News Updates on Wii Therapy

For Wednesday -- a News roundup on Wiihab and using the Wii in therapy:

'Wiihabilitation' helps patients recover quicker
Dayton Daily News (July 29, 2008)

Senior center adds Wii system
Marshfield Mariner (July 29, 2008)

Nintendo Wii Used For Rehab
KSAT.com, TX (July 28, 2008)

Golden gamers
New Orleans CityBusiness, LA (July 28, 2008)

Foundation Grant Funds "Wii-habilitation" Therapy
Southern Pines Pilot (July 26, 2008)

Bayfront uses Wii for rehab
Tampa Bay's 10, FL (July 25, 2008)

Wii Therapy for Patients with Alzheimer’s Disease

In February 2007, an article appearing in the Journal of the American Geriatrics Society reported that nursing home residents with a diagnosis of Alzheimer’s disease can change the rate of deterioration through exercise. Residents who participate in moderate exercise can experience a significantly slower decline in function than those residents who receive routine care. In this study, individuals in the study group participated in hour long therapy sessions twice a week for 12 months. The therapy program included walking, along with strength, balance and flexibility training. The control group received normal care. This study, which took place in Toulouse, France was lead by Dr. Yves Rolland and measured the effects of the exercise program on individual’s activities of daily living, physical performance nutritional status, behavioral disturbance and depression. This study, which had 134 participants whose average age was 83, showed that individuals in the exercise group improved their activities of daily living scores significantly. Average walking speeds improved significantly in the exercise group also.

The Wii gaming system could be utilized in therapy for Alzheimer's patients with reduced ability to perform activities of daily living. Wii Bowling, Wii Baseball, Wii Tennis and Wii Golf provide a therapeutic opportunity to improve both flexibility and balance. The therapist may also place weights on the patients’ wrists as a means of incorporating strength training into the activity.

Furthermore, Wii encourages reminiscing. Individuals with Alzheimer’s disease experience short term memory loss and often retreat to the past. These past memories often become their reality. Even though hand over hand cueing may be required for successful use of the game with this population, therapeutically playing Wii Bowling, Wii Baseball, Wii Tennis or Wii Golf, may stir memories of pleasant past experiences for these individuals. The therapeutic use of Wii may help reduce anxiety in this population.

Printout: Wii - Play it Safe

Playing the Wii is a great activity for older adults living in retirement communities. These independent elders are excited to find a computer related activity that both contains subject matter familiar to them (Bowling, Baseball, Tennis) and presents new technology in an easy to learn format. The enthusiasm that Wii generates may result in over-indulgence in the activity.

For maximum enjoyment, suggestions for the safe use of the Wii Gaming System should be posted in an obvious spot near where the game is set up for casual use. Below is a Safety Tip Sheet from The Wii OT, Mershon W. Hinkel, MSPH, OTR/L, that may be copied and placed either in a free-standing frame on the table top, or on the wall where the Wii is being used.

Wii PLAY IT SAFE

Wii is a great activity for all ages. By using a wireless remote, Wii has taken "playing" video games off the couch. Wii games are a physical activity, a social activity, and a wonderful way to interact with younger generations.

For an enjoyable, safe, and healthy time playing the Wii, follow the guidelines below:

1. Always use the included Wii wrist strap and the Wii remote safety jacket. The wrist strap prevents accidentally dropping or throwing the remote, and the jacket gives the remote a softer and less slippery surface.

2. Don't overdo it, especially when you're first starting out. Like with playing any new game or sport, you may find yourself using muscles you don't usually use, and these muscles may become strained or sore. Stretching before playing and using ice to relieve any soreness after playing can protect muscles and tendons from injury.

3. If you are concerned about your ability to balance, many of the Wii games can be played sitting down. You may also wish to use a form of support for extra safety to avoid falling.

4. Be sure the playing area is clear of potential obstacles that may get in the way of your arms or legs when playing. Be sure you are not too close to other players or observers.

5. If you have a condition such as epilepsy, are prone to motion sickness, or have a pacemaker, you may want to discuss using Wii and other video games with your health care provider prior to playing.

6. To avoid the spread of germs, wipe the remote's surface with a sanitizing wipe. Players may also want to use hand sanitizing gels between turns.

Safety Tips for Wiihab Therapy

Maintaining a safe environment for patients during therapy is always important. A good therapist should pay attention to and avoid potential risks. For example, therapists should think about fall prevention, infection control, and injury prevention in conjunction with any modality they choose to use, including Wii. Avoiding injury to other people (or damage to furniture, belongings, or equipment) is also important.

Fall Prevention and Wii

Many Wii games can be played from a seated position. However, sometimes the goals of therapy include getting a patient to stand and balance. For a patient whose balance may be in question, the therapist may wish to use a gait belt. Another option would be to use parallel bars for support or for safety, or using a walker with therapist at the side. For example, while the Wii balance board is very sensitive to shifts in weight, it can still be effectively used to train balance while the user relies partly on upper-body strength to support the lower body.

When using the balance board, be sure it is not on a slippery surface and that other people will not trip over it. The balance board is white and may be difficult to see on a white or light colored floor, especially for patients with low vision. This potential risk can be mitigated by placing the balance board on top of a non-stick mat, such as a yoga mat, in a darker color. For patients at risk for falls, Wii use that involves standing should always be supervised.

Infection control and Wii

If the Wii equipment is shared in a clinic setting, it must be appropriately cleaned between uses to prevent potential transfer of any pathogens (germs).

To fully clean the remote, the protective safety jacket should be removed from the remote. The jacket can be immersed for cleaning, but the remote can NOT be immersed. The remote itself should be wiped with disinfectant solution readily available in the clinic (use the same wiping method as for similar plastic items). The Wii remote strap can be removed and washed as well. (See the photo below of a Wii remote with safety jacket and with jacket removed.)


Photo by frostova on Flickr

Also, users can wear latex gloves while handling the remote for extra precaution.

Injury Prevention and Wii

Therapists incorporating Wii into a therapeutic plan should use the same strategies that they would use if a person had started a new sport. For example, if the patient has been bothered by a wrist or elbow in the past, the therapist may consider using ice and monitoring a patient to prevent overuse. Because of the "fun" element involved in Wii, overuse may be of particular concern. Also, therapists should make sure all movements are being done correctly and that patients do not compensate for a weak muscle with a stronger muscle group.

Avoiding injury to others or damage to equipment with the Wii

In the early days of the Wii, anecdotes of Wii bowlers accidentally throwing the Wii remote through a television screen abounded. The Wii remote's safety strap and safety instructions given at the start of each Wii session and game, as well as the new safety jacket, should help prevent this type of damage (or injury that could result if the remote hit another person).

Always clear the area of potential hazards or obstructions before using the Wii, make sure he safety strap is secured to the player's wrist, and use the padded secure-grip safety jacket on the remote (see the photo above of the remote with and without the safety jacket). Also, follow all safety precautions given by the Wii software.

Robert Wood Johnson funds video game health research

Robert Wood Johnson foundation has devoted more than $8 million to fund Health Games Research, a research group dedicated to discovering more about how video games can be used to improve health. The goals of the program are to support research that either increases physical activity or improves self-care (the activities involved in taking care of oneself).

This research funding is a wonderful step towards developing an evidence-base that supports use of video games as therapeutic activities. Many of the movements involved in playing the Wii or other interactive video games are already based on evidence and research that certain tasks improve balance, strength, coordination, and self-care abilities. Continuing to conduct research in this area will yield even more information about how providers can implement the use of video games in their practices and bring this technology to a wide variety of patients.

ABC News in Chicago reports on using the Wii in therapy

Check out this news report from Chicago on using the Wii in therapy. The article mentions the utility of Wii as a therapeutic modality for both adults and children. A therapist in the article discusses added benefits of using the Wii, such as the multigenerational interaction that takes place when children play the Wii with a therapist or parent.

Guitar Hero for Wii and fine motor control

William Randolph Hearst Burn Center at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City is using the Wii as part of therapy for burn victims. Many patients recovering from burns have skin grafts, and flexing, stretching, and moving the skin is an important part of therapy.

Guitar Hero uses a wireless guitar-shaped controller. The player "strums" a bar-shaped button on the body of the "guitar" and presses buttons on the neck of the "guitar" to select notes while following along with songs on the monitor. The game requires finger dexterity, and it has different modes and levels so that people can progress to more difficult movements. Playing games such as Guitar Hero that require movement of the fingers can help patients regain fine motor skills in the hands and also improve coordination. For patients with skin grafts on the hands or arms, the game can help them practice moving and stretching the skin as it heals.

Video: Wiihab for surgical patients

Today on CNET -- a video that includes using Wiihab for surgical patients. Physicians at St. Mary's Medical Center started a Wiihab program in the beginning of 2008, and they are prescribing time on the Wii using Wii Fit. Therapists there have found that patients benefit the most from the Wii Fit games using the balance board. (The part about Wiihab comes towards the end of the segment.)

• Taking virtual bullets and Wiihab
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• CNET.co.uk videos

Using Mario Kart in Wiihab (Part 1 of 6)

Have you thought about using Mario Kart in therapy but are wondering what goals it can help your patients reach? This post is the first in a series of six on areas that Mario Kart can target for improvement as part of a rehab plan. Many of the areas that will be described in this series are important in conditions including pervasive developmental disorders and sensory integration dysfunction.


Photo by SMercury98 on Flickr

Post 1: Bilateral Coordination

Bilateral coordination is the coordinated use of both sides of the body at the same time, either in similar movements or in alternating movements. An example of a similar movement is using both hands to pick up an object or using both hands to throw a beach ball; an example of alternating movement is walking up the stairs or pedaling with the feet or the hands.

In Mario Kart Wii, players insert the regular Wii remote, which is rectangular in shape, into a wheel-shaped adapter. Because the wheel Wii controller is held and controlled with both hands, bilateral coordination is involved in playing the game.

Also, effective playing of the game can involve alternating movements, such as holding down the "2" button to speed up the kart while using the "b" button on the reverse of the controller to "drift" while in manual mode. (Manual mode is optional, and less advanced patients can play in automatic mode.)

Nurses in NY using Wii to complement rehabilitation therapy

A hospital in New York has been using the Wii as part of therapy for more than nine months. As the article reports. Candy Perotti, a COTA from St. Francis hospital in Poughkeepsie had this to say:

"The Wii system has been an asset to our rehab unit...The system encourages patients to perform the actual movements of the sport. Driving games help patients with visual tracking and scanning. Bowling, tennis, and baseball improve hand/eye coordination."

(As a note, the driving game mentioned is likely Mario Kart -- if you're not familiar with the game, it is a driving game that allows the player to attach the regular Wii remote to a driving wheel-shaped remote.)


Photo by Michael T. Gilbert on Flickr

The article also mentions that using the Wii can help improve memory skills, as the patient has to remember the motions and steps involved in using each particular game. The social aspects of playing Wii with others can also help aid in patients' feelings of loneliness or isolation.

News reports of Wii use in pediatric therapy

Using the Wii as part of therapy can work for all age groups. Children especially enjoy video games and have grown up as "digital natives" who are fluent in the use of computers and technology, and so using the Wii as a component of OT/PT in pediatrics makes sense.

This story from Texas reports on how therapists are using Wii games to help children not only gain strength and flexibility, but also improve coordination. As in many cases, the games chosen are tailored to patients' needs, such as Bowling and Boxing for arm strength and coordination.

Wiihab might be particularly useful for children because it removes the boredom factor from therapy. Using the Wii is also a distraction technique, reduces anxiety, and incorporates play into therapy.

For OTs, using the Wii with pediatric patients can be an especially important component of a well-rounded therapy program because playing is part of a child's "occupation." Additionally, because the Wii is a popular toy for younger age groups, learning how to use the Wii may help a child with social interaction and playing with peers. Playing Wii also is an opportunity for children to interact with parents and adults in a way that has therapeutic value.

Pediatric centers in UK using Wii for children with hemiplegic cerebral palsy

In Newcastle, England, a professor at Newcastle University's Institute of Neuroscience has opened a research study in using video games, including the Wii, as a rehab tool for children with hemiplegic cerebral palsy. Hemiplegia affects one side of the body, and children diagnosed with this disability often neglect the disabled arm and leg. The study is using Wii controllers and laptops with specially designed games to encourage children to use their disabled arm. These adapted games have a lower level of complexity and a lower speed than those commercially available; the study has tested two games and a third will be added.

The principal researcher, Professor Janet Eyre, has noted improvements in the children's use of the less frequently used limb as well as improvements in coordination and social interaction:

"What has been striking to us, and the parents and children, is that by playing the games the children are using their [disabled] arm more in everyday life. We're trying to give them an incentive so that they will use it a lot."

She also notes the social value of using games, which are an integral part of childhood, to de-stigmatize therapy for children and families:

"Children sometimes feel stigmatised by therapy but everyone plays games, and they can play them with their parents or their brothers and sisters."

Therapy may hold a stigma even for adults; using the Wii and other video game / interactive tools may be of use even with older patients who resist therapy or who are unlikely to adhere to recommended courses of therapeutic treatment.

I Haz Wiihab?

Just a funny Friday post based on a photo found on Flickr. Apparently, even cats like the Wii Fit Balance Board.


Photo by Tscherno at Flickr