RPG as Therapeutic Recreation for People with Disabilities - Relevant Notes - Part 1

by Hawke Robinson published 2013/01/09 12:20:00 GMT-7, last modified 2022-11-12T09:45:32-07:00
Based on The Recreational Therapy Handbook of Practice, and WHO ICF (World Health Organization) (International Classification of Functioning). This will be edited periodically, and is only in a notes format for now. It is hoped to turn this into a more comprehensive document at a later date.

This page provides some excerpts from my notes in the Therapeutic Recreation for People with Disabilities course at Eastern Washington University (EWU RCLS-245). This is a course I am currently taking, working towards interdisciplinary degrees in Recreation Therapy, Music Therapy, and Research Psychology (About Hawke).

These are just excerpts from much larger notes, focusing on the portions where RPG could apply as treatment. This page attempts to point out the areas that RPG's could be used as therapeutic treatment as per the WHO ICFcodes and the recommended treatments listed in the Recreational Therapy Handbook of Practice by Porter & Burlingame.


Abbreviation Reference

  • CRPG = Computer-based RPG (all computer-based RPG's, MMORPG, MMO, MUSH, Solo computer RPG, etc.)
  • LARP = Live Action Role-playing.
  • MMORPG = Massive Multiplayer Online Role-playing Game
  • RPG = TRPG = Tabletop Role-playing Game


Unless otherwise specified, the use of RPG alone (rather than with a prefix) generally indicates primarily Tabletop Role-playing gaming in cooperative style, usually using paper, pencil, and dice. However, sometimes it may be equally applicable to other RPG types.


ICF Body Functions Qualifiers (severity of impairment)

Qualifier Rating Level of Impairment Percentage Impairment
0 None 0-4%
1 Mild 5-24%
2 Moderate 25-49%
3 Severe 50-95%
4 Complete 96-100%
8 Not Specified -
9 Not Applicable -


b - Body Functions

b1 Chapter 1 - Mental Functions


b114 - Orientation Functions

RPG may be helpful to work with improving General Mental Functions > Orientation.

  • Person
  • Place (especially use of maps)
  • Time


b126 - Temperament & Personality Functions

Temperament & Personality functions may be addressable using RPGs.

  • Mood disorders
  • Personality disorders
  • Organic brain disorders
  • Childhood disorders
  • Learned behaviors

Not sure about the efficacy of using RPGs to help those with substance abuse or child abuse issues.


For the above listed Temperament & Personality functions, improvements could likely be seen from the applicable treatment list when using RPG to address:

  • Specially designed experiences
  • Journaling (adventure journals)
  • Behavior modification
  • Group work
  • Social skills
  • Opportunities for leadership
  • Challenges
  • Role-playing (of course)

The only item from this category list that RPGs would not have direct influence is the item "medication".


b130 - Energy & Drive Functions

From the energy and Drive functions list:

  • Energy Level
  • Motivation
  • Impulse control

Could possibly be treated with RPGs, however the Appetite and Craving items might not be effectively addressed using RPGs.

If the client likes RPGing, then motivation levels will likely be higher than more "mundane" activities. Also, tabletop RPGs can be performed even when at a low energy level (as can CRPGs), while LARP would require clients to have higher energy and motivation levels for sustained, regular, participation.


b140 - Attention Functions


RPGs, could be useful for improving attention functions including shifting, dividing, sharing, and sustaining attention.

RPG's can meet the following recommendations for treatment from this list:

  • Gradudated tasks
  • Manipulate environment (most with LARP, and lesser degrees computer-based, but also tabletop when using dice, pencils, paper, miniatures, maps, etc.)
  • Progress from familiar to novel
  • Repetitive to complex
  • Treatment sessions appropriate length
  • Variety of interventions and medium
  • Positive feedback
  • Maintain eye contact
  • Structure or limit information
  • Break task into simple components.

RPGs definitely meet the needs for the above list quite well.



b144 - Memory Functions

RPGs can definitely address most, if not all, memory function treatment requirements:

  • Registering, storing, and retrieving information as needed.
  • Enhanve memory functions through repetition, graduated tasks, and cueing
  • External aids (notes on paper, miniatures, dice, maps)
  • Training in active listening skills (key part of tabletop RPG)
  • Chunking or grouping
  • Mental retracing
  • Visual imagery
  • Story method
  • Association
  • Pegging (ex. APIE) ???? (I need to look this up)


b147 - Psychomotor Functions


Though likely LARP would be the most significant impact for these functions, both CRPGs and TRPGs could be used for those with

greater impairments. CRPGs generally require use of the keyboard and/or mouse, and/or game controller. TRPGs generally offer opportunities for

use of paper and pencil, tokens, moving miniatures on maps/boards, rolling dice, selecting cards, etc.

The following areas might be addressable through RPG treatment at various levels:

  • Psychomotor retardation
  • Excitement and agitation
  • Posturing (involuntary flexion or extension of the arms and legs)
  • Catatonia (Neurogenic motor immobility, and behavioral abnormality manifested by stupor) - Not sure that RPGs could effectively treat.
  • Catatonia - Negativism - client understands instructions, then does the opposite.
  • Catatonia - Ambitendency - a state of ambivalence with alternation of cooperation and opposition.
  • Echopraxia - involuntary imitation of the movements of another person
  • Echolalia - automatic repetition of vocalizations made by another person

RPGs would be unlikely to be effective for those with complete, and upper levels of severe impairments in this category, but those with lower levels of severe, and moderate to mild impairment, might be able to benefit from using various RPGs as treatment.



b152 - Emotional Functions

RPGs, especially TRPG and LARP could help significantly in this area.  CRPG would have limited feedback and interaction benefits.

  • Appropriateness of emotion
  • Regulation of emotion
  • Range of emotion
  • Drama
  • Social skills training
  • Direct feedback



b156 - Perceptual Functions

Mental functions of recognizing and interpreting sensory stimuli.


  • Auditory perception
  • Visual perception
  • Tactile perception
  • Visuaspatialperception

TRPGs and CRPGs would not normally address the other categories:

  • Olfactory perception
  • Gustatory perception

However, it is not unusual for LARP settings to potentially address these other functions, and it would not be impossible to integrate to some degree these functions with TRPG.


b160 - Thought Functions

Mental functions related to the ideational component of the mind.


  • Pace of thought
  • Form of thought
  • Content of thought
  • Control of thought

While not very likely to be addressed with current CRPGs, it may be possible to address these in creative ways with TRPG and maybe some LARPs. Further research will be necessary to better determine the relevant efficacy.




b164 - Higher Level Cognitive Functions

RPGs are ideal for addressing this area of functioning.

  • Complex goal directed behaviors
  • Decision making
  • Abstract thinking
  • Planning
  • Plan implementation
  • Mental flexibility
  • Deciding which behaviors are appropriate under which circumstances (executive functions)
  • Hypothetical scenarios


All of the RPG media (tabletop, computer, live-action) can help in this area, but TRPG is most likely to have the strongest efficacy as treatment.

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