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 Therapy - For War Vets and Burn Victims

On Saturday, March 27, 2010, over 30 therapists attended Stockton College's Seminar: Wii-Hab - Using Nintendo Wii in a Therapeutic Setting. Everyone who participated went away with new ideas for their setting.
One participant asked a great question about configuring the Wii Fit balance board for amputees. The questioning therapist wondered if the Wii Fit balance board would configure properly if the one on the board wore a prosthesis. The answer was yes, since the balance board responds to pressure applied it.
Many war veterans must learn to walk again using prosthetic limbs and games offered using Wii Fit help speed their recovery. A fellow soldier and his wife are working hard to help wounded vets gain access to this valuable tool. According to an article appearing online at www.wtop.com, "Air Force Staff Sargent David Flowers and his wife founded Wii's for Warriors, a group that gives away free Nintendo Wii Fit to amputees at Walter Reed."
Seminar attendees also learned about the value of games like the ones available through Wii applications for burn victims. At a hospital in New York City, a study is underway to assess if burn victims improve more quickly using a Nintendo Wii game in therapy or traditional cooking activities.

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."

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.

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 .

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.

Using Nintendo Wii in Therapy: Benefits Seen Over Time

WiiHab - Rehabilitative Therapy Using the Wii by the "Wii OT” has been up and running for over a year now. Thank you for all of your visits and emails. So many people have responded to my blog. Not only have other occupational and physical therapists and students sent emails and responses but also family members whose loved ones are recovering from TBI, stroke or joint replacement and are benefiting from using Nintendo Wii have contacted me from time to time. And these responses have come from many states like Pennsylvania and Georgia and from countries far and near to the USA like England, Sweden and Canada. The use of Nintendo Wii as a therapeutic tool continues to spread, while therapists, researchers, and patients alike continue to recognize the advantages of including this tool in plans of care.

Just the other day, another article appeared in print and online about the benefits of using Nintendo Wii to help people recover from injury, illness and surgery. This article highlights 2 important points. First, mention is made that Wii offers an opportunity for socialization, helping reduce feelings of isolation. Second, this overview states that using the Wii is fun. Bringing fun into therapy helps patients who are dealing with a changing health status to reduce feelings of anxiety. Learning to use adaptive devices or learning to do familiar things in new ways is easier when feelings of isolation and anxiety are reduced. Reducing feelings of isolation and anxiety is such an important part of therapy.

So again, thank you for your support. Post your experiences in the comments section for all to see.

High School and Middle School Special Needs Students in Oregon To Benefit from Wii-Hab Pilot Program

As planned, Lon Thornberg, along with the occupational and physical therapists who he works with in Oregon, spent two days observing ways that activities and exercises available through Nintendo Wii might benefit children with special needs. The article posted on No Limits to Learning describes the program designed to help these three dedicated individuals develop a program for their students that will incoroparte the most effective Wii programs for their student population.

Activities offered through Nintendo Wii Sports provide opportunities to improve :

1. motor skills, especially gross and fine coordination,
2. cognitive skills, especially sequencing, memory and recognition

as well as many other areas.

If you have used activities offered through Nintendo Wii in a school based setting, please let Lon and me know about your experience.

FIFTH ANNUAL GAMES FOR HEALTH CONFERENCE

The Fifth Annual GAMES FOR HEALTH conference, made possible in part by the Robert Wood Johnson Foundation, takes place June 11-12 in Boston, MA.  "The Healthcare Guy" posts what Ben Sawyer, co-founder of Games for Health, has to say about the upcoming conference.  This article provides both a good background on the history of gaming for health as well as a glimpse into the newest games available for the therapy toolkit.  

One game that Mr. Sawyer mentions is Electronic Arts' EA Sports Active.  This game features a personal trainer who leads the participant through a workout that really makes the player break a sweat.  This game encourages the participant to strengthen the upper body, build endurance, improve balance and strengthen the lower extremities. 

During a recent "Wii-Hab - Using Nintendo Wii in a Therapeutic Setting" Seminar, a student was very interested in using Wii activities for high level patients in an outpatient occupational therapy and physical therapy rehabilitation setting.  EA Sports Active  provides high level activities that may be well suited for that population.  

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.

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.

The Wii can fight Childhood Obesity

Earlier, I wrote about the Wii and Health Promotion (October 8, 2008).   Using the Wii is a great tool to combat the sedentary lifestyle.  Now, researchers in England are looking into the use of Wii to combat obesity in children.    How are you using the Wii in your practice?   Do you find that it motivates those you are working with?  I see it every day.  Helping people move more in an enjoyable and motivating way promotes a positive attitude.  

News Updates on Wii Therapy

For Wednesday -- a News roundup on Wiihab and using the Wii in therapy:

'Wiihabilitation' helps patients recover quicker
Dayton Daily News (July 29, 2008)

Senior center adds Wii system
Marshfield Mariner (July 29, 2008)

Nintendo Wii Used For Rehab
KSAT.com, TX (July 28, 2008)

Golden gamers
New Orleans CityBusiness, LA (July 28, 2008)

Foundation Grant Funds "Wii-habilitation" Therapy
Southern Pines Pilot (July 26, 2008)

Bayfront uses Wii for rehab
Tampa Bay's 10, FL (July 25, 2008)