Today’s episode of Access-Ability is going to be a little different to most episodes of the show. I am currently a bit under the weather with a recurrent illness, and rather than skip a week of recording Access-Ability, I thought I’d use this week on the show to talk less about a specific example of a video game with good or bad accessibility settings, and instead talk about some more fundamental big picture thoughts on accessibility in gaming.

I’ve talked about this before on Access-Ability, but accessibility needs are rarely, if ever, a constant. Just because a gamer doesn’t need accessibility settings support today, doesn’t mean they won’t need them tomorrow. This is important to understand, not just in terms of understanding which accessibility settings are commonly important, but also for understanding how accessibility support is often used day to day.

So today, on Access-Ability, I’m going to be talking about some of the things currently making it difficult for me to play video games, and why it’s important that gamers, and developers, think of disability and accessibility as fluid rather than static.

Right now, when I record this episode of Access-Ability, I am dealing with pretty severe hearing loss on my left side, chronic fatigue, and some chronic pain issues in my face. None of these are permanent, but all of them are likely to pop up again down the line, and each time they do, they are likely to impact my ability to play video games.

First up, my hearing, As an autistic gamer, hearing issues have always been an intermittent barrier to gaming for me. I generally struggle with auditory processing issues, difficulty separating out sounds from one another, which generally makes following in-game audio in complex scenes tricky for me on the best of days. However, right now my ear issues are more physical in nature, while still likely a result of my being autistic.

Autistic people are estimated to have around four times the risk of inner ear infections and blockages compared to the general population. It’s common for autistic people to have one of their ears be physically a slightly different shape than normal, and become prone to chronic issues across their lives.

For me personally, this comes in the form of maybe once per year finding my left ear becomes painfully blocked. I suffer with a constant throbbing earache, as well as losing around 90% of my hearing on that side, for up to three weeks at a time.

Currently, I can basically not hear anything on my left hand side. When you pair that with the struggles I already have focusing on specific sources of audio as an autistic person, and I am really struggling with a lot of gaming tasks currently, as well as day to day life.

So, what accessibility settings are currently helpful for me on a temporary basis? Well, games that support turning stereo audio into mono audio allow me to hear all game audio in my right ear so nothing is being missed if I game with headphones on, such as while streaming. Additionally, subtitles become more important than usual to me, and the ability to balance game audio to turn down non essential sounds so that I am only hearing the most gameplay important audio in the audio mix helps me to follow along while my hearing is limited.

Lastly, games that allow for transcribing spoken voice chat into written text on screen are currently more accessible to me than other multiplayer titles.

Next up, chronic fatigue. While chronic fatigue issues are somewhat of a staple in my life, the causes for that fatigue can change over time. Often, as an autistic person, chronic fatigue becomes an issue when I have been travelling for work, dealing with large amounts of back to back socialisation. I can push through complex social situations, then come home and find myself physically exhausted for several days, trying to recover from large amounts of deliberate social output.

However, currently my fatigue is a result of my being ill. Since having Covid 19 a few weeks ago, I have found that I have had intermittent exhaustion, in part due to my breathing feeling at times more shallow than it was before. I can work through it by focusing on deep breathing exercises when I notice it, but it has noticeably impacted by overall level of energy during the daytime when it intermittently impacts me.

On top of my current ear issues, I am dealing with an additional source of chronic pain, occasional phantom tooth pain that has periodically come and gone since getting Covid-19. The pain has no apparent cause, and feels mostly like chewing on tin foil at random moments. Put alongside the chronic pain flare ups from my ear, and I have been constantly low level distracted and exhausted.

So, what gaming accessibility support options currently help me to play while fatigued and in pain? Well, one of the biggest supports is games that allow for pausing at any moment. While I love games like Elden Ring or Dark Souls, I can’t reasonably play them during fatigue or pain flare ups, because I can’t pause if I feel myself falling asleep in my chair, or if I am suddenly distracted by pain and need to take a break until my focus returns.

I have spent a lot of this week playing a game called Vampire Survivor while ill. The game is a single analogue stick game where players fight monsters using attacks that automatically fire on a repeating timer. While players do need to dodge enemy attacks and hit monsters approaching them, during much of the gameplay later in runs damage output is automated, and often with a good build momentarily being distracted by pain or exhaustion won’t be a huge deal, as your character will likely continue to defend themself pretty effectively from basic attacks.

I bring these accessibility needs up this week mainly to show, in practice, something I often talk about in abstract on this show. Just because you don’t need accessibility support today, doesn’t mean you won’t tomorrow, and thinking about accessibility support as something you may someday need, even if you don’t today, is important.

Often, when I talk to game developers about accessibility, they see disabled players as static groups with static needs, but the truth is that disability is a fluid state that changes and morphs for many over time. I am a disabled gamer, but what that means in terms of my accessibility needs changes over time. Just because a game supports my needs today doesn’t mean it will tomorrow.

Accessibility settings need to be common, extensive, and customisable. When we think about disabled users as static groups it feels easy to pop a few basic settings into a game and call it a day, but accessibility is a sprawling and complicated topic, with fixes often not as discreet and simple as they might from a distance seem.

I am incredibly thankful for the game developers who see accessibility as an ongoing quest. Just because someone doesn’t need a setting today, doesn’t mean they won’t tomorrow.

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