Therapeutic Use of Life Simulation Games for People with Cognitive Impairments Edmund F. LoPresti 1,2,3, Michael McCue 1, Deborah Endres 1 1 University of Pittsburgh, Pittsburgh, PA 15260; 2 Learning Technologies Program, Hiram G. Andrews Center, Johnstown, PA 15905; 3 AT Sciences, LLC, Pittsburgh, PA Background Simulations - have been used extensively by military, public safety, and health care organizations to prepare for potential emergencies - could also help prepare people with cognitive impairments for situations which might be associated with functional difficulties, social difficulties, or anxiety The Sims 2 (Electronic Arts, - a real-life simulation game - players create characters, maintain a household, pursue careers, and raise families - based on Maslow ’ s Hierarchy of Need), characters have fundamental physical needs as well as desires related to self-actualization - provides a consistent environment which can allow someone to explore real- world situations in an environment safely removed from reality Second Life ( - an online community in which participants interact as avatars in interactive graphical environments. - provides real-time social interactions between peers - a number of social and support groups already exist within Second Life for people with disabilities, including autism and stroke Potential Dangers - immersion in virtual environments could limit a person ’ s participation in real-life relationships - a therapist ’ s active role is crucial to facilitate transference of lessons learned in the game to application in real life - avatars in Sims and Second Life lack nuances of body language and vocal inflection that are present in real-life scenarios; for individuals with autism, this simplification can make communication easier to process, but could also limit transference to real-world communication Clinical Application - The Sims game has been used in a Cognitive Skills Enhancement Program (CSEP) at the Hiram G. Andrews Center. - CSEP provides services to young adults with a variety of cognitive impairments (including intellectual disability, learning disability, autism spectrum, and traumatic brain injury) to support self-awareness, social skills, and functional cognitive skills, especially related to preparing clients for a work environment. Self-Awareness: Character Creation -Clients are encouraged to create a character whose personality matches their own. -Players define a character ’ s personality by choosing the character ’ s primary life aspiration and characteristics along five personality dyads. - A member of the CSEP staff who is familiar with the client reviews the personality choices and discusses with the client to determine whether the personality seems like an honest and realistic match to the client ’ s own personality. Self-Awareness Clients have the opportunity to see how their personality traits effect their character ’ s behavior in the game. Staff have observed clients with motivation, socialization, or hygiene issues in real life facing those same issues in their characters ’ lives, along with the negative consequences. The game can also force clients to face their cognitive impairments; for example, attention deficit and impulsivity on the part of the client can have negative consequences on a character ’ s ability to meet their needs. Clients have expressed observations such as the character needing a regular routine like the client has, or conversely wanting the character to be less anxious and dependent on routine than the client is in real life. Planning and Problem Solving Clients need to prioritize what to buy their characters with a limited budget; prioritize actions, satisfying basic needs before desires or satisfying the most urgent needs first. Clients are challenged to plan how to meet a character ’ s needs and desires. Some planning relates to a client ’ s response to setbacks; such as housefires or job difficulties. One client expressed interest in using the game to recreate past problems and exploring what could be done differently. Employment Clients must make sure their character finds a job, goes to work on time, and develops needed job skills. Clients can give their character his or her own business; requiring the character to interact with customers and employees and anticipate customers ’ needs The game provided some clients an avenue for exploring social issues. All clients must learn how to foster their characters ’ friendships, since socialization is one of the characters ’ needs which must be met. Clients can also explore how different characters react differently to the same events. Social Skills Potential Use of Second Life Second Life has characteristics which could complement use of The Sims. While Second Life lacks the structure of The Sims, it has the potential to simulate a wide variety of situations. Further, it can allow for more realistic social scenarios, whether role-playing real world situations with staff or interacting with others in Second Life support groups or the general environment. Second Life also has the capacity to transmit information to a therapist by or instant message; so that a client could participate in a therapeutic activity in Second Life, and a therapist could be notified of the results. The Sims character creation screen showing selection of the character’s personality. The player must choose one aspiration, and has a certain number of “points” to distribute among the personality dyads. aspirations personality dyads A client must find a way to meet the character’s needs and wants while maintaining the character’s budget. basic needs wants and fears budget A character needs to develop job skills (bottom) or manage a business (right)