INTERVENTION SCI HARD was designed based on the needs and strengths of individuals with SCI/D while being responsive to identified gaps and challenges in health care provision in this population. Current theories of health behavior and standard practices for game development shaped its development. In particular, we referred to the previously described model proposed by Ritterband et al. for behavior change using internet interventions and prioritized fun and engagement in the design process. The program focuses on enhancing skills, encouraging positive health behaviors and empowering people within their own environments, recognizing that people have different resources and abilities. By teaching skills to better manage health, this self-management program should not only reduce the occurrence of complications but should also promote higher levels of social integration and QOL. In particular, playing the game should allow players to recognize the consequences of their behaviors as actions and inactions are tied to visible results and substantial changes in statistics.