With a background as a product and web designer I was, by 2007, freelancing as a result of the substantial amount of time I spend caring for my daughter, who was diagnosed with Cystic Fibrosis (CF) at 18 months. Prior to this diagnosis our family was unfamiliar with CF, but we quickly learnt about living with the condition and now, 12 years later, I have developed a solution that I believe will improve the lives of CF sufferers and their families.
CF causes abnormally thick mucus to build up in sufferers’ lungs, which can lead to blockages of the pancreatic ducts, intestines, and bronchi – which can in turn cause irreparable damage. In order to dislodge much of the mucus that has built up, and to keep lungs especially healthy in the longer-term, CF sufferers complete daily physiotherapy. For very young children, this can mean parents spending time each day positioning their child, trying to gently encourage mucus to be dislodged from their lungs with various techniques. As sufferers grow up, they will begin twice-daily respiratory (blowing) physiotherapy, in which they blow into a device with a particular level of force, for a specified number of times, again in a bid to dislodge the mucus that builds up.
It was this particular element of my daughter’s daily routine that inspired me to want to make physiotherapy more fun. Families struggle to ensure that the twice-daily physiotherapy has been completed properly; there is far too much room for debate about whether each blow has been forceful enough and, without sitting and watching every single blow (which most people can understand teenagers don’t warm to); there’s plenty of debate around whether enough blows have been completed, too.
One particular morning during 2013, I remember that my daughter didn’t want to complete her physiotherapy at all. Of course, living with CF can be difficult for anyone, let alone a young person. It is a lot of responsibility to put on the shoulders of someone who is not yet 10 but, for each missed or incomplete session of physiotherapy, parents are acutely aware of the potential long-term repercussions. Each round can therefore be incredibly highly charged, with parents often taking the exercises much more seriously than their children might.
My idea to solve this was to harness the power of games to make physiotherapy more enjoyable for my daughter and, therefore, less of an opportunity for family arguments. As an electronics hobbyist, I initially began using little light bulbs to simply track whether an individual blow had been completed correctly. My daughter’s attitude to treatment changed immediately, but it didn’t take too long before the attraction of these little lights wore off. I realised quite quickly that I would need to come up with innovative ideas to keep any new developments exciting.
By 2015 I had worked out how to link the standard physiotherapy device to a smart phone, and the proof of concept was established. Registering each perfect blow (not too strong, nor too weak), users would be able to use the ‘power’ of each blow to drive an element of a game through the smartphone app. Think space invaders, where you can only shoot down the invaders if your shots travel far enough and quickly enough to hit your target before it moves. Most importantly, the app also keeps a tally of the number of successful blows completed, meaning that parents don’t need to be so closely involved in monitoring the process. The child can be left to their own devices and parents can check whether the physiotherapy has been completed by checking the status of the app.
I presented this concept to the CF team at Addenbrooke’s Hospital and, with their early support, headed to the CF Trust in London just two weeks later. The Chief Executive and Head of Research ‘got it’ straight away, but the Trust couldn’t simply give money away, so I then realised that I would need to source some initial investment, because the CF Trust would only be able to support my concept through match-funding.
I won a place at Cambridge Social Ventures Incubator (at Judge Business School, University of Cambridge), and later that year I was one of the winners of the Big Venture Challenge (unLtd). Through these programmes I benefitted from support to build a social venture. Although I hadn’t known what ‘social ventures’ were beforehand, I discovered this was a fantastic fit for me because I felt it appropriate, that grant income secured from charities would directly benefit families managing chronic diseases. The time spent around other like-minded individuals was invaluable, especially in learning about sources of funding and support only
In 2017 having graduated from Cambridge Social Ventures incubator I founded Playphysio®, as I realised I would need to develop a sustainable business plan and get started on fundraising. This was supported by Allia’s Cambridge based ‘Serious Impact’ incubator. By this point my daughter, now a teenager, was less interested in the arcade style games but increasingly receptive to treatment tracking. There is a dangerous trend in teenagers living with CF that as they get older they do tend to become more laid back in their approach to physiotherapy. However, pretending that everything is fine, sadly results in serious irreparable lung damage. So it’s imperative that Playphysio® continues to develop solutions to suit CF sufferers of all ages – ensuring there is always another style, or level, of solution to keep patients engaged with their physiotherapy treatment.
It was this realisation that led me to approach REACTOR – while I had managed to develop one game, I realised that to keep the ‘solution’ working day after day, month after month, year after year, I would need truly enjoyable and engaging games to be incorporated into the app. Whether this would be achieved by asking existing game studios to create a version of their game to work with the app, or by working with game developers to create new games, I wasn’t yet sure. But REACTOR’s network was really helpful, introducing me to game developers and existing studios, but also helping me to better understand the different elements of gaming that would be essential to keep CF sufferers engaged in their physiotherapy. I applied for one of the European Regional Development Fund (ERDF) REACTOR grants, which was awarded to me for the specific project of enhancing the gamified elements of my app, through creating code to link existing games to work with the app’s software. I initially had one game and, as a result of the support provided to me by REACTOR, I was able to develop the first game and an additional three games along with a code framework to enable existing games to easily work with the app.
With more games available to play, I was ready to support Addenbrooke’s Hospital in writing a grant application to Addenbrooke’s Charitable Trust, with a view to running a clinical trial into the safety and acceptance of gamifying physiotherapy for children with CF. The application was successful and enabled a match-funded grant from the CF Trust, and the trial kicked off in December 2018. It is on a rolling recruitment programme to May 2019 with space for up to 30 participants aged eight to 16 to take part. At the end of 2018 we were thrilled to be awarded some additional funding from Comic Relief’s Tech for Good fund, to build an online ‘clinical dashboard’ which care teams can use to view patient data remotely.
Today there are more than 4,000 children in the UK living with CF, and more than 10,000 people of all ages – and encouraging all patients to commit to daily physiotherapy has the potential to save the health service millions of pounds by helping to prevent some of the irreparable lung damage caused by repeat infections. Our mission remains to reduce the burden of care for families; to collect data to inform medical research; and to save on costs of care.
My ambition once the trial is complete is to transform the daily experience of physiotherapy for as many CF sufferers, and their families, as possible. From there, the technology could easily be developed to support patients who manage other respiratory diseases with similar daily physiotherapy. And in the same way that fitness apps use gamification to keep people active, or to track their diet, Playphysio® can provide a similarly usable, engaging and rewarding – yet bespoke – service to CF sufferers, and make a world of difference to their lives.