Balance Exercises: Will Wii Activities Help Your Therapy Population?

The LinkedIn Group: Rehabilitation Medicine, posted a discussion about balance and the post stroke population. The discussion leader is promoting her website , particularly a review which she wrote on an article written by Ruth Ann Geiger, Jeffery B Allen, Joanne O’Keefe, and Ramona R Hicks. Their article, Balance and Mobility following Stroke: Effects of Physical Therapy Interventions With and Without Biofeedback/Forceplate Training explains their project which compared outcomes between two groups of participants who had hemiplegia; group A received physical therapy for 50 minutes 2 to 3 times a week which included 15 minutes of treatment using the NeuroCom Balance Master. Group B received physical therapy for 50 minutes 2 to 3 times a week which included approaches designed to improve balance and mobility. This second group did not participate in exercises using the NeuroCom Balance Master. If you read the article, you will see that both groups showed improvement based on the "Timed Get Up and Go" measure as well as the "Berg Balance Scale." You will also read that this study did not show a significant difference between the groups. Balance improved in both groups. This study did not include a quality of life measure or an satisfaction or enjoyment measure to see which approach was more pleasing to the participants. The specific intervention variable used in the above mentioned article is probably expensive and not available to most therapists working with patients with balance issues. On the other hand, a Nintendo Wii balance board is relatively inexpensive and easy to obtain. Games on Wii Fit Plus can be used to provide visual feedback about weight shifting, center of balance and flexibility. Albeit, Wii is far less sophisticated than the Balance Master, using the Wii in therapy requires less space to set it up and less expertise to use. In some cases, the Wii Balance Board (WBB) has been used with modifications and peripherals in studies aimed at assessing improvement in balance. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury, and Development of an interactive rehabilitation game using the Nintendo® WiiFit™Balance Board for people with neurological injury are two examples. Lean on Wii: Physical Rehabilitation With Virtual Reality and Wii Peripherals outlines more details about add-ons to the WBB. In some studies the Wii Fit Plus is used without changes. Examples include Wii-habilitation as balance therapy for children with acquired brain injury, Benefits of the Wii Fit as an Exercise Program for Older Adults, and Home-Based Balance Training Programme Using Wii Fit with Balance Board for Parkinson's Disease: A Pilot Study. Wii balance board activities can be used to help improve balance in many populations.

Wii Fit for Therapy - A Fun Way to Improve Many Deficits

I have recently returned from Anchorage, Alaska where I taught "WiiHab- Using Nintendo Wii in a Therapeutic Setting." The attendees were a great audience. The workshop began at 7:30 AM and ran til after 5 PM and everyone learned so many new ways to use Wii activities and exercises to meet therapeutic goals. Like at other WiiHab workshops, the Alaska participants brought a variety of expertise to the group. The therapists worked in all sorts of settings and enjoyed learning how Wii could strengthen their practice and improve their ability to achieve the goals set for different patient populations.
One patient population that Wii seems a natural fit for therapy is pediatrics. Kids are quick to master the use of the remote. And when compared to the geriatric population, the kids respond readily to the video game platform.
The Wii Fit and Wii Fit Plus offer so many great activities to improve weight shifting, dynamic balance and standing tolerance. Those who need to improve these areas the most often require much effort from the staff to guard and support them as they work on these goals. A group of therapists in Utah came up with a great modification to use with the balance board to help a student work on all of the above mentioned areas. Watch the student using Wii Fit with the modification as the therapists also provide hand over hand cueing for accuracy and verbal cueing for encouragement.
Use Wii more often in your therapy setting. If your rehab team wants to learn more, contact me and we will work together to bring the WiiHab workshop to your area of the country. The Wii brings FUN to Therapy. Don't be left out!

Rice University Students Modify Wii for use in Therapy

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.

Special Wii Software designed for Therapy

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

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.

SENIOR HEALTH & FITNESS DAY 2009

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.

Continuing Education Workshop featuring the "Wii OT"

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!

Using Wii to Detect Changes in Center of Balance

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.

Safety Tips for Wiihab Therapy

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

Fall Prevention and Wii

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

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

Infection control and Wii

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

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


Photo by frostova on Flickr

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

Injury Prevention and Wii

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

Avoiding injury to others or damage to equipment with the Wii

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

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

Video: Wiihab for surgical patients

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

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