Answering your colleagues' questions about Wiihabilitation Therapy

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.

 

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.