Accessibility consultants in the video game industry, as well as those with disabilities working on development teams, are putting their health at risk in the pursuit of making games more accessible, and as an industry we need to make finding solutions to this problem a priority area for future research.
When looking at accessibility barriers present in video games, I’ve often seen a distinction drawn between hard barriers, where a game is made completely unplayable for a person due to an insurmountable barrier, and soft barriers, where a game is technically still playable but challenging, exhausting, or painful for a disabled player to engage with. Hard barrier examples given are often things like a game without navigational pathfinding tools being unplayable for a sightless blind player, whereas a player with ADHD struggling to remember the next step of a lengthy quest chain would often be labelled as a soft access barrier.
However, a category of accessibility barrier that doesn’t always fit neatly into this discussion is accessibility barriers that a player can technically play through, but shouldn’t because of the risk of negative health outcomes with persistent exposure to potentially harmful triggers. On paper these are often treated as soft barriers, when in practice we should probably be treating them more in line with hard barriers to accessibility.
The most well known and most often considered group to fall into this category is players with conditions such as photosensitive epilepsy, where bright flashing lights among other potential triggers could cause dizziness, fatigue, or seizures. Also in this category would fit chronic motion sickness sufferers, as would players who suffer from chronic migraines.
Back in January of 2024, I interviewed Jeppe Newmand, a gamer and accessibility consultant with photosensitive epilepsy, about their experiences with the condition in relation to a visual setting in the Tekken 8 demo that posed a reasonably high risk of triggering seizures in photosensitive players. Jeppe is someone whose epilepsy is being managed by medication, reducing the risk of seizures being triggered, but not entirely removing that risk. Even without experiencing a seizure, they still experience negative symptoms such as nausea, pain, and disorientation from photosensitive triggers, allowing them to discuss potential photosensitivity triggers in media from their own first hand experience.
Jeppe is not alone, for many years much of the work being done to make video games more accessible for more gamers with photosensitive epilepsy was being done by consultants risking their own health to directly identify triggers in pieces of media. While these consultants can minimise the risk of their experiencing a seizure, they can never completely remove that risk. Consultants in this space frequently do end up experiencing seizures regardless of medication status, in the name of helping to prevent others from getting sick when a game or other piece of media ultimately releases.
Photosensitive epilepsy, much like chronic motion sickness and migranes, causes a snowball effect when triggered. The more frequently your body experiences a negative response to stimuli, the faster it will react next time, and the more severely it will react when triggered in the future. Illness isn’t simply a risk in the moment, but it increases risk going forward.
Photosensitivity consultants who experience seizures in the line of their work often do so knowing that they are impacting their own long term ability to avoid seizures in day to day life.
Thankfully, as an industry, we are starting to see the popularisation of tools designed to spot potential photosensitivity triggers in games, highlight them, and allow developers to remove them before asking a consultant to look over the experience for themselves. Tools like EA’s open source IRIS can be a vital first line of defense for identifying likely common photosensitivity triggers and removing them, reducing the risk of a consultant experiencing a seizure or other adverse event during their time with a game.
Tools like IRIS can’t be relied upon by themselves to guarantee that a game is safe for photosensitive players, photosensitivity triggers are varied and complex and no tool will know to look for uncommon triggers or something new and unique to a specific game causing issues, but tools like IRIS are incredibly important for the health and safety of the human consultants who are brought in to give more nuanced feedback on a game.
By reducing the risk of adverse reactions you keep consultants safe. That’s important not just for their ability to work in consultancy on this topic long term, but simply because consultants deserve an industry that’s doing everything it can to minimise risk and harm before they’re brought in for work.
A lot of the work I do as a cognitive accessibility specialist in the video game industry the past few years has often focused on motion sickness accessibility in games. I’ve suffered from chronic motion sickness for many years now, made considerably worse by trying to force myself to push through a game that I knew was making me ill.
Back in 2019, I was reviewing a PlayStation VR game for Polygon called Golem. Without diving too deep into the specifics, the game featured a number of design choices that ignored VR motion sickness mitigation best practices, and made me feel violently ill while playing. I felt an obligation to keep playing, as I was on a paid freelance work assignment for a major outlet.
I eventually stopped playing once I’d spent enough time with the game to verbalise what about it was making me so ill. I emailed my editor, who allowed my review to be based on an incomplete playthrough, and a deep discussion of the ways the game caused me to experience nausea, sweats, disorientation, and extreme mental and physical fatigue.
While this was before I was officially working as an accessibility consultant, I would consider this the first time that I knowingly made myself ill in order to explain the specific ways a game was negatively impacting my health.
Ever since that game, my motion sickness has come on more quickly, been set off by more varied triggers, with more extreme and debilitating results. I tried to push myself through a bout of motion sickness to be able to explain my experience, and forever made my symptoms worse.
Today, as an accessibility consultant, I put firm limits in place when taking on jobs focused on motion sickness consultation. I discuss with developers in advance of playing whether their games feature thingsv that I know will be common triggers for me. I play in a well ventilated room, not overly warm, when well rested, in small sessions. I allow myself to preemptively pause playing to discuss motion sickness triggers while they’re minor, before they become severe. I’ve learned how to provide critique before I experience anything that’ll have a severe and lengthy negative impact on my daily life. Still, I take a risk each time I do so. Each time I push too far while trying to find answers for a developer, I make my condition worse for the future.
While I do not personally experience chronic migraines, having only experienced one once in early 2024, I have spoken to chronic migraine sufferers who frequently discuss their experiences in the same terms – Any instance of a migraine being triggered makes future migraines more common and more debilitating, and consultants working to help identify common triggers in games do so while putting their own health at risk.
While common migraine triggers are in many ways more varied and less well understood than motion sickness or photosensitivity triggers, there are some we do know and could be doing a better job of watching out for during game development. Offering modes that dim bright screens or filter them to be less intensely white for example, changing flash bang grenades to turn a screen black rather than white, and performance modes that offer a more stable framerate can all help reduce the risk of migraines being triggered for players.
The fact that common triggers for migraines are less well understood is all the more reason we as an industry should be funding research to help identify more potential triggers, and trying to develop software to detect issues. Right now reducing migraines perhaps more than any other topic in this essay is reliant on feedback from people who have had migraines triggered during play, something we should really be attempting to avoid.
The groups who are put at risk by their work aren’t limited to consultants – My first experience was as a reviewer, feeling an unspoken pressure not to let my editor down, feeling like I would be a failure if I admitted to being too ill to progress further on an assignment. I pressured myself to push forward, to my own detriment.
Developers working on games are also put at risk. Recently, during GA Conf 2025 in London, Stacey Jenkins and Aidan Thompson from Ubisoft gave a fantastic talk about potential risk factors for vestibular conditions, in which they discussed the fact that often game developers working on titles experience unique vestibular illness triggers, and unique pressures to ignore the ill effects they are experiencing. From lower framerate development builds making motion sickness more likely, to buggy development builds featuring a higher risk of photosensitivity triggers, developers who raise concerns about their health while working on games are often basically told to power through it or quit their jobs, a choice nobody should be forced to make.
Seizures are not just a brief inconvenience, they are incredibly dangerous. Motion sickness isn’t just a brief feeling of illness, it can trigger days of exhaustion, brain fog, and intense nausea. Migraines aren’t just “a bad headache”, they can cause so much pain and disorientation they require multiple days of painful recovery, and even longer periods of exhaustion and brain fog. These conditions are serious, particularly once they become chronic and recurrent, and it’s important we treat them as serious threats to counter.
So, what is the solution to this issue of people being made ill while working on games, in roles such as consultancy?
Firstly, as much as possible should be done to research, remove, and reduce potential triggers before consultants are brought in. Bringing in consultants should be a final step, done to check that nothing was missed, rather than a first step to identify easily avoidable issues.
If you could have forseen an issue, you shouldn’t be making a consultant ill for them to find it and tell you about it.
Secondly, we need to be developing more open source tools such as EA’s IRIS to help with automating detection of common triggers that can help further reduce the risk of triggering illness. These tools need to be a priority for research, minimising the amount of triggers that consultants put themselves at risk to identify.
Also, design to be inherently accessible, rather than accessible through settings, where able. Just because someone’s not yet experiencing chronic issues with one of these conditions doesn’t mean you won’t be the trigger for them having a chronic ongoing response. If you rely on settings, players who aren’t yet experiencing chronic issues won’t know to turn on a setting that they need to protect them.
But most importantly, treat motion sickness, migrates, photosensitivity, epilepsy and other similar conditions as being serious. Working to reduce their impact on players, consultants, reviewers, and developers can’t be treated as something nice to offer when you’re able, it needs to be considered a priority. The more we can work to reduce these triggers in games broadly, the less frequently we’ll be asking disabled people to risk ongoing bouts of illness in order to check games for safety.
Later this summer, a piece of EU legislation called the GSPR, or General Product Safety Regulation, will come into effect, and will require all game developers who wish to sell their games in the EU, regardless of where they’re being developed, to reduce and minimise potential risks of harm caused by their software, including preventable and foreseeable risks of triggering the conditions we’ve discussed in this article.
It’s not reasonable to expect every video game to release without any material that could potentially, no matter how small the risk, possibly cause illness in any player, but assessing which risks exist, and if they could be avoided, is going to become legally mandated as time goes on, even outside of its general importance for the health of those impacted.
I would love to see this industry really step up the degree to which they take the risks posed to players, consultants, and developers’ health seriously.
It’s not an exaggeration to say that many of us who love games risk making our long term health outcomes worse when playing games designed without proper thought for avoiding potential illness risks. Making a player feel violently ill while playing might not look like a traditional hard progression barrier, but I think it’s time we started treating it as such.