Players with quadriplegia are using neuroscience and video games to take on the world.
On a mostly sunny July afternoon in 2014, Chris Scott jumped out of a plane. For Scott, a thrill-seeking instructor at Skydive Long Island in New York, this wasn’t unusual. It wasn’t out of the norm for jumping partner Gary Messina, either. Known to friends as “Gary Go Hard,” the New York City corrections officer had been dropping out of planes since his teens.
That’s why, on the eve of his 26th birthday, he strapped himself to Scott’s chest and prepared to jump once again.
It was a routine skydive from 13,000 feet. Scott, with 6,000 jumps under his belt, guided the pair toward the landing area, opening his chute on descent with no trouble. But 150 feet from the ground, disaster struck. The divers were hit by a “dust devil,” a small tornado, causing their parachute to collapse and sending them into freefall. Unable to reinflate, the two plunged to the ground.
The impact killed Messina. Scott miraculously survived, but his life changed in an instant. He remembers staring at the ground, then waking 11 days later with a broken neck. The injury paralyzed him from the shoulders down, forcing him into a wheelchair. Mastering the skills to get around with a mouth-operated joystick, known as a QuadStick, Scott slowly regained his independence.
During rehabilitation in 2017, he met David Putrino, a physical therapist and neuroscientist at New York’s Mount Sinai Hospital. Putrino, an Australian expat and recently crowned winner of the country’s Advance Healthcare Award, heads up the Abilities Research Center, a laboratory devising innovative ways to use virtual reality and video games to improve patient health and rehabilitation. In addition, he’s been exploring the limits of human performance, working with some of the best athletes in the world.
Putrino, in his energetic Australian accent, says Scott was an “amazing athlete” prior to his injury. The injury had devastated Scott, and so he turned to his doctors for help. Scott was eager to do something with his life, Putrino says, but he wasn’t sure what.
The two began brainstorming. During their discussions, Putrino discovered that something could be video games. Not only did Scott love them, he claimed to be a particularly talented player. Putrino wanted to see more. So the former skydiving instructor connected his QuadStick to a PlayStation 4 at the hospital. He loaded up NBA 2K, a basketball game, and challenged Putrino to a match.
“He proceeds to just kick my ass,” says Putrino. “Like properly. I’m not talking a little bit, like an embarrassing pantsing.”
Buoyed, the two had an idea. Chris’ talent and passion for video games would form the basis of an esports team of quadriplegic players. Putrino would call on his knowledge of elite athletic performance training to get the new squad ready to play video games like NBA 2K, FIFA and Call of Duty. Recruitment began, equipment was bought or donated. Eventually, a team of eight was formed.
The Quad Gods were born.
Putrino’s motley crew of esports hopefuls are on a mission.
Now sporting eight members, the Quad Gods aren’t just playing video games for fun. They’ve set an imposing goal: They want to take on able-bodied teams in competition — and they want to win. They’ve started training together. Chemistry is starting to build. Skills are progressing.
Esports, competitive video game tournaments, have risen to prominence over the last five years. Tournaments attract big dollars and plenty of eyeballs. In July, 16-year-old Kyle “Bugha” Giersdorf won the Fortnite World Cup and took home $3 million in prize money. The championship match for League of Legends, one of the world’s biggest titles, attracted more eyeballs than the Super Bowl this year.
For the Gods, it’s not about money or fame. It’s about therapy. Video games could supercharge their rehabilitation. Scientists, like Putrino, have long looked to video games as a therapeutic tool, knowing they have the potential to change and reshape the brain.
The phenomenon of the brain changing over time is well understood. The brain has a knack for recovering from injury and adapting to new circumstances by practically rewiring itself. If we use parts of our brain more often, those parts get stronger. Use them less and those regions are weakened. This ability is known as neuroplasticity, and Putrino thinks video games can kick the process into overdrive.
After a traumatic event, such as a spinal cord injury, patients may lose motor control in parts of their body. Quadriplegics, for example, have paralysis of their torso and all four limbs. As a result, the brain doesn’t need to exert control over those regions anymore and dedicates more power to other parts of the body. Putrino explains that can lead to an impressive amount of motor control in other muscles.
He tells the story of a patient named Sergio, paralyzed from the neck down, who was able to use a mouth stick to produce stunning paintings. The level of control he had over his facial muscles was “beyond that of a mere mortal,” Putrino says.
He’s already seen the phenomenon at work in stroke patients. After a stroke, patients often lose the ability to move their limbs. Recovery often involves tedious physical therapy, but Putrino’s work has shown that playing video games can result in better clinical outcomes. Patients using video games as part of their rehabilitation experience more improvements in motor function compared with those who don’t.
“It encourages your brain to become more plastic, and it encourages your brain to promote recovery,” Putrino says.
The idea of turning to video games for therapy has been floated since the 1980s, but scientists are just beginning to unravel the relationship between the brain, video games and positive clinical outcomes.
Mavericks like John Krakauer, a neurologist at Johns Hopkins Medical in Baltimore, have even taken to flipping the idea of the neuroscience laboratory on its head. Instead of hiring brain scientists, Krakauer put out the call for animators, programmers and software engineers to build his game “I Am Dolphin” in 2014. The game is now being used by stroke patients to improve movement quality, and preliminary findings suggest it may be more beneficial than conventional stroke therapy.
Richard Jacobs has a bullet lodged in his neck.
In 2015, the 36-year-old New Yorker with hair coiled into locks was bringing bags in from his car after work when two men approached him. One of them, brandishing a gun, demanded Jacobs hand over everything he had. When Jacobs refused, the man shot him.
He awoke in the hospital a quadriplegic. The attack had injured his spinal cord and doctors said it would be too risky to try to remove the bullet. Jacobs says that immediately after his injury he felt like Doctor Strange, Marvel’s comic book surgeon, who wakes up after a car accident to find his broken hands rendered useless.
“That’s kind of like how I felt when it came to gaming,” Jacobs says.
Before his own injury, Jacobs was an avid fan of role-playing games. “I like the games where it challenges your mentality, it challenges your brain,” he says. But as he tried to get back into gaming post-injury, he became frustrated. With his dexterity compromised, his PlayStation 4 controller kept slipping out of his hands. What once came naturally was incredibly difficult. Pressing the small buttons and pressure triggers made Jacobs’ favorite pastime almost impossible.
“All these little things was just getting to me, to the point where I was ready to give up on gaming,” he says.
But he didn’t quit. As a member of Mount Sinai Hospital’s Life Challenge program, which helps those with spinal injuries take part in activities that may seem impossible, Jacobs got a glimpse of other people just like him playing video games. Seeing Scott play with his mouth-operated joystick gave him the belief he could get back into gaming. Not long after, he was recruited by Scott to join the Quad Gods.
Jacobs calls it a “movement.” He explains that the team name was his doing and says it’s meant to capture the idea of the “godlike strength” that he and the other Gods possess.
“We are quads, but at the same time, we are gods. We have the power to do whatever we need to do,” he says. “We all have that inner strength that some people never tap into.”
It wasn’t too long ago that Jacobs was fumbling with an unwieldy controller, frustrated by his progress. Now he’s looking toward competition. Unsure which title (or titles) the team will eventually settle on for a tilt at the big leagues, Jacobs says he’s really into fighting games like Mortal Kombat and Street Fighter.
The goal might be competition, but in some ways, that’s just a bonus. Therapy is already paying dividends for Jacobs. He has slight movement in his fingers and feels that, with gaming, he’s got a chance to really work those finger muscles, stretching and moving with purpose.
Just as importantly, he feels less alone.
“When you go through something like this you never feel like anybody is going to want you on their team. Especially if you think of sport,” he says. “To feel like [the Gods] want me to be a part of the team? That makes you feel wanted.”
“It keeps me happy.”
Players with physical disabilities aren’t necessarily front of mind for video game manufacturers. In the past, players with disabilities would have to jury-rig custom controllers and hold fast for developers to include thoughtful accessibility settings. Most of the time, they’d simply miss out on playing at all.
“These are silent communities people don’t design for,” says Putrino. “They don’t identify [them] as a market priority.”
But accessibility has become a sticking point that can no longer be ignored.
Perhaps the most high-profile push for increasing accessibility came in the form of the Xbox Adaptive Controller, released in 2018. The endlessly customizable kit, which Microsoft developed in collaboration with disability advocate groups, allows players to link up their own switches, tubes, sticks and buttons, accommodating users with a vast array of physical limitations. It’s creation began a paradigm shift endlessly headlined with the words “game changing.”
For Jacobs, that cliche holds.
“It gives you a way to play the game and enjoy it without having to focus on actually being able to play the game,” he says.
The team’s ultimate goal is to make it to the highest echelon of competition, and the Adaptive Controller is a critical part of that journey. The hardware, coupled with switches and buttons donated by gaming peripheral powerhouse Logitech, allows each member of the team to have their own unique setup. Some click switches and pads with the side of their head or bump their controller with an elbow or forearm. Others can move their fingers across smaller buttons.
Couple the controller with Putrino’s extensive knowledge of elite athletic performance and suddenly the Gods become a competitive threat.
“The practice of rehab medicine is the practice of human performance,” he explains. “In the neuro-rehab world, all that we’re trying to do is get that last bit of potential out of the nervous system. When you think about it, that’s all we’re trying to do with athletes.”
The Gods will be subject to a regimen more akin to training a professional athlete. Such a schedule, Putrino thinks, won’t just be beneficial for rehabbing patients’ brains. If they put the work in, it could also see their nutrition, lung function, cognitive well-being, sleep and cardiovascular fitness all improve, too.
“I can only make a prediction at this point,” he says, “but I can’t imagine we’re not going to find that a couple of our Gods don’t start training really hard and start to work out a new muscle activation they didn’t know they had or start to gain a little bit of bulk.”
The future of gamified rehab, Putrino says, is all about deployment. He gives kudos to Xbox and Logitech for their level of support in the accessibility space, but says more companies need to get involved and provide nonconventional options to play.
“It’s a powerful group of people that deserve their own set of solutions,” he says.
As for the Gods, Putrino has also helped them establish a relationship with the NBA’s Brooklyn Nets. They’ve been given space in the Nets’ world-class training facilities. They’ve also been kitted out by Logitech with exceptionally powerful PCs. It’s the anxious, exciting beginning. In skydiving terms, the plane hasn’t even got off the ground yet.
But Jacobs is eager to prove a point.
“We could train hard enough to get to the point where, if you wasn’t looking at me physically, you wouldn’t know the difference,” Jacobs says. “And that’s where we trying to get to, and we will get there. And there’s just no ifs, ands or buts about that.”
Jacobs is uncompromising, but his resolve is partly born of tragedy.
On July 27, Chris Scott, the original God, passed away due to a chest infection. His unexpected death rattled the Gods, Putrino and those at Mount Sinai where Scott had been a regular for years. Putrino says it was “real rough,” but the Gods rallied around each other.
“Everyone just felt the need to take this further and really make sure we finish what we started with Chris,” he says.
Jacobs, who had a short time to get to know Scott after joining the Gods, says they’re in the process of designing a team logo, a shield emblazoned with the Quad Gods name backed by a set of rising wings. It’s a small tribute to Scott, who was fascinated by the Greek myth of Icarus and spent so much of his life diving out of planes.
“He wasn’t going to let nothing stop him even though he was paralyzed from the neck down.” Jacobs says. “He was just an example of somebody that kept pushing on without giving up.”
The Gods continue to carry that attitude in rehab and in competition. How far does Coach Putrino think it can take them?
“I want these guys to win the Olympics,” he says, only half-jokingly. “I want this to be a statement. I truly believe these guys are the right group to take that message pro.
“It’s going to be a battle, but I think they’re up to it.”
By Jackson Ryan, CNET