Optimistic endgames: Chess and neurorehabilitation

COMMENTARY

By Conor Sheridan

Chess has been a passion of mine since moving to Toronto last Fall. This centuries-old game can be seen played at picnic tables, coffee shops, and community centres throughout the bustling city. This past year, while volunteering in the stroke unit at the Toronto Rehabilitation Institute (TRI), I was surprised to encounter passionate chess players and eager learners alike within the inpatient population. Practice Leader of Therapeutic Recreation, Tracey Dion, has even organized a series of beginner chess classes that, in recent years, has led to in-hospital tournaments for players of all skill levels.

At TRI, chess has served as an avenue of social re-integration for individuals who wish to learn and to play chess following discharge, reports Dion. For instance, one former patient who previously experienced homelessness told Dion that after being discharged chess helped him and his friends stay on the “straight and narrow.” As practice leader, Dion also helps former patients find outlets in the community to actively pursue their interest in chess. The opportunities I had as a student at TRI to play chess with patients and to learn about their personal rehabilitation experiences ultimately sparked my curiosity about the application of chess within neurorehabilitation.

How Chess Changes the Brain

Much of what has been learned about how chess affects the brain originates from studies on people with typical neurological development and cognitive abilities. These anatomical characterizations and neuropsychiatric evaluations have included chess players of all skill levels (1). After years of research, scientists have now mapped specific brain regions and neural networks altered by the learning and mastery of chess (2–4). It appears that after much rehearsal, chess experts have a heightened capacity to process chess board arrangements and decode chess-related information (2). These abilities are believed to be associated with a unique activation of both brain hemispheres in regions responsible for object perception and pattern recognition, which have been documented during chess searching tasks (2).

Chess experts’ brains are so finely tuned that they can process chess configurations in the fusiform gyrus, the brain region most of us use for facial recognition (5–7). This suggests that unlike novices, expert chess players perceive groupings of chess pieces on the board as “chunks.” This chunking process is very similar to the way in which humans detect facial features, beauty, and emotional expressions based on the relationship between the eyes, mouth, and nose (8). In contrast, both novice players and individuals with prosopagnosia – an inability to recognize faces – process discrete pieces of visual information (e.g., chess pieces or facial features) independently of one another (8–10).

In chess-related research, the recognition of objects and their particular relations are referred to as the “lower cognitive” mechanisms of play (11). Expert chess players have also been shown to have unique neuroanatomical presentations in “higher cognitive” functions, such as attention, memory, metacognition, and problem solving. Chess is a strategy game, so critical thinking is necessary to evaluate future moves and effectively counter opponent’s tactics (11). During chess-related problem-solving tasks, experts achieve an elevated level of attention by deactivating unneeded neural networks. This process allows them to reallocate and streamline cognitive resources (12). Additionally, experts have heightened activation of the neural pathways responsible for sharing information between visual processing and decision-making regions of the brain (12). Lastly, when presented with a complex chess problem, chess experts differ from novices by activating brain regions responsible for higher-order reasoning (e.g., frontal and parietal cortex). Conversely, novices show activation in regions responsible for processing new information (i.e. temporal cortex) (3). This distribution pattern could potentially limit a novice player from planning long-term strategies, ultimately resulting in inferior play.

While this evidence demonstrates that chess experts show increased lower and higher chess-related cognitive abilities, evidence of the transfer of these cognitive skills to other domains is sparse. Chess players may have a heightened ability to remember chess board arrangements, but these abilities do not translate to non-chess related shapes or number lists (13,14). Chess experts’ in-game planning ability also does not transfer to other puzzles such as the Tower of London – a planning task that involves organizing objects in a specific order using the fewest moves possible (15). That being said, a recent meta-analysis estimating the relationship between chess skill and cognitive ability determined that chess skill correlates positively with four broad cognitive domains: reasoning, processing speed, comprehension, and short-term memory (1). Eventually, if researchers can better understand the neurological changes that occur as a by-product of chess play, this information could potentially serve as evidence for the use of chess as a tool in neurorehabilitation.

Chess and Neurorehabilitation

Chess practice and its translation to generalizable cognitive abilities is of particular importance for application to neuroatypical populations. Neuroatypical is a broad term that is used to describe individuals with any sort of brain-related disability (e.g., cognitive impairment). Understanding exactly how neuroatypical individuals may benefit from chess training has been the topic of many investigations worldwide (16–21). One study demonstrated that a chess program significantly reduced inattentiveness and hyperactivity symptoms in children with attention deficit hyperactive disorder (ADHD) compared to a control intervention group (16). Similarly, a group of German students with learning disabilities displayed improved concentration and calculation abilities after one hour per week of chess lessons in comparison to a control group that received supplementary mathematics instruction (17).

In addition to studies in children, researchers have also experimented with chess as a rehabilitative tool in adult populations (18,19). Cocaine dependency is characterized by neurological changes that result in increased impulsivity and reduced attention, working memory, and mental flexibility (20,21). In one study, individuals with cocaine dependencies were randomly assigned to either a monitored chess program or a physical activity program during a one-month drug abstinence period. After the intervention, individuals enrolled in the chess program significantly improved their working memory compared to those in the physical activity program (18). Another preliminary study noted that when individuals with schizophrenia were randomized between ten hours of chess programming and usual treatment, those in the chess program significantly improved their planning abilities compared the control group (19).

Chess and TBI

To date, no research has been conducted on the benefits of chess as a neurorehabilitation tool for individuals with traumatic brain injury (TBI). Broadly, many of the higher and lower cognitive changes experienced in TBI overlap to some degree with the changes observed in individuals with ADHD, cocaine dependency, and schizophrenia. As such, while no direct evidence of potential neurorehabilitative benefits of chess has been published, there is a mounting case that further research on chess and TBI may be worthwhile.

Individuals with TBI can present with a constellation of cognitive changes related to attention, memory, and executive function (24) that require individually-tailored rehabilitation plans (22). Individuals with a TBI could potentially address these cognitive deficits through participation in a chess training regime. Research has shown that training programs focusing on repeated practice improve various attention-related impairments following TBI (25–27). Building off these findings, chess training programs – if tailored to the attentional needs of the TBI demographic – may serve as a more engaging alternative to ‘mass practice’ programs (16,17). Memory impairments are also common after brain injuries, yet cognitive strategies such as word lists, paragraph listening, using visual imagery, and mnemonic devices have not been shown to improve long-term memory impairments (26,28–30). Lastly, research has shown that problem solving training has improved higher-order functioning following TBI (31). Chess provides an endless opportunity for a full gradient of problem solving challenges and notable improvements in executive function have been reported in patients with schizophrenia (19).

Individuals with TBI are often faced with chronic challenges that may impact almost every aspect of their day-to-day life. While rehabilitation and other medical interventions may support recovery, they are often costly. Exploring games, such as chess, may hold merit as an inexpensive and engaging addition to rehabilitation programs.

Like other game-based rehabilitation, chess may provide a way for individuals to socialize. Competition and collaboration are key elements to successful game-based programs (32). Chess is a competitive game, which may appeal to the predominantly younger TBI demographic (33). Chess can also be played in groups, which may facilitate collaboration by facilitating peer-to-peer learning. Using timed turns can also provide a natural obstacle that allows those at different stages of recovery (or novices and those more familiar with chess) to be able to play together.

Similar to other game-based cognitive rehabilitation interventions, chess training programs should be designed to allow individuals with cognitive impairment, and those who are new to chess, to experience success and enjoyment early on in the program. Lesson difficulty and practice matches must be tailored to individuals’ cognitive abilities and, in many cases, adapted to meet their concurrent physical limitations. Once a grasp of the rules and basic strategy has been obtained, compensatory tools such as memory aids and the use of instructional videos/tutorials can be incorporated to facilitate play. Chess play may not be feasible for some individuals experiencing more severe injuries or those who are not interested in the game. Yet, exploring chess-based neurorehabilitation for TBI may show that these 32 black and white game pieces have more to offer than their 6th century creators could have ever envisioned.

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