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

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.

Wii -Like Therapy Even before Wii hit the Market

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 Add-on May Enhance Use of Wii in Therapy

(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.

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

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

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."

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 -

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.

Intergenerational Value: Wii for Fun - Therapy in Itself

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.

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

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

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

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

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

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

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

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

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

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.

Fall, Football, and Wii-Hab

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.

Workshops Expand Therapists' Ability to Incorporate Nintendo Wii

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

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