Designing and researching games in health has underlayers of models we (unwittingly) hold on what rehabilitation should be  – and held within this our concepts of disability – driving our design decisions or the questions we ask.

Rehabilitation: all measures that aim to lessen bodily, mental or psychological disability or social isolation or the effects thereof and to guide those afflicted by it (back) into society

(Franke, 2010).

Following this definition every measure that was intended to lessen suffering should be thought of as rehabilitation. It would follow that any measure intended to rehabilitate someone is ‘rehabilitation’ regardless of the effect of such a measure, at the same time the definition does not leave room for measures that might not have been intended to rehabilitate but in effect lessen a person’s disability. Here we find the same hopeful designer-driven definition as we do in Serious Games versus the more effect driven definition of Serious Gaming (see my chapter Understanding Serious Gaming for more on this).

In the application of gaming in rehabilitation we can often recognise INTEGRATION and even SEGREGATION thinking. Supposedly, a subgroup of humans (the disabled) is in need of games that are different from games for ‘normal’ people. In this line of thinking segregation occurs for example when hard- and software platforms are especially built for the disabled. An integration approach would be to build different games for the disabled but using the same platform as ‘normal’ players.

When a game is prescribed as part of a therapy – when the game is on a device made exclusively for the disabled and the gameplay is entirely focused on rehabilitative action, than these games adhere to the MEDICAL or NATURAL MODEL. In this model of thinking disease is an opposite state to health and never the twain shall meet. The SALUTOGENESE MODEL views health and disease not as a dichotomy but as a gliding scale (Lindstrom, 2010). In this model every person at every moment in their lives is healthy to some extend and unhealthy to some extend. So even when we are diagnosed as diseased (by the medical model) there are parts of our lives in which we are healthy. Thinking within either the medical or the salutogenese model leads to a different approach of the player and possibilities for gameplay. One can approach the design as for the ‘disabled’ or for a ‘player with a disability’.

Some definitions of disability concern the limitations in the expression of individuality, normality, adaptation and differentiation (Franke, 2010). Games can allow for all different kinds of expression by their designers and by their players. They move in between the realms of art, exploration, creation and learning.  There are different ways in which mediated games could be used to bend limitations of expression that disabled people might struggle with. A game designed in such a way that the experience of a disabled person may be shared with any another human being connects the gameplay to the Right of Community and Participation (Franke, 2010).