Why WiiHab May Be Helpful Therapy In Preventing Falls

The Lancet published results of what researchers, observing falls in long term care residents, found through videos of the incidents. Take a minute to read the summary of this study (primary source: Robinovitch S, et al "Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study" Lancet 2012; DOI: 10.1016/S0140-6736(12)61263-X.) as published on MEDPAGE. Interestingly, the study found falls in this long term care population occurred at higher rates during standing and transferring and at lower rates during walking, with a larger proportion of falls attributed to center-of-mass disturbances as compared to base-of-support disturbances (trips, slips, and stumbles). Therapy that includes Wii Fit activities like Ski Jump can be used to increase awareness of center-of-mass and improve control and voluntary engagement of muscles required in weight shifting. Through my experience, the elders seem to enjoy Wii activities. The video game format and the Miis that they can create, encourage them to invest a bit more in their therapy than traditional, repetitive therapeutic activities. Based on knowledge gained through this study on causes of falls, elders would benefit from targeted programs that promote more control of center-of-mass.

Research Supports Wii in Therapy

Falls in community dwelling elders concern not only those who might be at risk, but also the physicians and therapists who see the sometimes life changing effects of these incidents. Research on prevention strategies abounds. Many approaches show results in reducing risk. Many students choose Nintendo® Wii Fit™ as an intervention in their research. A physical therapist published his study showing improvements in all of the chosen outcome measures. He used Nintendo® Wii Fit™ activities combined with traditional activities in his therapeutic approach. A second study conducted by a graduate occupational therapy student focuses on the benefits of Nintendo® Wii Fit™ activities for a older adult with Myasthenia Gravis. Her research also shows improvements in outcome measures. A third study presented in May 2012 further supports using Nintendo® Wii Fit™ activities as a key component of fall prevention programs for reducing fall risk in older adults.

Wii-Hab Therapy Article Appears in New York Times

Once I worked with a fantastic Occupational Therapist who always motivated his staff and kept morale high even during periods when the case load was tough. He would always say, "Everything that is old, is new again." He said this because his years of experience taught him that the treatment approach that was most talked about just the other day, would be overshadowed by a different treatment approach for a while, only to resurface again as the hot "new" topic once more. Rehabilitation approaches, like life, appear to be cyclical and using Wii in rehab appears to run in and out of the spotlight regularly. The New York Times shines that spotlight on Wii once more by publishing an article Saturday highlighting the value of Wii Golf in therapy. Wii activities bring FUN into treatment. FUN helps patients stay motivated. This article suggests that some in rehab even forget that they are exercising. They just think they are having fun as their strength, balance and cognition improves. A patient once said to me, "Every part of therapy doesn't need to be so hard." She loved Wii because the games let her feel successful and refreshed. She enjoyed laughing. Her standing tolerance was much higher during Wii Bowling than during the therapeutic ball tap activity. Bring those Wii games back out this week. If you wish you knew more about using Wii in therapy, keep a lookout for a workshop in your area.

Post-stroke Balance Improved With Yoga

Wii Fit Plus activities can be used in therapy in many creative ways. Wii therapy with yoga poses (found in the Wii Fit program) may be very beneficial. For individuals recovering from stroke, yoga helps improve balance, function, and quality of life. An occupational therapist led a study looking at the effects of a yoga program on participants who had strokes. The outcome measures included balance as measured by the 14-item Berg Balance Scale, balance efficacy as measured by the Balance Confidence scale and quality of life indicators as measured by the 49-item Stroke-Specific QoL scale. The researcher reports using seated, standing and floor postures. Wii Fit Plus offers 18 different Yoga poses as outlined in the Yoga Exercises for Wii Fit Plus cheat sheet. Each pose benefits the participant in ways ranging from improved postural alignment, to increased strength, to improved flexibility. Using yoga activities with Wii for therapy has the advantage of providing the therapist and patient with immediate feed back, a score that can be used to indicate improvement, and an easy way to boost carry through by including the Wii activities in a home program.

Wii based Movement Therapy

What is that quote from Shakespeare's Romeo and Juliet? Remember? Juliet says, "What's in a name? That which we call a rose by any other name would smell as sweet;" ******* WiiHab**** Wiihabilitation*****Wii Therapy*****Wii based Movement Therapy********* Different names; same results. Patient's have fun and have more motivation to stick with the rehab plan of care when Wii games are added as a complement to their traditional therapy program. P. McNultey, a neurophysiologist at Neuroscience Research Australia, presents data from her research in Brisbane today (July 20) demonstrating that patients who participated in an intensive 2 week program based on Wii showed significant improvement in their ability to use their limbs. This improvement occurred in participants even if they had experienced the stroke many years ago. Dr McNulty said, “The Wii is inexpensive, easy to use and, very importantly, fun. This type of rehabilitation motivates participants to actually complete their therapy, which is essential for maximum recovery.” Incorporating Wii into your treatment day makes therapy more fun for everyone. If set-up and space are concerns, try to pick a time slot or a day and use Wii activities as a therapeutic approach for the scheduled patients during that time. Are you wanting to increase your knowledge and understanding of which activities work best for which goals? Contact me about bringing The WiiHab Workshop to your area. What a fun way to earn those CEUs!

Wii Fit as Therapy for Cancer Related Fatigue

Activities available through Wii Fit are showing value as a user-acceptable therapy to help combat cancer related fatigue in patients with non small cell lung cancer (NSCLC). A nursing researcher from Michigan State University College of Nursing reported on her study that utilized Wii Fit Plus walking and balance activities with post surgical patients as they recover and transition to home. The participants in the pilot study funded by the National Cancer Institute and the Nintendo Wii game system utilized the virtual exercises to help them build activity tolerance while focusing on the fun of exercise.********************************** OTs often work with cancer patients post surgically to help them meet the goals highlighted in this study including reduction in levels of cancer related fatigue (for increased independence in self care), reduction in sedentary lifestyle (for reduced likelihood of post surgical complications such as pneumonia), increase in activity tolerance (for higher levels of independence in home management tasks) and increase in engagement in leisure time activities (for improved feelings of self worth, reduced feelings of depression - resulting in more willingness to engage in self care and other occupational roles). WiiHab activities offered in Wii Fit Plus, evidence-based approaches, should be used to help patients meet these goals. This study demonstrated that patients like this type of self paced, light intensity activity when recovering from cancer surgery even during chemo and/or radiation.

Wondering about Wii and Therapy?

A concern that often pops up during discussions about Wii and therapy is that the Wii is a passing trend for therapy. That idea may have been a possible concern initially, but after four to five years of use, research, and development Wii and newer video platforms have secured a place in treatment with many patient populations. Take a moment to read Do You Wii-Hab? Using Motion Gaming in Your Therapy Clinic . This great post by CHARLOTTE BOHNETT on WebPT.com highlights many uses for Wii in the clinic while also providing a brief comparison of Wii with Kinect for Xbox 360. Conversation among some researchers and developers of rehab software for both Wii and Kinect for Xbox 360 often gravitate to which system is best. My experience suggests that both systems offer benefits and a skilled therapist can use either system to achieve goals in their setting. An ongoing discussion among members of the WiiHab group on LinkedIn discuss some of the positive and negative aspects of each system. One frequently criticized aspect of Wii is the need for a hand held device or controller. Kinect for Xbox 360 does not require the player to hold a device. But critics of the Kinect system point out the need for a larger playing field. This aspect of the Kinect system sometimes makes using it difficult in certain clinic settings. Melissa from Chicago points out in this LinkedIn discussion that unlike the Wii system, the Kinect system is difficult to modify for some disabilities and furthermore, if a patient requires assistance to stand, the Kinect system will sometimes confuse the therapist holding the gate belt with the actual player.

Wii Fit for Therapy - A Fun Way to Improve Many Deficits

I have recently returned from Anchorage, Alaska where I taught "WiiHab- Using Nintendo Wii in a Therapeutic Setting." The attendees were a great audience. The workshop began at 7:30 AM and ran til after 5 PM and everyone learned so many new ways to use Wii activities and exercises to meet therapeutic goals. Like at other WiiHab workshops, the Alaska participants brought a variety of expertise to the group. The therapists worked in all sorts of settings and enjoyed learning how Wii could strengthen their practice and improve their ability to achieve the goals set for different patient populations.
One patient population that Wii seems a natural fit for therapy is pediatrics. Kids are quick to master the use of the remote. And when compared to the geriatric population, the kids respond readily to the video game platform.
The Wii Fit and Wii Fit Plus offer so many great activities to improve weight shifting, dynamic balance and standing tolerance. Those who need to improve these areas the most often require much effort from the staff to guard and support them as they work on these goals. A group of therapists in Utah came up with a great modification to use with the balance board to help a student work on all of the above mentioned areas. Watch the student using Wii Fit with the modification as the therapists also provide hand over hand cueing for accuracy and verbal cueing for encouragement.
Use Wii more often in your therapy setting. If your rehab team wants to learn more, contact me and we will work together to bring the WiiHab workshop to your area of the country. The Wii brings FUN to Therapy. Don't be left out!

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.