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The frontal lobes of the brain can be damaged by traumatic injuries; they can be damaged by substance abuse; they can be damaged by strokes. If the brain can be considered an orchestra, Tempest explained, then the frontal lobes act like the conductor. When her patients play the video poker machines, they are retraining that conductor. What were really looking to improve with the games are executive-functioning skills, she said. The things we are really addressing with that are attention, mental flexibility, self-regulation and working memory. Because the patients are playing video poker, she explained, they have to be able to retain information and then manipulate it in ways that can help them win. They also have to make different decisions based on the information, and they also get to relearn impulse control. They get to think about if its worth placing another bet, Tempest said. Should they see if they can get a full house or is it better to stay with a pair of kings? And while video poker is certainly not the most physically demanding activity, it can also help patients with significant mobility issues. Sometimes well have patients stand and play the video poker machines to work on standing tolerance, said Sandy McGinnis, one of the hospitals occupational therapists. We can also have them put wrist weights on, and theyre playing for a whole 15 minutes (a session). It can get you tired after doing it for 15 minutes. A bonus?

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There were slot attendants in just about all the aisles. They would often tell players which machines they thought would be hot (these pieces of advice had no validity except to get them tips should the machines they pointed out gushed forth coins) and the slot attendants were there to give players change if the players needed it. When big jackpots were hit, they came over to cheer and handle the crowds and maybe get that tip. Today, the slot attendant has almost gone the way of the dinosaur. It is rare to see them as you play. Kiosks now exist for getting and receiving credit slips. There are even some separate cages for slot players. No ones hands need to get dirty anymore. Slot play is now clean play. In the old days the sounds of the slots were loud and seemingly unregulated; over here a hit, over there a hit. You could hear music and machines dumping loads of coins into trays.

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