An Examination of Motivation in Physical Therapy Through the Lens of Self-Determination Theory: Implications for Game Design

While it is widely assumed that games can engage patients in therapy through their inherent ‘motivational pull’, relatively little attention has been paid to what HCI games research can learn from strategies employed by therapists. We address this gap by leveraging Self-Determination Theory (SDT) and its mini-theories Basic Psychological Needs Theory and Organismic Integration Theory as a theoretical lens on physical therapy for children and adolescents. Results from in-depth interviews with twelve therapists show that they carefully adjust sessions to allow patients to experience competence, making more comprehensive adjustments than currently offered by games. Additionally, we highlight how therapists leverage their relationship with patients to support motivation, but struggle to reconcile meaningful experiences of autonomy with therapeutic goals. On this basis, we reflect on implications for researchers and designers who create games for physical therapy, and the potential of SDT to provide a foundation for game design and therapeutic practice.