OT includes Nintendo Wii in "Playroom" Based Therapy

Children who perceive sensory input differently than their peers, often struggle at home and at school. These kids face difficulties in day to day life, struggling not only with self care activities like with dressing and feeding, but also with classroom tasks such as attending to classwork, manipulating pencils and paper and absorbing instructions. Lindsey Stamper, an occupational therapist in Paducah, Kentucky works with many kids with neurological impairments, helping them to "slowly expand their capabilities." She provides this help in a SENSORY PLAYROOM.
Using balance balls, swings, a padded floor and Nintendo Wii & balance board activities Lindsey helps kids improve their ability to process sensory input and to engage in activities of daily living with less difficulty.
An approach utilizing sensory integration techniques proves successful in mitigating problems in children who experience neurological processing deficits. Many Wii applications either independently or in conjunction with other sensory diet components enrich a child's sensory experience while helping the child reach processing goals. The Wii, an increasingly familiar video gaming system, contributes therapeutic opportunities to address proprioceptive, vestibular, tactile, auditory and visual needs in a non-threatening and fun fashion.
Are you a parent or therapist interested in sensory processing disorders and in helping kids who deal with the resulting problems? Please post a comment and start a discussion. How do you think activities using Nintendo Wii games -"wii-hab" - can help a child you know?

NASCAR INTERSECTS WII THERAPY (WIIHAB) as KYLE PETTY, Racing's Renaissance Man, meets the "Wii" OT

Sometimes unexpected opportunity and inspiration find you. On a recent Tuesday evening in Williamsburg, Va. I met someone who offers both to anyone willing to make the investment. Kyle Petty, known to many through ever popular NASCAR racing, spoke to the attendees of the Electrical Utility Fleet Managers Conference. His engaging speech explained his family's role in building the sport of auto racing. First, he told of his Grandfather, Lee, who was drawn to racing as a way to provide for his family. Next, through engaging stories, he introduced the listers to his now famous father, Richard. Richard loved the sport and drove for the thrill. Kyle explained that he, personally, also loved the thrill of racing like his father. Both Kyle and his wife were excited that their son Adam dreamed of carrying on the Petty racing legacy. Shock and sadness swept over every listener as Mr. Petty explained how that dream would not be realized. As he continued, Mr. Petty transformed our shock and sadness into admiration and hope as we learned how this amazing family turned tragedy into a vision and then into the reality of helping kids with special needs as a way to honor the life and dreams of their son, Adam.
Victory Junction, a camp for kids with chronic medical conditions and serious illnesses operates near Randleman, NC. Since opening in 2004, over 11,000 children and families have been served by programs designed especially for them. Many different populations are served over the summer as well as throughout the year. One aspect that makes this camp so special is that each week is dedicated to a specific diagnosis category, such as autism, cerebral palsy, and burns, among others. Mr. Petty explained the importance of this model. By bringing individuals who struggle with similar problems together, they learn that they are not alone. As therapists, we recognize that grouping in this manner enhances opportunity for peer modeling and social support.
Hopefully, everyone who reads this blog post will consider becoming involved at some level with this great organization. Occupational and physical therapist and students could volunteer as cabin counselors or in another capacity. Your expertise would be appreciated and you would learn so much. Students considering applying for occupational or physical therapy school could also spend a week with the campers and gain valuable experience while giving back so much. Parents looking for something special for their child may find that this camp would provide the care and respite they seek. I plan to contact Victory Junction about volunteering myself. I want to work with these special kids in the fresh air while they involve themselves in real world golfing, bowling, swimming, driving and fishing ... all the things that in the school setting we are luckily able to do in the virtual world through Wii Therapy.

Grant Award Brings Wii Into The Classroom

Since Nintendo brought Wii to the market in 2006, many avid players who also happen to work with individuals with compromised function recognized this tool’s potential for addressing deficits. A special needs teacher in Ohio saw many great ways that Wii activities could improve student outcomes in his classroom.

The teacher, Kevin McDaniels, applied for funds to purchase the needed equipment for his classroom through Mid Ohio Energy Cooperative, INC’s Community Fund because Kevin recognized that using Wii complimented student time spent in occupational and physical therapy. Using Wii activities in the classroom seems to help students improve hand writing and balance by challenging both their fine and gross motor skills.

Although Nintendo has lowered the price of the Wii Console recently, the dollar amount needed to bring the benefits of Wii into classrooms and rehabilitation clinics may be in excess of usual pre-set budgets. Grants and donations have historically filled budgetary gaps in programs focusing on helping address needs in many communities. Most communities have organizations ranging from service groups to corporations willing to help programs reach out and serve those community members with specific needs.

Interested occupational and physical therapists as well as teachers can learn more about skills for grant writing and finding potential donor organizations by attending a grant writing workshop available often through area high school or college adult learning programs, found through internet searches or through companies, such as Grant Writing USA

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).

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.

Occupational Therapist to Pilot Wii Program for School Based Treatment

Using Wii as a therpeutic tool for the geriatric population recieves a great deal of press but the use of Wii based activities for children in school based programs is discussed only occasionally in the news.  In Oregon, an occupational therapist, with the help of the assistive technology specialist and trainer has planned an assessment day during which students will try out several Wii applications.  The OT will gather useful information about which applications are best for various motor levels and abilities.  This fact finding day, described in the May 7,2009 post on No Limit 2 Learning will provide a wealth of information.  Take a minute to read about this well thought out venture by clicking here.

  

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.  

Sensory Processing Disorders (Part 1 of 3)

Therapists working with the K-8 population, especially students with diagnoses across the Autism spectrum must be equipped to address sensory processing disorders.  Sensory processing problems impact all areas of function and must be considered on a case by case basis. Subtle differences between children’s abilities require the therapist to individualize treatment protocols.  Components included in the sensory processing performance area are:

 

• Tactile –  Refers to the interpretation of sensory input, including temperature, pressure, pain, and touch, collected from receptors located in the skin
• Hypersensitivity – Tactile defensiveness- may avoid touch
• Hyposensitivity -  Decreased responsiveness to touch- may seek repetitive tactile input
• Auditory – Refers to the interpretation of  sound
• Hypersensitivity – Auditory defensiveness- may be overly sensitive to background sounds
• Hyposensitivity - Decreased responsiveness to sound – may not respond appropriately when called by name, may not be able to locate the source of a sound, or may make repetitive noises for no reason.
• Olfactory – Refers to the brain’s interpretation of  smell
• Hypersensitivity- May be overly sensitive to smells which others may not notice
• Hyposensitivity – May not notice smells others complain about.

 

(Continued next time…)

 

Please post your experiences under the comment section because in sharing your experience, you help increase everyone’s knowledge base.

Using the Wii Therapeutically in a School Setting: PART 2

Therapists working with the K-8 population, including students with diagnoses across the Autism spectrum, will also need to address perceptual processing problems including:

• right-left discrimination (ability to distinguish or identify left and right directionality)
• form constancy (recognition of objects or shapes as the same regardless of size, spatial orientation, or texture)
• position in space (recognition of the spatial orientation of objects in relationship to the surrounding environment)
• body scheme (perception of one’s own body arrangement in relationship to self and environment which facilitates the individual’s ability to orchestrate purposeful movement through space and focused manipulation of objects)
• figure ground (ability to discriminate or isolate a particular object or shape surrounded by or embedded in a varied background)
• depth perception (ability to recognize three dimensions in objects and self while  perceiving the relationships among and judging  the distances between these objects and/or self)
• spatial relations (ability to sense one’s position or place within the environment in relationship to other objects or people as well as the ability to perceive the relationship of one’s own body parts to each other)
• topographical orientation (ability to plan out a route and follow a route through recognition of landmarks, perception of landmark relationships and directional memory)

 Wiihab using activities and games found on the Wii Sports menu, used in conjunction with other more traditional approaches, targets problems children may have with perceptual processing, especially body scheme.     Do any of you have experience using Wii in a school program?  A group of students in NewJersey used Wii with a 13 year old with cerebral palsy.  Wiihab can also be a great tool for the school based therapist for addressing frequently encountered cognitive problems and psychosocial problems.  The next post will clarify those issues.

Using the Wii Therapeutically in a School Setting: PART 1

Jan from Maine writes on October 23, 2008:

Hi There,

I am an OT who would like to use Wii with my kids in the school setting. I am writing a grant for funding this and would like some feedback as to which program might be the best for my K-8 population and with my Autistic population.

Thank you!

Jan from Maine

Thank you, Jan, for your question. This question, of course, covers a very broad subject, so I will break it down into several important areas.  If more specific or timelier information is needed, Jan from Maine could leave a comment with her email address and I could address those specifics directly.

My response to this question will appear in multiple posts.  In the first few posts, I will outline and define several potential areas for occupational therapy intervention for the K-8 population, with a special focus on areas of OT intervention for those with autism.  The second group of posts will give examples of specific Wii activities to address these areas.  And finally, I will suggest some current research to use as supporting literature for a grant proposal. 

Some potential areas for intervention in the K-8 population include but are not limited to:

• Motor
  
• Perceptual
  
• Cognitive
  
• Psycho Social 

Occupational therapy intervention areas for children in this population with Autism include but are not limited to:

• Psycho social
  
• Sensory (processing) Integration
  
• Cognitive
  
• Perceptual
  
• Motor

Deficits in any of these areas can make classroom and daily activities challenging.  Identified students receive needed intervention from Occupational, Physical and/or Speech Therapists. The Nintendo Wii is emerging as a popular tool for therapists working with school aged children with special needs.  Wiihabilitation incorporating Wii Sports and Wii Fit can be used to address many of these frequently encountered problems and strategies for incorporating Wiihab in School based therapeutic programs will be discussed in detail in the latter parts of this segmented post.

Movement disorders in the K-8 (including those with Autism) may result from neuromusculoskeletal issues as well as from a complex mix of perceptual, muscular and motor issues.  Musculoskeletal involvement may result in:

• Alterations in muscle tone – (spastic- increased or flaccid- low/decreased)
  
• Decreased range of motion and/or strength
  
• Poor endurance
  
• Decreased postural control – alignment (standing or sitting)  

Additional motor or movement problems stem from a complex mix of deficits across several systems and may manifest as problems with:

• Coordination –both gross and fine (dexterity)
  
• Bilateral integration (using both sides of the body cooperatively, either simultaneously or alternately)
  
• Crossing the midline (passing one extremity across the midline of the body into the opposite side)
  
• Motor planning (praxis- the ability to perceive [visualize], organize and execute a motion or action accurately)
  
• Visual motor integration (the combined ability to visually perceive an object while accurately grasping and manipulating the object efficiently to complete the desired task)

Problems in any of these areas contribute to a student’s difficulty with classroom and self care activities.

Using Mario Kart in Wiihab (Part 1 of 6)

Have you thought about using Mario Kart in therapy but are wondering what goals it can help your patients reach? This post is the first in a series of six on areas that Mario Kart can target for improvement as part of a rehab plan. Many of the areas that will be described in this series are important in conditions including pervasive developmental disorders and sensory integration dysfunction.


Photo by SMercury98 on Flickr

Post 1: Bilateral Coordination

Bilateral coordination is the coordinated use of both sides of the body at the same time, either in similar movements or in alternating movements. An example of a similar movement is using both hands to pick up an object or using both hands to throw a beach ball; an example of alternating movement is walking up the stairs or pedaling with the feet or the hands.

In Mario Kart Wii, players insert the regular Wii remote, which is rectangular in shape, into a wheel-shaped adapter. Because the wheel Wii controller is held and controlled with both hands, bilateral coordination is involved in playing the game.

Also, effective playing of the game can involve alternating movements, such as holding down the "2" button to speed up the kart while using the "b" button on the reverse of the controller to "drift" while in manual mode. (Manual mode is optional, and less advanced patients can play in automatic mode.)

News reports of Wii use in pediatric therapy

Using the Wii as part of therapy can work for all age groups. Children especially enjoy video games and have grown up as "digital natives" who are fluent in the use of computers and technology, and so using the Wii as a component of OT/PT in pediatrics makes sense.

This story from Texas reports on how therapists are using Wii games to help children not only gain strength and flexibility, but also improve coordination. As in many cases, the games chosen are tailored to patients' needs, such as Bowling and Boxing for arm strength and coordination.

Wiihab might be particularly useful for children because it removes the boredom factor from therapy. Using the Wii is also a distraction technique, reduces anxiety, and incorporates play into therapy.

For OTs, using the Wii with pediatric patients can be an especially important component of a well-rounded therapy program because playing is part of a child's "occupation." Additionally, because the Wii is a popular toy for younger age groups, learning how to use the Wii may help a child with social interaction and playing with peers. Playing Wii also is an opportunity for children to interact with parents and adults in a way that has therapeutic value.

Pediatric centers in UK using Wii for children with hemiplegic cerebral palsy

In Newcastle, England, a professor at Newcastle University's Institute of Neuroscience has opened a research study in using video games, including the Wii, as a rehab tool for children with hemiplegic cerebral palsy. Hemiplegia affects one side of the body, and children diagnosed with this disability often neglect the disabled arm and leg. The study is using Wii controllers and laptops with specially designed games to encourage children to use their disabled arm. These adapted games have a lower level of complexity and a lower speed than those commercially available; the study has tested two games and a third will be added.

The principal researcher, Professor Janet Eyre, has noted improvements in the children's use of the less frequently used limb as well as improvements in coordination and social interaction:

"What has been striking to us, and the parents and children, is that by playing the games the children are using their [disabled] arm more in everyday life. We're trying to give them an incentive so that they will use it a lot."

She also notes the social value of using games, which are an integral part of childhood, to de-stigmatize therapy for children and families:

"Children sometimes feel stigmatised by therapy but everyone plays games, and they can play them with their parents or their brothers and sisters."

Therapy may hold a stigma even for adults; using the Wii and other video game / interactive tools may be of use even with older patients who resist therapy or who are unlikely to adhere to recommended courses of therapeutic treatment.