Episode Transcript
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Speaker 1 (00:01):
This podcast is for
educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to Know yourRegulator 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.
(00:23):
We're joined by Major EricJohnson, a retired Army
occupational therapist.
Whether it's through his workwith adaptive technology or
advocacy, eric's commitment tomaking therapy more accessible
and inclusive has had a real,lasting impact on the field.
Eric, welcome to the show.
Speaker 2 (00:40):
Thank you so much.
I'm so excited to be here andcan't wait to get chatting about
all things gaming and all thatstuff.
So thank, you Absolutely.
Speaker 1 (00:51):
Your journey is
incredible and from military
service to working with Xbox onthe Xbox Adaptive Controller
let's kind of start at thebeginning you got to see the
power of therapy in really themost intense setting combat
zones.
What did those experiencesteach you about occupational
(01:11):
therapy?
Speaker 2 (01:12):
Yeah, you know, it's
interesting because if you think
about like kind of thetherapeutic uses and benefits of
video games in general, like Icould even take it back way more
than when I was actually goingthrough the therapeutic process
with occupational therapy.
And so my story begins as ayoung private in the army when I
(01:36):
was burned really bad while Iwas overseas, and so you can
kind of see I have burn scars onmy arms and legs and but I
remember in that moment there wewere recovering down in San
Antonio at a burn center and Iwas teamed up with another kid
who was going through cancertreatment and we kind of lived
together but neither of us couldreally go outside because the
(01:59):
sensitivity of the sun and myburns did not really match
really well.
And then also with his cancertreatments, his chemo, like he
was very sick, and so one of thethings that really kind of
brought us together was theability to escape that real
world, or that the real world,into this fictional world.
And we played Final Fantasy VIIand he was such a he would play
(02:21):
and I would watch and we justspent hours in a different land
with bodies that weren't damaged, you know, and so it was like
this very kind of therapeuticeye opening moment, that
psychosocial component of gaming.
And so fast forward.
You know we go into Afghanistan.
I mean, of course, you know Iended up recovering, staying in
the military, going to OT school, and then ended up recovering,
(02:47):
staying in the military, goingto OT school, and then had been
an OT for a few years at thispoint, and the Office of the
Surgeon General gave me a calland said hey, we're trying to
set up a brain injury program inAfghanistan and we'd like you
to kind of head it up.
It's a pilot and we're hopingthat what we can get from it is
(03:07):
being able to treat people inthe theater of battle, of
operations and being able tokeep them there.
And so when I got there, Iremember I was in like, like
literally, I probably had five,a five by five foot space maybe,
and and I started doing sometreatment out of that little
(03:28):
closet and that expanded a bitto a tent.
I got a full tent and they saidyou could put whatever you want
in here.
And you know, when you'reworking with a small amount of
space, you have to get prettycreative, and so one of the
things that I knew very well wasgaming, and I knew that gaming
had some really good benefits indifferent ways.
(03:51):
So I did a lot of research oncognition, executive function
and how I could kind of pullgaming into the mix and use it
on this generationally relevantpopulation, right.
So it's, like you know, 18 to35-year-old humans, right, and
so what are they going to want?
To play Video games, right, andwhat a great way to do it in a
(04:14):
space that I'm trying to seesome recovery but also keep them
engaged.
And so that's where it reallykind of started, kind of taking
off.
And that therapeutic componentwas huge because there was
buy-in.
Every time that I did it they'relike oh yeah, you want me to
play DJ Hero or get on thebalance board and work on my
balance and weight shift, or doyou want me to work on my
(04:35):
vertigo?
Or maybe my thinking is alittle slow, I can work on
stimulating that cognition.
So that's kind of where it was.
It was pretty cool and Ithought it was really innovative
at the time.
I didn't see a lot of peopledoing that.
So you know it was pretty cool.
You know I thought it wassomething fun, you know
obviously.
Speaker 1 (04:53):
That's awesome.
No, it really does kind ofreframe the work that you're
doing with your therapy andmaking it something more
enjoyable, more fun, and givesyou that kind of community, like
you said, that, thatpsychosocial component of things
, and that's huge in healing.
What's the kind of impact thatyou've seen through this?
Speaker 2 (05:18):
I get two different
approaches from it.
Like half of the people will belike, oh, it's silly, it's just
video games, and the other halfis, oh my gosh, what a smart
idea.
You know, because as we, as weget older, our, our world is
growing older, younger, if youwill like.
So our 50 year olds are kind of30 year olds and our you know,
(05:41):
30 year olds are like 20 yearolds and you know our 30 year
olds are like 20 year olds andyou know our 70 year olds are
like 50 year olds.
And so if you think about kindof where our world is going,
just in general, technology isinevitable, right.
So we are moving forward, andwe are moving forward quickly in
a space that says, like, when Iam now in the hospital or in a
(06:03):
nursing home or skilled nursingfacility, as a 70, 80-year-old,
I'm going to want some form oftechnology in my hands, whether
that be for leisure or forconnection or for therapy, you
know.
And so I have the writings onthe wall and if people aren't
really adopting it, like they'regoing to be behind, you know
(06:25):
the curve when it all comes.
Right now, if you go to askilled nursing facility,
typically you'll see olderadults who want to read the
newspaper, do some gardening,and those are like those
activities that they are thatare true to them.
But if we think about in 20, 30years, true to them is going to
be.
I want to talk to my family.
I want to play chess with mydad, but he's in a skilled
(06:48):
nursing facility and I can playonline 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 Ibetter be playing video games as
my therapy right.
So, and I think that there'sgoing to be a move to really
you're going to see that happenmore and more, because the
(07:10):
gamification of therapeuticpractices, you know it's
powerful, it really is.
Speaker 1 (07:16):
Yeah, absolutely no.
That's such a great point, andI also hope that there will be
some games in whatever facilityI'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 thinkabout how we've integrated
technology into schools, youknow it was something that we
(07:37):
were very, a lot of people werereally adamant.
Let's, you know, we don't wantto 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 futureis going, and if you're not on
board, you'll be left behind.
And you know, I think that it'sthe, the component of having
those video games beingavailable and just digital
(08:02):
technology being available.
Um, in those homes, I mean,there's I think there's a, a
grandma gamer, I think, yeahyeah um, and they talk about all
the time, just how uh thecognitive, um the the positive
cognitive, uh I can't find theword that I'm thinking of.
Speaker 2 (08:24):
Yeah, effects of
gaming.
Speaker 1 (08:25):
Yeah, exactly that.
It keeps you sharper, you know,and so I would hope that we've
got tools that are keeping ussharper as we continue to move
forward, especially withtechnology.
So you were part of the teamthat was behind the Xbox
Adaptive Controller.
Can you talk to us about howyou got involved with that
project?
Speaker 2 (08:46):
Yeah, you know, it's
interesting because it's one of
those things where yourintentional actions have
unintentional benefits.
Yeah, and in this space.
So I come back from Afghanistanand I am named the Chief of
Occupational Therapy at at theamputee center at Walter Reed up
(09:10):
in DC.
It's like the biggest you knowbody of amputees, probably in
the world.
You know, especially at thetime of war that we were in, I
think we had 200 amputees, allfrom blast injuries and and
everything.
And so when we came back, solike one of the, the part of the
(09:30):
process for occupationaltherapy is you do an initial
evaluation and theninterventions and you know, and
all this stuff, but part of your, your evaluation, is an
occupational profile.
So we're trying to get a verygood idea of the human, the who
the human is that we're workingwith, and so it always.
I always ask them like so tellme about some of the things that
(09:51):
you feel like you've lost andyou wanna make sure that we work
on during therapy while you'rehere.
And the top two answers werealways like I wanna be able to
play video games and I wannahave sex.
So you know like fair enoughfair enough for both of those,
right and great.
The cool thing is OT was reallyis is really designed to be
(10:13):
able to do both of those, but inthis particular situation, the
the gaming stuff was always kindof coming up, coming up.
The gaming stuff was alwayskind of coming up, coming up and
so I started to do a lot ofadaptive gaming kind of like, by
myself, and it was just likemaking splints so they could
(10:33):
hold a controller a traditional.
so, like your traditionalcontroller looks like this,
right?
So you have, you know, twohands buttons, joysticks, and so
to be able to hold a controllerlike that, you obviously have
to have two hands.
If I'm missing a hand all of asudden, it gets a lot more
tricky because I'm trying topush all these buttons with one
hand.
And even more challenging is,even if I could do it, I have to
(10:57):
hold it somehow.
So I would start making splintsfor the residual limb that would
just hold the controller whileyou can do all the other motions
, right.
So that was like kind of thatfirst step and then I would.
I started researching a lot ofdifferent types of controllers.
In general, if you're familiarwith Dance Dance Revolution,
it's a bunch of buttons on theground and they're just buttons,
(11:20):
and so you could really justuse those buttons as just big
buttons.
So if I lost a hand, maybe Ican use one of those buttons as
a foot, you know.
And so I started looking at allthese different adaptive type
of ways to be able to play.
And at one point in time anengineer came in and he started
talking about you know, what areyou guys doing over there?
(11:41):
And I was like I'm trying toget this guy to be able to play.
And he's like, well, why don'tyou just take this, you know
this button and then you canjust put, you know, like, these
buttons over on this side?
And then you know, put thisover here.
And just, and I was like youknow, like I'm not an engineer,
I can't do that stuff.
And so he and I teamed up tostart doing some of this stuff,
(12:02):
and so what he would do is hewould actually like rip rip
apart one of these controllers.
He would wire, solder, likebuttons that would come out, big
buttons, and so then you'd beable to like hit buttons around
that were linked directly to the, you know, the boards of the
controller.
And so we started making theselittle adaptive devices.
(12:24):
We'd make these big rigs andwe'd put the buttons kind of
connected to the controller, outand um, and sip and puff
controls, all kinds of differentthings, and um anyway.
So we created a, uh, ournonprofit, which is warfighter
engaged, and we basically werelike, let's do something where
we can do this service for freefor service members, veterans
and families, and um, and thenwe would, you know, you know,
(12:49):
get donations, money to be ableto contribute to that Right.
And so at one point in timeMicrosoft gave us, like they saw
what we were doing.
Xbox was like hey, we love whatyou guys are doing.
Would you mind coming toRedmond, washington, which is
right outside of Seattle, to youknow Xbox headquarters and talk
to some of our developers, xboxheadquarters and talk to some
(13:11):
of our developers?
And so we said we got connectedwith the team out there and
started talking about possibleoptions where you know, hey,
what if we did this kind ofadaptive controller, like a hub
where we can put all thesebuttons in, you know?
And so instead of having to,you know, reinvent the wheel and
and solder things together, wecan just plug things in and
(13:32):
it'll just work.
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 wasthe hardware.
And so that was the beginningof the journey for the Xbox
Adaptive Controller.
And of course, you know, if youlook at it, it's you know, this
(13:55):
is it right?
So we take the traditionalcontroller, that is, you know,
this one, and we make it intothat.
And so the big key componentwas, like, we have to have all
the switches that are on acontroller be able to plug into
a controller, and so what yousee back here is 19 different
inputs, and then you have someon the sides for joysticks, and
(14:18):
they can be completelycustomizable, adaptable and um,
and you get this beautiful kindof 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 wascrazy because when we got the
call they were like hey, wouldyou 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 andcontinuous healing.
You know, I mean I'm sure thatyou do your therapy sessions and
some people are in OT, I wouldimagine, for life and that can
really have such a profoundeffect on just the healing
(15:10):
journey itself.
So that's so awesome.
I know that you also worked onrepresentation 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 forhumans and I had an opportunity
and Halo was similar.
I had been working with Xbox alittle bit and, of course, 343
is under the Microsoft familyand 343 is the company that
(15:47):
makes Halo, company that makesHalo, and and so they were like,
hey, we got your name from, youknow so, and so, who knows,
you're a military OT and wewould love to like have a
conversation with you about ournext game, because we are going
(16:08):
to include amputees and we wantto 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'sgoing to be.
You know, all these things couldpotentially happen and they ask
interesting questions.
(16:28):
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 askme all these different things,
but but one of the biggestthings that that I contributed
was to to, to, to label themcorrectly.
They're like we want to makesure that we're very intentional
with how we call amputeesamputeeses and we want to see,
(16:51):
like, what type of amputationthey have.
So when I first got to themthey were like, okay, this is a
upper um, like uh, above elbowamputee was at the shoulder,
below elbow amputee was at theelbow, um, and same thing with
the legs.
And I was like, okay, well,first of all, let's call it the
(17:11):
right.
So if you're going to do abelow elbow amputation, let's
say, call it trans radialamputation, because that's what
it's called, and if we do aboveelbow, it's called a trans
humeral amputation.
So so now, if you go into thegame, that's how they're called.
They call them the right thing.
(17:32):
They, you know, they made surethat 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, transtibial, like all those things
are correctly, you know,identified in the game.
(17:53):
And before it was launched, theHalo team, the researcher that
I was working with, she wassharing some of these things to
the you know world and she cameup with, she showed, the layout
of how you can customize yourplayer to be that type of
(18:14):
amputee and she tagged me on it.
It was like this is your work,eric and I was like oh my gosh,
like.
Halo team recognized me Like itwas so cool and what a gift to
be able to have that.
And you got to represent such acommunity 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 torepresent that community, you
educated those you know withHalo on how to properly
represent the community, how toproperly refer to different.
You know amputations, so that'sreally awesome.
Speaker 2 (18:53):
Yeah, you know real
quick before we move.
I just want to say one otherthing On that note.
You know, we, when we firstwent to Microsoft, like they
didn't know what occupationaltherapy was.
You know, almost nobody hadheard of any and so, like it was
like my life's work to like goin there and just jam it in
their face as much as possibleOccupational therapy,
(19:14):
occupational therapy.
And to the point where, as wewere working with them, they saw
they not only saw the value inOT coming out of it, they hired
one of my students to work forMicrosoft as an occupational
therapist and to this day she'sstill worked.
She's been working for them, Ithink, since like 2017, 2016,
(19:40):
something like that, and so sheso, um, so, and, and she's now
one of their senioraccessibility, uh, specialists
and everything, and she's stillon our team at warfighter and so
it's so cool that they wouldsee like not only do we see the
importance of OT, we want tobring one on.
(20:01):
Yeah, what a, what a perfectsituation, you know totally.
Speaker 1 (20:06):
That's great, though,
for them to take it, for them
to listen and and take actionand then continue to implement
that into their business.
It's fantastic, that's awesome.
So, when I get back to licensedprofessionals here in Texas,
what are some of the regulatoryconsiderations that occupational
(20:27):
therapists should keep in mindwhen they're considering
integrating thesenon-traditional tools like
gaming into therapy?
Speaker 2 (20:36):
Yeah.
So this is tricky.
So you know, if we think aboutregulation, a lot of times we go
to documentation becausedocumentation 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 spokeearlier about if for some reason
(20:59):
, I talked about gaming, I'lleither get one or two responses
One that's really cool and whata what a valuable tool.
The other one is this isgarbage, it's a toy you can't
even like.
How do you say video games istherapy, right?
So this is how I put it inperspective in general.
First of all, whenever I dodocumentation again, this is
(21:22):
where I'm going to go isdocumentation, because it's so
important.
Whenever I look atdocumentation, I'm never
documenting.
I'm never getting reimbursedfor the task.
I'm getting reimbursed for thetask.
I'm getting reimbursed for thetherapy that's happening, right.
So tons of us will value certaindifferent occupations in
different ways.
For example, the OT community.
We so highly regard gardening.
(21:44):
We think gardening is the kingor the queen of occupations.
It is the best way to dotherapy.
Nobody's ever going to questionit because it is gardening, you
know.
But if we look at statisticsand actually and I don't have
them in front of me, butstatistically there are almost
twice as many gamers in Americathan there are gardeners, and
(22:06):
and so is arguably way moreimportant to the patient more of
the population than gardeningis, and so why do we devalue
that?
So if I were to look like, ifI'm using gaming in a clinical
setting, the most importantthings is I'm not going to be
writing any goals that revolvearound gaming.
(22:26):
You know, it's not going to saylike patient will use his score
in Halo from.
It's not going to say likepatient will use his score in
(22:53):
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'sdifferent.
But what I am going to do isI'm going to look at the things
that I'm working on potentiallystanding tolerance, energy
conservation, maybe we'reworking on balance, all these
different things.
I can definitely look atopportunities to use gaming.
So, for example, I'll give youone example that we had.
So one of my patients at onepoint had gotten in a car
accident or something likemotorcycle accident or something
.
He had kind of shattered theleft side of his body and, big
(23:16):
guy, but probably in his 50s,loved video games and as we were
working on therapies, we werereally trying to get him to
stand more and to have moreactivity tolerance, and so we
put him up at a high table andjust had him engage in something
, some kind of activitybasically.
(23:38):
And this one particular one waslike building a puzzle, right,
we were trying to distract himby building the puzzle.
He would stay up and he wouldbe kind of motivated to kind of
engage with his activity, right.
So he stood up for about aminute and a half, right, and he
was like oh my gosh, I can'tstand up anymore.
(23:59):
I like hurts too much, likeit's too much the next day.
And so we started talking aboutit 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'mgoing to do is I'm going to take
the adaptive controller and I'mnot going to use it for
accessibility, I'm going to useit for therapy.
So just like I can make buttonsgo out for people with
(24:21):
accessibility, I can bringbuttons out and make them
further away from somebody.
So if I want to like have himextend his arm or work on
balance moving left and right, Ican put these buttons out here,
right, and so I made this wholething.
Where his joystick was overhere, there's buttons over here
and he would have to kind ofweight shift to get to the other
(24:42):
ones.
And the next day he went fromgoing a minute and a half from
working on a puzzle to 17minutes just playing video game,
and I mean it's as simple asbeing intentional with the human
that you're working with.
right, it's not the answer forevery single patient.
It isn't, but here's the thing.
(25:04):
So now, how do I document that?
Do I say patient played videogames today for 17 minutes?
No, but what I do want to sayis that when I'm writing goals,
I'm writing goals for activity,tolerance, balance, all those
things.
And so what I would say ispatient, was patient engaged in
activity today designed toincrease standing tolerance and
(25:28):
balance?
Patient engaged for 17 minuteswhile standing at high, high,
low table.
And then I would put supplementthat this is what we did.
We, you know, we played videogames, or with the, with the
adaptive gaming setup orsomething like that.
Because the regulators arelooking that you have skilled
therapy in your practice.
(25:48):
It's not necessarily what youdid.
Like they're not going to say,well, he played puzzle, that's
skilled today, and then if heplayed video games tomorrow,
it's not skilled.
They want to see what are youworking on?
I'm working on standingtolerance.
I'm working on, you know,balance.
I'm working on all these thingscrossing midline.
I work with stroke patients,with stuff like this as well,
(26:08):
you know, like maybe they have aneglect and so I set up buttons
so they have to, like, attendto one side, you know.
So things like that give me theability to challenge them in
different ways, and so you know.
So that is so.
So the biggest issue again withregulation people will.
How can I bill for gaming?
You know well you don't bill forgaming, you bill for therapy.
(26:30):
And one of the things that Ithink one of my dreams is to
build a clinic that is, a gamingclinic.
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 youknow people would say, look, how
do you get reimbursed?
It's like, well, I'm notreimbursing for playing, you
(26:51):
know, Xbox, I'm being reimbursedfor skilled therapies.
So that's, I think,regulation-wise, like that's the
biggest kind of thing toconsider 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 andand and backing it up.
No, that's super, that'scrucial.
You know.
Like you said in, documentationis just, that's your records.
That's definitely a sticklerfor regulators, for sure, and I
think, like you said, it alsodemonstrates the effectiveness
(27:28):
of the type of therapy thatyou're using.
And, again, so cool that youcan kind of break these things
down or just take a differentlook, engineer a different way
to make therapy fun, make itengaging 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 startgetting you know more and more,
um, kind of research andevidence behind it, it'll look a
lot more duh type thing, like,oh, you know, because, uh,
(28:15):
that's what happens.
You know, you, you putsomething out there, you do
research and then you provideevidence 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 havefor them?
Speaker 2 (28:33):
Yeah, absolutely, you
know, here's the thing in
general.
So you have again we've talkedabout technology is moving
forward, right, and gaming isn'tnecessarily the only you know
means of therapeutic technology.
There is so much other stuffout there.
Roots we love the traditionalkind of OT spaces that we were
(28:58):
born in and now, 100 years later, still thrive in, but if we're
not staying generationallyrelevant and we're not kind of
moving forward with what thecurrent trends in occupations
are, then we're going to beagain left in the past, and
that's something that we'vealways fought for our identity
(29:19):
and we need to continue to fightfor what that looks like moving
forward.
And if occupation is ourfoundation, what is the current
occupations of this world?
What is the current occupationsof you know, humans I mean you
and I are on a podcast right nowusing technology in a way that
we couldn't have done 20 yearsago.
(29:40):
You know this would not havehappened like this, and so we
have to kind of understand likewe harness it or we let it pass
us by.
And so, for all these OTs, Ireally, really encourage you to
look at small ways, simplethings that you can incorporate
in practice, Even using a cellphone, to to like guide
(30:01):
therapeutic intervention at home.
Like you, can, you know, forlack of a better term prescribe
or do a treatment plan for themto go home and work on cognitive
type situations on their phones?
You know, set up schedules allthose things happen.
You know in a digital spacethat you can really help
facilitate a forward movementfor your clients.
Speaker 1 (30:22):
Yeah, very well said,
it's awesome.
Well, thank you, eric, so muchfor joining me today.
Your story is incredible.
I'm very grateful for your timeFor our listeners.
If this sparked ideas,questions or even career shifts,
that's the kind of inspirationthat we're here for To learn
more about Eric's work, checkout the links in the episode
(30:43):
description below.
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