WiiHab in the Forefront - Preview of Premier Issue of G4H - GAMES FOR HEALTH -Journal Now Available

One frequently heard criticism of video games in therapy has been the lack of evidence that using gaming actually impacts specific outcomes. Now a group of dedicated professionals has created a forum which will share the results of studies that use gaming as a variable in health care research. This peer review journal, Games for Health Journal: Research, Development, and Clinical Applications, will be published bimonthly by Mary Ann Liebert, Inc., publishers. Therapists interested in using Wii or other gaming systems in their therapeutic setting may want to check this source out. A preview is available as well as an opportunity to sign up for a biweekly eNewsletter.
Just yesterday I was reminded of the importance of fun in therapy as I spoke with a student struggling in her fieldwork experience. Seasoned OTs forget from time to time to encourage our proteges to seek therapeutic activities that allow our clients to succeed while they experience a sense of enjoyment. Gaming is the perfect tool for bringing laughter, enjoyment and success into therapy. Follow the articles published in Games for Health Journal: Research, Development, and Clinical Applications to boost your own confidence for using Wii and other gaming systems during therapy sessions.

Canadian Researchers Demonstrate Efficacy of Wii-Hab Following Stroke

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."

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 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.

WiiHab in the News Throughout The Summer (Part 1)

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.

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

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).

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.

Robert Wood Johnson funds video game health research

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.