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.

Nintendo Wii Boxing Tournament Highlights Benefits of Therapy

October is National Physical Therapy Month. The staff at Shriners Hospitals for Children in Greenville devised an activity to illustrate several therapeutic attributes of Nintendo Wii based treatments. The PT department at this nationally recognized hospital started a boxing tournament designed to illustrate how the Wii gaming system can be used to help young patients develop strength, improve motion and boost quality of life in an engaging way. The PTs are also providing insight to the participants as to how therapists can grade an activity to foster success for those with less function or challenge those with increasing ability.

The benefits of using Wii in occupational, physical and speech therapy seem limited only by the knowledge and creativity of the therapist designing the plan of care. Would you like to improve your level of expertise in using Nintendo Wii in your therapeutic setting? Contact Mershon W. Hinkel at the email address on this blog's profile page to find out about an opportunity to gain experience using the Wii in therapy by attending the workshop,entitled WiiHab: Using Nintendo wii in a Therapeutic Setting.

Notre Dame researchers create program for Wii use in therapy

One of the first aspects of Wii Fit that attracted therapists to its unique design was the balance test. The balance test indicates how equally - or not- the participant distributes their weight through their lower extremities when the individual stands on the board. Occupational and physical therapists found this feature helpful for many patient populations, helping bring an innovative change into therapy using Wii. This blog mentioned the center of gravity aspect and one of the therapeutic indications in a post dated September 5, 2008.
Now a team of students have created software to expand this therapeutic feature -WiiHab feature - into a more user friendly format. Individuals recovering from a stroke utilize the center of balance indication to improve dynamic balance and gait. These students hope to market this program to rehab centers for both clinic and eventual home use. Watch the interview with the design team to understand more fully what their product hopes to address.

Nintendo Wii offers Opportunities for Occupational and Physical Therapy

Nintendo Wii offers limitless opportunities for treatment in both occupational and physical therapy. No matter where along the age spectrum your patient population falls, something offered with the Nintendo Wii system can benefit your case load. Two articles in the news today highlight Wii-Hab or ways Wii might be used as a part of occupational and physical therapy.
In the first news article out of Leeds, England, one reads about a new bedside entertainment system for hospitalized Children. This news piece points out that playing games on a Wii system not only reduces anxiety about treatment but also encourages movement.
The second article about patients at Vanderbilt Children's Hospital features a video that focuses on key aspects of Wii-Hab. Watch the video to see and hear both a mother and a physician explain some of the benefits Wii brings during occupational and physical therapy for a child diagnosed with autism. A couple of benefits discussed include improving muscle tone and encouraging physical engagement with the environment.

New Hardware For Wii - Will it enhance Therapy?

Check out this trailer for the new controller Nintendo hopes to launch in 2012. What are your thoughts on therapeutic value and/or possibilities for clinical application?
Will this device require the participant to be at a higher level? Looks like one needs both hands to make it work. Take a look and post a comment.

Rice University Students Modify Wii for use in Therapy

Creative students from Rice University in Houston, Texas developed a Wii-Hab system to help patients during therapy at Shriner's Hospital. This new use of Wii in therapy, based on Wii balance board technology, helps improve balance and decrease dependence on balance aides. Team Equiliberator worked together to develop a system that proves to be relatively inexpensive, yet effective in encouraging participants to work toward improvements. These balance gains occur as the players enjoy age appropriate fun. Watch the video and read the article to learn how these students used Wii balance boards along with their own newly developed hand rail sensor system to create a Wii based therapy activity that also produces data for quantifying changes (improvements) in balance.

Wii Use for Therapy After Stroke

A study lead by Dr. Gustavo Saposnik, director of Stroke Outcomes Research Unit, St. Michael Hospital’s (Toronto) , shows the value of Wii activities for individuals in therapy following a stroke. WiiHab - Rehabilitative Therapy Using The Wii by "THE WII OT" previously brought this study to readers' attention in February of 2010.
Recovering from a stroke requires a long process involving repetitive actions in order to provide the brain an opportunity to "rewire". For most stroke patients, who may naturally suffer depression following the loss of function, this requirement of repetitive, long-term therapy falls by the wayside. Wii offers this population a way to expand the benefits of occupational and physical therapy into the home setting, reaping improved outcomes while discovering a new, motivating use for leisure time.

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.

Wii-Hab - Utilizing Wii Fit and Other Wii Programs in Therapy

The utilization of activities offered through Nintendo Wii continues to gain popularity with rehab therapists working with multiple populations. Just recently, an article from the Boston Herald appeared online in Therapy Times highlighting the improvement a young girl experienced following therapy for a traumatic brain injury. Not so long ago, an article about Rep. Gifford's rehab mentioned Nintendo Wii as a likely adjunct to traditional therapy.
Often my readers write and ask how Wii activities might be useful for their loved one.

Addressing specific cases would be difficult through an online platform such as this blog. So mostly, it is suggested that those looking for a therapist use care in selecting the setting for their particular situation. On MASTERSDEGREE.COM the writer provides a list of 15 questions to help those looking for a therapist of any type know what questions to ask before signing up. In the rehab setting, the opportunity to hand pick the therapist is rarely available. But usually rehab therapists, OTs especially, use a client-centered approach, assuring that the plan of care targets the individual's needs and learning style. If the therapist is familiar and comfortable with technology and Wii equipment is available, a high likelihood exists for including Wii activities since so many therapeutic objectives (as mentioned throughout this blog) can be addressed in an engaging way.
If your facility has either not embraced Wii technology yet or has put Wii away on a shelf, contact me at OTRMershon@gmail.com. I will work with your facility mangers to bring a Wii-Hab Workforce Training Session geared toward your specific population to your location.

Wii Fit - Therapy for Fall Prevention - WiiHab

The Saturday Evening Post online published a piece by Peter Perry about the potential of Wii Fit for improving balance. Take a moment to read about the research Kathleen Bieryla of Bucknell University has completed. Kathleen, an assistant professor of biomedical engineering, focused on improving clinical measures of balance in older adults by using activities in Wii Fit.
In the same Saturday Evening Post piece, Bryce Taylor, MSPT explains three of his trademark Wii-Hab therapeutic exercises using Wii Fit to improve back health and increase core muscle strength.

"Wii Therapy" in Detroit

Watching this video explains some of the benefits from the perspective of the patients using Wii in therapy. If a patient finds the therapy engaging they will be more involved. Hopefully then, the patients will push harder toward the goal and remain adherent to the plan of care. In this video, you will also hear the OT, PT and speech therapist explain why they find Wii-Hab to be such a useful tool to use in this setting.

Wii - Therapy in the broadest sense

In the UK like elsewhere, senior health and wellness are serious concerns. One administrator of a senior housing center developed an unique program for the residents to enjoy.

Prospective OT student writes about Wii As A Therapy Tool

Whitney Kramer, a student at Michigan State University used Wii technology in a classroom and recognized many aspects of Wii that she plans to later use as a therapist. Follow the link to read what she observed.

CEP 452 - Technology and Education: Wii As A Therapy Tool: "I know this class is primarily about technology and its uses in the classroom, but as a kinesiology major myself, I tend to look at t..."

Wii Related Therapy Benefits Highlighted in Research

Researchers with the department of Occupational Therapy at Kaohsiung Medical University in Taiwan have an article in press entitled Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome.
Children with Down syndrome (DS) between the ages of 7 and 12 were randomly assigned to one of three groups: standard OT interventions (SOT), VR using Wii technology interventions (VRWii) or the control group. Sensori motor functions were the targeted outcome measures and were assessed pre and post intervention using The Bruininks–Oseretsky Test of Motor Proficiency-Second Edition(BOT-2)(Bruininks &Bruininks,2005), The Developmental Test of Visual Motor Integration(VMI)(Beery, 1997), and The Test of Sensory Integration Function (TSIF)(Lin, 2004). Activities offered through Wii Sports were chosen for the VRWii intervention group. The results of this study indicated that the group of DS subjects who received Wii therapy demonstrated statistically significant improvement in motor proficiency, visual-integrative abilities and sensory integrative functions as compared to the SOT and control groups.
Evidence continues to mount in support of Wii-hab for improved outcomes in many populations. In this study as well as in the study published in October of 2008 by Judith E Deutsch, Megan Borbely, Jenny Filler, Karen Huhn and Phyllis Guarrera-Bowlby the authors comment on the intrinsic values of Wii technology including engagement, encouragement and feedback. Furthermore, Wii provides an opportunity for atypical children to interact with peers both with or without similar disabilities.

Wii Add-on May Enhance Use of Wii in Therapy

(Image from: http://seattletimes.nwsource.com/html/technologybrierdudleysblog/2009290380_e3_nintendo_previews_next_wii.html)

Nintendo announced last year a plan to market an add-on called a Wii Vitality Sensor.
Many OTs and PTs will think this add-on looks like a tool often used in the clinic. The Wii vitality Sensor looks and works like the familiar pulse-ox device often used to measure pulse and oxygen concentration in a client's blood. Now Nintendo plans to use that data to provide feedback to players and to control actions of a player's avatar.
Like the balance board, this new add-on will expand the therapeutic value of Wii activities while making recording improvements much easier during therapy.

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?

Special Wii Software designed for Therapy

Kaasa Health GmbH of Düsseldorf has developed software - Wiiware- specifically for use in a clinical setting. This program focuses on balance training making that often boring and monotonous work fun. Building on the fact that the balance board is a force plate capable of extracting data about one's center of balance and ability to shift weight, this specifically designed game environment helps those with balance issues improve. Since balance ability influences fall risk in seniors, playing this video game might be a key component in reducing the occurrence of falls and the associated physical, emotional and monetary costs in elders. Using Wii Fit in therapy was shown to improve balance and ability to walk with a walker when a group of therapists added 4 sessions of Wiihab to a regular therapy program. Now, with the development of specific software program for rehab, more therapists may begin to incorporate Wii into the clinical setting.

Special Wii Software designed for Therapy

Kaasa Health GmbH of Düsseldorf has developed software - Wiiware- specifically for use in a clinical setting. This program focuses on balance training making that often boring and monotonous work fun. Building on the fact that the balance board is a force plate capable of extracting data about one's center of balance and ability to shift weight, this specifically designed game environment helps those with balance issues improve. Since balance ability influences fall risk in seniors, playing this video game might be a key component in reducing the occurrence of falls and the associated physical, emotional and monetary costs in elders. Using Wii Fit in therapy was shown to improve balance and ability to walk with a walker when a group of therapists added 4 sessions of Wiihab to a regular therapy program. Now, with the development of specific software program for rehab, more therapists may begin to incorporate Wii into the clinical setting.

Wii in Therapy: Additional chances to Enhance Your Skills

Fall 2010 brings opportunities to learn about Wii modifications as well as to brainstorm with other therapists about creative uses for Wii. Join colleagues for "Wii-Hab: Using Nintendo Wii in a Therapeutic Setting."
Due to demand, Easter Seals Capper Foundation- Topeka, Kansas, added an additional workshop date. Now you can sign up to attend the added session on Friday, September 24.

September 24, 2010 - Easter Seals Capper Foundation, Topeka, Kansas

October 16, 2010 - Penn State Abington Campus - Philadelphia, Pennsylvania

October 29, 2010 - Allegany College of Maryland - Cumberland, Maryland

After attending the workshop therapists will return to their work setting with new ideas about Wii. Be the therapist who knows how to take Wii beyond bowling toward challenging therapeutic activities to improve outcomes in many settings!

Novel Use of Wii Fit Data may have Implications for Therapy

University of Maryland, working with several other Universities, plans to use Wii Fit data generated by an athlete when healthy as a baseline measure of balance ability. These recorded scores would then be available in the event that the athlete suffered a concussion during play.

Although therapists rarely have specific information about a person's baseline status, aspects of this novel application suggest ways that Wii could be utilized in therapy.
Researchers working on this study point to Wii Fit's "objective and practical" qualities which allow trainers to gather data post injury in a client friendly way. Athletes report enjoying activities using Wii Fit.

The enjoyment factor comes as no surprise to therapists who use Wii technology in their practice. Clients of all ages seem willing to engage in Wii therapeutic activities. Though true baseline data for our clients may not be available for comparison, data gathered early in treatment will provide objective scores, that when compared to later records will support not only increases in performance components, but also improvements in activity engagement.