" Playing video games may help tumor patients. "
Our clients are interested in providing (and studying) alternative rehabilitation solutions for tumor patients. One such solution is a therapeutic video game which they had previously commissioned. The game uses an exercise bicycle as a game controller and places the player in a series of cognitive challenges. Our clients predict that the agility and mental focus required for playing this video game may help tumor patients.
Project goal
Create an interactive storyline to accompany a therapeutic video game to provide cognitive and physical stimulation for brain tumor patients undergoing a 12-week rehabilitation session.
Netherlands Cancer Institute and Tilburg University.
Target audience
Brain tumor patients undergoing rehabilitation therapy.
Our interactive narrative design follows Marwin, a shy but intelligent alien, on his quest throughout the Terra universe to uncover the truth about his home planet.
We used Unity Game Engine to prototype a video game teaser to demonstrate how our gameplay, interactions and story world would all fit together and contribute to an overall successful therapy experience.

Together with our clients at the National Cancer Institute and Tilburg University we conceived and designed Terra, an interactive video game narrative for a 12-week rehabilitation program for brain tumor patients. The Terra video game uses a previously designed exercise bike as a controller. Terra is meant to provide players cognitive and physical stimulation because this is considered beneficial for positive therapy outcomes. Our narrative follows Marwin 3001 on his quest through the Terra universe to uncover the truth about his home, Planet X.

Two animated characters (a purple alien and a blue robot) on a solid black background
Problem space

We were challenged with creating an interactive story that would sustain player attention, reduce stress and provide beneficial therapeutic outcomes. Another design constraint was to align the elements of our story to fit with the existing bicycle controller. (The previous team to work on this project designed this controller as they had research evidence suggesting that the exercise component of the game is essential for positive therapy outcomes.) Lastly, our clients asked us to include cognitive challenges within the game which would test player attention, processing speed and memory.

  • How might we balance player enjoyment/engagement while also including cognitive challenges and exercise prompts which to players might seem overwhelming?
  • How can we best fit the bicycle interaction into the story's plot?
  • How can we design for cognitively impaired patients without being able to user test with this group?
Venn diagram showing 'video game narrative design on one side, and 'therapeutic benefits' on the other.

To better grasp the problem space I began locating previous research studies on cognitive video game therapy. I located two relevant articles which discussed cognitive game design challenges and potential opportunities. I presented my research findings in a table summarizing the study method, findings, conclusions and ideas that I had while reading the article. I also organized my thoughts into three key themes:

  • Gameplay choices must matter
  • Therapy tasks & gameplay balance
  • Knowledge exchange with experts
Chart depicting desk research summary of video game therapy interventions.
Ideation & validation

Next, our team challenged ourselves to form a basic story synopsis in a one-day design sprint. By the end of the day we had all of our story assets, including: plot, setting, character goals and character backstories.

We asked our clients (who were medical experts and researchers) for a list of cognitive strategies that patients use to overcome challenges in their everyday lives. We devised a plan for how we would include these strategies throughout the game. One idea was to include a helper character. Annie the robot embodies the "helper" archetype and would play a central role in our narrative. For instance, Annie provides players strategies for how to proceed in the game. These strategies mimic strategies that would be used by a cognitively impaired individual in their everyday life.

A photo of paper story assets on top of a table.
terra story assets

Our protagonist, Marwin, embodies the hero archetype. We planned for our game to be styled as a first-person narrative where the player embodies Marwin. Our intention here was to boost player confidence by having them act the part of the hero. At the same time, a hero must overcome difficult situations and this was a way for us to more easily introduce challenges into the game without the risk of players feeling like they are being assigned a list of boring tasks.

We also devised a plan for integrating the bicycle controller interaction into our storyline. Sometimes the bicycling action powers the spaceship within the game, at other times the player must bicycle fast in order to make something explode. The challenge here was coming up with enough interactions for high and low bicycle exercise intervals.

Chart depicting bicycling interaction plan for Terra video game

We used Unity Game Engine to prototype a video game teaser to demonstrate how our gameplay, interactions and story world would all fit together. We also outlined a more detailed and interactive storyline in Twine (an online, interactive narrative design tool) in order to show to our clients how player gameplay choices might be used to influence game outcomes without overwhelming players. Twine has a visual, node-based interface that allows you to quickly prototype interactive storylines.

Terra interactive story outline in Twine software platform

I was surprised at how receptive our clients were to the bulk of our story ideas (even the ideas my teammates and I considered to be over-the-top). Our design approach for this project was to begin with intuition, ideate early, refine and validate our ideas later on with our clients. This strategy kept us from feeling overly constrained while trying to come up with creative story ideas.

Story arc summarizing Marwin's character journey.