Monday, August 25, 2008

"Technical Difficulties" - What if the Wii isn't Working?

If the technology that supports the Wii Gaming System is not working, is the OT out of luck? No, but she better be able to quickly figure out another therapeutic activity to substitute in its place.

Last week, a technical difficulty at a facility where I was working brought down the entire cable/TV system, and even after trying to follow the cable company's detailed directions for use, no picture appeared on the screen. Just as we were getting ready for a Wiihab session, we realized we were out of luck.

The patient was in occupational therapy to improve upper body strength along with overall endurance and activity tolerance following a recent hospitalization for an infection. Prior to the recent hospitalization, this particular patient ambulated short distances with a rolling walker while wearing bilateral static ankle supports. Functional transfers from bed to wheelchair and from wheelchair to power rover were independent.

Following hospitalization, this patient required contact guard for all transfers. Dressing and bathing, which were performed with modified independence before hospitalization, required minimal assist to contact guard following the hospitalization. The plan of care was designed to restore the patient to the prior level of independence.

Therapeutic exercises for upper body strengthening, therapeutic activities to increase endurance, balance and standing tolerance, and retraining in energy conservation techniques for self care filled the treatment time. Following a unit of traditional graded upper body exercises, the patient usually participated in several games of Wii Tennis. Prior to the initial injury, tennis was an enjoyable activity for this individual and introducing Wii Tennis into the treatment plan brought new enthusiasm for therapy. Keenness for therapy was assessed by the patient’s insistence on being seen promptly. This eagerness for treatment replaced the past behavior of cancelling appointments or disregarding appointment time.

When the Wii didn’t work, both the therapist and the patient were understandably disappointed. As a substitute for swinging arms through complete range of motion while serving and returning the virtual tennis ball, the patient had to transfer black and orange cones from tabletop to upper shelf and back again. Instead of guarding the patient myself to protect against possible falls as the swing of the remote sent the ball across the net, another person in the clinic had to become involved in the treatment session to either stand along side the patient or to toss the beach ball toward the patient. Though the physical aspects of the activities used as an alternative to the Wii game may have been equivalent, the cognitive and psycho-social aspects seemed far lacking. Even if I could mope or gloat in response to the work, my patient seemed to miss the reaction of the personal avatar painstakingly created during the first Wii session. And though the movements were all completed, I sensed little, if any, push or determination with stacking the cones or batting the beach ball.

“I hope they fix that Wii before my next session”, was all that was said when therapy ended.

I was in complete agreement!

Wednesday, August 20, 2008

Wii for Fun vs. Wii for Therapy - Lessons I Learned

Advance for Occupational Therapists published the “Play it Safe” reproducible hand out in this week’s issue. Welcome to the Advance readers who found this blog through that publication.

Personal experience taught me a few more lessons about "playing it safe" with the Wii. While working out with Wii Fit, I enthusiastically participated in the hula hoop game. To play this game and score the big points, one must twist and shift their hips side to side, while extending their torso to either the left or the right and reaching their arms overhead to catch the flying hoops. The next morning, my low back was stiff and painful. I would have gladly put a sock aide, reacher and/or dressing sick to the test, had one been handy.

Happy 50th Birthday Hula Hoop!
Photo by tonythemisfit on Flickr

To relieve the tightness and pain in my back, I designed a plan of care for myself that included moving, stretching and icing. As we know, moving a bit to warm up is important before stretching, as is icing a bit to cool down after the workout. I found hamstring stretches to be very helpful.

Through this experience, the difference between Wii for fun and Wii for therapy became very clear. When using Wii for therapy, the game must be a part of a plan of care with a goal. The goal may be increased range of motion, increased strength of a weakened extremity, or improved eye-hand co-ordination (to mention a few).

Before using the Wii to work toward one of these goals, the therapist needs to lead the participant through some warm up movements. Following the use of the Wii, the therapist needs to lead the participant through some stretches.

Including upper body stretches in the plan of care not only helps the participant avoid stiffness but also helps increase the therapeutic movement of the targeted area. Furthermore, sandwiching the Wii gaming activity (therapeutic activity) into a therapy session which begins with functional mobility and functional transfer training (warm up) and ends with stretches for a specific area (therapeutic exercise) helps delineate Wii for therapy from simply Wii for fun.