Got (Treatment) Game? Using board games in treatment for people with traumatic brain injury can help with cognitive-linguistic skills and self-awareness. Have You Tried This?
Free
Have You Tried This?  |   December 01, 2016
Got (Treatment) Game?
Author Notes
  • Nikki (Ashlee) Dudley, MS, CCC-SLP, is a clinical manager at NeuroRestorative, which provides post-acute rehabilitation services for people of all ages with brain and spinal injuries and other neurological challenges. Nikki.Dudley@neurorestorative.com
    Nikki (Ashlee) Dudley, MS, CCC-SLP, is a clinical manager at NeuroRestorative, which provides post-acute rehabilitation services for people of all ages with brain and spinal injuries and other neurological challenges. Nikki.Dudley@neurorestorative.com×
  • Editor’s note: This is the second of two “Have You Tried This?” columns focusing on the use of board games with clients. The previous column involved middle school students with social challenges.
    Editor’s note: This is the second of two “Have You Tried This?” columns focusing on the use of board games with clients. The previous column involved middle school students with social challenges.×
Article Information
Attention, Memory & Executive Functions / Traumatic Brain Injury / Have You Tried This?
Have You Tried This?   |   December 01, 2016
Got (Treatment) Game?
The ASHA Leader, December 2016, Vol. 21, 42-43. doi:10.1044/leader.HYTT.21122016.42
The ASHA Leader, December 2016, Vol. 21, 42-43. doi:10.1044/leader.HYTT.21122016.42
“You shorted me $500,000!” says John as we play the 1970s classic board game “Masterpiece.”
I hand him the money, feigning displeasure but silently satisfied that—after much work together—John clearly realizes that people can take advantage of him if he is not careful.
This is why I use board games in treating clients with traumatic brain injury (TBI): It helps to maximize their mastery of cognitive-linguistic skills and self-awareness. Since sustaining a TBI 10 years ago, this particular client—John—has struggled with money management, depending on others and being exploited. It is only through this board game that he has developed new awareness and broken the cycle of dependence.
To help my clients achieve functional goals, I run board-game–centered social groups at NeuroRestorative—an outpatient brain injury rehab center—in Ashland, Kentucky. In “Master-piece,” players bid on and negotiate with others to trade works of art, build a portfolio, amass money and win the game. Together we target clients’ challenges and deficits:
  • Sonny struggles with rigid thinking, and in a fast-paced game such as this, it is necessary to adapt and change decisions.

  • Amy shows difficulty when asked to describe her paintings. The words do not come with ease, and I suggest strategies to defeat the anomia.

  • Richard struggles to clearly name a painting, so he receives stares from the other clients. The looks of contemplation act as visual cues to slow his rate of speech and over-articulate.

  • John impulsively begins speaking out of turn, for which he receives some dirty looks. This provides a moment to educate him on compensatory skills to improve turn-taking.

The board-game approach pushes the limits of what clients can do, but in an environment of fun.
Guile on
This particular game, “Masterpiece,” presents a high-stakes art auction that requires players to manage money, take risks, discuss options for future investments, and avoid impulsive behaviors that could undermine their success. The game emphasizes the use of guile to outbid another player or trick them into spending too much cash.
At the start of the game, each of four players receives $1.5 million and takes turns rolling dice to determine a transaction type: bank auction, private auction or buy/sell a painting from the bank. In our game, John rolls a bank auction and puts Vincent Van Gogh’s “Sunflowers” up for bid. Players stake their claims with pointed fingers, until John proclaims, “Going once, going twice, sold to Sonny for $400,000!” The same routine happens with a private auction, which creates meaningful repetition of directions to increase memory recall.
The group of four continues to negotiate and finagle for an hour until all the paintings are auctioned off. Players count up their fortunes and announce their worth in assets and cash. As they clap for the winner, Amy ever-so-smugly states, “I obviously have the most beautiful pieces.” This comment is spoken fluently, as opposed to earlier in the game, when word-finding was a challenge.

Based on your clients’ attention level, choose a game they can complete. At NeuroRestorative, we use games that last 30 minutes to an hour. After that, determine if and how you may need to modify the game area for the client.

Winning at goals
The value of “Masterpiece”—one of the dozens of games that challenge cognitive-linguistic deficits—has far exceeded the $1 I spent on it at a yard sale. So why don’t clinicians use games like this in treatment more? Some fear negative reactions to words like “play” or “game” in reference to treatment. On the contrary, I have found that board games offer plentiful and valuable data for goals in a plan of care.
Are you interested in trying this with your clients? To make this work, you need to individualize the gameplay. Get to know your clients and understand what hobbies, themes and types of games they might enjoy. Games come in all shapes and sizes: cards, dice, trivia, medieval, monsters, Civil War and so forth.
Next, based on your clients’ attention level, choose a game they can complete. At NeuroRestorative, we use games that last 30 minutes to an hour. After that, determine if and how you may need to modify the game area for the client: Does the table have adequate space for an augmentative and alternative communication device? Is there a clear space for wheelchairs? Will you need adaptive equipment to hold cards for clients with impaired fine motor skills?
Skill-builders
Once your game is rolling, facilitate your clients’ cognitive-linguistic skills and treatment goals throughout. For example, when we play “Masterpiece,” I:
  • Remind players to count their money periodically because (as in real life) there are consequences for overdrawing.

  • Urge players to remember prices of sold paintings in case they later encounter those paintings (cue those with memory difficulties to write notes about the paintings).

  • Direct players’ attention to the auctioneer’s bidding, particularly with players who are easily distracted.

  • Advise impulsive buyers to set a budget before a bidding round begins, and encourage them not to exceed it.

Every game we play with clients can be modified, just like a treatment plan. As speech-language pathologists, we teach against rigidity and promote flexible thinking. Let’s ask ourselves, “Have we stepped outside the box for our clients?”
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
December 2016
Volume 21, Issue 12