Designing Games for Players with Cognitive Impairments: Lessons from the Lab

"The biggest surprise was how dramatically cognitive abilities varied within our target population. During our user testing sessions, I watched one participant solve complex spatial puzzles in under ten seconds while expressing frustration that the game wasn't challenging them enough. Twenty minutes later, another participant struggled with what I considered the simplest tutorial level. Both users had the same diagnosis. Both were part of our target demographic. But their cognitive strengths and challenges were completely different."

"This taught me that traditional difficulty curves don't work for cognitive remediation games. You can't design three difficulty settings and call it accessible. Instead, you need systems that automatically adapt in real time based on user performance. If someone breezes through the first five levels, the algorithm should immediately jump them ahead. If someone struggles with basic interactions, the system needs to provide more scaffolding without making them feel patronized."

A cognitive remediation game targeting players with schizophrenia revealed dramatic variability in cognitive ability across individuals who share the same diagnosis. Hours of interviews and user testing involved participants from diverse backgrounds and skill levels. Traditional static difficulty curves and a few preset levels proved inadequate for accessibility. Games should implement automatic, real-time adaptive systems that increase challenge for quick solvers and provide scaffolding for those who struggle, without infantilizing them. Auto-balance systems present significant technical challenges and high user-experience stakes, because poor balancing will drive away both highly capable and low-capacity players. Many target players are already experienced gamers.

Read at Medium