WiiHab - Rehabilitative Therapy Using the Wii by the "Wii OT"

For Therapy: Is Nintendo Wii Fit Always a Good Choice?

2011-10-27T06:10:00.000-04:00

Nintendo first introduced the Wii gaming console into the US market in 2007. A few savvy therapists recognized the potential of Wii games for therapy rather quickly. Research into the effectiveness of Wii activities began soon after the Wii was introduced and one of the first published projects demonstrated the effectiveness of Wii activities in improving balance and other measures in a adolescent with cerebral palsy. Over the next few years, many other pilot studies, along with research conducted on a larger scale produced outcomes indicating that Wii activities can improve outcomes in several patient populations.
In the most recent issue of BMC Geriatrics, Kate Laver, Julie Ratcliffe, Stacey George, Leonie Burgess, and Maria Crotty present the findings of their research.
Is the Nintendo Wii Fit really acceptable to older people?: A discrete choice experiment found in
BMC Geriatrics 2011, 11:64 (20 October 2011) finds that for hospitalized older people Wii Fit activities may not be the best choice. This study indicates that some hospitalized older adults prefer traditional therapy to Nintendo Wii Fit activities for rehab.
The researchers hypothesized that the older adults would have a more positive view of the use of Wii Fit in therapy following exposure to use. The research outcome did not support that hypothesis, finding instead that this particular study group(n=18) indicated a preference for traditional therapy approaches to Wii Fit activities. The participants often cited as a reason that they thought more traditional approaches were more effective. The participants engaged in Wii fit activities for 25 minutes a day, 5 days a week, averaging 6 sessions.
The authors of this study present a thorough review of their work, including areas of potential future research brought to mind by this study.
This study produced findings that were not in sync with the popular presentation of Wii and Wii fit activities in therapy. In my own practice, I choose to use Nintendo Wii activities in conjunction with traditional approaches. I find with older adults, especially if they have cognitive impairments or signs of depression, Wii activities are less readily accepted. In the above mentioned study, each participant took the Mini Mental State Examination(MMSE) and scored greater than or equal to 21/30, ruling out cognitive impairment. In future studies aimed at determining acceptability of Nintendo Wii activities in therapy, including a depression scale measurement may provide additional insight into willingness to accept new approaches over more traditional therapeutic methodologies in this population.

Nintendo Wii Boxing Tournament Highlights Benefits of Therapy

2011-10-15T08:46:00.009-04:00

October is National Physical Therapy Month. The staff at Shriners Hospitals for Children in Greenville devised an activity to illustrate several therapeutic attributes of Nintendo Wii based treatments. The PT department at this nationally recognized hospital started a boxing tournament designed to illustrate how the Wii gaming system can be used to help young patients develop strength, improve motion and boost quality of life in an engaging way. The PTs are also providing insight to the participants as to how therapists can grade an activity to foster success for those with less function or challenge those with increasing ability.

The benefits of using Wii in occupational, physical and speech therapy seem limited only by the knowledge and creativity of the therapist designing the plan of care. Would you like to improve your level of expertise in using Nintendo Wii in your therapeutic setting? Contact Mershon W. Hinkel at the email address on this blog's profile page to find out about an opportunity to gain experience using the Wii in therapy by attending the workshop,entitled WiiHab: Using Nintendo wii in a Therapeutic Setting.

Notre Dame researchers create program for Wii use in therapy

2011-08-15T08:11:00.003-04:00

One of the first aspects of Wii Fit that attracted therapists to its unique design was the balance test. The balance test indicates how equally - or not- the participant distributes their weight through their lower extremities when the individual stands on the board. Occupational and physical therapists found this feature helpful for many patient populations, helping bring an innovative change into therapy using Wii. This blog mentioned the center of gravity aspect and one of the therapeutic indications in a post dated September 5, 2008.
Now a team of students have created software to expand this therapeutic feature -WiiHab feature - into a more user friendly format. Individuals recovering from a stroke utilize the center of balance indication to improve dynamic balance and gait. These students hope to market this program to rehab centers for both clinic and eventual home use. Watch the interview with the design team to understand more fully what their product hopes to address.

Nintendo Wii offers Opportunities for Occupational and Physical Therapy

2011-06-12T09:17:00.000-04:00

Nintendo Wii offers limitless opportunities for treatment in both occupational and physical therapy. No matter where along the age spectrum your patient population falls, something offered with the Nintendo Wii system can benefit your case load. Two articles in the news today highlight Wii-Hab or ways Wii might be used as a part of occupational and physical therapy.
In the first news article out of Leeds, England, one reads about a new bedside entertainment system for hospitalized Children. This news piece points out that playing games on a Wii system not only reduces anxiety about treatment but also encourages movement.
The second article about patients at Vanderbilt Children's Hospital features a video that focuses on key aspects of Wii-Hab. Watch the video to see and hear both a mother and a physician explain some of the benefits Wii brings during occupational and physical therapy for a child diagnosed with autism. A couple of benefits discussed include improving muscle tone and encouraging physical engagement with the environment.

New Hardware For Wii - Will it enhance Therapy?

2011-06-10T00:09:00.001-04:00

Check out this trailer for the new controller Nintendo hopes to launch in 2012. What are your thoughts on therapeutic value and/or possibilities for clinical application?
Will this device require the participant to be at a higher level? Looks like one needs both hands to make it work. Take a look and post a comment.

Rice University Students Modify Wii for use in Therapy

2011-04-13T09:24:00.003-04:00

Creative students from Rice University in Houston, Texas developed a Wii-Hab system to help patients during therapy at Shriner's Hospital. This new use of Wii in therapy, based on Wii balance board technology, helps improve balance and decrease dependence on balance aides. Team Equiliberator worked together to develop a system that proves to be relatively inexpensive, yet effective in encouraging participants to work toward improvements. These balance gains occur as the players enjoy age appropriate fun. Watch the video and read the article to learn how these students used Wii balance boards along with their own newly developed hand rail sensor system to create a Wii based therapy activity that also produces data for quantifying changes (improvements) in balance.

Wii Use for Therapy After Stroke

2011-04-08T07:52:00.008-04:00

A study lead by Dr. Gustavo Saposnik, director of Stroke Outcomes Research Unit, St. Michael Hospital’s (Toronto) , shows the value of Wii activities for individuals in therapy following a stroke. WiiHab - Rehabilitative Therapy Using The Wii by "THE WII OT" previously brought this study to readers' attention in February of 2010.
Recovering from a stroke requires a long process involving repetitive actions in order to provide the brain an opportunity to "rewire". For most stroke patients, who may naturally suffer depression following the loss of function, this requirement of repetitive, long-term therapy falls by the wayside. Wii offers this population a way to expand the benefits of occupational and physical therapy into the home setting, reaping improved outcomes while discovering a new, motivating use for leisure time.

Wii -Like Therapy Even before Wii hit the Market

2011-03-15T20:07:00.001-04:00

In 2006, NeuroGym Technologies introduced a training system for use in rehab called the NeuroGym Trainer. This computer based technology offered therapists a way to provide rehab patients with visual and auditory feedback. A therapist could use this system to help patients learn to shift their weight, to help strengthen a targeted muscle group, or to help improve coordination. This system utilized sensor pads and a video game format. Many goals mentioned in the NeuroGym Trainer video can be addressed using Wii Fit and/or other Wii applications. Watch the video. How do you think you could Wii activities in similar ways? Do you have patients on your case load with goals that could be addressed with Wii activities? The patients would have more fun!
I have a client who hopes to move from the skilled care unit to the personal care unit. This client needs to dress and undress the upper and lower body with set-up only in a reasonable amount of time each day. Standing tolerance as well as dynamic balance must improve before that functional goal can be obtained. Playing "Fishing" (Wii Play) while standing requires dynamic balance while building endurance. This game will also require problem solving and visual discrimination. Honing those skills will also help this client dress in a timely fashion. I plan to get this OT client Wii fishing during the next therapy session and meet that functional goal in two weeks with the help of Wii-Hab.

Wii-Hab - Utilizing Wii Fit and Other Wii Programs in Therapy

2011-03-05T08:34:00.000-05:00

The utilization of activities offered through Nintendo Wii continues to gain popularity with rehab therapists working with multiple populations. Just recently, an article from the Boston Herald appeared online in Therapy Times highlighting the improvement a young girl experienced following therapy for a traumatic brain injury. Not so long ago, an article about Rep. Gifford's rehab mentioned Nintendo Wii as a likely adjunct to traditional therapy.
Often my readers write and ask how Wii activities might be useful for their loved one.

Addressing specific cases would be difficult through an online platform such as this blog. So mostly, it is suggested that those looking for a therapist use care in selecting the setting for their particular situation. On MASTERSDEGREE.COM the writer provides a list of 15 questions to help those looking for a therapist of any type know what questions to ask before signing up. In the rehab setting, the opportunity to hand pick the therapist is rarely available. But usually rehab therapists, OTs especially, use a client-centered approach, assuring that the plan of care targets the individual's needs and learning style. If the therapist is familiar and comfortable with technology and Wii equipment is available, a high likelihood exists for including Wii activities since so many therapeutic objectives (as mentioned throughout this blog) can be addressed in an engaging way.
If your facility has either not embraced Wii technology yet or has put Wii away on a shelf, contact me at OTRMershon@gmail.com. I will work with your facility mangers to bring a Wii-Hab Workforce Training Session geared toward your specific population to your location.

Wii Fit - Therapy for Fall Prevention - WiiHab

2011-01-11T21:21:00.004-05:00

The Saturday Evening Post online published a piece by Peter Perry about the potential of Wii Fit for improving balance. Take a moment to read about the research Kathleen Bieryla of Bucknell University has completed. Kathleen, an assistant professor of biomedical engineering, focused on improving clinical measures of balance in older adults by using activities in Wii Fit.
In the same Saturday Evening Post piece, Bryce Taylor, MSPT explains three of his trademark Wii-Hab therapeutic exercises using Wii Fit to improve back health and increase core muscle strength.

"Wii Therapy" in Detroit

2010-12-05T10:37:00.003-05:00

Watching this video explains some of the benefits from the perspective of the patients using Wii in therapy. If a patient finds the therapy engaging they will be more involved. Hopefully then, the patients will push harder toward the goal and remain adherent to the plan of care. In this video, you will also hear the OT, PT and speech therapist explain why they find Wii-Hab to be such a useful tool to use in this setting.

Wii - Therapy in the broadest sense

2010-12-04T10:24:00.004-05:00

In the UK like elsewhere, senior health and wellness are serious concerns. One administrator of a senior housing center developed an unique program for the residents to enjoy.

Prospective OT student writes about Wii As A Therapy Tool

2010-11-17T07:45:00.002-05:00

Whitney Kramer, a student at Michigan State University used Wii technology in a classroom and recognized many aspects of Wii that she plans to later use as a therapist. Follow the link to read what she observed.

CEP 452 - Technology and Education: Wii As A Therapy Tool: "I know this class is primarily about technology and its uses in the classroom, but as a kinesiology major myself, I tend to look at t..."

Wii Related Therapy Benefits Highlighted in Research

2010-11-15T11:22:00.009-05:00

Researchers with the department of Occupational Therapy at Kaohsiung Medical University in Taiwan have an article in press entitled Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome.
Children with Down syndrome (DS) between the ages of 7 and 12 were randomly assigned to one of three groups: standard OT interventions (SOT), VR using Wii technology interventions (VRWii) or the control group. Sensori motor functions were the targeted outcome measures and were assessed pre and post intervention using The Bruininks–Oseretsky Test of Motor Proficiency-Second Edition(BOT-2)(Bruininks &Bruininks,2005), The Developmental Test of Visual Motor Integration(VMI)(Beery, 1997), and The Test of Sensory Integration Function (TSIF)(Lin, 2004). Activities offered through Wii Sports were chosen for the VRWii intervention group. The results of this study indicated that the group of DS subjects who received Wii therapy demonstrated statistically significant improvement in motor proficiency, visual-integrative abilities and sensory integrative functions as compared to the SOT and control groups.
Evidence continues to mount in support of Wii-hab for improved outcomes in many populations. In this study as well as in the study published in October of 2008 by Judith E Deutsch, Megan Borbely, Jenny Filler, Karen Huhn and Phyllis Guarrera-Bowlby the authors comment on the intrinsic values of Wii technology including engagement, encouragement and feedback. Furthermore, Wii provides an opportunity for atypical children to interact with peers both with or without similar disabilities.

Wii Add-on May Enhance Use of Wii in Therapy

2010-10-12T23:47:00.005-04:00

(Image from: http://seattletimes.nwsource.com/html/technologybrierdudleysblog/2009290380_e3_nintendo_previews_next_wii.html)

Nintendo announced last year a plan to market an add-on called a Wii Vitality Sensor.
Many OTs and PTs will think this add-on looks like a tool often used in the clinic. The Wii vitality Sensor looks and works like the familiar pulse-ox device often used to measure pulse and oxygen concentration in a client's blood. Now Nintendo plans to use that data to provide feedback to players and to control actions of a player's avatar.
Like the balance board, this new add-on will expand the therapeutic value of Wii activities while making recording improvements much easier during therapy.

OT includes Nintendo Wii in "Playroom" Based Therapy

2010-09-18T12:01:00.006-04:00

Children who perceive sensory input differently than their peers, often struggle at home and at school. These kids face difficulties in day to day life, struggling not only with self care activities like with dressing and feeding, but also with classroom tasks such as attending to classwork, manipulating pencils and paper and absorbing instructions. Lindsey Stamper, an occupational therapist in Paducah, Kentucky works with many kids with neurological impairments, helping them to "slowly expand their capabilities." She provides this help in a SENSORY PLAYROOM.
Using balance balls, swings, a padded floor and Nintendo Wii & balance board activities Lindsey helps kids improve their ability to process sensory input and to engage in activities of daily living with less difficulty.
An approach utilizing sensory integration techniques proves successful in mitigating problems in children who experience neurological processing deficits. Many Wii applications either independently or in conjunction with other sensory diet components enrich a child's sensory experience while helping the child reach processing goals. The Wii, an increasingly familiar video gaming system, contributes therapeutic opportunities to address proprioceptive, vestibular, tactile, auditory and visual needs in a non-threatening and fun fashion.
Are you a parent or therapist interested in sensory processing disorders and in helping kids who deal with the resulting problems? Please post a comment and start a discussion. How do you think activities using Nintendo Wii games -"wii-hab" - can help a child you know?

Special Wii Software designed for Therapy

2010-09-15T12:55:00.007-04:00

Kaasa Health GmbH of Düsseldorf has developed software - Wiiware- specifically for use in a clinical setting. This program focuses on balance training making that often boring and monotonous work fun. Building on the fact that the balance board is a force plate capable of extracting data about one's center of balance and ability to shift weight, this specifically designed game environment helps those with balance issues improve. Since balance ability influences fall risk in seniors, playing this video game might be a key component in reducing the occurrence of falls and the associated physical, emotional and monetary costs in elders. Using Wii Fit in therapy was shown to improve balance and ability to walk with a walker when a group of therapists added 4 sessions of Wiihab to a regular therapy program. Now, with the development of specific software program for rehab, more therapists may begin to incorporate Wii into the clinical setting.

Special Wii Software designed for Therapy

2010-09-15T12:55:00.006-04:00

Wii in Therapy: Additional chances to Enhance Your Skills

2010-09-09T07:43:00.000-04:00

Fall 2010 brings opportunities to learn about Wii modifications as well as to brainstorm with other therapists about creative uses for Wii. Join colleagues for "Wii-Hab: Using Nintendo Wii in a Therapeutic Setting."
Due to demand, Easter Seals Capper Foundation- Topeka, Kansas, added an additional workshop date. Now you can sign up to attend the added session on Friday, September 24.

September 24, 2010 - Easter Seals Capper Foundation, Topeka, Kansas

October 16, 2010 - Penn State Abington Campus - Philadelphia, Pennsylvania

October 29, 2010 - Allegany College of Maryland - Cumberland, Maryland

After attending the workshop therapists will return to their work setting with new ideas about Wii. Be the therapist who knows how to take Wii beyond bowling toward challenging therapeutic activities to improve outcomes in many settings!

Novel Use of Wii Fit Data may have Implications for Therapy

2010-09-01T08:53:00.006-04:00

University of Maryland, working with several other Universities, plans to use Wii Fit data generated by an athlete when healthy as a baseline measure of balance ability. These recorded scores would then be available in the event that the athlete suffered a concussion during play.

Although therapists rarely have specific information about a person's baseline status, aspects of this novel application suggest ways that Wii could be utilized in therapy.
Researchers working on this study point to Wii Fit's "objective and practical" qualities which allow trainers to gather data post injury in a client friendly way. Athletes report enjoying activities using Wii Fit.

The enjoyment factor comes as no surprise to therapists who use Wii technology in their practice. Clients of all ages seem willing to engage in Wii therapeutic activities. Though true baseline data for our clients may not be available for comparison, data gathered early in treatment will provide objective scores, that when compared to later records will support not only increases in performance components, but also improvements in activity engagement.

Wii - For Seniors - Benefits identified

2010-08-29T15:18:00.005-04:00

At the 2010 annual meeting of the American College of Sports Medicine held in Baltimore, MD in June, Elizabeth Orsega-Smith, Ph.D presented a poster highlighting the results from her study exploring the many benefits of playing Nintendo Wii for Seniors. The pilot study, led by Dr. Orsega-Smith, an associate professor in the department of health, nutrition, and exercise sciences at the University of Delaware, Newark focused on the value of Wii as a way to help seniors burn more calories and become more active. Dr. Orsega-Smith reports that in addition to physical activity levels, other measurable variables include "psychosocial levels, self-esteem, social support, and quality of life,”

According to Dr. Orsega-Smith, this pilot study is only the beginning. These researchers hope to expand the study, incorporating functional measures such as "Timed Get Up and Go Test" as well as the "Berg Balance Test".

For occupational and physical therapists, the results of this study should encourage the use of Wii in therapy in the geriatric setting. Since sedentary lifestyle is a major risk factor for falls, increasing activity and feelings of well being in the Senior population may help reduce overall health care costs through a reduction in fall risk.

Watch: Wii Used for Therapy...Wii-Hab

2010-07-30T07:33:00.004-04:00

Madonna rehab released a video showing therapists working with a few patients with brain injury using Wii in therapy.
The cation below the video reads:
"Madonna Rehabilitation Hospital features the Wii and similar games as part of its CARF accredited brain injury program. In conjunction with other rehabilitation methods, the Wii games help improve balance, coordination, visual and motor skills. In addition, the games help "re-wire" the brain as patients with brain injury improve cognitive skills involved with problem solving, following directions and social interaction."

Wii in Therapy: Enhance Your Skills

2010-07-26T08:38:00.000-04:00

Fall 2010 brings opportunities to stretch your imagination by learning about modifications as well as brainstorming with other therapists about creative uses for Wii. Join colleagues for "Wii-Hab: Using Nintendo Wii in a Therapeutic Setting."

September 23, 2010 - Easter Seals Capper Foundation, Topeka, Kansas

October 16, 2010 - Penn State Abington Campus - Philadelphia, Pennsylvania

October 29, 2010 - Allegany College of Maryland - Cumberland, Maryland

After attending the workshop therapists will return to their work setting with new ideas about Wii. Be the therapist who knows how to take Wii beyond bowling toward challenging therapeutic activities to improve outcomes in many settings!

WiiHab - Therapy Blog listed in "Top 50 Occupational Therapy Blogs."

2010-07-22T08:03:00.008-04:00

Readers may like to know that WiiHab- Rehabilitative Therapy using the Wii by the "Wii OT made the list of the "Top 50 Occupational Therapy Blogs." (To view this list, click July 2010 under Blogs in the left-hand margin.)
Wiihabilitation, a site out of England posted a headline recently: Wiihabilitation increases participation in therapy. This headline refers to a work published in VIRTUAL REHABILITATION in August of 2008 by Ramchandani, A. Carroll, K. Buenaventura, R. Douglas, J. and Justin Liu from Stanford Univ., Stanford, CA.
Options for using Wii in therapy abound. Adaptations make Wii useful and engaging across patient populations, limited only by the imagination of the therapist.

Wii-hab therapy for people recovering from brain injury -

2010-07-08T13:47:00.006-04:00

A professor of adaptive physical education at Skyline College in San Bruno, CA, explains how he uses Wii activities to help clients who continue to struggle with physical and cognitive issues long after the initial brain injury. Chip Chapman describes his work with individuals who may have had extensive therapy in a medical setting earlier, but are seeking help for residual disability in an adaptive physical educational setting now. Professor Chapman speaks about the importance of repetition and consistency with this population. The value of using Wii activities with individuals who have cognitive and physical deficits from brain injury has been documented in the literature. In October of 2008 an article was published in Physical Therapy by J. Deutsch et al which highlighted the value of incorporating Wii activities into a rehab program for an adolescent with cerebral palsy. The child participated in activity for 60 - 90 minutes during 11 different sessions.
Wii brings fun into the rehabilitation process. Fun and engaging activities help make the repetitive work of rehab more enjoyable.

Kansas Optometrists Present Poster on "The Use of the Nintendo Wii Balance Board with the Head Injury Population"

2010-07-02T08:02:00.005-04:00

At the recent 6th International Congress of Behavioral Optometry, Dr. Joseph B. Sullivan along with Dr. Julie A. Toon presented a poster detailing their use of the Wii Fit balance programs for adults with head injury.
These optometrists utilize Wii fit balance activities to help address residual visual disturbances affecting balance and spatial awareness including convergence issues, oculomotor problems, and visual field deficits. The presenters also explain that other problems including "muscle paresis, decreased reaction time, reduced stamina and decreased attention span" contribute to the difficulties adults with brain injury experience during recovery.
These optometrists illustrate their use of Wii activities to help adults with brain injury improve the integration of the visual and vestibular systems. These gains are documented on a spreadsheet which allows the doctors to quickly assess changes in BMI, balance percent by side, body test results, Wii Fit age, and performance on activity procedures.
Take a moment to look at this poster. Medical uses of virtual reality continue to increase as improved outcomes using tools available through Wii Sports and Wii Fit are documented. Wiihab proves itself to be versatile, affordable and fun. How have you utilized Wii therapy lately? Post your experiences in the comment section!

NASCAR INTERSECTS WII THERAPY (WIIHAB) as KYLE PETTY, Racing's Renaissance Man, meets the "Wii" OT

2010-07-01T10:00:00.001-04:00

Sometimes unexpected opportunity and inspiration find you. On a recent Tuesday evening in Williamsburg, Va. I met someone who offers both to anyone willing to make the investment. Kyle Petty, known to many through ever popular NASCAR racing, spoke to the attendees of the Electrical Utility Fleet Managers Conference. His engaging speech explained his family's role in building the sport of auto racing. First, he told of his Grandfather, Lee, who was drawn to racing as a way to provide for his family. Next, through engaging stories, he introduced the listers to his now famous father, Richard. Richard loved the sport and drove for the thrill. Kyle explained that he, personally, also loved the thrill of racing like his father. Both Kyle and his wife were excited that their son Adam dreamed of carrying on the Petty racing legacy. Shock and sadness swept over every listener as Mr. Petty explained how that dream would not be realized. As he continued, Mr. Petty transformed our shock and sadness into admiration and hope as we learned how this amazing family turned tragedy into a vision and then into the reality of helping kids with special needs as a way to honor the life and dreams of their son, Adam.
Victory Junction, a camp for kids with chronic medical conditions and serious illnesses operates near Randleman, NC. Since opening in 2004, over 11,000 children and families have been served by programs designed especially for them. Many different populations are served over the summer as well as throughout the year. One aspect that makes this camp so special is that each week is dedicated to a specific diagnosis category, such as autism, cerebral palsy, and burns, among others. Mr. Petty explained the importance of this model. By bringing individuals who struggle with similar problems together, they learn that they are not alone. As therapists, we recognize that grouping in this manner enhances opportunity for peer modeling and social support.
Hopefully, everyone who reads this blog post will consider becoming involved at some level with this great organization. Occupational and physical therapist and students could volunteer as cabin counselors or in another capacity. Your expertise would be appreciated and you would learn so much. Students considering applying for occupational or physical therapy school could also spend a week with the campers and gain valuable experience while giving back so much. Parents looking for something special for their child may find that this camp would provide the care and respite they seek. I plan to contact Victory Junction about volunteering myself. I want to work with these special kids in the fresh air while they involve themselves in real world golfing, bowling, swimming, driving and fishing ... all the things that in the school setting we are luckily able to do in the virtual world through Wii Therapy.

Wii Therapy - For War Vets and Burn Victims

2010-03-28T15:38:00.007-04:00

On Saturday, March 27, 2010, over 30 therapists attended Stockton College's Seminar: Wii-Hab - Using Nintendo Wii in a Therapeutic Setting. Everyone who participated went away with new ideas for their setting.
One participant asked a great question about configuring the Wii Fit balance board for amputees. The questioning therapist wondered if the Wii Fit balance board would configure properly if the one on the board wore a prosthesis. The answer was yes, since the balance board responds to pressure applied it.
Many war veterans must learn to walk again using prosthetic limbs and games offered using Wii Fit help speed their recovery. A fellow soldier and his wife are working hard to help wounded vets gain access to this valuable tool. According to an article appearing online at www.wtop.com, "Air Force Staff Sargent David Flowers and his wife founded Wii's for Warriors, a group that gives away free Nintendo Wii Fit to amputees at Walter Reed."
Seminar attendees also learned about the value of games like the ones available through Wii applications for burn victims. At a hospital in New York City, a study is underway to assess if burn victims improve more quickly using a Nintendo Wii game in therapy or traditional cooking activities.

Easy Reference Chart: Use of Nintendo Wii in Occupational Therapy

2010-03-21T09:52:00.004-04:00

In October 2008 ADVANCE FOR OCCUPATIONAL THERAPY published a chart highlighting Use of Wii Sports games for various therapy uses. I developed this chart as a precursor to the Wii-Hab Workshop. Since that date, many OT and PT students, with the help and guidance of faculty and mentors have developed research projects aiming to determine the therapeutic value of Wii or other video gaming systems. Last year, a student from Keuka College surveyed therapists about their use of Wii in therapy. This year a group of Danish students contacted this blog looking for help in finding articles supporting the use of Wii as a therapeutic tool. OT programs in the United States are also gathering and reporting Wii related data. PTs as well are busy adding to the knowledge and building proof that activities offered through Nintendo Wii programs help improve outcomes.
In April, The AOTA 90th Conference and Expo will feature at least 11 sessions related to using Wii in therapy.
Next weekend the Wii-Hab Workshop at Stockton College, Pamona, NJ is filled, but Anne Arundel Community College in Annapolis, Maryland still has space for the April 10th seminar. Penn State Abington is still accepting registration. Speak to the continuing education department about available discounts.

Intergenerational Value: Wii for Fun - Therapy in Itself

2010-03-17T08:01:00.003-04:00

A child who visits his Grandma in an assisted living facility decides the residents need a bit of excitement. He raised funds and purchased a Wii system for that facility. Now the residents keep themselves busy with bowling and baseball.
In my workshops, therapists hear about ideas for finding funds to help them bring the benefits of Wii into their facilities. Just recently, the executive director of Twilight Wish Foundation spoke at a meeting I attended. She suggested that perhaps her organization could work with community groups, such as Little League Teams or other sports organizations, interested in helping to purchase Wiis for elders in group living arrangements. This idea promotes interaction between generations and communities.
The intergenerational benefits the Wii brings benefits not only to grandparents and young children but also to parents and children with special needs. The Wii provides a great tool for parents who strive to help their children who struggle with sensory integrative issues, social issues as well as motor challenges.
One motor skill that families can address using the Wii is balance. Challenge the child's balance skills by playing games they love while placing them in creative positions. Since many Wii games can be played while standing or sitting, Wii provides an activity many are able to enjoy. Whether for therapy or fun, Wii provides a way for members of various generations to interact, improving quality of life for each participant.

Canadian Researchers Demonstrate Efficacy of Wii-Hab Following Stroke

2010-02-26T08:58:00.006-05:00

The American Heart Association held the 2010 International Stroke Conference in San Antonio, Texas, February 24 - 26, 2010. The results of a study led by Gustavo Saposnik, MD and conducted at St. Michael's Hospital in Toronto were presented. This poster presentation explained the objective of this study as " to evaluate feasibility, safety, and efficacy of VR using Nintendo Wii gaming technology on motor function during stroke rehab." Readers may view the abstract of this poster beginning on page 3 of this link.
The outcome of this research is detailed in the chart accompanying the abstract found at that link.
Several news writers have summarized the results. In the Bloomberg Businessweek summary, Dr. Saposnik is quoted as saying, "Basically, we found that Wii therapy produced a 30 percent better improvement than recreational therapy in the time it took for the Wii patients to execute a task, and in how well they were able to execute a task."
In this study, the group assigned to recreational therapy preformed activities such as playing with cards and manipulating blocks in the game 'JENGA'. The intervention group participated in Wii activities including Wii Sports tennis and Wii Cooking Mama tasks.
Those participants in the intervention group demonstrated that "VR using Wii is a novel, safe and feasible strategy to facilitate motor function after sroke."

Nintendo Wii for Fun and for Therapy: Sign up for a Spring Workshop

2010-02-22T13:08:00.010-05:00

Regulars at the Los Altos Hillview Recreation Center in California's Silicon Valley now find Wii games engaging and entertaining. The center’s director purchased the Wii with grant funds back in 2008, but the system stayed on the shelf until a volunteer dusted it off and put it into play. A local real estate broker and attorney brought her enthusiasm and expertise to the center, teaching many how to bowl or how to complete a successful ski jump. Watch the video to see these folks in action.
This video provides a great example of using Wii for fun while giving therapists an opportunity to look for ways to change the experience, making it a therapeutic session. First, notice that neither player follows one of the most basic “play it safe” rules. Always use the wrist strap and non-skid remote cover to reduce the risk of a flying remote. Second, in a therapeutic setting, warm-up stretches, passive range of motion or flexibility activities should precede the engagement in Wii activities. Also, during the video, the lady bowler indicates that she feels fatigue or slight strain in her arm following a few frames. A therapist would monitor a player, making sure not only to avoid overuse but also to apply ice if the participant feels fatigue or pain.

Another thing a therapist might do to increase the therapeutic value of Wii would be teach pursed-lip breathing and cue the participant in the proper use of this breathing technique during the activity. One might even print out the patient education sheet and give the sheet to the patient. The information on the handout will help both the patient and family members fully understand the technique for pursed-lip breathing and the importance of using this breathing technique during activities of daily living.

Wii offers endless opportunities for strengthening targeted muscle groups, challenging cognition, improving coordination, increasing endurance, and building confidence.
Therapists wanting to gain more experience with using Nintendo Wii in therapy may attend one of the Wii-hab workshops scheduled for this spring. On March 27, 2010 Stockton College in Pomona, NJ will be the host.

On April 10, 2010, Anne Arundel Community College is offering this workshop. The class will be held at the Arundel Mills Campus bringing this great opportunity to therapists from the Washington Baltrimore area.
To sign up, contact Continuing Education by phone at 410-777-2325 or email at iscenter@aacc.edu

And on May 1, 2010 Penn State University Abington Campus will sponsor this workshop. Occupational, physical, and speech therapists as well as hospital administrators and nurses working in rehabilitation from both the Delaware and Lehigh Valley areas will find the Penn State Abington Campus a convenient location.

Medical News: Multiple Benefits Seen for Exercise in Seniors - from MedPage Today

2010-01-27T07:57:00.005-05:00

An article appearing in Medscape's Medical news Multiple Benefits Seen for Exercise in Seniors summarizes much of the evidence gathered about benefits of an active lifestyle. "Successful survival", defined as "living past 70 in general good physical and mental health", occurred more often in study participants who had a most active lifestyle during the period 10 to 15 years prior to 70 when compared to a cohort who had a most sedentary lifestyle during that same period.
Since encouraging regular physical activity in the most sedentary adults fosters long lasting benefits, healthcare providers as well as family and friends often hope to find ways to promote change.
Changing various health behaviors occurs through a process. Many theories of health behavior change offer insight into ways to maximize success for those attempting to alter behavior. One theory in particular, the Transtheoretical Model (Stages of Change), explains behavior change as a journey through various phases of awareness and action. Each phase leads to increased awareness of the need for change. Those along the journey of change gain confidence in their ability to make and maintain the desired modification.
Nintendo Wii activities play an important role as a fun way to bring exercise into an individual’s daily schedule. Individuals in the "pre-contemplation" stage, when exposed to activities in Wii Sports and Wii Fit, may increase their awareness of both their need for exercise and their need to improve endurance and balance. This awareness may help them move to the "contemplation" stage. Since Wii Sports and Wii Fit bring a fun factor into exercise, individuals may decide that moving more can be enjoyable. In fact, they may begin to view physical activity while using the Wii not as exercise but as just a fun activity, helping the individual move on to the "preparation for action" stage. Furthermore, Wii Fit activities provide great feedback and can be played together with others (two aspects of other theories of learning and change). As a result, individuals may begin to engage regularly in the use of Wii Sports and Wii Fit activities. Once these individuals are well entrenched in this "action" stage, the individual is well on their way to a less sedentary lifestyle.
Ford Vox, MD explains however, that activities offered through Nintendo Wii games should not be used as a replacement for the actual sport. But for those individuals who have a sedentary lifestyle, not participating regularly in any physical activity, Wii offers a motivating vehicle to change.

Dr. Ross Clark's Study Highlights Wii Fit Balance Board Benefits

2010-01-22T09:34:00.004-05:00

Therapists as well as other staff working with the elderly recognize the threat falls carry for older adults. Falls often result in life altering changes including fractures, head injuries, and/or decreased self efficacy making continued independent living difficult for individuals who experience a fall. Volumes exist on this topic. Researchers (Tinetti, Lachman, Howland and many other authors) divide risk factors into two groups – extrinsic and intrinsic.

EXTRENSIC
poor lighting
throw rugs
clutter
multiple medications
ill-fitting or
improper footwear

INTRINSIC
muscle weakness
balance problems
postural hypotension
decreased flexibility
cognitive impairment
vision impairment
fear of falling

Various post-fall therapeutic plans of care as well as fall prevention intervention programs aim to reduce fall risk by identifying and mitigating individual intrinsic and extrinsic fall risk factors.
Dr. Ross Clark of University of Melbourne conducted a study in which he utilized the Wii Balance Board as a tool for identifying center of balance, an important component of standing balance.

Take time to look at the list of fall risk factors. Can other risk factors be addressed using Wii activities? Of course! Post your experience for others to read.

Wii therapy in Columbus: From rehabilitation to special education

2010-01-17T13:27:00.001-05:00

Dr. Tim Barrett writes for Examiner.com in Columbus, Ohio. Recently he posted an article explaining the many benefits of using Wii in therapy for a variety of problems. In this article, Dr. Barrett mentions Lon Thornburg. Lon's blog offers so much information to help therapists and families as they care for children with special needs. Robbie Winget, an occupational therapist also shares his enthusiasm about using Wii in therapy with Dr. Barrett.
Soon, this blog will give readers a chance to share their opinions and experiences using Nintendo Wii with those they care for. Keep following and when the survey posts take a little time to complete it.

Funny Videos of Wii Injuries and Accidents

2010-01-12T08:00:00.000-05:00

Mention of Wii injuries and accidents frequently occurs in this blog. Check out this collection of funny videos showing accidents as they happen. A clever occupational therapist could employ these videos during a therapy session with a goal of increased safety awareness, improved sequencing, or most any other cognitive focus. A therapist might have the client first review the Play It Safe checklist, second watch the videos and third discuss what unsafe practice led to the accident. Simple, yet effective! Another way to creatively incorporate Wii technology into your day to benefit your client with cognitive issues from TBI, stroke, PDD, Autism, Alzheimer's, and/or change of mental status to name a few. The concept of using Nintendo Wii in therapy, an approach known as WiiHab, Wii-Hab or Wiihabilitation, broadens!

Wii Purchases Bring Therapeutic Benefits Into Homes

2010-01-04T11:37:00.008-05:00

New Wii Consoles flew off the shelves at retail outlets during the pre-holiday shopping sales. During one week in December, Walmart offered a $50 gift card for lucky customers who found Wiis in stock. So now many have a chance to experience Wii at home. In a UK paper an article explains ways to avoid injury when playing new games in the comfort of your own home.
New Wii owners, including those with chronic conditions express various ways they hope to use Wii in 2010. One Wii enthusiast with a spinal cord injury uses Wii to build arm strength. In an article entitled Wiiiiii!: Adaptive Exercise That’s Actually Fun the author offers good suggestions for therapeutic uses of Wii applications as well as suggestions for simple ways to make Wii applications more user friendly for this population.
New Wii owners with Multiple Sclerosis also recognize therapeutic value in Wii Sports and Wii Fit activities. Having Nintendo Wii in one's home allows the participant to pace themselves to avoid fatigue while playing many great games. Many Wii games increase flexibility and endurance.
Families with special needs children bought Wiis for home use. These families look forward to increased social interaction with their children. Social interaction in a safe environment may help improve social skills for these children. Wii activities offer opportunities for spontaneity; this area often challenges children with autism and other developmental delays. Also, during these cold winter months, the Wii offers an easy way to add more physical activity into a child's routine, providing an outlet for energy and the possibly of reducing negative behaviors such as tantrums.
While playing Wii participants need to follow safe practices to avoid injury. Players might also want to add wrist weights to increase the challenge. Parents might also want to speak with their child's occupational therapist for ideas for increasing challenge by altering positioning while playing certain Wii Sports activities.

Wii Sports Activities Encourage Speech in Aphasia Group

2009-12-06T13:46:00.001-05:00

The versatility of Wii therapy, sometimes called wiihabilitation, becomes more apparent everyday. Although the software programs were not developed for therapy or with disabilities or rehabilitation in mind, so many of Nintendo Wii software applications offer opportunities for every member of the rehab team.
For those recovering from life events that alter their neurological, physical, or social functioning, the rehab team, led by a pysiatrist and most often comprised of an occupational therapist, a speech pathologist, a physical therapist, a clinical psychologist, a clinical social worker, a recreation therapist, a registered dietitian and a nurse create and carry out the plan of care that will propel the client forward toward a restored state of health. A stroke is one medical emergency that can alter a person's ability to live independently. Some who suffer a stroke experience residual language deficits known as aphasia.
The Adler Aphasia Center in Maywood, New Jersey provides ongoing help to clients and families touched by aphasia. In addition to providing direct services, the staff conducts research. Therapists at this center recently conducted a research study and reported the results of observing communicative acts during Wii group activities. The poster is available online. This study of Wii use in therapy contributes to the growing body of evidence-based resources supporting effectiveness of Wii activities in rehabilitation. Readers can examine the results and learn how Wii-hab influences communicative acts among the aphasic population participating in this original research.

New Study Shows Mood Alters reaction to Pain

2009-11-11T16:17:00.005-05:00

Results of a recently published study indicate that negative and positive emotions are closely related to pain perception. Lead author, Mathieu Roy, a post=doc student at Columbia, reports that negative emotions are shown to amplify our perception of pain. The subjects reacted more strongly to painful stimuli while looking at unpleasant images than they did when they gazed upon pleasant images.
Wii Bowling seems to have a similar affect on residents of nursing facilities. My personal experiences using Nintendo Wii in therapy suggest that the results of this study ring true. Clients who complain of pain as they stand at a table top doing unilateral or bilateral upper extremity tasks seem relatively pain free as they stand gazing at pleasant Wii scenes, bowling frame after frame. Standing for longer periods while not perceiving pain helps clients boost their confidence while building strength, balance, and endurance for daily activities, functional transfers and functional mobility .

OT Students in North Carolina Research Benefits of Wii

2009-11-09T14:59:00.003-05:00

Two professors along with six occupational therapy students from Winston-Salem State University in North Carolina are conducting a study into the effectiveness of Wii activities for Seniors(over 60). More specifically, these researchers will look at the impact of one game in the Wii Sports suite on quality of life, confidence in preventing falls and social skills in a specific population - those over 60 who live in a retirement community. The research team hopes to release the results of the study in January.

Students across the country are planning studies using Wii activities as the independent variable or the tool that is manipulated by the researcher. In the study mentioned above, the researchers have identified three dependent variables, quality of life, confidence in preventing falls and social skills. The researchers hope to find changes in those dependent variables as a result of the "application" of the independent variable which in this case is Wii Bowling. To find the anticipated changes this group of researchers will use a Pre-test, Post-test approach, which means that they will survey each group before the intervention (application of the independent variable) and then again after the intervention. The scores obtained from these 2 surveys will be compared using some statistical test. Usually the results of the statistical test is calculated using a computer program such as SPSS. The Wii intervention will prove to be effective if the difference between the 2 scores(Outcomes)are determined to show statistical significance, in other words, the differences in outcomes are so large that these differences probably are not due to chance.
Research requires perseverance and attention to detail. I look forward to reading the results of this study.

Career TV Features "Wii OT" using Wii in Therapy

2009-11-05T21:57:00.004-05:00

Career TV posted a newly created segment featuring the "Wii OT". Watch this video to see how incorporating Wii into therapy helps many clients improve their function.

Fall, Football, and Wii-Hab

2009-11-05T07:47:00.003-05:00

Occupational and physical therapists in the Northeast have two upcoming opportunities this Fall to attend Wii-Hab: Using Nintendo Wii in a Therapeutic Setting. Therapists in the Baltimore/Washington area can still sign up for this course being offered at Anne Arundel Community College on Saturday, November 21, 2009. To sign up, contact Continuing Education by phone at 410-777-2325 or email at iscenter@aacc.edu This course runs from 8AM until 4PM. If your favorite football team has any kick off time other than NOON, attendees will be able to enjoy both experiences in one day. Call today to secure a spot in this interactive and engaging continuing education opportunity.
On December 5, 2009, therapists in South Jersey may attend this Workshop at Richard Stockton College of New Jersey.
Sign up today and enjoy this opportunity.
OTs, PTs, COTAs, and PTAs will gain continuing education credit in a fun, active program that will help build confidence in using new technology with clients who have various diagnoses including joint replacement, stroke, cancer related fatigue, COPD, and others.

Wii Benefits Across the Life Span

2009-10-26T07:45:00.004-04:00

Students worked together to create a video touting the benefits of Wii-Hab. In this snappy video, viewers get an idea of how Wii is used to encourage improved muscle strength and flexibility in adults.

Children also benefit from using the Wii in therapy. The blog entry posted on October 5, 2009 shares with readers a story about Wii use in a classroom as an addition to traditional therapy. News station KEPR CBS 19 in Pasco, Washington posts a video of Wii being used in a school setting by therapists to improve coordination and balance.

Read Lon Thornburg’s great blog to learn more about creative uses of Wii with children who have developmental disabilities.

Workshops Expand Therapists' Ability to Incorporate Nintendo Wii

2009-10-13T08:45:00.005-04:00

Allegany College of Maryland hosted a "Wii-Marathon" for therapists October 2 and October 3. Therapists arrived from many states including West Virginia, Virginia, Pennsylvania and New York to learn more about the therapeutic uses of Wii technology, an affordable, portable and easy to obtain therapeutic tool.
Penn State Abington, located in a suburb of Philadelphia, will host the next workshop. On October 21, 2009 occupational and physical therapists, along with Nurses and Nursing Home Administrators can be a part of this educational, interactive experience . Space is limited, so contact Penn State Abington Continuing Education to grab one of the few remaining spots.

Grant Award Brings Wii Into The Classroom

2009-10-05T09:55:00.000-04:00

Since Nintendo brought Wii to the market in 2006, many avid players who also happen to work with individuals with compromised function recognized this tool’s potential for addressing deficits. A special needs teacher in Ohio saw many great ways that Wii activities could improve student outcomes in his classroom.

The teacher, Kevin McDaniels, applied for funds to purchase the needed equipment for his classroom through Mid Ohio Energy Cooperative, INC’s Community Fund because Kevin recognized that using Wii complimented student time spent in occupational and physical therapy. Using Wii activities in the classroom seems to help students improve hand writing and balance by challenging both their fine and gross motor skills.

Although Nintendo has lowered the price of the Wii Console recently, the dollar amount needed to bring the benefits of Wii into classrooms and rehabilitation clinics may be in excess of usual pre-set budgets. Grants and donations have historically filled budgetary gaps in programs focusing on helping address needs in many communities. Most communities have organizations ranging from service groups to corporations willing to help programs reach out and serve those community members with specific needs.

Interested occupational and physical therapists as well as teachers can learn more about skills for grant writing and finding potential donor organizations by attending a grant writing workshop available often through area high school or college adult learning programs, found through internet searches or through companies, such as Grant Writing USA

Exercising With Wii? This Link Suggests Doing Some Research.

2009-09-14T11:06:00.004-04:00

A writer working for a Philadelphia online paper, the Examiner.com focuses on Wii Fit. In her article posted on September 8, 2009 she suggests that Wii Fit enthusiasts compile research to build the evidence needed to support the value of Wii Fit. The author, Raina Casare lists 4 steps Wii Fit players should follow to compile needed support of Wii Fit’s value as a true tool for virtual reality fitness.

As therapists, following these same steps can help us gather data supporting Wii Fit’s importance as a therapeutic tool for occupational and physical therapy.

Many students choose to do research aimed at boosting Wii as a tool for therapy. From time to time, students write to me and ask for help on these projects, but many forget to share the outcomes once they finish. If you completed a study involving Wii, why not post information about it under comments. In truth, these early studies and surveys lay the groundwork for more in depth Wii-Hab research in the future.

Wii-Hab Meets Medical Illustration

2009-09-09T11:48:00.009-04:00

An artist, who received her MFA (Master of Fine Arts) in Advertising Design from Savannah College of Art and Design, which is located in my hometown of Savannah, GA, created wonderful visuals depicting the crucial aspects of Wii-Hab. Angela Moramarco infuses the very human components - the brain, the muscles, the bones and the soft tissue - into the very technical components - the remote and the console - of Nintendo Wii. These great illustrations tell a concise story. Nintendo Wii, when used correctly in a therapeutic setting, helps patients build new connections within the brain and between the brain and the muscles. For some patients therapy can be difficult and repetitious. Wii offers occupational and physical therapists a versatile tool to use as a part of the therapy plan not only for improving strength, endurance, and flexibility but also for improving sequencing and problem solving in a variety of patient settings including pediatrics (autism, cerebral palsey, PDD) and geriatrics (stroke, joint replacement, fall prevention).

WiiHab - Using the Nintendo Wii in a Therapeutic Setting

2009-08-22T22:49:00.001-04:00

Therapists throughout Maryland, Pennsylvania and New Jersey will have the opportunity to learn more about using Wii in therapy during the Fall months. On both Friday, October 2 and Saturday, October 3, Allegany College of Maryland located in Cumberland, Maryland will host the Wii-Hab workshop. On Wednesday October 21, 2009 the Wii-hab Workshop will be held at Penn State Abington. This location is in easy driving distance from Philadelphia and any of the suburbs. The Penn State workshop has been approved for 6 CEUs for Registered Nurses, expanding the appeal for this interactive seminar. The Wii-Hab workshop will be offered at Anne Arundel Community College on November 21. Therapists from the Baltimore/Washington area will like this location. For therapists living in New Jersy, the December 5 date at Stockton College will be great for them. Sign up early! Tell a friend.

WiiHab in the News Throughout The Summer (Part 1)

2009-08-20T20:26:00.002-04:00

Frequently, during the summer months articles appeared in newspapers, on television, and in blogs explaining the benefits people gain when Wii activities are incorporated into their rehabilitation programs. In June, the El Paso Times printed an article about Del Sol rehabilitation center’s use of the Wii in their Physical and Occupational therapy programs. The accompanying picture tells the whole story! Also in June, Hulig News ( an independent public news organization) placed a great story on line about a patient at University of Wisconsin, Madison’s American Family Children’s Hospital. This story offers some insight into the versatility of Wii as a therapeutic activity. More positive reviews of Wiihab can be found when you read an article from June 15, 2009 in the Vail Daily. Therapists in Silverstone, Colorado include many different Wii programs into the plan of care for their patients. They report improved outcomes, particularly with knee replacement patients. A study which will contribute to the evidence-base for using Wii in therapy for knee replacement patients is taking place in Toronto. Researchers hope to complete this study by the end of the year.

Reports of Injuries from Wii Sports and Wii Fit

2009-07-30T10:20:00.001-04:00

Whenever a certain colleague of mine mentions the Wii, talk of fear of injuries to players creeps into the conversation. An article appeared recently in the New York Times entitled, More Wii Warriors are Playing Hurt. Readers find references to strains and sprains as well as rotator cuff tears and knee injuries. This article suggests that Wii related injuries are increasing along with the popularity of the Wii gaming system, itself. In the therapeutic setting, I have not had any experience with patients adding to their injuries or pain using the Wii, because we are very careful to follow the"Play It Safe" (for Wii Sports) suggestions while working with patients. Earlier this summer though, I met someone who had broken his toe playing the Wii. Aaron Martin, a delightful and inspiring speaker, known best as the face of BASSEDGE, related the story of how he broke his toe playing a Wii game with friends. He hit his foot on a chair as he lunged to make the play. A reminder ofPoint # 4 from the "Play it Safe" sheet may have helped Aaron avoid that injury.

Although reports fill the internet of Wii related injuries to players and equipment, many more reports tout the benefits of using the Wii. Any activity can result in injury if the participant over-indulges or disregards safe practices. Using Wii Fit in therapy requires additional safety measures to insure against potential falls, especially when using this tool to improve balance and encourage weight-shifting in an elderly population. Safe use of therapeutic tools is common sense and usual practice for therapists. I always remind my colleague that stories of Wii injuries relate to public use of the gaming system, not to the supervised use of Wii as a therapeutic tool for Wii-hab.

Aaron Martin, BASSEDGE, meets the "Wii" OT

2009-07-29T21:34:00.000-04:00

Using Nintendo Wii in Therapy: Benefits Seen Over Time

2009-07-18T13:47:00.018-04:00

WiiHab - Rehabilitative Therapy Using the Wii by the "Wii OT” has been up and running for over a year now. Thank you for all of your visits and emails. So many people have responded to my blog. Not only have other occupational and physical therapists and students sent emails and responses but also family members whose loved ones are recovering from TBI, stroke or joint replacement and are benefiting from using Nintendo Wii have contacted me from time to time. And these responses have come from many states like Pennsylvania and

Georgia

and from countries far and near to the

USA

England

Sweden

and

Canada

. The use of Nintendo Wii as a therapeutic tool continues to spread, while therapists, researchers, and patients alike continue to recognize the advantages of including this tool in plans of care.

Just the other day, another article appeared in print and online about the benefits of using Nintendo Wii to help people recover from injury, illness and surgery. This article highlights 2 important points. First, mention is made that Wii offers an opportunity for socialization, helping reduce feelings of isolation. Second, this overview states that using the Wii is fun. Bringing fun into therapy helps patients who are dealing with a changing health status to reduce feelings of anxiety. Learning to use adaptive devices or learning to do familiar things in new ways is easier when feelings of isolation and anxiety are reduced. Reducing feelings of isolation and anxiety is such an important part of therapy.

So again, thank you for your support. Post your experiences in the comments section for all to see.

MCG's DR. HERZ PRESENTS RESULTS OF STUDY OF WII THERAPY AND PARKINSON'S

2009-06-13T09:13:00.006-04:00

Completeing the research and publishing the studies that form the basis for evidence-based medicine takes time, money, and expertise. Lead researcher, Dr. Ben Herz, from Medical College of Georgia, is among the first researchers to publish a study which demonstrates the benefits of using Nintendo Wii in a therapeutic setting. On June 12, 2009 he presented the results of his study that examined the benefits of an occupational therapy intervention for patients with Parkinson's disease using actvities available through Nintendo Wii .

Those attending the fifth anual Games for Health in Boston heard Dr. Herz's report that the study participants demonstrated a decrease in depression as well as an increase in agility. These improvements would be very beneficial to someone with Parkinson's since those with Parkinson's disease experience both depression and bradykinesia (slowing of movement).

High School and Middle School Special Needs Students in Oregon To Benefit from Wii-Hab Pilot Program

2009-06-11T21:47:00.006-04:00

As planned, Lon Thornberg, along with the occupational and physical therapists who he works with in Oregon, spent two days observing ways that activities and exercises available through Nintendo Wii might benefit children with special needs. The article posted on No Limits to Learning describes the program designed to help these three dedicated individuals develop a program for their students that will incoroparte the most effective Wii programs for their student population.

Activities offered through Nintendo Wii Sports provide opportunities to improve :

motor skills, especially gross and fine coordination,
cognitive skills, especially sequencing, memory and recognition

as well as many other areas.

If you have used activities offered through Nintendo Wii in a school based setting, please let Lon and me know about your experience.

FIFTH ANNUAL GAMES FOR HEALTH CONFERENCE

2009-06-01T08:50:00.003-04:00

The Fifth Annual GAMES FOR HEALTH conference, made possible in part by the Robert Wood Johnson Foundation, takes place June 11-12 in Boston, MA. "The Healthcare Guy" posts what Ben Sawyer, co-founder of Games for Health, has to say about the upcoming conference. This article provides both a good background on the history of gaming for health as well as a glimpse into the newest games available for the therapy toolkit.

One game that Mr. Sawyer mentions is Electronic Arts' EA Sports Active. This game features a personal trainer who leads the participant through a workout that really makes the player break a sweat. This game encourages the participant to strengthen the upper body, build endurance, improve balance and strengthen the lower extremities.

During a recent "Wii-Hab - Using Nintendo Wii in a Therapeutic Setting" Seminar, a student was very interested in using Wii activities for high level patients in an outpatient occupational therapy and physical therapy rehabilitation setting. EA Sports Active provides high level activities that may be well suited for that population.

SENIOR HEALTH & FITNESS DAY 2009

2009-05-28T07:58:00.006-04:00

May 27, 2009 was National Senior Health and Fitness Day. As you may know, seniors who stay active and physically fit help themselves avoid some of the declines associated with aging; in particular, the increased risk for falls.

According to the website, www.fitnessday.com/ the common goal for this day is to help keep older Americans healthy and fit. Many health related facilities held special events to help raise fitness awareness in those who they serve. The life care community where I work scheduled many different events to encourage all of the residents at all fitness levels, to either stay or become active.

Occupational Therapy's interactive Wii Fit presentation proved to be a very popular. Thirty-five participants, many of which had never seen a Wii, a Wii Fit balance board, or a Mii before, enjoyed learning all about using the Nintendo Wii and playing the fun games. Wii Fit offers an exciting alternative to the more traditional machine-based exercises, encouraging participants to improve their balance, endurance, and strength while having fun and experiencing new technology that they know their grandchildren also enjoy.

Occupational Therapist to Pilot Wii Program for School Based Treatment

2009-05-15T10:05:00.004-04:00

Using Wii as a therpeutic tool for the geriatric population recieves a great deal of press but the use of Wii based activities for children in school based programs is discussed only occasionally in the news. In Oregon, an occupational therapist, with the help of the assistive technology specialist and trainer has planned an assessment day during which students will try out several Wii applications. The OT will gather useful information about which applications are best for various motor levels and abilities. This fact finding day, described in the May 7,2009 post on No Limit 2 Learning will provide a wealth of information. Take a minute to read about this well thought out venture by clicking here.

New Wii Remote Accessory May Increase Therapeutic Value for High Level Clients

2009-05-14T15:27:00.003-04:00

Nintendo plans to release a new accessory for the Wiimote. The Wii MotionPlus can be easily attached to the remote. Once attatched, this device enhances the remote's ability to detect and reflect arm and wrist motions. This increased sensitivity and accuracy may improve Wii's value as a therpeutic tool for rehabing higher functioning clients. By enhancing the remote's ability to detect even the slightest movement of the wrist and arm, Nintendo might be making it easier to target specific muscles and to encourage increases in strength, coordination and endurance . The release date for this attachment is June 8, 2009 for the USA markets.

Students Enjoy "Wii-Hab - Using the Nintendo Wii in a Therapeutic Setting"

2009-05-05T16:23:00.011-04:00

Allegany College of Maryland

hosted the most recent Wii-Hab workshops. Students learned how the games in Wii Sports and Wii Fit can be used as therapeutic activities (97530) and/or therapeutic exercises (97110) and/or Neuro-muscular re-education (97112) to achieve specific patient goals. The participants also had fun as they pacticed using Wii Sports and Wii Fit in innovative ways. Students also enjoyed applying what they learned by designing treatment plans for case study patients described as having poor endurance, weakness and lack of coordination.

Additional Wii-Hab workshops at Allegany College of Maryland are planned for October 2 or 3, 2009. Penn State Abington will host Wii-Hab: Using Nintendo Wii in a Therapeutic Setting on October 21, 2009. On Saturday, November 21, 2009, Wii-Hab: Using Nintendo Wii in a Therapeutic Setting, will take place in the Baltimore/Washington, D.C. area at Anne Arundel Community College's Arundel Mills campus.

Gathering Evidence of the Effectiveness of Wii-Hab

2009-04-17T23:22:00.006-04:00

Therapists are always encouraged to think in terms of evidence-based approaches when designing treatment plans for their patients. Local newspapers and blogs , including WiiHab - Rehabilitative Therapy Using the Wii, often publish stories about Wii and the use of Wii Sports and Wii Fit in therapy. The March 2, 2009 addition of Advance for Occupational Therapy Practitioners published an article by Elizabeth Karan that included treatment success stories for 2 patients who had suffered strokes. She told about improvements in balance and endurance as well as improved function in ADL performance and ambulation.

Gathering actual evidence-based outcomes take time because researchers must design a study, gain approval from an Institutional Review Board (IRB), and in many cases, find research subjects to study before finally conducting the experiment and collecting the data. But researchers are busy doing all of those things to find out just how effective the Wii is for therapy. Medical College of Georgia is conducting a study to determine if occupational therapy enhances the treatment for Parkinson's Disease.

Playing Wii is part of that treatment.

Judith E Deutsch, Megan Borbely, Jenny Filler,

Karen Huhn and Phyllis Guarrera-Bowlby published

a case report in October of 2008 in which they explained

the benefits playing Wii had for an Adolescent With Cerebral Palsy .

Now, a researcher in Canada is looking for subjects

to participate in her study as she works to

measure the

therapeutic value of active video games,

including Nintendo Wii.

The Benefits of Wii from a Patient's Perspective

2009-04-06T23:10:00.005-04:00

Occupational therapists like to utilize a patient-center approach in all aspects of treatment. According to this article, Nintendo Wii as Therapy and Fun For Multiple Sclerosis, Wii, from a patient's perspective, is both enjoyable and therapeutic when coping with Multiple Sclerosis.

Problems for those with multiple sclerosis include fatigue, balance, flexibility and motor control. Wii provides an array of activities which encourage a person to use and improve balance, flexibility and motor control. These activities are fun and engaging, helping the participant focus on what they can do. These self-paced activities allow for frequent rests while providing excellent feedback on improvements in a fun format. Wii sports games, such as Bowling, baseball and Tennis help with motor control and flexibility. The training moduals for each sport records your progress while the fitness modual calculates your Wii Age and posts it for encouragement. Wii fit has great activities for improving balance and flexibility. All of these games can be played for short periods with rests as needed. Wii therapy brings a smile to all who try it. Have you tried wiihab in your clinical setting yet?

Continuing Education Workshop featuring the "Wii OT"

2009-03-22T20:00:00.000-04:00

Allegany College in Cumberland, Maryland is now offering a second one-day continuing education workshop featuring the "Wii OT''. The May 1st educational workshop is filled to capacity. So, on Saturday, May 2, 2009 another opportunity for occupational and physical therapists (and other rehabilitation professionals) to be introduced to the Nintendo Wii as a therapuetic tool will be offered. The WiiHab Therapy Workshop offers a full day of exciting activities to help therapists and others involved in health care learn not only the great benefits of using the Wii in their clinical setting, but also the best methods to ensure that using the Wii is truly therapuetic.

Course Description:

Rehabilitation therapists have a long history of using innovative and entertaining activities to help patients reach therapeutic goals. In this one-day course, therapists will be introduced to the Nintendo Wii as a therapeutic tool which can help patients increase strength, balance, endurance, flexibility and hand-eye coordination. Additionally, participants will learn appropriate adaptations and modification for Wii play in various patient populations, particularly older adults. Course will include case studies and practical considerations for patient safety.

Continuing Education Information:

Approved by the Maryland Board of Occupational Therapy Practice for 7 contact hours. Approved by the Maryland Board of Physical Therapy Examiners for .7 CEU’s. All other professionals will receive 7 contact hours from Allegany College of Maryland.

For more information, call:

Linda Atkinson, Director,

Institute for Health

and Human Services

(301) 784-5526

I look forward to seeing many of you there!

The Wii can fight Childhood Obesity

2009-03-19T20:50:00.004-04:00

Earlier, I wrote about the Wii and Health Promotion (October 8, 2008). Using the Wii is a great tool to combat the sedentary lifestyle. Now, researchers in England are looking into the use of Wii to combat obesity in children. How are you using the Wii in your practice? Do you find that it motivates those you are working with? I see it every day. Helping people move more in an enjoyable and motivating way promotes a positive attitude.

Following Stroke, The Wii Encourages Bilateral Upper Extremity Use

2009-02-23T06:55:00.004-05:00

Using Wiihab encourages many responses. Often occupational and physical therapists are challenged to find therapeutic activities to elicit one desired response, bilateral upper extremity use. Those recovering from stroke may find using the involved extremity uncomfortable and challenging because of muscle weakness, increased or decreased muscle tone, poor sensation, or loss of position sense (proprioception). Boxing in Wii Sports, especially, offers an opportunity to use both upper extremities reciprocally and spontaneously. Boxing in virtual reality creates a need to make alternating movements with the arms to protect yourself from punches or to knock out your opponent. If the participant's bilateral cordination is sluggish, their opponent will punch them. Many will work hard to avoid that! All of the Wii games promote therapeutic movement and many news reports explain the value patients find in using games as therapy.

Share your stories!

Sensory Processing Disorders (Part 3 of 3)

2008-12-15T14:47:00.003-05:00

(More on sensory processing disorder…)

School-based therapists recognize the entwined nature of the sensorimotor performance components and program plan accordingly. The Wii provides another tool for the therapists, allowing them to challenge and grade movement through space as well as encourage targeted actions. Are any readers using the Wii in your setting?

Therapists must also identify issues in other performance areas such as cognitive and psycho-social. Manifestations of problems within the cognition and psycho-social arenas will be discussed in future posts.

Please post your experiences under the comment section because in sharing your experience, you help increase everyone’s knowledge base.

Sources:

· The Sensory Processing Disorder Resource Center

www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

· Kranowitz, CS., Miller, LJ. (2005). The Out-of-Sync Child. New York, NY. Penguin Group.

· Bhojne,U, Chitnis, A. (2002). VESTIBULAR DYSFUNCTION IN CHILDREN WITH PERVASIVE DEVELOPMENTAL DISORDER. The Indian Journal of Occupational Therapy. XXXIV(1).3-6. Retrieved from http://medind.nic.in/iba/t02/i1/ibat02i1p3.pdf

Sensory Processing Disorders (Part 2 of 3)

2008-11-28T14:46:00.001-05:00

(Continued from last post…)

Sensory Processing Disorders (Part 1 of 3)

2008-11-14T14:40:00.002-05:00

Therapists working with the K-8 population, especially students with diagnoses across the Autism spectrum must be equipped to address sensory processing disorders. Sensory processing problems impact all areas of function and must be considered on a case by case basis. Subtle differences between children’s abilities require the therapist to individualize treatment protocols. Components included in the sensory processing performance area are:

Tactile – Refers to the interpretation of sensory input, including temperature, pressure, pain, and touch, collected from receptors located in the skin

Hypersensitivity – Tactile defensiveness- may avoid touch
Hyposensitivity - Decreased responsiveness to touch- may seek repetitive tactile input

Auditory – Refers to the interpretation of sound

Hypersensitivity – Auditory defensiveness- may be overly sensitive to background sounds
Hyposensitivity - Decreased responsiveness to sound – may not respond appropriately when called by name, may not be able to locate the source of a sound, or may make repetitive noises for no reason.

Olfactory – Refers to the brain’s interpretation of smell

Hypersensitivity- May be overly sensitive to smells which others may not notice
Hyposensitivity – May not notice smells others complain about.

(Continued next time…)

Please post your experiences under the comment section because in sharing your experience, you help increase everyone’s knowledge base.

Using the Wii Therapeutically in a School Setting: PART 2

2008-10-31T06:18:00.009-04:00

Therapists working with the K-8 population, including students with diagnoses across the Autism spectrum, will also need to address perceptual processing problems including:

right-left discrimination (ability to distinguish or identify left and right directionality)
form constancy (recognition of objects or shapes as the same regardless of size, spatial orientation, or texture)
position in space (recognition of the spatial orientation of objects in relationship to the surrounding environment)
body scheme (perception of one’s own body arrangement in relationship to self and environment which facilitates the individual’s ability to orchestrate purposeful movement through space and focused manipulation of objects)
figure ground (ability to discriminate or isolate a particular object or shape surrounded by or embedded in a varied background)
depth perception (ability to recognize three dimensions in objects and self while perceiving the relationships among and judging the distances between these objects and/or self)
spatial relations (ability to sense one’s position or place within the environment in relationship to other objects or people as well as the ability to perceive the relationship of one’s own body parts to each other)
topographical orientation (ability to plan out a route and follow a route through recognition of landmarks, perception of landmark relationships and directional memory)

Wiihab using activities and games found on the Wii Sports menu, used in conjunction with other more traditional approaches, targets problems children may have with perceptual processing, especially body scheme. Do any of you have experience using Wii in a school program? A group of students in NewJersey used Wii with a 13 year old with cerebral palsy. Wiihab can also be a great tool for the school based therapist for addressing frequently encountered cognitive problems and psychosocial problems. The next post will clarify those issues.

Using the Wii Therapeutically in a School Setting: PART 1

2008-10-27T12:53:00.005-04:00

Jan from Maine writes on October 23, 2008:

Hi There,

I am an OT who would like to use Wii with my kids in the school setting. I am writing a grant for funding this and would like some feedback as to which program might be the best for my K-8 population and with my Autistic population.

Thank you!
Jan from Maine

Thank you, Jan, for your question. This question, of course, covers a very broad subject, so I will break it down into several important areas. If more specific or timelier information is needed, Jan from Maine could leave a comment with her email address and I could address those specifics directly.

My response to this question will appear in multiple posts. In the first few posts, I will outline and define several potential areas for occupational therapy intervention for the K-8 population, with a special focus on areas of OT intervention for those with autism. The second group of posts will give examples of specific Wii activities to address these areas. And finally, I will suggest some current research to use as supporting literature for a grant proposal.

Some potential areas for intervention in the K-8 population include but are not limited to:

Motor
Perceptual
Cognitive
Psycho Social

Occupational therapy intervention areas for children in this population with Autism include but are not limited to:

Psycho social
Sensory (processing) Integration
Cognitive
Perceptual
Motor

Deficits in any of these areas can make classroom and daily activities challenging. Identified students receive needed intervention from Occupational, Physical and/or Speech Therapists. The Nintendo Wii is emerging as a popular tool for therapists working with school aged children with special needs. Wiihabilitation incorporating Wii Sports and Wii Fit can be used to address many of these frequently encountered problems and strategies for incorporating Wiihab in School based therapeutic programs will be discussed in detail in the latter parts of this segmented post.

Movement disorders in the K-8 (including those with Autism) may result from neuromusculoskeletal issues as well as from a complex mix of perceptual, muscular and motor issues. Musculoskeletal involvement may result in:

Alterations in muscle tone – (spastic- increased or flaccid- low/decreased)
Decreased range of motion and/or strength
Poor endurance
Decreased postural control – alignment (standing or sitting)

Additional motor or movement problems stem from a complex mix of deficits across several systems and may manifest as problems with:

Coordination –both gross and fine (dexterity)
Bilateral integration (using both sides of the body cooperatively, either simultaneously or alternately)
Crossing the midline (passing one extremity across the midline of the body into the opposite side)
Motor planning (praxis- the ability to perceive [visualize], organize and execute a motion or action accurately)
Visual motor integration (the combined ability to visually perceive an object while accurately grasping and manipulating the object efficiently to complete the desired task)

Problems in any of these areas contribute to a student’s difficulty with classroom and self care activities.

How can a game be therapy?

2008-10-19T13:48:00.002-04:00

Medicare reimburses for therapeutic procedures or treatments provided by a skilled and licensed therapist for the purpose of improving function and reducing disability or impairment in an individual who has been referred to therapy and has a diagnosis supporting the medical necessity for therapy. A Therapeutic Activity (CPT 97530) is further defined on the Highmark Medicare Services website as:

Therapeutic activities are considered reasonable and necessary for patients needing a broad range of rehabilitative techniques that involves movement. Movement activities can be for a specific body part or could involve the entire body. This procedure involves the use of functional activities (e.g., bending, lifting, carrying, reaching, catching, and overhead activities) to improve functional performance in a progressive manner. The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination. They require the skills of a clinician and are designed to address a specific functional need of the patient.

In order for therapeutic activities to be covered, all of the following requirements must be met:

The patient has a condition for which therapeutic activities can reasonably be expected to restore or improve functioning; and
The patient’s condition is such that he/she is unable to perform therapeutic activities except under the direct supervision of a clinician and
There is a clear correlation between the type of exercise performed and the patient’s underlying functional deficit(s) for which the therapeutic activities were prescribed.

Therapeutic activities may be medically necessary when the professional skills of a clinician are required, and the activity is designed to address a specific need of the patient. These dynamic activities must be part of a documented treatment plan and intended to result in a specific outcome.

Therapists have traditionally used “games” such as balloon volleyball, bean bag toss, modified basketball, and obstacle courses to reach therapeutic goals. The Wii is not the first computer game or program to be used in a therapeutic setting. Therapists have used dance programs such as Dance, Dance Revolution, and some virtual reality programs to help them meet rehab goals. Using the Wii as a therapeutic activity is supported by the requirements set forth by Medicare. Games available on The Wii, especially those included in Wii Sports and Wii Fit, are a perfect addition to the therapeutic activity toolkit. Through various games functional loss can be improved and restored. Tennis for example, encourages a patient to use the shoulder through a more complete range of motion than traditional activities such as stacking cones or moving the plastic pieces along the tubular track on the shoulder arc contraption. Patients seem to enjoy the Wii and this element of fun appears to reduce the anxiety and anticipation of the pain. The therapist must monitor the patient, ensuring safety, pacing and appropriate rests.

Each time I use the Wii with a patient, I learn another way the Wii provides a therapeutic experience. Recently, I used the Wii boxing training module , “Working the Bag” with an elderly patient who has difficulty dressing due to decreased range of motion in both shoulders and a decline in cognitive functioning. The newness of a computer game required a gradual introduction and a careful explanation. But once the patient tried out the activity, the personal exhilaration resulting from the rapid movement of both arms and the Wii’s animation and audible reinforcement was apparent. This experience seemed to elevate this patient’s mood and create a stimulus for returning to therapy for another session later in the week. As a result of the enthusiasm that the Wii stimulated, I was able to add to the treatment plan additional therapeutic exercises aimed at improving arm strength, range of motion and endurance to help this improve this patient’s ability to play the Wii. In this case, a game was therapeutic not only because it was a dynamic activity used to improve the functional use of both upper extremities, but also because it motivated the patient to participate in an enhanced treatment plan, hoping to improve their ability to play the Wii.

Answering your colleagues' questions about Wiihabilitation Therapy

2008-10-16T08:37:00.001-04:00

Over the past year, conversations with colleagues have often included several questions about the therapeutic use of Wii in various clinical settings. Below are a few of the questions I frequently encounter and the answers I provide. What are some questions you have about incorporating Wii into your program?

Will patients take the Wii seriously?

Initially, many patients view the Wii skeptically, not unlike the way they view any therapeutic activity. I find that many patients in rehab often seem wary of the treatment plan and at first proceed doubtfully through 3 sets of 10 of this exercise and/or 15 minutes of bilateral upper extremity reaching activities. However, in contrast to traditional, often repetitive, exercises or activities, the patients quickly begin to enjoy the Wii activities and games. By using activities available in the training module of Wii Sports, a therapist can design a highly effective program to meet many goals. For example, following joint replacement surgery, the therapist may wish to encourage weight shifting and increased standing tolerance, two outcomes necessary for increased independence in self care and home management. The Wii Sports Boxing Training Module offers 3 activity choices. The first activity is labeled “Working the Bag”. This activity requires the participant to hold the Wii remote in one hand and the Nunchuk in the other. A boxing bag appears in front of the Mii and by extending the arms forward at chest height alternately, the participant punches the bag. If enough forceful punches are thrown, the bag falls from the ceiling, a bell sounds and the next bag appears in front of the Mii.

When using this activity therapeutically, the therapist must monitor the patient to guard against over exertion, against loss of balance, and against poor body mechanics. During the first attempts at this activity, fatigue may prevent the patient from completing the round in a standing position. Since this activity can also be performed from a chair, the patient may continue in a seated position affording benefit by challenging the upper body, overall endurance and sitting balance. Upon completion of this activity, skepticism will be replaced by belief that the Wii can provide a very beneficial therapeutic experience.

Wii in Health Promotion

2008-10-08T20:52:00.003-04:00

A recent vacation opportunity brought to light other clinically relevant uses of the Wii. The Wii can play a motivating role in Health Promotion and Lifestyle Modification across all ages. For many who have a more sedentary lifestyle, the Wii proves to be useful tool in encouraging change. The Wii stimulates those who may usually choose to only watch sports, to get up (or remain seated) and swing the remote at the tennis ball, the golf ball or the baseball. Others swing the remote to bowl or box.

Photo by abbynormy on Flickr

In the school setting, students who might usually shy away from physical education (PE) classes rush to sign up for PE revolving around Wii Sports and other Wii programs. Teachers have found that the students who are reluctant to play team sports are more than willing to get out of their desks for some friendly Wii competition. The students like the feedback Wii provides and are motivated by the improvement that the Wii makes readily visible.

In the clinic setting, the Wii has an application in Health Promotion. Researchers in the area of Fall Prevention (Lachman, M., Howland, J.,& Tennstedt, A.,1998) have identified a sedentary lifestyle as a primary risk factor for falls. In older adults, a sedentary lifestyle and a fear of falling (Edelberg, 2001) often go hand in hand, creating a reciprocal nature among fall risk factors in the elderly population. Using Wii as a therapeutic activity with elders allows the clinician to work towards goals such as increasing standing and activity tolerance, improving dynamic balance and reducing fear and anxiety. The fun nature of Wii along with the built-in reinforcement of improved scores encourages and motivates elders to be more active and engaged in therapy.

Another great therapeutic use of Wii is in Lifestyle Modification Programs. Lifestyle Modification Programs help clients struggling with obesity, type 2 Diabetes, or other chronic conditions to implement changes in daily routines, reducing disease burden. Initially, the Wii gently introduces increased physical activity into the daily schedule. For those participants with a history of computer gaming, the Wii allows them the familiar pleasure of gaming while increasing physical activity. Wii also encourages social interaction and creates opportunity for community building through the creation of bowling leagues and baseball teams.

Exercising in the virtual environment created through the Wii should not be considered a replacement for exercise in the real world, but Wii Gaming can be used effectively to provide additional activity throughout the day. The Wii may help those who are extremely sedentary to take initial steps toward increasing activity. By increasing the level of daily activity, participants may gain strength, endurance and improved balance, leading to improved well-being.

References:

Edelburg, H. (2001). Falls and function: How to prevent falls and injuries in patients with impaired mobility. Geriatrics. 56(3). 41-45.

Lachman, M., Howland, J.,& Tennstedt, A.(1998). Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE).Journals of Gerontology: Series B: Psychological Sciences and Social Sciences. 53B(1). 43-50.

The Wii and Autism

2008-09-13T09:53:00.002-04:00

Occupational therapists provide care in diverse settings for a wide range of ages. One of the most rewarding settings for the occupational therapist involves working with children with developmental issues. OT intervention may be offered as soon as the child arrives in the NICU through a hospital based service, once the child goes home through a birth to 3 program, and once the child enters school within the school based setting. Children with Autism Spectrum Disorder comprise a growing number of the case-load mix. The occupational therapists’ contribution to these children’s plan of care or IEP includes activities aimed at improving physical, sensory and social issues.

One mother found an innovative way to help her son improve his ability to filter auditory sensory input as well as a way to increase all types of coordination and encourage appropriate social interactions. This mother, MaryTara Wurmser purchased an Nintendo Wii for her son to use at home. She tells about her experience and explains the benefits afforded her son from this activity. She encourages others to “Consider the Nintendo Wii for Kids with Autism.”

Using Wii to Detect Changes in Center of Balance

2008-09-05T16:46:00.003-04:00

Following hip or knee joint replacement, a slight leg-length discrepancy can often occur. This slight difference in leg length shifts an individual’s center of balance, challenging both the static and dynamic balance of the joint recipient. The leg-length discrepancy can be a contributing factor in a person’s decrease in functional ability.

Those recovering from joint replacement surgery often demonstrate decreased standing tolerance and balance, decreased flexibility, and pain. Faced with increased pain and decreased flexibility, individuals avoid weight bearing and weight shifting, which can contribute to the development of a compensatory gait pattern. Though the literature points out that the impact of a leg length discrepancy continues to be debated, for the clinician whose goal is to restore functional independence, this possible contributor to dysfunction should be considered.

The Wii Fit Balance Board offers the therapist an easy way to assess center of balance. The Body Test calculates the players center of balance as well as their BMI. This Body Test also measures an individual’s body control, or their ability to keep their weight centered. Games or activities included with Wii Fit help teach a person how to move their body to improve their ability to maintain the optimal center of balance. The games provide feed back for improvement in several ways. For example, in the ski jump activity, a small box in the upper right hand corner of the screen uses a small blue dot floating inside a larger yellow dot to indicate the player’s center of balance. If the individual maintains their body alignment in an optimal position prior to extending their knees for the “jump”, the distance of the jump is longer, resulting in a higher score. The visual feedback from the dot, along with the positive reinforcement from increasing scores, help motivate the participant to keep trying to improve their weight shifting and weight bearing.

If a client has continued difficulty maintaining their center of balance, the therapist may suspect a leg length discrepancy. Although length discrepancies are often not reported and may be rare, following surgery for a single knee replacement, some patients report discrepancies of up to a quarter of an inch. An orthotist can place an insert inside the shoe, correcting this issue. Often, clients sense the correction immediately because eliminating the difference in leg length, helps to align the pelvis. An orthotist can again use a lift to correct this imbalance. Hip replacements may also lead to one leg being shorter and one being longer.

Now the client, wearing his adjusted shoes, may have an easier time maintaining his center of balance. The therapist will need to always take precautions for fall prevention when using the Wii Sports or the Wii Fit for therapy in a population with joint replacements. Some of the balance games may not be appropriate for early stages of rehab for those with joint replacement because of pain or weight bearing restrictions or precautions, but maybe quite helpful in the latter stages of therapy as the client progress toward full recovery.

Wii Sports - Learning the Basics

2008-09-03T15:36:00.001-04:00

When a therapist chooses to use a new technique for rehabilitation, the first step is to become familiar with the basics. Using the Wii as a therapeutic activity or exercise requires the same approach. Dan Birlew authored You & Wii – Everything You Need to Know and Prima Games, a Division of Random House, published it. This book not only explains the basics, but also includes a full explanation of Wii Sports. By reading this book, the therapist can learn what Wii Sports offers.

Wii Sports offers both an opportunity to play a game and an opportunity to improve skills. In the Bowling Training section, power throws can be utilized to increase standing tolerance and standing balance, build strength in the upper extremity, encourage shoulder flexion and improve flexibility throughout the upper extremity. Once the player has signed into this activity, they are allowed 10 throws to knock down as many pins as possible. This training module builds in difficulty as the bowling lane as additional pins are added. On the first throw, the player attempts to bowl down 10 pins. By the tenth throw, the player bowls the ball into a field of 91 pins.

The therapist can increase the workout gained from Wii Sports activities in so many ways. By simply placing wrist weights on the targeted upper extremity or by increasing the length of time that the participant must stand while playing are just a sample of the ideas. Have you tried using any of the Wii Sports training sections? If you have, you know that by spending time in an existing activity, the participant can open new training games. Once earned, these new challenges appear on the menu.

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

2008-08-25T16:01:00.003-04:00

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!

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

2008-08-20T14:18:00.005-04:00

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.

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.

News Updates on Wii Therapy

2008-07-30T14:48:00.004-04:00

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

2008-07-29T07:08:00.000-04:00

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

2008-07-28T22:43:00.002-04:00

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

2008-07-21T15:12:00.006-04:00

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

2008-07-18T14:14:00.002-04:00

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

2008-07-17T13:55:00.002-04:00

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

2008-07-17T11:12:00.003-04:00

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

2008-07-16T13:56:00.004-04:00

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.)

Using Mario Kart in Wiihab (Part 1 of 6)

2008-07-15T22:28:00.012-04:00

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

2008-07-15T22:16:00.006-04:00

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

2008-07-14T21:57:00.002-04:00

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

2008-07-11T22:30:00.002-04:00

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?

2008-07-11T14:41:00.000-04:00

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

Wii use in nursing homes

2008-05-22T15:47:00.000-04:00

A news report in Cincinatti discusses use of the Wii in nursing homes. In the video, elderly patients play Bowling and discuss what they think of using the Wii.

Wiihab for burn victims

2008-05-10T22:38:00.000-04:00

The BBC has reported that the Wii has therapeutic value for improving flexibility and range of motion for burn victims. Wii is being used as a complementary therapy technique in the East Grinstead Hospital, which is a regional center for treating patients with burns in the southeast regions of England. Burns specialists at the hospital noted several advantages to using the Wii, such as patients' enjoyment of the activity and the ability of patients to continue using the Wii at home once they are discharged.