OIPO Disability Abstracts: Artificial Intelligence, Machine Learning, Virtual Reality, and Gaming

Updated 4/17/2024

Artificial Intelligence and Machine Learning

Binns, R., & Kirkham, R. (2021). How could equality and data protection law shape AI fairness for people with disabilities? arXiv – CS – Computers and Society. DOI: arxiv-2107.05704.

This article examines the concept of ‘AI fairness’ for people with disabilities from the perspective of data protection and equality law. This examination demonstrates that there is a need for a distinctive approach to AI fairness that is fundamentally different to that used for other protected characteristics, due to the different ways in which discrimination and data protection law applies in respect of Disability. We articulate this new agenda for AI fairness for people with disabilities, explaining how combining data protection and equality law creates new opportunities for disabled people’s organisations and assistive technology researchers alike to shape the use of AI, as well as to challenge potential harmful uses.

Newman-Griffis, D., Sage Rauchberg, J., Alharbi, R., Hickman, L., & Hochheiser, H. (2022). Alternative models: Critical examination of disability definitions in the development of artificial intelligence technologies. arXiv:2206.08287 [cs.AI]. DOI: https://doi.org/10.48550/arXiv.2206.08287.

Disabled people are subject to a wide variety of complex decision-making processes in diverse areas such as healthcare, employment, and government policy. These contexts, which are already often opaque to the people they affect and lack adequate representation of disabled perspectives, are rapidly adopting artificial intelligence (AI) technologies for data analytics to inform decision making, creating an increased risk of harm due to inappropriate or inequitable algorithms. This article presents a framework for critically examining AI data analytics technologies through a disability lens and investigates how the definition of disability chosen by the designers of an AI technology affects its impact on disabled subjects of analysis. We consider three conceptual models of disability: the medical model, the social model, and the relational model; and show how AI technologies designed under each of these models differ so significantly as to be incompatible with and contradictory to one another. Through a discussion of common use cases for AI analytics in healthcare and government disability benefits, we illustrate specific considerations and decision points in the technology design process that affect power dynamics and inclusion in these settings and help determine their orientation towards marginalisation or support. The framework we present can serve as a foundation for in-depth critical examination of AI technologies and the development of a design praxis for disability-related AI analytics.

Lillywhite, A., & Wolbring, G. (2019). Coverage of ethics within the artificial intelligence and machine learning academic literature: The case of disabled people. Assistive Technology Online Before Print. DOI: https://doi.org/10.1080/10400435.2019.1593259.

Disabled people are often the anticipated users of scientific and technological products and processes advanced and enabled by artificial intelligence (AI) and machine learning (ML). Disabled people are also impacted by societal impacts of AI/ML. Many ethical issues are identified within AI/ML as fields and within individual applications of AI/ML. At the same time, problems have been identified in how ethics discourses engage with disabled people. The aim of our scoping review was to better understand to what extent and how the AI/ML focused academic literature engaged with the ethics of AI/ML in relation to disabled people.  Of the n = 1659 abstracts engaging with AI/ML and ethics downloaded from Scopus (which includes all Medline articles) and the 70 databases of EBSCO ALL, we found 54 relevant abstracts using the term “patient” and 11 relevant abstracts mentioning terms linked to “impair*”, “disab*” and “deaf”. Our study suggests a gap in the literature that should be filled given the many AI/ML related ethical issues identified in the literature and their impact on disabled people.”

Lillywhite, A., & Wolbring, G. (2020). Coverage of artificial intelligence and machine learning within academic literature, Canadian newspapers, and Twitter tweets: The case of disabled people. Societies, 10(3). DOI: https://doi.org/10.3390/soc10010023.

Artificial intelligence (AI) and machine learning (ML) advancements increasingly impact society and AI/ML ethics and governance discourses have emerged. Various countries have established AI/ML strategies. “AI for good” and “AI for social good” are just two discourses that focus on using AI/ML in a positive way. Disabled people are impacted by AI/ML in many ways such as potential therapeutic and non-therapeutic users of AI/ML advanced products and processes and by the changing societal parameters enabled by AI/ML advancements. They are impacted by AI/ML ethics and governance discussions and discussions around the use of AI/ML for good and social good. Using identity, role, and stakeholder theories as our lenses, the aim of our scoping review is to identify and analyze to what extent, and how, AI/ML focused academic literature, Canadian newspapers, and Twitter tweets engage with disabled people. Performing manifest coding of the presence of the terms “AI”, or “artificial intelligence” or “machine learning” in conjunction with the term “patient”, or “disabled people” or “people with disabilities” we found that the term “patient” was used 20 times more than the terms “disabled people” and “people with disabilities” together to identify disabled people within the AI/ML literature covered. As to the downloaded 1540 academic abstracts, 234 full-text Canadian English language newspaper articles and 2879 tweets containing at least one of 58 terms used to depict disabled people (excluding the term patient) and the three AI terms, we found that health was one major focus, that the social good/for good discourse was not mentioned in relation to disabled people, that the tone of AI/ML coverage was mostly techno-optimistic and that disabled people were mostly engaged with in their role of being therapeutic or non-therapeutic users of AI/ML influenced products. Problems with AI/ML were mentioned in relation to the user having a bodily problem, the usability of AI/ML influenced technologies, and problems disabled people face accessing such technologies. Problems caused for disabled people by AI/ML advancements, such as changing occupational landscapes, were not mentioned. Disabled people were not covered as knowledge producers or influencers of AI/ML discourses including AI/ML governance and ethics discourses. Our findings suggest that AI/ML coverage must change, if disabled people are to become meaningful contributors to, and beneficiaries of, discussions around AI/ML.

Morrison, R. J. (2019, Summer). Ethical depictions of neurodivergence in SF about AI. Configurations, 27(3), 387-410. DOI: https://doi.org/10.1353/con.2019.0021.

In science fiction (SF), representations of artificial intelligence (AI) run the gamut from being cognizant of the full spectrum of potential human emotion, to lacking any comparable emotional states. When a feeling/unfeeling AI—the novum of the text—interacts with human characters, the presence of strong emotional capability is shown to be positive, and any absence of emotional capability is shown to be negative, even abject. This aligns perceived emotional capability with normality, establishing that the empirical “zero world” of the text is one in which those who lack normative emotional affect lack value.

Nugent, S. E., & Scott-Parker, S. (2022). Recruitment AI has a disability problem: Anticipating and mitigating unfair automated hiring decisions. In M. I. Aldinhas Ferreira & M. Osman Tokhi (Eds.), Towards Trustworthy Artificial Intelligent Systems [Intelligent Systems, Control and Automation: Science and Engineering Vol. 102]. (pp 85–96).

Artificial Intelligence (AI) technologies have the potential to dramatically impact the lives and life chances of people with disabilities seeking employment and throughout their career progression. While these systems are marketed as highly capable and objective tools for decision making, a growing body of research demonstrates a record of inaccurate results as well as inherent disadvantages for historically marginalised groups. Assessments of fairness in Recruitment AI for people with disabilities have thus far received little attention or have been overlooked. This paper examines the impacts to and concerns of disabled employment seekers using AI systems for recruitment, and discusses recommendations for the steps employers can take to ensure innovation in recruitment is also fair to all users. In doing so, we further the point that making systems fairer for disabled employment seekers ensures systems are fairer for all.

Packin, N. G., (2020, November 3). Disability Discrimination Using AI Systems, Social Media and Digital Platforms: Can We Disable Digital Bias?  SSRN. DOI: http://dx.doi.org/10.2139/ssrn.3724556.

Social media platforms and digital technological tools have transformed how people manage their day-to-day lives, socially as well as professionally. Big data algorithms help us improve our decision-making processes, and sophisticated social networks, enable us to get connected to other individuals and organizations, get exposed to information, and even learn about different opportunities. But as individuals come to be more and more comfortable with social networks and big data algorithms, fewer give much thought to how personal data gleaned from social networks and fed into algorithms affects the administration of government and the provision of private services. Algorithmic assessment of personal characteristics enables widescale discrimination by government and private entities, and such discrimination is particularly pernicious for persons with disabilities.

According to the social model of disability, disability is not only inherent to the individual and determined by the impairment but is also a product of the social environment. Social expectations, conventions, and technology determine which traits are outside the norm and which traits are disabling. Whether a technology perpetuates or mitigates disability depends on social norms, including norms that are embedded in law. A wheelchair might mitigate the impairment, but only if legal rules dictate a built environment where wheelchair users and non-wheelchair users can move in a similar fashion, can the disability be mitigated. Similarly, digital technologies can limit the ways in which some traits are disabling only if bias and discriminatory features against individuals with disabilities are not embedded within their use. We must ensure that technology developments continue to improve the life quality and opportunities for individuals with disabilities, and that we design systems that better accommodate the disabled, enhance their access, and help level the playing field between them and the able-bodied. We should regulate to ensure that individuals with disabilities are legally protected from discrimination. Additionally, and not less importantly, we must make sure that individuals with disabilities are not left out of innovations because of the difficulty in detecting the different types of disabilities as well as disability bias, proving it, and designing around it.

Parvin, N. (2019). Look up and smile! Seeing through Alexa’s algorithmic gaze. In K. Fritsch, A. Hamraie, M. Mills & D. Serlin (Eds.), Crip Technoscience [Special Section]. Catalyst, 5(1). DOI: https://doi.org/10.28968/cftt.v5i1.29592.

Echo Look is one latest product by Amazon built on the artificial intelligence agent Alexa designed to be a virtual fashion assistant. This paper draws on feminist theory to critically engage with the premises and promises of this new technology. More specifically, I demonstrate how the introduction of Echo Look is an occasion to think through ethical and political issues at stake in the particular space it enters, in this case no less than what is perceived of (women’s) bodies and what fashion is and does. In addition, the specific domain helps us see this category of technology anew, illuminating its taken-for-granted assumptions. More specifically, it serves as yet another reminder of what algorithms cannot do and of their oppressive potency.

Ringel Morris, M. (2020, June). AI and accessibility:  A discussion of ethical considerations [Viewpoint]. Communications of the ACM, 63(6), 35-37. DOI: https://doi.org/10.1145/3356727.

“According to the World Health Organization, more than one billion people worldwide have disabilities, the field of disability studies defines disability through a social lens; people are disabled to the extent that society creates accessibility barriers. AI technologies offer the possibility of removing many accessibility barriers; for example, computer vision might help people who are blind better sense the visual world, speech recognition and translation technologies might offer real time captioning for people who are hard of hearing, and new robotic systems might augment the capabilities of people with limited mobility. Considering the needs of users with disabilities can help technologists identify high-impact challenges whose solutions can advance the state of AI for all users; however, ethical challenges such as inclusivity, bias, privacy, error, expectation setting, simulated data, and social acceptability must be considered” (p. 35).

Robertson, S., Magee, L., & Soldatić, K. (2022). Intersectional inquiry, on the ground and in the algorithm. Qualitative Inquiry, 28(7), 814–826. DOI: https://doi.org/10.1177/10778004221099560.

This article makes two key contributions to methodological debates in automation research. First, we argue for and demonstrate how methods in this field must account for intersections of social difference, such as race, class, ethnicity, culture, and disability, in more nuanced ways. Second, we consider the complexities of bringing together computational and qualitative methods in an intersectional methodological approach while also arguing that in their respective subjects (machines and human subjects) and conceptual scope they enable a specific dialogue on intersectionality and automation to be articulated. We draw on field reflections from a project that combines an analysis of intersectional bias in language models with findings from a community workshop on the frustrations and aspirations produced through engagement with everyday artificial intelligence (AI)–driven technologies in the context of care.

Shew, A. (2020, March). Ableism, Technoableism, and Future AI. IEEE Technology and Society Magazine, 39(3), 40-85. DOI: https://doi.org/10.1109/MTS.2020.2967492.

Ableism (discrimination in favor of nondisabled people and against disabled people1) impacts technological imagination. Like sexism, racism, and other types of bigotry, ableism works in insidious ways: by shaping our expectations, it shapes how and what we design (given these expectations), and therefore the infrastructure all around us. And ableism shapes more than just the physical environment. It also shapes our digital and technological imaginations – notions of who will “benefit” from the development of Artificial Intelligence (AI) and the ways that those systems are designed and implemented are a product of how we envision the “proper” functioning of bodies and minds.

Smith, P., & Smith, L. (2021). Artificial intelligence and disability: Too much promise, yet too little substance? AI Ethics 1, 81–86. DOI: https://doi.org/10.1007/s43681-020-00004-5.

Much has been written about the potential of artificial intelligence (AI) to support, and even transform, the lives of disabled people. It is true that many advances have been made, ranging from robotic arms and other prosthetic limbs supported by AI, decision support tools to aid clinicians and the disabled themselves, and route planning software for those with visual impairment. Many individuals are benefiting from the use of such tools, improving our accessibility and changing lives. But what are the true limits of such tools? What are the ethics of allowing AI tools to suggest different courses of action, or aid in decision-making? And does AI offer too much promise for individuals? I have recently undergone a life changing accident which has left me severely disabled, and together with my daughter who is blind, we shall explore the day-to-day realities of how AI can support, and frustrate, disabled people. From this, we will draw some conclusions as to how AI software and technology might best be developed in the future.

Tilmes, N. (2022). Disability, fairness, and algorithmic bias in AI recruitment. Ethics and Information Technology, 24, Article 21.  DOI: https://doi.org/10.1007/s10676-022-09633-2.

While rapid advances in artificial intelligence (AI) hiring tools promise to transform the workplace, these algorithms risk exacerbating existing biases against marginalized groups. In light of these ethical issues, AI vendors have sought to translate normative concepts such as fairness into measurable, mathematical criteria that can be optimized for. However, questions of disability and access often are omitted from these ongoing discussions about algorithmic bias. In this paper, I argue that the multiplicity of different kinds and intensities of people’s disabilities and the fluid, contextual ways in which they manifest point to the limits of algorithmic fairness initiatives. In particular, existing de-biasing measures tend to flatten variance within and among disabled people and abstract away information in ways that reinforce pathologization. While fair machine learning methods can help mitigate certain disparities, I argue that fairness alone is insufficient to secure accessible, inclusive AI. I then outline a disability justice approach, which provides a framework for centering disabled people’s experiences and attending to the structures and norms that underpin algorithmic bias.

Trewin, S., Basson, S., Muller, M., Branham, S., Treviranus, J., Gruen, D., Hebert, D., Lyckowski, N., & Manser, E. (2019, September). Considerations for AI Fairness for People with Disabilities. AI Matters, 5(3), 40-63. DOI: https://doi.org/10.1145/3362077.3362086.

In society today, people experiencing disability can face discrimination. As artificial intelligence solutions take on increasingly important roles in decision-making and interaction, they have the potential to impact fair treatment of people with disabilities in society both positively and negatively. We describe some of the opportunities and risks across four emerging AI application areas: employment, education, public safety, and healthcare, identified in a workshop with participants experiencing a range of disabilities. In many existing situations, non-AI solutions are already discriminatory, and introducing AI runs the risk of simply perpetuating and replicating these flaws. We next discuss strategies for supporting fairness in the context of disability throughout the AI development lifecycle. AI systems should be reviewed for potential impact on the user in their broader context of use. They should offer opportunities to redress errors, and for users and those impacted to raise fairness concerns. People with disabilities should be included when sourcing data to build models, and in testing, to create a more inclusive and robust system. Finally, we offer pointers into an established body of literature on human centered design processes and philosophies that may assist AI and ML engineers in innovating algorithms that reduce harm and ultimately enhance the lives of people with disabilities.

White, J. J. G. (2022). Artificial intelligence and people with disabilities: A reflection on human–AI partnerships. In F. Chen & J. Zhou (Eds.), Humanity driven AI: Productivity, well-being, sustainability and partnership (pp 279–310). Springer, Cham. DOI: https://doi.org/10.1007/978-3-030-72188-6_14.

Artificial intelligence (AI) has much potential to enhance opportunities and independence for people with disabilities by addressing practical problems that they encounter in a variety of domains. Indeed, the partnership between AI and people with disabilities already has a history that spans several decades, through the use of assistive technologies based, for example, on speech recognition, optical character recognition, word prediction, and text-to-speech conversion. Contemporary developments in machine learning can extend and enhance the capabilities of such assistive technology applications, while opening the way to further improvements in accessibility. AI applications intended to benefit people with disabilities can also give rise to questions of values and priorities. These issues are here discussed in relation to the role of design practices and policy in shaping the solutions adopted. AI can also contribute to discrimination on grounds of disability, especially if machine learning algorithms are substituted partly or completely for human decision making. The potential for bias and strategies for overcoming it raise as yet unresolved research questions. In exploring some of these considerations, a case is developed for favoring approaches which shape the normative and social context in which AI technologies are developed and used, as well as the technical details of their design.

Virtual Reality

Brandt, M., & Messeri, L.  (2019). Imagining feminist futures on the small screen: Inclusion and care in VR fictions. In C. Bruun Jensen & A. Kemiksiz (Eds.), Anthropology and Science Fiction: Experiments in Thinking Across Worlds [Feature Issue]. Nature Culture Issue 5. https://www.natcult.net/journal/issue-5/imagining-feminist-futures-on-the-small-screen/.

Virtual reality signifies not only an immersive media technology, but also a cultural desire to allow bodies to inhabit other worlds as easily as pushing a button or putting on goggles. As the VR industry has grown, so too have popular imaginings of its potential. We draw on feminist technoscience studies to analyze and evaluate recent VR science fiction media narratives. How do they articulate VR’s role in the future, and for whom? Who are the heroes of these worlds and what makes them heroic? Steven Spielberg’s would-be blockbuster Ready Player One (2018) (RPO) offers a techno-masculine narrative in which a hero saves the world. In contrast to RPO, television and streaming small screen science fiction narratives have focused on the extent to which VR can save not worlds, but individuals. A surprisingly consistent trope has emerged in these shows: one of VR as a therapeutic tool for a woman coping with trauma. While certainly a departure from RPO’s Hollywood vision of VR, this analysis examines how episodes of Reverie, Philip K. Dick’s Electric Dreams, Kiss Me First, and Black Mirror offer visions of VR that reflect the feminist ambitions of the contemporary VR industry.

Jiang, Z., Meltzer, A., & Zhang, X. (2023). Using virtual reality to implement disability studies’ advocacy principles: Uncovering the perspectives of people with disability. Disability & Society. DOI: https://doi.org/10.1080/09687599.2022.2150601.

One central aim of disability studies is to shift understandings of disability, such that disability comes to be understood as about the social disadvantage/oppression that people face when society does not cater to impairment of body/mind. Nevertheless, there remains a need for more practical tools for disability advocacy, through which to transmit disability studies’ ideas of disability to the general community. Drawing on a qualitative study of the perspectives of 23 people with physical and sensory impairments, this paper proposes virtual reality as an advocacy tool to communicate the principles and beliefs of disability studies. The findings highlight that, due to the nature of the technology, participants feel virtual reality has clear potential as a disability advocacy tool that can facilitate empathy, perspective-taking and positive social change, with a particular focus on how it is the environmental barriers and social attitudes around people that disables them.

Redden, R. (2018, April 11). VR: An Altered Reality for Disabled Players. First Personal Scholar. Waterloo, ON: The Games Institute (GI) at the University of Waterloo in collaboration with IMMERSe, The Research Network for Video Game Immersion. Retrieved from: http://www.firstpersonscholar.com/vr-altered-reality/.

“…gather(s) the experiences and ideas of accessibility advocates who are working to inform VR’s trajectory. [The author is also]… providing..[a]… perspective of the VR station and its access. By putting existing ideas and experiences together, …[the author] hope[s] to promote the work that folks with disabilities are already doing in advising (and designing) games themselves, and the role of the public VR station in advocating and creating better VR” (n.p.)

Zhang, K., Deldari, E., Lu, Z., Yao, Y., & Zhao, Y. (2022). “It’s Just Part of Me:” Understanding Avatar Diversity and Self-presentation of People with Disabilities in Social Virtual Reality. In The 24th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS ’22), October 23–26, 2022, Athens, Greece. New York: ACM. DOI: https://doi.org/10.1145/3517428.3544829.

In social Virtual Reality (VR), users are embodied in avatars and interact with other users in a face-to-face manner using avatars as the medium. With the advent of social VR, people with disabilities (PWD) have shown an increasing presence on this new social media. With their unique disability identity, it is not clear how PWD perceive their avatars and whether and how they prefer to disclose their disability when presenting themselves in social VR. We fill this gap by exploring PWD’s avatar perception and disability disclosure preferences in social VR. Our study involved two steps. We first conducted a systematic review of fifteen popular social VR applications to evaluate their avatar diversity and accessibility support. We then conducted an in-depth interview study with 19 participants who had different disabilities to understand their avatar experiences. Our research revealed a number of disability disclosure preferences and strategies adopted by PWD (e.g., reflect selective disabilities, present a capable self). We also identified several challenges faced by PWD during their avatar customization process. We discuss the design implications to promote avatar accessibility and diversity for future social VR platforms.


Anderson, S. L. (2017). The corporeal turn: At the intersection of rhetoric, bodies, and video games. Review of Communication, 17(1), 18-36. DOI: https://doi.org/10.1080/15358593.2016.1260762.

Through a critical literature review, this article examines the trend in game studies toward studying bodies, both of players and of characters, in communication scholarship. Specifically, first I discuss how the field of rhetoric has gradually become more familiar with studying games. Second, I map rhetorical studies’ involvement in materialism, specifically through the investigation of bodies. Third, I offer an extensive, though not exhaustive, review of how game studies has hitherto approached research regarding bodies. The article concludes by forecasting the future of game bodies and game studies with an eye toward Artificial Intelligence (A.I.) gaming, augmented reality, and virtual reality. This article argues that instead of creating a single, unifying theory of gaming bodies, games scholars should identify themes of bodies in games.

Anderson, S. L. (2023). Video game accessibility defined through advocacy: How the websites AbleGamers.org and CanIPlayThat.com use the word accessibility. Games and Culture Online First. DOI: https://doi.org/10.1177/15554120231170156.

This study investigates how the word “accessibility” is used in online news articles published by two video game-based disability advocacy organizations. AbleGamers is an accessibility and disability advocacy charity focused on improving the lives of people with disabilities through gaming. Can I Play That? publishes accessibility reviews of video games. Both organizations have news pages that publish disability and accessibility news. The study examines 50 news articles published by these organizations for how they use the word “accessibility.” The articles produced 105 instances of the word “accessibility.” The study finds nine themes for how “accessibility” is used. The study compares those uses and concludes by producing six pseudo-definitions for video game accessibility.

Anderson, S. L. (2024). Ability machines: What video games mean for disability [Digital Game Studies]. Bloomington: Indiana University Press.

Video games are both physically and cognitively demanding—so what does that mean for those with a disability or mental illness? Though they may seem at odds, Ability Machines illuminates just how vital video games are to understanding our bodies and abilities.

In Ability Machines, Sky LaRell Anderson shows us how video games can help us imagine what our abilities mean and how they engage us physically, behaviorally, and cognitively to envision our agency beyond limitations. On the surface, this can mean games provide power fantasies; more profoundly, games can fundamentally reshape cultural and personal understandings of mental health, illness, disability, and accessibility. Video games are indeed ability machines that produce a reimagined state of agency.

Featuring a comparative analysis of key video game titles, including Metal Gear Solid VWolfenstein II, Celeste, Devil May Cry 5Hellblade: Senua’s SacrificeHades, Nier: Automata, and more, Ability Machines tackles larger questions of ability and how our bodies relate to interactive media.

Anderson, S. L., & Johnson, M. R. (2021). Gamer identities of video game live streamers with disabilities. Information, Communication & Society Ahead-of-Print, 1-16.  https://doi.org/10.1080/1369118X.2021.1907433.

This study investigates the strategies video game streamers with disabilities employ to navigate their identity as gamers as it relates to their subject positions as persons with disabilities. Through an analysis of online videos featuring eight streamers with disabilities, this study reveals four themes around how streamers establish their identities regarding both disability and gaming: establishing gaming capital, acknowledging disability, gaming to overcome challenges, and feeling empowered to ‘inspire’. Our analysis discusses how the four themes coalesce around a co-constitutive identity of ‘disabled streamer’ that is unique from both gamer and disability identities yet informed by and negotiated through each of these in various ways. The study sheds light on the ongoing mutual creation and transformation of gaming and disability identities on the internet.

Anderson, S. L., & Schrier, K. (2021). Disability and video games journalism: A discourse analysis of accessibility and gaming culture. Games and Culture Online First. DOI: https://doi.org/10.1177/15554120211021005.

In this article, we conduct a discourse analysis of 60 articles to reveal themes that describe how games journalism reflects and constitutes understandings of disability and accessibility in gaming. First, we map prior research on media’s relationship to disability, as well as approaches to disability in game studies, including the introduction of two primary paradigms for addressing issues of accessibility in gaming. Second, the project reveals six thematic categories that describe how game journalism reflects and constitutes understandings of disability and accessibility in gaming: gamers with disabilities, portraying disability, game design, game controllers, discussing accessibility, and advocacy. Further comparison of the categories reveals four additional themes of discourses, namely, self-congratulations, fetishization, awareness as advocacy, and problem-solving. The article concludes with implications for the games industry, for theory, and for how the field of game studies can investigate disability.

Austin, J. (2021, December). “The hardest battles are fought in the mind”: Representations of Mental Illness in Ninja Theory’s Hellblade: Senua’s Sacrifice. Game Studies, 21(4). The International Journal of Computer Game Research, Game Studies Foundation. Supported by the Swedish Research Council (Vetenskapsrådet), The Joint Committee for Nordic Research Councils for the Humanities and the Social Sciences, Blekinge Institute of Technology, IT University of Copenhagen, and Lund University. Retrieved from: http://gamestudies.org/2104/articles/austin.

This paper explores the videogame Hellblade: Senua’s Sacrifice (Ninja Theory, 2017) through a disability studies lens in order highlight the unique challenges associated with representations of psychosis in fictional, immersive gameplay environments. Throughout this paper I employ close reading strategies to critically examine specific scenes from Hellblade that alternately subvert or uphold stereotypical representations of psychosis; furthermore, I acknowledge the largely positive effects of the designers’ collaboration with stakeholders in the mental health community. However, I note the difficulties associated with framing psychosis as a conventional disability in theoretical discourse and call for the continued collaboration between the humanities and the medical sciences to promote scholarship that does not inadvertently perpetuate stigmatizing tropes. Lastly, I also argue for an active divestment of the term “madness” in the humanities and note the potential for videogame studies to establish a scholarly standard for doing so.

Baker, M. M. (2022, October). The visual and narrative rhetoric of mental health in Gris. Journal of Gaming & Virtual Worlds, 14(3), 249-266. DOI: https://doi.org/10.1386/jgvw_00061_1.

Interdisciplinary game studies have long been fascinated by video games and their potential to improve mental health. Despite this interest, there is not yet a cohesive rhetorical framework to connect conversations about mental health with specific types of games. Following Waszkiewicz and Bakun’s (2020) call to adopt the term ‘cosy’ for games which inspire feelings of safety in players, encourage self-actualization and utilize soft aesthetics helps clarify discussions of the games suited to help improve mental health and allow players to process complex emotions. This article uses a close reading of the Nomada Studios game  to argue that considering cosiness when studying the connection between games, emotion and mental health will help researchers find a connection between game aesthetics and the types of psychological issues that a game can address effectively.

Beeston, J., Power, C., Cairns, P., & Barlet, M. (in preparation). Characteristics and motivations of players with disabilities in digital games. York, UK & Charles Town, WV: Department of Computer Science Deramore Lane, University of York and The AbleGamers Charity.  Retrieved from: https://arxiv.org/ftp/arxiv/papers/1805/1805.11352.pdf.

In research and practice into the accessibility of digital games, much of the work has focused on how to make games accessible to people with disabilities. With an increasing number of people with disabilities playing mainstream commercial games, it is important that we understand who they are and how they play in order to take a more user-centered approach as this field grows. We conducted a demographic survey of 230 players with disabilities and found that they play mainstream digital games using a variety of assistive technologies, use accessibility options such as key remapping and subtitles, and they identify themselves as gamers who play digital games as their primary hobby. This gives us a richer picture of players with disabilities and indicates that there are opportunities to begin to look at accessible player experiences (APX) in games.”

Bierre, K., Chetwynd, J., Ellis, B., Hinn, D. M., Ludi, S., & Westin, T. (2019). Game not over: Accessibility issues in video games. San Francisco: Games Accessibility Special Interest Group, International Game Developers Association. Retrieved from: https://www.researchgate.net/publication/267403944_Game_Not_Over_Accessibility_Issues_in_Video_Games.

An issue that has been facing the game industry recently is the need to provide accessible games. There are various legal, financial, and ethical reasons for wanting more accessible games. This paper will examine the scope of the problem by reviewing the need for accessibility, the current state of the industry, and some proposed initiatives that we feel should start to occur in the near future. We also will look at case studies of several commercial games that have provided accessibility features.” (author’s abstract)

Boluk, S., & LeMieux, P. (2017). Blind spots: The Phantom Pain, The Helen Keller Simulator, and disability in games. In Metagaming: Playing, Competing, Spectating, Cheating, Trading, Making, and Breaking Videogames. Minneapolis & London: University of Minnesota Press. DOI: https://doi.org/10.5749/9781452958354.

“…[this] chapter…examines the practices of blind players and the concept of disability in videogames. From Hideo Kojima’s Metal Gear Solid V: The Phantom Pain (2015), a graphic spectacle that begins with extensive cutscenes of a limping, hook-handed veteran, to the The Helen Keller Simulator (circa 2005), an unpopular Internet meme typically consisting of a black screen with no feedback, [this] chapter…considers metagaming in the context of critical disability studies. On one extreme, the hospitalized hero in The Phantom Pain allegorizes the hypertrophy of the graphics industry—his single eye standing in for single-point perspective and his hook hand recalling the limited articulation of a game controller. On the other extreme, The Helen Keller Simulator represents the atrophy of experimental games without gameplay—a failed simulation that cannot articulate the phenomenal experience of deaf and blind persons, but ultimately serves as a commentary on the impoverished representational capacity of videogames as a medium—the withoutness of all games. In contrast to the cinematic spectacle in The Phantom Pain and the minimal mechanics in The Helen Keller Simulator, [this] chapter…concludes with a discussion of alternative approaches to playing The Legend of Zelda: Ocarina of Time. Around the same time speedrunners like Narcissa Wright first experimented with temporal constraints in Ocarina of Time, Jordan Verner and Drew Wissler began developing metagaming practices through which both blind and blindfolded players navigate videogame spaces and invent new games according to alternate sensory economies. Rather than attempt to represent disability or make games more accessible, these practices reveal that there are always more ways to play” (n.p.).

Bozdog, M., & Galloway, D. (2020). Worlds at our fingertips: Reading (in) What Remains of Edith Finch. Games and Culture , 15(7), 789-808. DOI: https://doi.org/10.1177%2F1555412019844631.

Video games are works of written code that portray worlds and characters in action and facilitate an aesthetic and interpretive experience. Beyond this similarity to literary works, some video games deploy various design strategies that blend gameplay and literary elements to explicitly foreground a hybrid literary/ludic experience. We identify three such strategies: engaging with literary structures, forms, and techniques; deploying text in an aesthetic rather than a functional way; and intertextuality. This article aims to analyze how these design strategies are deployed in What Remains of Edith Finch to support a hybrid readerly/playerly experience. We argue that this type of design is particularly suited for walking simulators (or walking sims) because they support interpretive play through slowness, ambiguity, narrative, and aesthetic aspirations. Understanding walking sims as literary games can shift the emphasis from their lack of “traditional” gameplay complexity and focus instead on the opportunities that they afford for hybrid storytelling and for weaving literature and gameplay in innovative and playful ways.

Brown, M., & Anderson, S. L. (2020). Designing for disability: Evaluating the state of accessibility design in video games. Games and Culture. DOI:  https://doi.org/10.1177/1555412020971500.

This project evaluates the current state accessibility of video games, specifically in terms of designing for disability. We evaluate 50 games chosen for their sales data, critical reception, awards won, and other criteria to examine the widest possible sample of the most prominent games released in 2019. This approach to selecting games allows for identifying design trends as they emerge from the most widely played or influential games. The results highlight design pitfalls and innovations regarding accessibility in four key areas: auditory, visual, motor, and difficulty. As a feed-forward project, the aim is not simply to catalog what games include which accessibility features, a nearly impossible feat considering how varied the design features are, depending on the game. This report also attempts to point to future directions for how games can continue to innovate in accessibility.

Burrell-Kim, D. (2023, July). “Stuttering Matt”: Linguistic ableism and the mockery of speech impediments in video games. Game Studies, 23(2). The International Journal of Computer Game Research, Game Studies Foundation. Supported by the Swedish Research Council (Vetenskapsrådet), The Joint Committee for Nordic Research Councils for the Humanities and the Social Sciences, Blekinge Institute of Technology, IT University of Copenhagen, and Lund University. Retrieved from: https://gamestudies.org/2302/articles/burrellkim.

Language ideology and the representation of language in videogames has been largely neglected in the field of game studies; only recently have researchers begun to examine this crucial topic more. Recent studies (see Burrell-Kim, 2020a; Ensslin, 2010; Ensslin 2011; Goorimoorthee, Csipo, Carleton & Ensslin, 2019; Tarnarutckaia & Ensslin, 2019) have found that language and language users are often represented through stereotypes built on oppressive language ideologies that often result in real-world discrimination (Gee, 2015; Lippi-Green, 2012; MacSwan, 2018). Ableism has been a significant and growing research topic in game studies (e.g., Carr, 2014; Jerreat-Poole, 2020). Yet, no studies currently exist examining inequitable representations of language-related disabilities and speech impediments, which I will refer to as linguistic ableism. In real-life interactions and mainstream media, people with speech impediments are routinely misrepresented and discriminated against (Dolmage, 2018; Gayoso, 2018; Johnson, 2008; St Pierre, 2016). Thus, this study aims to explore how linguistic ableism occurs in mainstream roleplaying video games through the representation of speech impediments in Red Dead Redemption 2 (Rockstar Games, 2018), The Witcher 3: Wild Hunt (CD Project Red, 2015), Dragon Age: Origins (BioWare, 2009), Dragon Age II (Bioware, 2011), Dragon Age: Inquisition (BioWare, 2014), and Cyberpunk 2077 (CD Project Red, 2020). This study utilizes multimodal, medium-specific discourse analysis (Ensslin & Balterio, 2019; Hawreliak, 2018; Pérez-Latorre, Oliva & Besalú, 2017) to analyze video clips of characters with speech impediments collected from the selected games. A majority of the encounters with linguistic ableism indicate that speech impediments are most often used to signal a lack of intelligence in characters or are framed as a source of humor for players through mockery. As the first empirical examination of linguistic ableism in videogames, this study aims to both raise awareness of the ways in which language is often utilized for discrimination in videogame representation and highlight possibilities for the normalization of diverse voices in videogames.

Carr, D. (2014, December). Ability, disability and Dead Space. Game Studies, 14(2). The International Journal of Computer Game Research, Game Studies Foundation. Supported by the Swedish Research Council (Vetenskapsrådet), The Joint Committee for Nordic Research Councils for the Humanities and the Social Sciences, Blekinge Institute of Technology, IT University of Copenhagen, and Lund University. Retrieved from: http://gamestudies.org/1402/articles/carr.

This paper focuses on representations of able bodies and disability within Dead Space. The method used is textual analysis. The inquiry is shaped by two essays in particular: Williams’s screen studies account of ‘body genres’ (1999) and Snyder and Mitchell’s disability studies extension of Williams’s work (2006). In her essay, Williams describes the pleasurably excessive and spectacular aspects of body genres. Three instances of ‘excess’ in Dead Space are used to structure the analysis. These are (1) the abject bodies of the game’s undead monsters, (2) the colourful nature of the protagonist’s deaths and the uncertainty of his existence, and (3) the extravagant amount of gore and blood on offer. Through textual analysis, it is found that Dead Space represents the idea of disability as threatening, and able-bodied identity as conditional and precarious. Locales that are culturally associated with positivism and corporeal assessment (clinical and medical facilities) are tainted; contaminated by the intrusions of uncontrolled, excessive and abject bodies. It is argued that these aspects of the game contribute to the generation of sensations associated with generic horror, including fear, anxiety and dread. At the same time, the game offers players the opportunity to display attributes that are culturally associated with able bodied status, including accuracy, precision and control.

Carr, D. (2019). Methodology, representation, and games. Games and Culture, 14(7-8), 707-723. DOI: https://doi.org/10.1177/1555412017728641.

This article is about textual analysis, methodology, and representations (of bodies, identities and social groups) in digital games. The issues under consideration include textual analysis as procedure, the role of fragmentation in textual analysis, game ontology and the remit of textual analysis, and the role of the player-as-analyst in relation to subjectivity and embodied interpretation. These issues are discussed using a combination of game studies literature, film theory, and literary theory–and with reference to Deus Ex: Human Revolution (2011).

Carr, D. (2020). Bodies that count: Augmentation, community and disability in a science fiction game. In K. Allan & R. Cheyne (Eds.), Science Fiction, Disability, Disability Studies [Special Issue]. Journal of Literary & Cultural Disability Studies, 14(4), 421-436. DOI: https://doi.org/10.3828/jlcds.2020.28.

The article examines the overlaps between disability studies and digital game studies through an analysis of the science fiction digital game Deus Ex: Mankind Divided. Using an adaptation of Mitchell and Snyder’s work on disability and narrative prosthesis in literature, the power implied by erasure-by-metaphor is considered, as are issues of migration, appropriation, and the grotesque. By examining ability, disability, and tangibility in relation to the game’s rules, game-play, and narrative elements, this analysis demonstrates the relevance of disability theory to science fiction games.

Chakraborty, J. (2017). How does inaccessible gaming lead to social exclusion? In J. Lazar & M. A. Stein (Eds.), Disability, human rights, and information technology  [Pennsylvania Studies in Human Rights] (pp. 212-223). Philadelphia: University of Pennsylvania Press.

“Modern day video games provide great entertainment for the masses. From the latest first-person-shooter (FPS) games with ultra-high definition graphic engines to the most cutting-edge 3-D real-time-strategy (RTS) games, there is a video game for everyone. Or is there?” (p. 212).

Crooks, H. R., & Magnet, S. (2018). Contests for meaning: Ableist rhetoric in video games backlash culture. In A. Day & K. Nielsen (Eds.), Re-Reading, Re-Imagining, and Re-Framing [Theme Issue]. Disability Studies Quarterly, 38(4).  DOI: http://dx.doi.org/10.18061/dsq.v38i4.5991.

An increasing number of video games focus on empathetic identification across difference. Since the mid-2000s, games that encourage catharsis and immersive engagement with trauma range from the personal as in That Dragon, Cancer (2014), in which players experience what it is like to parent a terminally ill child to geopolitical struggles as in Peacemaker (2007) which encourages player empathy for both sides of the Israeli-Palestinian Conflict. These games are rapidly gaining in popularity and commercial backing. As more games focus on issues of social justice, the backlash against these concerns among a vocal segment of the gaming community is increasing in frequency and intensity. A branch of the men’s rights movement has focused on video games aimed at understanding difference, and has attracted attention suggesting that all those advocating for social justice in games (dubbed Social Justice Warriors) should be understood to have narcissistic personality disorder (NPD). We argue that these claims to NPD need to be understood as a form of structural ableism mobilized by the men’s rights movement. In doing so, we argue that by situating the mental health labels evoked by current men’s rights’ activist rhetoric about feminist anti-racist interventions in game culture is a new form of the old practice of attaching mental health labels to people challenging social norms underpinning the dominant culture.

Cullen, A. L. L., Ringland, K. E., & Wolf, C. T. (2018, April). A better world: Examples of disability in Overwatch. First Person Scholar [Feature Issue on Mad Crip Games]. Waterloo, ON: The Games Institute (GI) at the University of Waterloo in collaboration with IMMERSe, The Research Network for Video Game Immersion. Retrieved from: http://www.firstpersonscholar.com/a-better-world/.

“We interpret Overwatch characters as having a disability if they show signs of physical (e.g. amputation, low vision/sight) or psychosocial (e.g. autism, mood disorder) impairment. The impairments of Overwatch characters are interpreted as disabilities- that is, impairments that diminish their ability in the context of Western society. As evidenced by Overwatch gameplay and lore, however, these impairments are not necessarily disabling or remarked upon as disabilities in the social context of Overwatch” (n.p.).

DeAnda, M. A. & Straznickas, G. L. (2023). Undetectable Starting Points: Rethinking “Passing” in Level Design through Queerness, Disability, and Roxy’s Got Balls. In J. Malazita, C. O’Donnell, & E. LaPensée (Eds.), Critical Game Design [Special Issue]. Design Issues, 39(1), 27–41. DOI: https://doi.org/10.1162/desi_a_00704.

In this article, the authors tease out meritocracy from level design by comparing “passing” game levels with “passing” as performances for survival by marginalized peoples. We use HIV to demonstrate passing as a response from the intersections of queerness, race, and disability to inform heuristics for level design that tease out meritocratic design practices. We finish by illustrating our heuristics in action through Roxy’s Got Balls, an online drag queen bingo event.

Doell, I. (2018, April 4). “Share melancholy thoughts”: Playing with mental illness in The Sims 4. First Person Scholar [Feature Issue on Mad Crip Games]. Waterloo, ON: The Games Institute (GI) at the University of Waterloo in collaboration with IMMERSe, The Research Network for Video Game Immersion. Retrieved from: http://www.firstpersonscholar.com/share-melancholy-thoughts/.

Provides an analysis of the video game The Sims 4 and how it misrepresents mental illness.

Dumont, A., & Bonenfant, M. (2023). Thinking inclusiveness, diversity, and cultural equity based on game mechanics and accessibility features in popular video games. In M. S. Jeffress, J. M. Cypher, J. Ferris, & J. A. Scott-Pollock (Eds.), The Palgrave Handbook of Disability and Communication. Cham: Palgrave Macmillan. DOI: https://doi.org/10.1007/978-3-031-14447-9_14.

Video games remain inaccessible for many players with disabilities. Limited knowledge, misconceptions and poor design choices hinder a large segment of the population from engaging in the cultural and social life video games provide. This chapter analyzes how developers of popular video games conceive inclusiveness, diversity of practices, and cultural equity through the design of game mechanics and accessibility features, as well as what video games reveal about the discursive and social context from which they emerge. Using a sociosemiotic methodological framework based on the Foucauldian concept of “discourse,” the authors analyze and discuss the implications of the mechanics and accessibility settings of the video games Celeste, Marvel’s Spider-Man: Miles Morales, and The Last of Us Part 2, as well as the paratexts surrounding their release.

E-collection ‘Special Issue on Video Games for Mental Health.’ (2019). JMIR Mental Health, 6(5). Retrieved from: https://mental.jmir.org/themes/722.

JMIR Mental Health is a peer-reviewed eHealth journal focusing on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change.

This feature issue includes the following articles:

  • Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study
  • Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games
  • The Potential of Game-Based Digital Biomarkers for Modeling Mental Health
  • Framing Mental Health Within Digital Games: An Exploratory Case Study of Hellblade

Ellis, K., Leaver, T., & Kent, M. (Eds.). (2022). Gaming disability: Disability perspectives on contemporary video games (1st ed.). New York: Routledge. DOI: https://doi.org/10.4324/9780367357153.

This book explores the opportunities and challenges people with disabilities experience in the context of digital games from the perspective of three related areas: representation, access and inclusion, and community.

Drawing on key concerns in disability media studies, the book brings together scholars from disability studies and game studies, alongside game developers, educators, and disability rights activists, to reflect upon the increasing visibility of disabled characters in digital games. Chapters explore the contemporary gaming environment as it relates to disability on platforms such as Twitch, Minecraft, and Tingyou, while also addressing future possibilities and pitfalls for people with disabilities within gaming given the rise of virtual reality applications, and augmented games such as Pokémon Go. The book asks how game developers can attempt to represent diverse abilities, taking games such as BlindSide and Overwatch as examples.

A significant collection for scholars and students interested in the critical analysis of digital games, this volume will be of interest across several disciplines including game studies, game design and development, internet, visual, cultural, communication and media studies, as well as disability studies.

Farris, A. (2020). The player and the avatar: Performing as other. Storytelling, Self, Society, 16(2), 177–199. DOI: https://doi.org/10.13110/storselfsoci.16.2.0177.

This article considers the ethics of identity play in game worlds. Although previous scholarship has examined the ways in which race, gender, and sexuality operate in game worlds, there has been a lack of attention to the way that disability identity also functions in these spaces. Seeking to highlight this omission as well as encourage disability-rights activists to rethink their long-standing opposition to simulation, the author of this article conducted a survey with sixty gamers of diverse backgrounds. This article shares the results of this survey as well as recommendations for future research on the ethics of avatar performances.

Fawcett, C., & Kohm, S. (2020). Carceral violence at the intersection of madness and crime in Batman: Arkham Asylum and Batman: Arkham City. Crime Media Culture, 16(2), 265-285. DOI: https://doi.org/10.1177/1741659019865298.

The action-adventure video games Batman: Arkham Asylum (2009) and Batman: Arkham City (2011) draw on familiar comic book narratives, themes and characters to situate players in a world of participatory violence, crime and madness. In the first game, the player-as-Batman is situated in Arkham Asylum, a high-security facility for the criminally insane and supervillains that also temporarily houses a general population of prisoners from Blackgate Penitentiary. The elision of criminality and mental illness becomes amplified in the second game with the establishment of Arkham City, a combined facility that conflates asylum and prison, completely dissolving any distinction between crime and madness. We draw on Rafter’s conceptual framework of popular criminology to seriously interrogate the representation of violence, crime and madness in these games. More than simply texts offering popular explanations for crime, the games directly implicate the player in violence enacted upon the bodies of criminals and patients alike. Violence is necessary to move the action of the game forward and evokes a range of emotional responses from players who draw from personal experience and other cultural and media representations as they navigate the game. We argue that while the game celebrates violence and the brutal conditions of incarceration, it also offers possibilities for subversive and critical readings. While working to affirm assumptions about crime and mental illness, the game also provides a visceral and visual critique of excessive punishment by the state as a source of injustice for those deemed mad or bad.

Ferrari, M., McIlwaine, S. V., Jordan, G., Shah, J, L., Lal, S., & Iyer, S. N. (2019). Gaming with stigma: Analysis of messages about mental illnesses in video games. JMIR Mental Health, 6(5). DOI: https://doi.org/10.2196/12418.

Background: Video game playing is a daily activity for many youths that replaces other media forms (eg, television); it serves as an important source of knowledge and can potentially impact their attitudes and behaviors. Researchers are, thus, concerned with the impact of video gaming on youth (eg, for promoting prosocial or antisocial behavior). Studies have also begun to explore players’ experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing and shaping of knowledge, and messages about mental illness.

Objective: The aim of this review was to identify how mental illness, especially psychosis, is portrayed in commercial video games.

Methods: We performed keyword searches on games made available between January 2016 and June 2017 on Steam (a popular personal computer gaming platform). A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained.

Results: We used a game elements framework (characters, game environment/atmosphere, goals, etc) to describe and unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%, 97/100) portrayed mental illness in negative, misleading, and problematic ways (associating it with violence, fear, insanity, hopelessness, etc). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. Mental illness was associated with mystery, the unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo experimental treatment to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as an ongoing struggle and an endless battle with the mind and oneself.

Conclusions: The game elements of the identified commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings in relation to current evidence on the impact of media portrayals of mental illness and stigma. Furthermore, we reflect on the ability of serious video games to promote alternative messages about mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce the stigma associated with mental illness.

Flynn, S. M., & Lange, B. S. (2010). Games for rehabilitation: The voice of the players. In Proc. 8th Intl Conf. Disability, Virtual Reality & Associated Technologies, Viña del Mar/Valparaíso, Chile, 31 Aug. – 2 Sept. 2010  (pp. 185-194). Highland Park, NJ: International Society for Virtual Rehabilitation. Retrieved from: http://www.icdvrat.org/2010/index2010.htm.

The purpose of this study is to explore the use of video games from the perspective of the disabled player. Over 150 participants responded to an online survey exploring the use of video games for rehabilitation. The respondents represented 9 countries throughout the world. The survey consisted of questions regarding subject demographics, living situation, activities of daily living assistance requirements, use of assistive devices, and computer use. Other questions addressed the responders’ disability. Video game play experience, activity, game play, controller use and accessibility are addressed. Questions regarding the use of currently available off the shelf video games in rehabilitation are explored. Lastly, we surveyed the future of video games and how they can be improved for rehabilitation and leisure enjoyment. The results of this survey are presented. In general, individuals with disabilities enjoy playing video games and play video games often. However, players with disabilities would appreciate educating the game industry about disabilities and how to makes games with a more ‘universal game design.’”

Fordham, J., & Ball, C. (2019, April). Framing mental health within digital games: An exploratory case study of Hellblade. JMIR Ment Health, 6(4). DOI: https://doi.org/10.2196/12432.

Background: Researchers and therapists have increasingly turned to digital games for new forms of treatments and interventions for people suffering from a variety of mental health issues. Yet, the depiction of mental illness within digital games typically promotes stigmatized versions of those with mental health concerns. Recently, more games have attempted to implement more realistic and respectful depictions of mental health conditions. Objective: This paper presents an exploratory analysis of a contemporary game that has the potential to change the way researchers, practitioners, and game designers approach topics of mental health within the context of gaming. Methods: A case study of Hellblade: Senua’s Sacrifice was conducted using frame analysis to show how key design choices for this game present the potential for new ways of approaching games and mental health. Results: A case study of Hellblade’s development shows how research-informed collaborative design with mental health practitioners, scientists, and individuals with mental health problems can lead to a realistic depiction of mental illness in games. Furthermore, the use of frame analysis demonstrates how to harness narrative, mechanics, and technology to create embodied experiences of mental health, which has the potential to promote empathetic understanding. Conclusions: This paper highlights an exemplary case of collaborative commercial game design for entertainment purposes in relation to mental health. Understanding the success of Hellblade‘s depiction of psychosis can improve serious games research and design. Further research must continue to provide deeper analysis of not only games that depict mental illness, but also the design process behind them.

Forlano, L. (2016, March). Hacking the feminist disabled body. In S. Bardzell, L. Nguyen, & S. Toupin (Eds.), Issue #8: Feminism and (un)hacking [Special Issue].  Journal of Peer Production.  Retrieved from: http://peerproduction.net/issues/issue-8-feminism-and-unhacking-2/peer-reviewed-papers/issue-8-feminism-and-unhackingpeer-reviewed-papers-2hacking-the-feminist-disabled-body/.

This article develops feminist understandings of hacking the body through a personal engagement with the socio-technical systems that are used to manage chronic disease and disability. Drawing on science and technology studies along with feminist studies about the mediated body, this essay develops a feminist understanding of hacking through an ethnographic account of the first several years of living as a Type 1 diabetic with an insulin pump and continuous glucose monitor. In particular, I will describe the ways in which these devices discipline everyday activities including: the tensions of being embedded with competing proprietary systems: the ways in which I disobey the devices and they disobey me; the ways in which we collaborate; the invisible labor required to navigate everyday life; and, the ways in which this experience challenges and extends notions of what it means to be human during a time of networked things and bodies. This critical analysis of the embodied experience of using and becoming part of a network of medical technologies serves to complicate the revolutionary claims about hacking and technology. Instead, they bring to life the ways in which these technologies reconfigure definitions around what it means to be human, enable unique socio-cultural hacking practices even among mundane activities in everyday life, reshape the boundaries between public and private, allow for failure, and create new kinds of bodily labor. Through this analysis, I argue that a feminist hacker ethic(s) features the disabled body (along with all of its features and bugs) as an important site of socio-technical engagement.

Furini, M., Mirri, S, & Montangero, M. (2019). Gamification and accessibility. In Proceedings for the 16th IEEE Annual Consumer Communications & Networking Conference (CCNC), 11-14 January 2019, Las Vegas, NV. Los Alamitos, CA: IEEE Computer Society Conference Publishing Services (CPS).  https://ieeexplore.ieee.org/document/8651750

Many different environments are looking at gamification to improve education, business, tourism, smart-cities management, etc. Despite its popularity, and despite the availability of many studies that propose approaches to transform a non-game activity into a game, a gamification strategy guideline is missing. Usually, the proposed methods are too general to be effective (e.g., simple rules, incentive mechanisms such as scores or vague prizes). In a society where algorithms personalize everything, and where people with different impairments (either technological or physical) are present, it is important to also understand peoples preferences in terms of games. In this paper, through a questionnaire filled by 22 people, we show that the game preferences (rules, mechanics, focus, motivations, and gaming environment) are assistive-technology dependent. These preferences can be used to customize the gamification process and therefore the study might be helpful to develop effective gamification strategies.

Gallagher, R. (2018, September). Minecrafting Masculinities: Gamer Dads, Queer Childhoods and Father-Son Gameplay in A Boy Made of Blocks. Game Studies, 18(2). The International Journal of Computer Game Research, Game Studies Foundation. Supported by the Swedish Research Council (Vetenskapsrådet), The Joint Committee for Nordic Research Councils for the Humanities and the Social Sciences, Blekinge Institute of Technology, IT University of Copenhagen, and Lund University. Retrieved from: http://gamestudies.org/1802/articles/gallagher.

Keith Stuart’s 2016 novel A Boy Made of Blocks tells the story of dad Alex and son Sam. Both characters are grappling with what it means to be(come) a man: where Sam’s autism casts doubt on his capacity to lead a ‘normal’ adult life, Alex’s personal and professional issues have shaken his sense of his own masculinity. The pair find relief in Minecraft (Persson and Mojang, 2011), discovering that the game offers a space where they can learn more about one another while rehearsing strategies for dealing with the problems they face. In its portrayal of a father-son relationship mediated via a videogame, Stuart’s novel testifies to the increasingly important role games play in contemporary discourses of gender, ability, education and parenting. Drawing on Kathryn Bond Stockton’s work on gaming and queer childhood, and on discussions of development and temporality from queer theory, crip theory and disability studies, this article interprets A Boy Made of Blocks as an attempt to imagine modes of masculine identity that depart from normative understandings of ‘manliness’ while eschewing the juvenility, solipsism and ‘toxic’ prejudice long seen as hallmarks of geek and gamer masculinities. Ultimately, however, the developments Stuart’s protagonists undergo are more about accommodating themselves to the cultural changes wrought by post-Fordism than they are any radical reimagining of masculinity. While this failure is disappointing, it also underlines the important role that game studies has to play, not merely in charting the course of gaming culture’s development, but in illuminating what has been happening, in recent decades, to the very concept of ‘growing up’.

Gaming and disability: Fun and function. (2018). reSearch, 14(1). Landover, MD: National Rehabilitation Information Center (NARIC). Retrieved from: https://naric.com/?q=en/publications/volume-14-issue-1-gaming-and-disability-fun-and-function.

“In this edition of reSearch, we explore the topic of video games, including online and virtual games, as leisure and/or rehabilitation tools for individuals with disabilities” (n.p.).

Gandolfi, E., Ferdig, R. E., & Calabria, K. (Eds.). (2018, July). Digital games for special needs: Special needs for digital games [Special Issue].  G|A|M|E: The Italian Journal of Game Studies Issue 7. Collaboration of Ludica, Film Forum at the Università Degli Studi di Udine, and Dipartimento di Storia, Beni Culturali e Territorio at Università degli Studi di Cagliari. Retrieved from: https://www.gamejournal.it/issues/game-n-7-2018/

“The goal of this special issue is to provide insights and guidelines for realizing and responding to this potential. The five articles collected address several aspects of the interplay between digital games and individuals with special needs. Aside from their topical differences, these contributions seem to share an underlying value given to the inclusion of individuals with disabilities in the world of gamers. The authors also collectively recognize the fact that games should be created with affordances that allow for universal access” (n.p.).

Gardner, D. L., Boyd, L., & Gardner, R. T. (2024). Piecing Together Performance: Collaborative, Participatory Research-Through-Design for Better Diversity in Games. In IEEE Transactions on Games. DOI: https://doi.org/10.1109/TG.2023.3349369.

Digital games are a multi-billion-dollar industry whose production and consumption extend globally. Representation in games is an increasingly important topic. As those who create and consume the medium grow ever more diverse, it is essential that player or user-experience research, usability, and any consideration of how people interface with their technology is exercised through inclusive and intersectional lenses. Previous research has identified how character configuration interfaces preface white-male defaults [39, 40, 67]. This study relies on 1-on-1 play-interviews where diverse participants attempt to create “themselves” in a series of games and on group design activities to explore how participants may envision more inclusive character configuration interface design. Our interview findings describe specific points of tension in the process of creating characters in existing interfaces and the sketches participant-collaborators produced challenge the homogeneity of current interface designs. This project amplifies the perspective of diverse participant-collaborators to provide constructive implications and a series of principles for designing more inclusive character configuration interfaces, which support more diverse stories and gameworlds by reconfiguring the constraints that shape those stories and gameworlds.

Gibbons, S. (2013, October 9). Playing for transcendence: Deus Ex: Human Revolution and disability. First Person Scholar. Waterloo, ON: The Games Institute (GI) at the University of Waterloo in collaboration with IMMERSe, The Research Network for Video Game Immersion. Retrieved from: http://www.firstpersonscholar.com/playing-for-transcendence/.

My commentary takes up the relationship between transhumanism and gaming in Human Revolution. I discuss narrative support for and against transhumanism, and argue that theories of posthumanism offer another area of inquiry with respect to embodiment. I suggest that as the game explores how technology changes our understanding of human ability, it also points toward how disability does not consist of a set of deficiencies, but is instead shaped by environments. Finally, I contend that the game’s inaccessibility is instructive for considering its imbrication in a culture of difficulty that valorizes overcoming the body.

Gibbons, S. (2015). Disability, neurological diversity, and inclusive play: An examination of the social and political aspects of the relationship between disability and games. In Game Studies in Media Res [Special Issue]. Loading… The Journal of the Canadian Game Studies Association, 9(14), 25-39. Retrieved from: http://journals.sfu.ca/loading/index.php/loading/issue/view/14.

This article explores existing connections between disability studies and game studies and suggests how the two fields might greater inform each other. While existing research explores the use of games to reduce pain and achieve rehabilitative goals, new research on games from a disability studies perspective can also consider the persuasive messages that games advance about disability, and how these messages affect questions of identity, inclusion, and acceptance. By arranging the relationship between disability and games into four topics – therapeutic and educational tools, game simulations, accessible features and controls, and narrative inclusion and identification – this article explores, attempts to address, represent, and simulate autism in digital games. It focuses on Auti-Sim (2013), a simulation exercise, and To the Moon (2011), an adventure role-playing game. Drawing on the writings of autistic activists and existing scholarship on disability simulations, the author considers how these games may influence the player’s understanding of autism at social and political levels, and how these artifacts engage with the overarching goals of disability inclusion and autism acceptance.

Hart, D. M. (2021). Beyond normative gaming: Cripping games and their fandoms. Unpublished doctoral dissertation, Miami University. http://rave.ohiolink.edu/etdc/view?acc_num=miami161822794824977.

In this project, which is situated at the intersections of disability studies, video game studies, and fan studies, I argue that disability is an integral part of video games and their communities of fans. Contrary to the misconception that digital spaces are technoutopias that foster equality through anonymity and virtual disembodiment, digital spaces tend to magnify bodymind differences and perpetuate systems of oppression. This is especially true in terms of disability, race, and gender. Disability has always been present in video games, but not necessarily in a positive way. The inaccessibility of games and related cultures exists both in terms of physical inaccessibility and cultural inaccessibility, the latter referring to the discouragement of marginalized individuals from playing video games and participating in gaming cultures. The inaccessibility of games has had a direct and reciprocal effect on representation in games, as characters who are not white, male, straight, and able-bodied/minded are often absent or negatively depicted. Gameplay is often normative and does not encourage the player to experience alternate ways of being. I refer to non-normative forms of gameplay as cripping a game in homage to Bonnie Ruberg’s notion of queering a game. I focus specifically on crip temporality in video games as it is related to mental illness, or mad time. Negative stereotypes of mental illness abound in video games; as a counterpoint, I analyze games that alter the player’s experience with time in a way that does not stigmatize madness. In the two final chapters, I blend a qualitative reception study of fan reactions to the Dishonored series with an analysis of video game fanworks, i.e., creative works made by fans about existing media. I analyze disability-related mods that fall into three broad categories: 1) mods that add accessibility options to video games, 2) mods that improve the representation of disabled characters, and 3) mods that alter the way a game functions to crip the gameplay experience. I conclude with a reflection on how events in 2020, including the COVID-19 pandemic and Black Lives Matter protests, have intersected with the topics of this dissertation.

Hassan, L. (2023). Accessibility of games and game-based applications: A systematic literature review and mapping of future directions. New Media & Society. DOI: https://doi.org/10.1177/14614448231204020.

Digital game technologies, that is, games and emerging game-based applications, are pervasively spread in society as a means of entertainment, education and exercise, amongst other uses. With this popularity, attention has been directed towards the accessibility of these technologies to people with disabilities to ensure equity, equal access to opportunities and realize earnings from a significant customer group. This study investigates: How is the attention of academic game accessibility research divided across game technologies, disability categories and use domains? And where is attention needed? To answer these questions, I conducted a review of research (162 manuscripts) on game technologies’ accessibility published between 2016 and 2020, inclusive. The reviewed literature appears to have a utility focus (e.g. on education and health management) that relatively de-emphasizes the importance of game accessibility for entertainment or fun purposes. Auditory, motor and mobility disabilities, and emerging gamification, exergames, virtual reality (VR) and augmented reality (AR) are especially under researched in the academic domain.

Haukaas, D. (2024). Disability identity in simulation narratives [Literary Disability Studies]. Cham: Palgrave Macmillan Cham. DOI:  https://doi.org/10.1007/978-3-031-44482-1.

Disability Identity in Simulation Narratives considers the relationship between disability identity and simulation activities (ranging from traditional gameplay to more revolutionary technology) in contemporary science fiction. Anelise Haukaas applies posthumanist theory to an examination of disability identity in a variety of science fiction texts: adult novels, young adult literature and comics, as well as ethnographic research with gamers. Haukaas argues that instead of being a means of escapism, simulated experiences are a valuable tool for cultivating self-acceptance and promoting empathy. Through increasingly accessible technology and innovative gameplay, traditional hierarchies are dismantled, and different ways of being are both explored and validated. Ultimately, the book aims to expand our understandings of disability, performance, and self-creation in significant ways by exploring the boundless selves that the simulated environments in these texts allow.

Henry, E. S. (2017). Reimaging disability in role-playing games. In E. Torner, E. L. Waldron, & A. Trammell (Eds.), Analog Game Studies [Vol. II] (pp. 93-96). Philadelphia: ETC Press.  https://analoggamestudies.org/2015/02/reimagining-disability-in-role-playing-games/.

“Role-playing games have a fraught relationship with disability. Take Numenera (2013) as an example: the game is set in a world where scientists have continued the project of eugenics, endeavoring to “perfect” the human form. This setting effectively erases disability from Numenera’s cyberpunk future. Here, disabled bodies are rendered invisible and therefore undesirable and unplayable. But while eugenics may lie far from the concerns of able-bodied designers, for disabled players, seeing eugenics succeed is not interesting. It is terrifying. Numenera, however, marks only one case where the problematic of disability in role-playing games is particularly clear. This essay analyzes the ways that disability is handled within the World of Darkness setting in order to articulate some common problems with the implementation of disability in role-playing games” (p. 93).

Hoffman, K. M. (2019). Social and cognitive affordances of two depression-themed games. Games and Culture, 14(7-8), 875-895. DOI: https://doi.org/10.1177/1555412017742307.

Video games can have a variety of intended and unintended effects on players, making the impacts of games and the role that individual design elements play in causing those impacts a valuable area of research. This study explored the social and cognitive effects on players of two “art games” (Depression Quest and Actual Sunlight) by analyzing player-generated discussion board posts, focusing on (1) what real-life social and cognitive effects the games had on players and (2) what elements of the games made the players consider them “good” or “bad” games. Players reported or demonstrated that the games led to understanding and empathy, self-evaluation, lessons learned, clinical discussion of depression, encouragement to others, a sense of community, and opening dialogue with friends and family. Discussions of game quality centered on realism, game endings and message, and player agency.

Holloway, C., Gerling, K., Power, C., Spiel, K., Barbareschi, G., Cox, A., & Cairns, P. (2019, October). Disability interactions in digital games: From accessibility to inclusion. In CHI PLAY ’19 Extended Abstracts: Extended Abstracts of the Annual Symposium on Computer-Human Interaction in Play Companion Extended Abstracts (pp. 835–839). DOI: https://doi.org/10.1145/3341215.3349587.

Digital games are a hugely popular activity enjoyed for the diverse experiences and relationships that they offer players. In 2019, games are more accessible to an increasingly diverse audience of disabled players through both new gaming technology and in-game options that allow people to tune their experiences. As a significant cultural medium, it is also challenging perceptions of disability in how characters are depicted. In this workshop, we aim to understand better the research challenges in making games for and with disabled players. We explore opportunities in games and disability through the lens of the new Disability Interaction (DIX) manifesto.

Jerreat-Poole, A. (Ed.). (2018, March 14). Mad/Crip Games and play: An introduction [Feature Issue]. First Person Scholar. Waterloo, ON: The Games Institute (GI) at the University of Waterloo in collaboration with IMMERSe, The Research Network for Video Game Immersion. Retrieved from: http://www.firstpersonscholar.com/map-crip-intro/.

“I want this special issue to be the community I’ve never found, a gathering place for players and developers and writers who aren’t neurotypical, who aren’t able-bodied, who didn’t make it to the conference or game jam because the building was inaccessible or the forced socialization gave them panic attacks. I want this to be a queer Mad crip utopia. I want us to agree on how best to dismantle the ableist, racist, cis-hetero-patriarchy, those exploitative and painful hierarchies that make up the fabric of North American culture, of settler colonialism. I want us to like each other, support each other. I’m hungry for family” (n.p.).

Jerreat-Poole. A. (2020, February). Sick, slow, cyborg: Crip futurity in Mass Effect. Game Studies, 20(1).  Retrieved from: http://gamestudies.org/2001/articles/jerreatpoole.

This paper uses “cripping strategies” (Sandhal p. 149) to read game texts for disability representation, uncovering productive moments of tension and discomfort that disrupt the smooth story of hyper-able bodies performing extraordinary feats in the military science fiction (SF) trilogy Mass Effect (ME). In Disability Media Studies, Elizabeth Ellcessor and Bill Kirkpatrick call this practice “negotiation”: “how readers selectively attend to and interpret texts to form their own meanings from them” (p. 12). Following their example, I adopt “a disability perspective” which “is about decentering the physically and cognitively ‘normal’ character, the ‘normal’ viewer” (p. 140). Performing crip negotiation in my analysis of ME1-3, I explore the sick, slow, and cyborg moments that offer alternative futures for crip bodies, and interrogate the complex relationships between disability, culture, and technology. ME1-3 can be read as embodying what Alison Kafer terms “crip futurity” (2013, p. 21). Kafer explains that disabled bodies are cut out of all imagined futures or left behind as the neoliberal able-bodied pace of society rushes forward. Kafer insists that “I, we, need to imagine crip futures because disabled people are continually being written out of the future, rendered as the sign of the future no one wants” (p. 46). Turning to SF as a site to do this critical imagining, I look for futures in which technology has not eradicated disability but exists in a constellation of complex relationships with crip embodiments. In these futures disabled bodies exist alongside spaceships, Artificial Intelligence (AI), and particle beam weapons. Finally, I consider the intersections of gender, race, and disability, and how these identity positions impact access to futuristic technology and treatment as imagined in ME1-3.

Jerreat-Poole, A. (2022). Virtual Reality, disability, and futurity: Cripping technologies in Half-Life: Alyx. In D. Bolt (Ed.), Disability Futurity [Feature issue]. Journal of Literary & Cultural Disability Studies, 16(1), 59–75. DOI: https://doi.org/10.3828/jlcds.2022.4.

The article takes up Valve’s 2020 science fiction virtual reality (VR) game Half-Life: Alyx as a site through which to explore the complex relationship between bodies, technology, and disability. It discusses the way that VR inadvertently challenges both the fantasy of hyperable-bodiedness found in action-adventure, first-person shooter, and science fiction video games, and the myth of digital disembodiment—the idea that we can (and perhaps should desire to) transcend the physical body through digital avatars. Technology has an intimate relationship with pain, discomfort, and physicality, and this analysis of VR and Alyx foregrounds the messiness of embodied bionic encounters. Within the science fiction alternate reality of the game, technology plays a key role, often explicitly enhancing or augmenting the body. In an imaginative turn, the article takes up drones, gravity gloves, and the telephone headset as objects through which to fashion a more feminist and ethical future. Engaging in imaginative “criptastic hacking” (Yergeau in Hamraie and Fritsch 4), the article discusses potential ways of using technology as access aids, enacting a “cripped cyborg politics” (Kafer 106) and exploring the intimate relationships between organic and inorganic bodies.

King, M., Marsh, T., & Akcay,  Z. (2022, January). A Review of Indie Games for Serious Mental Health Game Design. In B. Fletcher, M. Ma, S. GöbelJannicke, B. Hauge & T. Marsh (Eds.), Joint International Conference on Serious Games, JCSG 2021: Serious Games. Virtual Event, January 12–13, 2022, Proceedings [Lecture Notes in Computer Science Series Vol. 12945] (pp 138-152).

Mental health disorders present a global challenge being the largest contributor to non-fatal burden of disease. In fact, those who are experiencing symptoms of mental illness often wait ten years before seeking help. This is frequently due to help-seeking barriers such as stigma and cost. One way to combat help-seeking barriers is through increasing the mental health literacy of the public. This has been achieved successfully through digital delivery of mental health information and services, including serious games. Early research suggests that serious games are an effective tool for improving mental health literacy. However, factors such as poor-quality game design and research studies mean that developers face challenges when designing, developing, and analyzing serious games. To address these challenges this paper will provide an analysis of indie games that feature topics of mental health, trauma, and grief. Indie games share similarities to research environments, often being created by small teams on a limited budget. Even with these limitations they can tell impactful and emotional stories, making them a valuable source of inspiration for developers of serious mental health games.

King, M., Marsh, T., & Akcay,  Z. (2022, January). Using Indie Games to Inform Serious Mental Health Games Design. In B. Fletcher, M. Ma, S. GöbelJannicke, B. Hauge & T. Marsh (Eds.), Joint International Conference on Serious Games, JCSG 2021: Serious Games. Virtual Event, January 12–13, 2022, Proceedings [Lecture Notes in Computer Science Series Vol. 12945] (pp 153-166).

Mental health literacy (MHL) is an important 21st Century skill. Good MHL can help to reduce barriers to help-seeking by equipping the public with the knowledge needed to help themselves or someone experiencing a mental illness. One Australian-based organization that does this through a training course is Mental Health First Aid (MHFA) Australia. There are many digital interventions that aim to achieve this goal and serious games are no exception. Serious games have been identified as ideal for developing 21st Century skills, meaning MHL literacy is a promising candidate for serious games development. In fact, evidence suggest that serious games are effective as a tool for improving MHL. However, they often suffer from poor-quality game design, poor study design, high dropout rates, variability in studies and loss of motivation and engagement of players. This means that there are many challenges to consider when developing serious games. Here we describe our experiences in the development of a serious game prototype that utilizes the principles of MHFA. The aim of this development is to improve the confidence of players in delivering MHFA. Additionally, it aims to address the challenge of serious games quality by taking an artistic approach that combines narrative, aesthetics and mechanics using indie games for inspiration. There are many well-designed indie games that tell emotional and character driven stories of mental illness. They provide inspiration on the development of honest and relatable characters, which offer a positive representation of those experiencing a mental illness.

Ledder, S. (2019). On dis/ability within game studies: The discursive construction of ludic bodies. In K. Ellis, R. Garland-Thomson, M. Kent, & R. Robertson (Eds.), Interdisciplinary approaches to disability: Looking towards the future [Vol. 2] (pp. 30-44). New York: Routledge.

“This chapter introduces the cultural model of dis/ability within critical disability studies. It argues how dis/ability is represented within different games by analysing audio-visual, narrative, ludic and simulation levels. The disregard towards dis/ability within the digital game industry can be traced back to the ableist hegemony. While in the game industry dis/ability mostly is no outspoken issue, there is one realm of game development where dis/ability is made relevant explicitly – human health and wellbeing. Within digital games different forms of dis/ability are produced, although most of these representations rely on the medical model. Digital games take part in the flexible normalism when they represent certain people with disability as normal – people who would be available as labour force. On the ludic level, we can analyse what the goal of a game is and what is expected from the player. Damage in most games is calculated as a subtraction from the value determined by health.”

Mancera, L., Baldiris, S., Fabregat, R, Gomez, S., & Mejia, C. (2017, July). aTenDerAH: A videogame to support e-Learning students with ADHD. In M. Chang, N. S. Chen, R. Huang, Kinshuk, D. Sampson, & R. Vasiou (Eds.), Proceedings of the 17th IEEE International Conference on Advanced Learning Technologies (ICALT 2017), IEEE Computer Society, Timisoaa, Romania (pp. 438-440). Los Alamitos, CA: IEEE Computer Society Conference Publishing Services (CPS).

“This paper presents aTenDerAH, a videogame designed to support e-Learning processes of young-adults students, especially those suffering from Attention Deficit Hyperactivity Disorder (ADHD). aTenDerAH was developed using Unity as the cross-platform game engine and development tool, Cinema 4D for creating models and animations in 3D, and Photoshop for creating textures to the 3D models. The videogame was integrated into the architecture of Atutor e-learning platform to carry out a case study of the perception of aTenDerAH from the point of view of a student suffering from ADHD, a student without this syndrome and a teacher. Participants agreed on being satisfied with the tool goals and the positive influence of the videogame in the learning process” (p. 438)

Mandryk, R. L., & Birk, M. V. (2019). The potential of game-based digital biomarkers for modeling mental health. JMIR Mental Health, 6(4). DOI: https://doi.org/10.2196/13485.

Background: Assessment for mental health is performed by experts using interview techniques, questionnaires, and test batteries and following standardized manuals; however, there would be myriad benefits if behavioral correlates could predict mental health and be used for population screening or prevalence estimations. A variety of digital sources of data (eg, online search data and social media posts) have been previously proposed as candidates for digital biomarkers in the context of mental health. Playing games on computers, gaming consoles, or mobile devices (ie, digital gaming) has become a leading leisure activity of choice and yields rich data from a variety of sources. Objective: In this paper, we argue that game-based data from commercial off-the-shelf games have the potential to be used as a digital biomarker to assess and model mental health and health decline. Although there is great potential in games developed specifically for mental health assessment (eg, Sea Hero Quest), we focus on data gathered “in-the-wild” from playing commercial off-the-shelf games designed primarily for entertainment. Methods: We argue that the activity traces left behind by natural interactions with digital games can be modeled using computational approaches for big data. To support our argument, we present an investigation of existing data sources, a categorization of observable traits from game data, and examples of potentially useful game-based digital biomarkers derived from activity traces. Results: Our investigation reveals different types of data that are generated from play and the sources from which these data can be accessed. Based on these insights, we describe five categories of digital biomarkers that can be derived from game-based data, including behavior, cognitive performance, motor performance, social behavior, and affect. For each type of biomarker, we describe the data type, the game-based sources from which it can be derived, its importance for mental health modeling, and any existing statistical associations with mental health that have been demonstrated in prior work. We end with a discussion on the limitations and potential of data from commercial off-the-shelf games for use as a digital biomarker of mental health. Conclusions: When people play commercial digital games, they produce significant volumes of high-resolution data that are not only related to play frequency, but also include performance data reflecting low-level cognitive and motor processing; text-based data that are indicative of the affective state; social data that reveal networks of relationships; content choice data that imply preferred genres; and contextual data that divulge where, when, and with whom the players are playing. These data provide a source for digital biomarkers that may indicate mental health. Produced by engaged human behavior, game data have the potential to be leveraged for population screening or prevalence estimations, leading to at-scale, nonintrusive assessment of mental health.

Marchisotto, J. (2019, May). Playing nothing: Games and cognitive difference in Murphy. Journal of Literary & Cultural Disability Studies, 13(2), 159-175. DOI: https://doi.org/10.3828/jlcds.2018.44.

In Murphy, Samuel Beckett uses games to undermine expectations of cognitive normativity. He aligns mental disability with play, re-contextualizing cognitive difference as an interactive process rather than a frightening Otherness. Informed by visits to mental hospitals and personal experience with psychoanalytic treatment, characters in Murphy often enter interdependent relationships that question their own subjectivities, exploring what it means to be recognized as mentally disabled. The article suggests Beckett uses games to unsettle logical narrative sequence and permit unanticipated results. The ludic framework emphasizes the features games share with non-normative epistemologies, or “cripistemologies.” Near the end of the novel Murphy plays chess with the schizophrenic Mr Endon, seeking equal recognition as mentally disabled. The game results in “Nothing,” a Nothing that is not a void but the feeling of an inarticulate something, the presence of which develops through playful exchange. This Nothing allows space for understandings of cognitive difference existing outside normative conventions, expanding considerations of mental disability through processes of exchange.

Martinez, J. J., Froehlich, J. E., & Fogarty, J. (2024). Playing on hard mode: Accessibility, difficulty, and joy in video game adoption for gamers with disabilities. Forthcoming in Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems (CHI ’24).

Video games often pose accessibility barriers to gamers with disabilities, yet there is no standard method for identifying which games have barriers, what those barriers are, and whether and how they can be overcome. We propose and explore three phases of the “game adoption process”: Discovery, Evaluation, and Adaptation. To advance understanding of how gamers with disabilities experience this process, the resources and strategies they use, and the challenges experienced, we conducted an interview study with thirteen gamers with disabilities with differing backgrounds. We then engage with existing theories of consequence-based accessibility, of difficulty, and of identity-based gaming to better understand how these processes manifest “access difficulty” and to characterize the experience of “disabled gaming.” Finally, we present design recommendations for game developers and distributors to better support gamers with disabilities in the game adoption process by engaging with community-made resources, supporting socially-created access, and creating customizable experiences with opportunities for unconventional play

Meinen, L. E. (2023). Share the Experience, Don’t Take it: Toward Attunement With Neurodiversity in Videogames. Games and Culture. DOI: https://doi.org/10.1177/15554120221149538.

Videogames increasingly focus on marginalized experiences such as neurodivergence. Specifically, the immersive and embodied aspects of videogames allow neurodivergent people to better explain their experiences. However, current research is limited to instrumentalization, by specifically looking for the therapeutic or educational benefits of videogames. I reflect on ethical questions that arise if we try to communicate the embodied experiences related to neurodiversity through videogames. I argue that videogames with the explicit goal to create empathy or care for neurodivergence can also be restrictive. Instead, I put forward attunement as an intersubjective and nonhierarchic mode of affective engagement with neurodiversity through gaming. An analysis of the videogames Unravel and Celeste helps me to illustrate what attunement in a videogame could look like. I conclude that better understanding neurodiversity through play, means “letting it be” instead of (re)shaping it to be easily consumable in videogames.

Meints, J., & Green, A. (2019, August). Representations of Disability and Player Agency in Borderlands 2. G|A|M|E: The Italian Journal of Game Studies Issue 8, 43-50. Collaboration of Ludica, Film Forum at the Università Degli Studi di Udine, and Dipartimento di Storia, Beni Culturali e Territorio at Università degli Studi di Cagliari. Retrieved from: https://www.gamejournal.it/representations-of-disability-and-player-agency-in-borderlands-2/.

This paper examines the first-person shooter Borderlands 2 through the lens of the social model of disability and rhetoric. Borderlands 2 encourages player agency while positioning the player within a visual rhetoric of disability. This combination of rhetoric and agency depicts disability as a social construct as opposed to the more common vision of disability as an innate flaw. This social model of disability within the game exists in tension with some ableist slurs and harmful stereotypes about disabled bodies also found in Borderlands 2. Nevertheless, Borderlands 2 models one approach how games can depict disability without positioning the disabled body as undesirable or grotesque.

Mejeur, C. (2023). Games as critical literature: Playing with transhumanism, embodied cognition, and narrative difference in SOMA. In T. Ghosal (Ed.), Global Perspectives on Digital Literature: A Critical Introduction for the Twenty-First Century. New York: Routledge. DOI: https://doi.org/10.4324/9781003214915-7.

Video games provide players with unique opportunities to play with identities and stories, and at times this narrative play can lead to new, potentially queer encounters with difference, embodiment, and humanity. This chapter explores SOMA (Frictional Games 2015) as a case study for narrative play and embodiment in games. A first-person, narrative game set in a post-apocalyptic world, SOMA tasks players with surviving and confronting themes of transhumanism, embodied cognition and identity, and the political costs of posthuman futures. SOMA exemplifies narrative difference in games and beyond––how we construct, play with, and experience our worlds differently.

Milligan, C. A. (2019, September). Immanent interbodies: Composing disability through embodied choragraphy. In P. Bratta & S. Sundvall (Eds.), Digital Technologies, Bodies, and Embodiments [Special Issue]. Computers and Composition, 53, 75-85. DOI: https://doi.org/10.1016/j.compcom.2019.05.006.

In this article, I argue that many praxes of composition stumble into pitfalls of ableism built into the default computer technologies that classrooms employ. Writing software and hardware writ large typically conflate the particularities of embodiment with the generality of “the body” equipped to succeed by standards of normalcy. Therefore, I propose a trajectory away from idealized interfaces, and toward immanent “interbodies,” which more fully account for embodiment’s contradictive mutabilities. Such work requires strategies for composing disability to draw attention to the embodied ways that many composition practices are performed in writing processes. Composing disability, I argue, makes our writing more like our bodies by subverting the standard use of writing technologies that construct classroom discourses. These praxes contribute to embodied choragraphy, which calls into question ableist pedagogies. Through wide citation of diverse scholarship and description of classroom exercises utilizing videogames and related media, this article challenges the fields’ commitment to computers and composition, and questions what versions of embodiment it finds value in.

Perry, P. (2023, December 20). Ctrl Shift: How Crip Alt Ctrl Designers Change the Game and Reimagine Access. DOI: https://doi.org/10.31219/osf.io/mahn5.

To being, this PhD covers a comprehensive literature review. The research embarked upon in this thesis delves into the intricate domain of game controllers, crip technology, and game design. Initially, the thesis scrutinizes the historical relationship between game controllers and Human- Computer Interaction (HCI), exploring the consequent impact on disability. This investigation also addresses the prevalent trope of the “technological cure” within the scope of HCI. Shifting the lens to User-Centered Design (UCD), the research delineates its evolution in the context of console game controller design. Given UCD’s evident shortcomings in producing universally accessible controllers, the research pivots to community-derived solutions. A deeper dive is taken into the inherent limitations posed by mental models in console controllers. This exploration further demystifies the often- misunderstood concept of affordance in UCD. The narrative then pivots to the transformative feats of crip hackers, prompting the reader to envision a future where such innovation is applied to game controllers. Delving into HCI, the thesis explores the notions of Embodiment and Entanglement with Crip HCI, questioning the feasibility of introducing activist affordances in controllers. This inquiry culminates in an analysis of Alt Ctrl games, assessing their potential to harmonize with procedural rhetoric, metaphor, and activism in the gaming realm. It maps both the history of Alt Ctrl Games and serves to create a working definition for the genre. This PhD’s practice based research delves into the design methodologies employed by crip designers in the creation of Alt Ctrl games, offering a distinctive perspective on game development. It begins with an introspective analysis of the researcher’s own practices as a disabled game practitioner, documenting the methods employed in their creative process. Building upon this personal exploration, the study extends to a collaborative framework where a group of disabled designers is paired with Alt Ctrl game developers. Utilizing an asynchronous participatory workshop model, the research probes into the shared practices and dynamics within these partnerships. Central to this study is the examination of how these collaborations, deeply rooted in the designers’ personal experiences and the boundaries posed by assistive technology, confront and challenge conventional co-design frameworks. It brings to light the necessity and potential of a Crip game design methodology, one that inherently incorporates disability considerations from the outset. This approach not only advocates for ethical game design but also aims to shift the gaming landscape, fostering more inclusive and accessible design processes for creating games.

Poetics of play. (2019, April). InVisible Culture: An Electronic Journal for Visual Culture (IVC) Issue 30. Rochester, NY:  University of Rochester, Graduate Program in Visual & Cultural Studies. Retrieved from: https://ivc.lib.rochester.edu/category/issues/current-issue/.

Scholarly articles and creative works that address the poetics and politics of video games.

Powers, G. M., Nguyen, V., & Frieden, L. M. (2015). Video game accessibility: A legal approach. Disability Studies Quarterly, 35(1).  DOI:  DOI: http://dx.doi.org/10.18061/dsq.v35i1.4513.

Video game accessibility may not seem of significance to some, and it may sound trivial to anyone who does not play video games. This assumption is false. With the digitalization of our culture, video games are an ever increasing part of our life. They contribute to peer to peer interactions, education, music and the arts. A video game can be created by hundreds of musicians and artists, and they can have production budgets that exceed modern blockbuster films. Inaccessible video games are analogous to movie theaters without closed captioning or accessible facilities. The movement to have accessible video games is small, unorganized and misdirected. Just like the other battles to make society accessible were accomplished through legislation and law, the battle for video game accessibility must be focused toward the law and not the market.

Raffety, E., & Insa-Iglesias, M. (2023). Re-imagining Christian education through neurodivergent fellowship, play, and leadership in online videogaming. In T. Hutchings (Ed.), Teaching with Games: Formative Gaming in Religion, Philosophy and Ethics [Special Issue]. gamevironments no. 19.  DOI: https://doi.org/10.48783/gameviron.v19i19.220.

From Fall 2020 to Spring 2022, the Center of Theological Inquiry, funded by a grant from the Templeton World Charity Foundation’s Diverse Intelligences Initiative and in collaboration with Glasgow Caledonian University in Scotland, created a Minecraft (2011) videogame prototype titled The Spiritual Loop. This videogame prototype was designed and developed for fostering spiritual growth and connection based on ethnographic research with neurodivergent persons and their Christian faith communities in the United States. Considering the lack of access disabled persons experience with respect to Christian communities in the US (Carter 2007), alongside the disproportionate emphasis on educational and therapeutic outcomes with respect to neurodivergent gamers (Spiel and Gerling 2021), our participatory fieldwork with neurodivergent players led us to emphasize the game’s opportunities for spiritual connection versus mastery of biblical content or Christian virtues.

This paper highlights two findings with respect to gaming and Christian education. First, despite the consistent emphasis on fostering Christian community and connection, neurotypical players frequently mistook the game’s goal as Christian education, whereas neurodivergent players readily appreciated the game’s fellowship potential. Second, neurodivergent players seamlessly assumed leadership roles in online game play, confirming the ability of online communities to transform theological hierarchies (Campbell 2012). Based on these findings, we suggest that a bifurcation in fellowship and education in traditional Christian formation reflects ableist biases. The flexible, playful environment presented in online gaming spaces offers critical opportunities for fostering fellowship between neurodivergent and neurotypical Christians, as well as untapped opportunities for neurodivergent leadership to flourish in reimagining more accessible environments for Christian education.

Ringland, K. E. (2017, May 30). Who has access? Making accessible play spaces in Minecraft for children with autism. Analog Game Studies [Online Journal].  Pittsburgh: Carnegie Mellon University.  Retrieved from: http://analoggamestudies.org/2017/05/who-has-access-making-accessible-play-spaces-in-minecraft-for-children-with-autism/.

“In this essay, I will explore how parents and children have worked together to create an accessible play space. Here, the physical and virtual have become inevitably intertwined as they have not only configured their physical access to the game, but also their software, virtual world, and social interactions” (n.p.).

Ringland, K. E. (2019, May). A Place to Play: The (Dis)Abled Embodied Experience for Autistic Children in Online Spaces. CHI ’19 Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, Glasgow, Scotland [Paper No. 288]. New York: ACM New York. Retrieved from: https://doi.org/10.1145/3290605.3300518.

Play is the work of children-but access to play is not equal from child to child. Having access to a place to play is a challenge for marginalized children, such as children with disabilities. For autistic children, playing with other children in the physical world may be uncomfortable or even painful. Yet, having practice in the social skills play provides is essential for childhood development. In this ethnographic work, I explore how one community uses the sense of place and the digital embodied experience in a virtual world specifically to give autistic children access to play with their peers. The contribution of this work is twofold. First, I demonstrate how various physical and virtual spaces work together to make play possible. Second, I demonstrate these spaces, though some of them are digital, are no more or less “real” than the physical spaces making up a schoolyard or playground.

Rodéhn, C. (2022, March). Introducing Mad Studies and Mad Reading to Game Studies. Game Studies, 22(1). The International Journal of Computer Game Research, Game Studies Foundation. Supported by the Swedish Research Council (Vetenskapsrådet), The Joint Committee for Nordic Research Councils for the Humanities and the Social Sciences, Blekinge Institute of Technology, IT University of Copenhagen, and Lund University. Retrieved from: http://gamestudies.org/2201/articles/rodehn.

The aim of this paper is to introduce and develop mad studies as a theory and mad reading as a method for examining representations of madness in games. Mad studies is a theoretical field that examines madness and critically addresses systematic and symbolic sanism. In this text, mad studies is positioned as a shift of perspective from previous psy sciences-influenced research to a more inclusive way of studying madness in games. Mad reading is explained as (1) a situated reading, (2) challenging sanist representations, (3) reading the explicitly mad, (4) revealing where madness is not clearly visible, and (5) maddening games. The paper offers suggestions on how to put mad studies and mad reading into practice when studying games. The paper is primarily theory-driven but gives examples from several games, particularly the game Outlast.

Rodríguez Jiménez, M., Pulina, F., & Lanfranchi, S. (2015). Video games and Intellectual Disabilities: A literature review. Life Span and Disability XVIII, 2, 147-165.

Video games are ubiquitous in the society and this technology has transcended its initial playful side to become also an educational and cognitive training tool. In this sense, different studies have shown that expert game players gain advantages in various cognitive processes respect to non-players and that playing with video games can result in particular profits that in some cases could be generalized to other tasks. Accordingly, video games could be used as a training tool in order to improve cognitive abilities in atypical populations, such as relating to individuals with intellectual disabilities (ID). However, literature concerning video games in people with ID is sparse. In this paper we executed a narrative review of the studies about the use of video games in relation to people with ID.

Romano, K. D. (2014). (Dis)Abled Gaming: An Autoethnographic Analysis of Decreasing Accessibility for Disabled Gamers. Unpublished Master’s Thesis, Communication Department, University of South Florida, Tampa, FL. Retrieved from: http://scholarcommons.usf.edu/etd/5575.

Within the context of culture, disability has long existed as a stigmatizing quality (Goffman, 1963). As a result, people with disabilities are often overlooked or completely omitted from various, cultural artifacts. This exclusion of people with disabilities is largely recognized as unproblematic because their disabilities imply an inevitable failing. Through my own experiences as a disabled gamer, I have recognized that video games have also framed gamers with disabilities as problematic. Video games are largely constructed in a one-size-fits-all mentality (Grammenos, 2014), where very specific people, with very specific kinds of bodies, are granted access to play them. Since disabled gamers are not necessarily capable of playing video games in similar ways that able-bodied gamers can, it is assumed that we can’t play video games and that we shouldn’t want to. By using autoethnography as theory, I venture through a few stories from my life in which my own disability has rendered gaming either difficult or impossible. I seek to use these autoethnographic pieces as living examples of the problems involved with a traditional discussion of accessibility for people with disabilities. This thesis is a call for a renegotiation of “accessibility,” and how generalized formulations of this concept are still capable of excluding people who are disabled in very particular ways. In accordance with Shakespeare’s (2006) interactive model, I use my stories to show how my disability is a culmination of both the material and social qualities of my body. It is from this model that I seek transcendence from thinking of disabled bodies in either a medical or social model (Oliver, 1990) approach. Accessibility should be regarded as an interactive and cyclical process, which takes place between the individual, her body, the environment, and back again. An assessment of video game accessibility should be referred to in a similar way, where developers may attempt to be inclusive to people of varying kinds and levels of disability, rather than focusing solely on able-bodied modes of gaming.

Ruberg, B. (2020, March). Empathy and its alternatives: Deconstructing the rhetoric of “empathy” in video games. Communication, Culture and Critique, 13(1), 54–71. DOI: https://doi.org/10.1093/ccc/tcz044.

This article analyzes the contemporary discourse that surrounds video games. Specifically, it confronts the rhetoric of “empathy,” which has become a buzzword in North American industry, academic, education, and media conversations about video games and their supposed power to place players into others’ shoes—especially those games created by queer or otherwise marginalized people. Scholars like Wendy Chun and Teddy Pozo and game designers like Robert Yang have spoken out against this rhetoric. Building from their writing, as well as critiques from the creators of queer independent games commonly mislabeled as “empathy games,” this article delineates the discriminatory implications of the term. Rather than simply dismissing “empathy,” however, this article unpacks it, turning to textual artifacts like news stories and industry presentations, as well as the 2016 video game Unravel (ColdWood Interactive), to deconstruct the term’s many meanings and to identity alternative (queerer) models of affective engagement with video games.

Santoro, G., Costanzo, A., & Schimmenti, A. (2019). Playing with identities: The representation of dissociative identity disorder in the videogame “Who am I?’Mediterranean Journal of Clinical Psychology, 7(1), 1-10. Retrieved from: https://cab.unime.it/journals/index.php/MJCP/article/view/2053.

Who am I: The Tale of Dorothy (WAI) is the first videogame ever that addresses the treatment of an individual suffering from dissociative identity disorder (DID). WAI describes the life and internal experience of a 14-year-old girl named Dorothy who suffers from DID. The goal of this videogame is to integrate all Dorothy’s dissociated identities. Notably, several symptoms of DID are correctly portrayed in the game, such as identity confusion, identity alteration, amnesia, and psychotic-like experiences. Furthermore, WAI identifies the developmental origins of DID in the individual’s exposure to severe traumatic experiences in the attachment relationships during childhood, which is consistent with current empirical evidence on the developmental precursors of the disorder. Therefore, WAI may represent an innovative possibility for illustrating the main features of DID to gamers, students, and lay people. Accordingly, playing WAI can have important educational implications, as it might serve to reduce mental stigma toward people suffering from DID.

Shell, J. (2021, April 1). What Do We See: An Investigation Into the Representation of Disability in Video Games. DOI: arXiv:2103.17100v1.

There has been a large body of research focused on the representation of gender in video games. Disproportionately, there has been very little research in respect to the representation of disability. This research was aimed at examining the representation of disabled characters through a method of content analysis of trailers combined with a survey of video gamers. The overall results showed that disabled characters were under-represented in video games trailers, and respondents to the survey viewed disabled characters as the least represented group. Overall, both methods of research concluded that the representation of disabled characters was low. Additionally, the characters represented were predominantly secondary, non-playable characters not primary. However, the research found that the defined character type was a mixture of protagonists and antagonists, bucking the standard view of disabled characters in video games.

Silva, M. C. A. P., Maneira, A., & Villachan-Lyra, P. (2018, April). Digital educational games: Inclusive design principles for children with ADHD. In K. Tyner & C. Costa (Eds.), Proceedings of Play2Learn 2018 (pp. 30-45). Lusófona University and the University of Texas-Austin: The Gamilearning Project. Retrieved from: http://gamilearning.ulusofona.pt/play2learn-2018-proceedings/.

This work presents the characteristics inherently present in games which can positively influence children’s learning and are considered of special relevance in the learning process of those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The development of digital educational game requires the game designer’s awareness of the influence of learning outcomes of all game elements. Starting with the first creative ideas until the last testing sessions. Despite being the most common neurobehavioral disorder related to human infancy and a cause of severe hindrance to the personal and academic life of children, studies discussing how digital games can be developed or better adjusted to effectively support these children’s learning process seems to be lacking. The main objective of this article is to provide guidelines with which game designers can create better educational games by improving their accessibility and inclusiveness, while having this target audience in mind. To do so, 11 guidelines are presented based on essential components of Interaction Design, User Interface and User Experience, as well as foundations of Cognitive Psychology and clinical characteristics common to children with ADHD. These guidelines are Simple interactivity; Recurring rewards through positive feedbacks; Removal of distracting elements; Emphasis on relevant elements; Level flexibility; Reduced level duration; Multiplayer option; Unlimited game session duration; Validation of important game actions; High visual standards; Motivation and fun as main components. The isolated use of each guideline is already a contribution to the process of creating educational digital games for children with ADHD. However, this work intends to promote a complete and directed guidance to the game designer, who will be able to develop games that effectively improve the learning conditions of children with ADHD by combining the different proposed guidelines.

Sousa, C. (2020). Empowerment and ownership in intellectual disability gaming: Review and reflections towards an able gaming perspective (2010-2020). In F. Costa Luz & C. Costa (Eds.), Videogames and Culture: Design, Art and Education [Feature Issue]. International Journal of Film and Media Arts, 5(1), 14-23. DOI: https://doi.org/10.24140/ijfma.v5.n1.02.

As with other populations, the usage of games by people with Intellectual Disability (ID) has been increasingly approached by research. Notwithstanding, the role of games in the lives of people with disabilities tends to be studied through a categorical picture that emphasizes its therapeutic characteristics and neglects games as recreation and as a form of cultural expression. The present work aims to review the main research outcomes of the last 10 years in the field of gaming and ID. It presents an analysis of the main research objectives and approaches to gaming adopted in the analysed studies, as a path to reflect on two specific concepts: empowerment and ownership. Therefore, a Systematic Literature Review (SLR) methodology, accompanied by statistical and content analysis procedures, was adopted to analyse a sample of 61 peer-reviewed research papers (2010-2020) in this field. The obtained results emphasize the passive role of individuals with ID in games research, with gaming mainly seen through therapeutic our game-based learning approaches. The presented reflection on inclusive research, through the parallelism between game studies and critical disability studies, also highlights that the access to games, as a cultural expression, for people with ID could foster the inclusion of these individuals in the public sphere, both in media and in the democratic civic structures. The produced insights intend to frame future approaches that situate the potential of games and their accessibility as strategies to decrease environmental barriers and hindrances that people with ID face in their specific contexts and foster inclusion.

Sousa, C., Neves, J.C., & Damásio, M.J. (2022). The pedagogical value of creating accessible games: A case study with higher education students. In E. Melser & D. Kao (Eds.), Innovations in Game-Based Learning [Special Issue]. Multimodal Technologies and Interaction, 6(2), 10. DOI: https://doi.org/10.3390/mti6020010.

The potential of games in empowering underrepresented groups is a central theme in the field of media studies. However, to ensure that everyone can benefit from them, it is necessary to ensure that they are inclusive and accessible. In the present work, we have implemented a Participatory Action Research (PAR) approach to target this problem, right at the stage of training new game designers and game developers. Thus, through a game-design-based or experimental game design pedagogical approach, we intended to promote inclusive and accessibility-driven game design and development skills in students, while decreasing their negative attitudes towards people with Intellectual Disability (pwID). A protocol with a Non-Governmental Organization in the field was established and, during two semesters, students were challenged to develop 10 accessible games and physical interfaces for pwID and motor disabilities, through participatory processes. Pre and post assessment was conducted, through a mixed-method approach. After participating in this process, students reported satisfaction and increased knowledge of cognitive and motor accessibility, and inclusive game design in general. Moreover, the attitudinal assessment showed significantly lower levels of prejudiced beliefs towards pwID (p < 0.05).

Spöhrer, M., & Ochsner, B. (Eds.). (2024). Disability and video games: Practices of en-/disabling modes of digital gaming [Palgrave Games in Context]. Cham: Palgrave Macmillan Cham. DOI: https://doi.org/10.1007/978-3-031-34374-2.

This collection intends to fill a long overdue research gap on the praxeological aspects of the relationships between disabilities, accessibility, and digital gaming. It will focus on the question of how Game Studies can profit from a Disability Studies perspective of en-/disabling gaming and issues of disability, (in)accessibility and ableism, and vice versa. Instead of departing from the medical model of disability that informs a wide range of publications on “disabled” gaming and that preconceives users as either “able-bodied,” “normal” or as “disabled,” “deficit,” or “unable to play,” our central premise is that dis/ability is not an essential characteristic of the playing subject. We rather intend to analyze the complex infrastructures of playing, i.e., the complex interplay of heterogeneous human and non-human actors, that are en- or disabling.

Contents include:

Spors, V., & Kaufman, I. (2021, September). Respawn, Reload, Relate: Exploring the Self-Care Possibilities for Mental Health in Games through a Humanistic Lens. Proceedings of the ACM on Human-Computer Interaction, 5(CHI PLAY), Article No. 263, 1–31. DOI: https://doi.org/10.1145/3474690.

Games have the potential to not only entertain and immerse people, but can be used as vehicles for meaning-making. Given these qualities, games are approached as inspiration for caring technologies, especially for mental health. This transformative process often prioritises learning from games as systems, but not necessarily from the experiences of people with mental distress who play games for self-care. In this paper, we report on a participatory workshop series that sets out to further illuminate the connection between games, self-care and mental health from a humanistic, person-centred perspective. Over four workshops, we engaged 16 people with experiences of mental distress in speculative making activities and discussions of how self-care technology inspired by games could be re-envisioned. By thematically analysing our discussions and collective sense-making, we showcase how participants actively “re-frame” games for self-care. Finally, we sketch out how game developers and makers of gameful self-care technologies could build on our findings.

Stang, S. (2018, March 21). Madness as true sight in The Cat Lady and Fran Bow. First Person Scholar [Feature Issue on Mad Crip Games]. Waterloo, ON: The Games Institute (GI) at the University of Waterloo in collaboration with IMMERSe, The Research Network for Video Game Immersion. Retrieved from: www.firstpersonscholar.com/madness-as-true-sight-in-the-cat-lady-and-fran-bow/.

“In this article, I discuss the way Hellblade has been praised and critiqued for its use of mental illness as a mechanic in order to compare it to The Cat Lady and Fran Bow” (n.p.).

Stiegler A., & Zimmermann G. (2015). Gamification and accessibility. In J. Zhou & G. Salvendy (Eds.), Human Aspects of IT for the Aged Population, Design for Aging, ITAP 2015. Lecture Notes in Computer Science [Vol. 9193] (pp. 154-154). Switzerland: Springer International. https://link.springer.com/chapter/10.1007/978-3-319-20892-3_15

There are many software requirements for the development of accessible applications, in particular for elderly people or people with disabilities. In particular, user interfaces have to be sufficiently abstract to cover required adaptations. In this paper, we introduce a gamification approach for teaching, connecting and engaging developers on accessible design of applications. A particular challenge hereby is combining gamification patters with the requirements of accessibility. As many gamification patters build on visual representation or usage metaphors, they are not suited for adaptation. Instead, we derive a representation-agnostic set of gamification patters from actual game design of commercial games. We identify and illustrate five categories of representation-agnostic gamification patterns, based on a games survey: action space, reward, challenge, progress, and discovery.

Stone, K. (2018, September). Time and reparative game design: Queerness, disability, and affect. Game Studies, 18(3). The International Journal of Computer Game Research, Game Studies Foundation. Supported by the Swedish Research Council (Vetenskapsrådet), The Joint Committee for Nordic Research Councils for the Humanities and the Social Sciences, Blekinge Institute of Technology, IT University of Copenhagen, and Lund University. Retrieved from: http://gamestudies.org/1803/articles/stone.

This essay uses a personal account of the process of creating a videogame to explore themes of queerness, disability, and labour. I track the production of the videogame Ritual of the Moon, a game following a queer woman sent to the moon. It is played for 5 minutes per day over 28 days with choices that determine the player’s unique path. The story takes up imagining the future, especially what the future looks like for queer women. Time becomes cyclical, and the fear of women with power bleeds from the past into the future, creating a future that exists between utopia and dystopia. The themes embedded in the game were experienced during production, as well: the effects of psycho-social disability (commonly labelled mental illness) on labour and art practice, queer discovery and narratives, and working through and with “negative” feelings. This paper intermixes theories of queer time with crip time to detail possible approaches to a queer, accessible art practice that takes seriously social inequalities yet moves towards healing. I augment Eve Sedgwick’s idea of reparative reading to form a reparative art practice, one that is inclusive of the paranoid, critical, difficult, and bad feelings that are a part of queer and debilitated life.

Stone, K. (2023). Reparative Game Creation: Designing For and With Psychosocial Disability. In J. Malazita, C. O’Donnell, & E. LaPensée (Eds.), Critical Game Design [Special Issue]. Design Issues, 39(1), 14-26. DOI: https://doi.org/10.1162/desi_a_00703.

This article proposes a design framework called Reparative Game Creation, a process of creating interactive media focused on healing, emotional acceptance, and accessibility for the psychosocially disabled. It is informed by disability studies, affect theory, anti-capitalist thought, and artist-scholarship on research creation and/or critical practice. Though much of game design and game studies focus on the end product or the player experience, this article instead focuses on the process of game design, and as such does not analyze particular games but instead proposes new ways of creating games informed by psychosocial disability.

Stone, K. (2024). The earth’s prognosis: Doom and transformation in game design. In L. op de Beke, J. Raessens, S. Werning, & G. Farca (Eds.), Ecogames: Playful Perspectives on the Climate Crisis (pp. 447-462). Amsterdam: Amsterdam University Press. DOI:  https://doi.org/10.5117/9789463721196_ch21.

This chapter describes the design of four games created by the author: Ritual of the Moon (2019), Humaning (2017), the earth is a better person than me (2018), and UnearthU (2022). Each of these games portray aspects of physical and emotional transformation, and the way that transformation may come about through varied connections to the environment fostered primarily through gameplay accessing the player’s imagination. The paper puts together disability studies scholarship with ecocriticism to analyze the common affects of the climate crisis, such as despair, anxiety, and doom through the lens of game creation.

Supangan, R. A., Acosta, L. A. S., Amarado, J. L. S., Blancaflor, E. B., & Samonte, M. J. C. (2019). A gamified learning app for children with ADHD. In ICIGP ’19 Proceedings of the 2nd International Conference on Image and Graphics Processing, Singapore, Singapore — February 23 – 25, 2019 (pp. 47-51). New York: ACM New York. Retrieved from: https://doi.org/10.1145/3313950.3313966.

Special Education is an Educational Service provided by private or public schools that cater students with disabilities. Attention Deficit Hyperactivity Disorder (ADHD) is a common behavioral disorder that begins at infancy stage. But it can also develop during teenage state and even in adulthood. This study focused on providing an interactive supplementary tool in assisting ADHD children in learning Mathematics, Language and Basic Hygiene. This gamified system was designed for an Android mobile application of Level 1 lectures in animated presentation. This tool was made available in order for the parents and teachers track students or ADHD children’s progress through different activities taken in the e-tutor system. In conclusion, the user acceptance testing showed that the Android application was approved in content and suitable to use for special education services.

Szykman, A. G., Gois, J. P., & Brandão, A. L. (2015, December). A perspective of games for people with physical disabilities. In OzCHI ’15 Proceedings of the Annual Meeting of the Australian Special Interest Group for Computer Human Interaction, Parkville, VIC, Australia (pp. 274-283).  New York: ACM New York. Retrieved from: http://dx.doi.org/10.1145/2838739.2838765.

People with physical disabilities have to handle obstacles to conduct their lives. In Digital Games Development and Natural User Interface (NUI), researchers have shown interest in overcoming these obstacles. In this study, we collected data to evaluate how they are conducting their studies. We gathered 1485 articles from scientific databases and selected 93, from which we extracted information regarding the contribution of each study, the users responses to each approach, intervention tools and other topics. Our conclusion presents a perspective of studies of games focusing on the rehabilitation and accessibility of people with physical disabilities, a guideline with considerations of the researchers in the field and our suggested directions for new studies.

Tang, J. S. Y., Falkmer, M., Chen, N. T. M., Bӧlte, S., & Girdler, S. (2019, March). Designing a serious game for youth with ASD: Perspectives from end-users and professionals. Journal of Autism and Developmental Disorders, 49(3), 978–995. DOI: https://doi.org/10.1007/s10803-018-3801-9.

Recent years have seen an emergence of social emotional computer games for individuals with Autism Spectrum Disorder (ASD). These games are heterogeneous in design with few underpinned by theoretically informed approaches to computer-based interventions. Guided by the serious game framework outlined by Whyte et al. (Journal of Autism and Developmental Disorders 45(12):1–12, 2014), this study aimed to identify the key motivating and learning features for serious games targeting emotion recognition skills from the perspectives of 11 youth with ASD and 11 experienced professionals. Results demonstrated that youth emphasised the motivating aspects of game design, while the professionals stressed embedding elements facilitating the generalisation of acquired skills. Both complementary and differing views provide suggestions for the application of serious game principles in a potential serious game.

van Gillern, S., & Nash, B. (2023). Accessibility in video gaming: An overview and implications for English language arts education. Journal of Adolescent & Adult Literacy Early View. DOI: https://doi.org/10.1002/jaal.1284.

Scholars in recent years have explored the connections between video games, literacy, and learning. Research illustrates that video games can serve as texts for engagement and analysis in English language arts classrooms. Scholars have also demonstrated how games themselves effectively integrate a complex array of learning principles that help players understand and progress in the game. In this article, we explore how recent efforts in game design to promote accessibility for differently abled gamers have implications for literacy education that can promote inclusivity and equity in English language arts classrooms. While recognizing the social construction of the concept of (dis)abilities, we explore existing literature on the video games, literacy, accessibility, and universal design for learning. We then demonstrate specific ways that video game designers promote visual, auditory, motor, and cognitive accessibility for gamers and share how literacy educators can draw upon these strategies to promote accessibility in their curriculum and instruction to help all students engage, learn, and thrive.

Van Ommen, C. A., & Chaparro, B. S. (2022). Exploring Video Game Satisfaction of Gamers with Disabilities. In M. Antona & C. Stephanidis (Eds.), Universal Access in Human-Computer Interaction. Novel Design Approaches and Technologies, HCII 2022 [Lecture Notes in Computer Science Vol. 13308]. Springer, Cham. DOI: https://doi.org/10.1007/978-3-031-05028-2_26.

It is estimated that 61 million Americans are living with a disability, and that 33 million of those play video games. Gamers with disabilities face many barriers in gaming, such as being unable to hear necessary audio or move various components on a controller, which may impact their game satisfaction. Since there has been little research to validate gaming satisfaction measures in gamers with disabilities, an exploratory study was conducted to assess factors that contribute to satisfaction among this population. Results indicate that the items of the validated Game User Experience Satisfaction Scale (GUESS-18) are helpful in understanding video game satisfaction in this population. Participants were able to use the GUESS-18 without modifications, but suggested the addition of areas related to game customization, challenges faced, and learnability.

Wästerfors, D. (2011). Stretching capabilities: Children with disabilities playing TV and computer games. Disability & Society, 26(3), 337-349.  DOI: https://doi.org/10.1080/09687599.2011.560417.

Intervention studies show that if children with disabilities play motion-controlled TV and computer games for training purposes their motivation increases and their training becomes more intensive, but why this happens has not been explained. This article addresses this question with the help of ethnographic material from a public project in Sweden. By applying interactional constructionism to detailed instances of play situations, the article specifies the social dynamics as well as identificatory attractions of these games for children with disabilities.

Wästerfors, D., & Hansson, K. (2017). Taking ownership of gaming and disability. Journal of Youth Studies, 20(9), 1143-1160. DOI: https://doi.org/10.1080/13676261.2017.1313969.

Gaming among young people with disabilities is often understood within a habilitation frame, as if video and computer games primarily should help to exercise and ‘improve’. Little is known about how these games are used within a private frame, and how young people with disabilities operate their gaming as concrete persons rather than as treatment-receiving clients. Through the use of stories, descriptions, and demonstrations from Swedish youth and young adults with disabilities (muscle diseases, cerebral palsy, and Asperger’s syndrome), we explore these gamers’ practical maneuvers, verbal accounts, and biographical-narrative concerns in relation to digital games. As they strive to bypass or overcome digital inaccessibility, various challenges find their way into their gaming practices, not only to complicate, distract, or disturb them but also to give them extra meaning. Gamer–game identifications turn multifaceted, with disabilities serving as paths both around and into the games’ ‘magical circles’. We suggest partly new concepts – beyond a habilitation frame – to capture how young people struggle to take ownership of gaming and disability: engrossment maintenance, vicarious gamers and biographical as well as situational refuge.

Westin, T., Bieree, K., Gramenos, D., & Hinn, M.  (2011, July). Advances in game accessibility from 2005 to 2010. In C. Stephanidis (Ed.), Universal Access in Human-Computer Interaction. Users Diversity: 6th International Conference, UAHCI 2011, Held as Part of HCI International 2011, Orlando, FL, USA, July 9-14, 2011, Proceedings, Part II (pp.400-409). Berlin: Springer.

The research in the area of game accessibility has grown significantly since the last time it was examined in 2005. This paper examines the body of work between 2005 and 2010. We selected a set of papers on topics we felt represented the scope of the field, but were not able to include all papers on the subject. A summary of the research we examined is provided, along with suggestions for future work in game accessibility. It is hoped that this summary will prompt others to perform further research in this area.

Whyte, E. M., Smyth, J. M., & Scherf, K.S. (2015, December). Designing serious game interventions for individuals with autism. Journal of Autism and Developmental Disorders, 45(12), 3820-3831. DOI: https://doi.org/10.1007/s10803-014-2333-1.

The design of ‘Serious games’ that use game components (e.g., storyline, long-term goals, rewards) to create engaging learning experiences has increased in recent years. We examine of the core principles of serious game design and examine the current use of these principles in computer-based interventions for individuals with autism. Participants who undergo these computer-based interventions often show little evidence of the ability to generalize such learning to novel, everyday social communicative interactions. This lack of generalized learning may result, in part, from the limited use of fundamental elements of serious game design that are known to maximize learning. We suggest that future computer-based interventions should consider the full range of serious game design principles that promote generalization of learning.

Wilhelmsson, U., Engstrom, H., Brusk, J., & Ostblad, P. A. (2017). Inclusive game design facilitating shared gaming experience.  In F. Liarokapis & K. Debattista (Eds.), Serious Games and Education [Special Issue]. Journal of Computing in Higher Education, 29(3), 574–598. DOI: https://doi.org/10.1007/s12528-017-9146-0.

This article presents the result from a study comparing the perception and understanding of a game story between sighted and visually impaired players playing the same game. In particular, whether sighted and visually impaired players could experience and recount the same story construed from the plot elements that are either manifested by audio and graphics in the case of sighted players or primarily by audio in the case of visually impaired players. To this end, we have developed a graphical point-and-click adventure game for iOS and Android devices that aims to show how inclusive game design may be used to facilitate a shared gaming experience between sighted and visually impaired players. The game provides players with audio feedback that enables visually impaired players to interact with and experience the game, but in a manner that does not interfere with the overall appearance and functionality of the game. Thus, it has been designed to be fully inclusive to both groups of players and to give the same gaming experience when it comes to story content. The game has been evaluated through formal user tests where subjects have been asked to play the first chapter of the game followed by an interview. The study shows that the perception of the story was almost identical between the two groups. Generally it took visually impaired players a little longer to play the game but they also seem to listen more carefully to the dialogue and hence also build a slightly deeper understanding of the characters. The study also shows that the sighted players did not respond negatively towards the inclusive game design employed in the game.

Yeager, S. A., & Ciccoricco, D. (2024, Spring). Embodied simulations and neurodivergent temporalities in To the Moon. In  E. Y. Chang & A. Bird (Eds.), Games Studies [Feature Issue]. Configurations, 32(2), 111-128. DOI: https://doi.org/10.1353/con.2024.a924125.

We position games as ludic time machines; beyond simply representing neurodiversity, they can prompt players to consider neurodivergent temporalities. In the 2D psychological adventure game To the Moon (Gao 2011), players control two scientists who travel through the memories of a man on his deathbed. Digging ever deeper into their seemingly neurotypical client’s past, the scientists learn how his marriage was strained by the complexities of cross-neurotype communication. We show how To the Moon’s storyworld and gameplay destabilize fixed understandings of neurotypicality, encourage deeper mutual understanding of temporal embodiment, and prompt players to reconsider their relationship to neurodiversity.