Following Stroke, The Wii Encourages Bilateral Upper Extremity Use

Using  Wiihab encourages many responses.  Often occupational and physical therapists are challenged to  find therapeutic activities to elicit one desired response,  bilateral upper extremity use.   Those recovering from stroke may find using the involved extremity uncomfortable and challenging because of muscle weakness, increased or decreased muscle tone, poor sensation, or loss of position sense (proprioception).   Boxing in Wii Sports, especially, offers an opportunity to use both upper extremities reciprocally and spontaneously.   Boxing in virtual reality creates a need to make alternating movements with the arms to protect yourself from punches or to knock out your opponent.  If the participant's bilateral cordination is sluggish, their opponent will punch them.  Many will work hard to avoid that!  All of the Wii games promote therapeutic movement and many news reports explain the value patients find in using games as therapy.  

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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.

Robert Wood Johnson funds video game health research

Robert Wood Johnson foundation has devoted more than $8 million to fund Health Games Research, a research group dedicated to discovering more about how video games can be used to improve health. The goals of the program are to support research that either increases physical activity or improves self-care (the activities involved in taking care of oneself).

This research funding is a wonderful step towards developing an evidence-base that supports use of video games as therapeutic activities. Many of the movements involved in playing the Wii or other interactive video games are already based on evidence and research that certain tasks improve balance, strength, coordination, and self-care abilities. Continuing to conduct research in this area will yield even more information about how providers can implement the use of video games in their practices and bring this technology to a wide variety of patients.

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.)