM&R residency and then doing sports medicine fellowship. And just, in general, the knowledge base is there. It's still the same human body. It's still very much the injuries that we're used to diagnosing and treating. And especially if you game yourself, then you already have that knowledge base to connect with your player, which is a lot of what we do in sports fellowship. You're learning how to play different sports, even if you haven't played them yourself. And so going out there and doing educational programs just for free to let people know that you know some stuff and self-advertising can be a really good way to let this player population know that you're available and that you have something to offer. And keeping up on the research. So there's the e-sports research network. They have a Discord. They're happy to have people join. It's a lot of academics. So both in the medical space, but also like PhDs and things like that, where they're constantly sharing articles that come out and talking about research studies and if people are interested in collaborating and things like that. So if you're interested in getting involved, I recommend joining that Discord and kind of lurking a little bit. Maybe go to the intros, put your intro in. And just keeping an eye out on the research that comes out with the journals. There's a couple of e-sports journals. Just so you are staying up to date because it's really fast paced. I mean, if you were to go into like PubMed and put in e-sports research and just like look at the little bars, it's going up exponentially. It's a big boom and it's a good time to get involved right now. So just kind of putting yourself out there, asking if you can get involved and things like that. I'll add the adaptive gaming side of that because as a trainee, that's something that I have had to do over the last two years of incorporating it into my residency. I spent a lot of time before I ever reached out to anyone just looking up stuff on YouTube because that's the easiest way at this day and age to find information and watching Twitch streams. But then I just talked to my residency program about this is what I wanna do. I'm really interested in this. How can I incorporate this? And over the last two years, I now have like a once a month continuity clinic where I do adaptive gaming evaluations for a half day once a month. And I have a monthly event that I've been able to establish that we do once a month regardless of what rotation I'm on. So there's opportunities if you talk to your program of incorporating your interest as long as you are very vocal and pushy about making it happen. Oh yeah, and the contact info will be there if you wanna talk to any of us or ask me questions about how I made it happen. It's rotating through. Okay, hi. Thanks for the presentation. I just wanted to ask the panel if they had any thoughts on the, I guess, virtualization or digitization of sort of conventional sports. Like I know Taekwondo is moving towards an electronic-based platform. I just wanted to ask if you had any thoughts We're seeing it more and so this virtual sports active eSports that's kind of the name that's been placed around it and so I actually am working with the International Taekwondo Federation and their eSports are their virtual sports activity so I've seen it progress over the past three years. It's not contact. It looks like it's contact in the video game but it's non-contact and so I think as we're looking at the gamification of sport or someone said the fortification of game we're going to see more and more and so I think from our community we want to promote physical activity and gaming that this is a great opportunity to gamify sport so you still have that level of competition and the physical activity and the gaming aspect that a lot of people get from eSports and so I think that the International Olympic Committee they're on the right track staying in their lane which is traditional sport and doing gamified versions of traditional sport where we are seeing it a lot more a lot more of international sporting federations have joined the Global eSports Federation to help for us to help them have a digital or virtual portion of their game so we're going to be seeing it more and more and I think from a competitive standpoint just like at the inaugural Olympic eSports Week I don't it's not going to be for Paris 24 but I think for LA 28 we may be looking at a potential opportunity for a true medal. There are other, at the Global Esports Federation, we offer medals for countries competing in your traditional esport title. Gotcha, okay. Thank you. Hi guys, thanks for giving this talk. It's been amazing so far, but my question was, when I think about e-gaming, I think about competitive gaming. But then when I hear adaptive sports or adaptive gaming, my mind goes to things like Minecraft or things where you could create your own universe. So I was wondering if you guys see a difference in preference between the populations that you work with in adaptive gaming, whether they prefer doing those games that are competitive versus the ones that are like Minecraft. They all wanna play the exact same games. There is no personal preference regardless of their physical capabilities. They want to play the games with their friends. So very often, especially, I feel like every kid between five and 15 that's male plays Fortnite right now. And that's what they'll tell you. I wanna play Fortnite. Or sometimes it's Minecraft or NBA 2K. But they wanna play the exact same games and they wanna be able to do it with their community, with their friends. Some of them also do wanna be competitive. That's something that we're working with right now is we're talking to professional organizations in the Cincinnati area of incorporating collegiate esports with some of the people in our community where we can do an abled body and someone who's adaptive setup to be on a team together and start doing competitive tournaments through that. So they are very much just like any other gamer. Got it. Thank you. Christian took my question, actually. So I guess another question is, Andy, you put up a slide with the different elements that connect the gamers, like connectivity, all that stuff. Do you notice a difference in terms of which ones, the adaptive gamers emphasize more, taking away the enablement? I think connection, really. That's probably the number one. I think that a study showed that 99% did want to play with other people. They wanted to use it as a form of connection. I think people with disabilities often feel left out. I have a team member out in Kansas City where I'm based out of. He plays with a friend. He always has to go to, the friend always has to come to his house, right? And I would say, hey, do you want to go to your friend's house, right, to connect and to play? And do you want to go to this esports lounge place or this bar? He's like, well, I can't. My controller's not there. So this is just the idea that people with disabilities have difficulties moving and transporting and getting around and whatnot. The social stigma out there as well for people with disabilities, you don't see a lot of people with power chairs in grocery stores all the time. Like I always, I wander grocery stores all the time. I don't see it very prevalent. So anyway, that being said, I think there are a lot of opportunities that people take. A lot of people that we know, they really want just the Austin point. They want to connect with their family and friends. They want to play the same games. And that's the reason why. So that's what we've found, at least with our population. So. All right, thank you. Yeah. Hi, thanks so much. So my question is more in regards to the esports athletes as patients. How receptive are they to modifications? I know that Dr. Moore was talking about how you wouldn't tell Serena Williams to change her grip, but like I say, someone who has like ECU pathology and you say, instead of using your wrist movement, you use a forearm movement. Do you find it's generally hard for them to make modifications that might impact their performance or are they actually generally receptive to the changes you give them that's beneficial? By the time I see them, they're receptive because they are in pain. They can't play anymore or their performance has significantly declined. And so we have a fellow who just did a case presentation about a player, an athlete that came in, severe pain, the grip was crazy. I don't even know how he was holding his phone, but it's mobile gaming. And I think, you know, for the US, we haven't talked a lot about mobile gaming here. It's not as prominent here as it is in India or Africa or what we're seeing like in Brazil, but mobile gaming, it's a big part of esports. There are professional leagues and titles in esports on the mobile phone. And so we recommended A, changing the grip, but also just like temporarily, what things can you do to modify until this pain gets better? You know, there was a study that was out probably I think in 2019 or 2020 that gamers, they just don't go to the doctor. And so by the time they will seek help, they're in a lot of pain or they have stopped playing or someone's told them you need to retire. And it's like, no, just come see us. Let's get you into therapy. Let's do some treatments, get you better, fix your ergonomics, and then you can get back to playing. So I think by the time they come to the office, depending on where, if it's a pain or if it's an itis or a gnosis, I think that that changes. But when it's pain related, oh, they'll change. If there's either, or if their performance is declining, they are open and receptive. When it's preventative, I'm not getting any like, and saying, oh, here's a stretching program to do like a pre-game warmup, a pre-practice. They're like, yeah, yeah, yeah. So that's still coming, but they've been receptive. Thanks. Hello, I have a couple questions. First one is about, you mentioned there's no, like really like doping, like no issues with that or because there's no like rules about it, but do you see that as becoming a thing and help for that if you do, how do you think that will affect like people who like have like diagnoses that like take like prescribed Adderall? I mean, there are some professional leagues that will have some rules depending on who the publisher is or the tournament organizer may be, but that's not across all sports. And so they may be sanctioned for, let's say League of Legends, but I can go and compete in NBA2K if I wanted to, because there's no rules or regulations there. So there are a few leagues, but a lot of that comes down to the publishers. The publishers kind of run this industry. And so they're putting the tournament on, and they set the rules and the regulations. I think just across the industry, the gaming and the e-sports industry, we are going to start to see something and whether that's whoever decides to participate in any Olympic e-sports week. Like I said, right now, it's just at that education stage. And I made sure that that was really very important because we're talking to gamers. No one's ever educated them on why you shouldn't be abusing caffeine or amphetamines or no one's told them they should be active. And so we're at a very different time as regarding like a traditional sport where you've grown up in Pop Warner Football or AAU, and you've had coaches and nutritionists and people telling you, you should be doing these things. And so we're talking to a community that really hasn't had this education yet. So I think in the next few years, people that may want to participate in any Olympic event, there will probably be a level of doping or someone regulating it, but officially across the board, it's just not a regulating body right now. But I think we all need to take the time, especially in educating our patients. And just like in traditional sport, you can get a waiver for some of the banned substances that you're on, depending if you're competing in a traditional sport, if you have a true diagnosis. So it's just something I think we need to do much more education about, especially because this is the youth. And this was a staggering statistic, which I did not know. And even with vaping, vaping is a big part of this e-sports industry from a sponsorship, from an ad perspective. And from taking your first smoke or drag of a cigarette to going to doing a hard drug, it's 15 years in that time. For you taking your first drag of a vape to a hard drug is 15 months. And so when we're talking about the youth and in e-sports and advertising with vaping, I mean, it's just, we're living in a different time. So I think regulation will be coming, who will do it and how, I'm not for sure, but I think we need to do our part in the education and awareness. I agree. I think that it will eventually be part of things. I mean, there's the health implications, but there's also the fair play implications, which is a huge part of why it's regulated. And there are different regulations that in traditional sport at the collegiate level and then the pro level and then the Olympic level for like how much you can have of certain things. And you have to remember, caffeine is a performance enhancement drug, right? I mean, and so, especially for e-sports players, they're cognitive small muscle athletes. So reaction time, movement time, cognitive, executive functioning and things like that are really gonna be tied to a high level performance. And we know caffeine can augment those in the positive direction. So it's something that needs to be considered. Another thing that also needs to be considered is always consider e-sports players being like precision athletes. So if you think of like archery and shooting in the Olympics and then there's the question of the use of beta blockers for that and helping with anxiety. And so that's another thing to keep in mind that someone hasn't really looked into. And I'm not even sure if this patient population is really aware of it. It's not something that's come across my clinical practice, but just if that's something that they will come across and if people will start using that and then things like that. So I think it's coming as this continues to grow, it has to for it to continue to be taken seriously. But because there's multiple titles, it kind of is a little bit different because people kind of own those titles, right? There's game developers and they own it. So it's a little different than being like basketball or something like that. But yeah, great question. Thank you. And then another question, maybe you can comment on whether like this field will like move into, because I know there's like a, I guess more people who aren't really competitive, but maybe they're making like a lot of their living from like streaming, playing single programs or like speed running. And I reason why, because I know there was one person I follow who like had to stop speed running for like a month because he had a wrist injury. And so do you think that's also like, or if it's already like a thing that you're starting, that's a field starting to move into or you're seeing patients in that sense? Yeah. I've definitely seen streamers and people who are not competing in e-sports, but they are, it is their livelihood to play video games. And they've had issues, everything like cubital tunnel, decrepane and things like that. This is their livelihood. So if they can't stream the hours, they usually have also contracts with certain gaming studios and things like that and developers. And if they can't do that, it's a really big deal. You know what I mean? And they're playing for like hours at a time when they're streaming. So I think that it's also very important and this is all very applicable, generalizable to that population and just recreational gamers in general. Thank you. The contact information is currently up on the slide if you're interested. Hi, thanks for the really informative talk. It's very interesting. And I have a question. So what about like negative comments in like the more competitive games? Have you noticed that affects your players like mental health at all? I'll jump in first. Yes, it's online safeguarding, cyber bullying, cyber wellness. This is definitely a space that more people are paying attention to. A lot of times it is women are targeted and they have been shown to have the most online abuse. Just you can hear their voice on the headset. It's been shown to then decrease their competitive nature and then not be able to get enough points and then get onto a team or a league. And so online safeguarding, it's a really big topic and it's an area for exploration for sure. You know, there are now some companies with like an emotional AI that can kind of lay over a Twitch stream or Discord or social that actually will start to block emotional, sentimental, social, emotional things. And so with the kind of movement in that space, I think hopefully we will start to see a little bit less but it's a major, major problem. And that's a cause for a lot of, you know, suicide, you know, that's happening and certainly from the youth but online safeguarding is a very big deal. I agree, yeah. It's just definitely something you need to do. And sometimes it's like for parents it's just like turn off the chat. You know what I mean? Just disable the chat. And then I have a question for the more adaptive gaming. Do you guys ever use like eye tracking technology too? Yeah. So like the Tobii? And what about like VR? I know we talked a lot about Xbox and PlayStation and the controllers and PC, but what about like VR too? So yes to eye tracking. We try to already tap into and get help from the speech language people with the eye gaze. We use it. It's difficult and we do a lot of education on the types of games, right? Because eye tracking is a little bit slower and it can be anyway. So the type of games that people play, turn-based games, strategy-based games, those games would be good. What was the, oh, VR. VR is difficult, particularly with movement, right? As you have lower limb paralysis, you define boundaries within space that you're gonna play with. If you have upper limb paralysis or some kind of movement disorder, really impact your ability to grip those controllers and to move around. So without, I mean, because I'm an OT, I focus a lot on independence. We just sent off a VR kit to somebody who still wanted to play, but needed that help to put the stuff on all the time, which is perfectly fine because we're about play anyhow. So that's not something we tackle. There's a lot, there's not a lot of work done in VR as far as movement goes with people with disabilities. There's some different software within, it's called WalkinVR, it's based out in Poland, I believe, where you can modify and they can track your limbs instead of actually having to hold the controller. So there are some options. It's not something that we often focus on there, so. Thank you. Hello. I'd just like to confirm first there was a streamer that completed Elden Ring with an EEG. So there was people even that play video games with like bananas and stuff like that online. So people are very creative. My question was in, for patients in hospitals without any access to like occupational therapists who are well-versed in adaptive gaming or recreational therapists, are there any resources that you recommend for providers or anything as like the first step to like access this world like as there are so many? That's like my life goal right now is to fix that problem. So OTs, rec therapists and child life specialists are in my opinion are the three people in the hospital that are most akin to this fitting in their bucket. It's a matter of finding the ones who care enough about gaming that are willing to learn and take the time because it does take time to set up and find something that works for them. The other issue is finding the funding for it. And so that's a big issue that we have. There are some different charities that exist in the United States that will actually provide money to hospitals to hire people for video games in general and adaptive gaming can fall under that. So some hospitals can even apply for that position and actually be funded by different organizations. You just have to convince the hospital that it's worth applying for that grant. And the other thing is that AbleGamers actually has like online ticketing that you can do. So there's a little part of the website where you can submit a ticket and kind of explain what you game, what your limitations are, like what gaming means to you. And it'll go to their peer counselors, which he's the boss of the peer counselors. And we'll go through their ticketing system and they'll reach out, kind of talk through emails about some stuff and then they actually do Zoom meetings with them kind of like talking, hey, can I watch you play? Like what's going on, what's difficult? And then have you tried this? Have you thought about this? Because one of the biggest issues in adaptive gaming right now is people just don't know it exists or that there's so many options because it is so diverse and there's so many different things that you can make that even I feel like every week I see something different that's new that someone has done. So it's constantly evolving. Thank you. Well, thank you so much for the engagement. Wonderful questions, we appreciate it.

eSports medicine

tailored healthcare

vision health

musculoskeletal issues

mental health

adaptive gaming

disabilities

software accessibility options

pediatric rehabilitation

competitive games

online abuse