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!

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.

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.

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.

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 .

Wii-Hab Meets Medical Illustration

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).

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

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

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.