MCG's DR. HERZ PRESENTS RESULTS OF STUDY OF WII THERAPY AND PARKINSON'S

Completeing the research and publishing the studies that form the basis for evidence-based medicine takes time, money, and expertise. Lead researcher, Dr. Ben Herz, from Medical College of Georgia, is among the first researchers to publish a study which demonstrates the benefits of using Nintendo Wii in a therapeutic setting. On June 12, 2009 he presented the results of his study that examined the benefits of an occupational therapy intervention for patients with Parkinson's disease using actvities available through Nintendo Wii .

Those attending the fifth anual Games for Health in Boston heard Dr. Herz's report that the study participants demonstrated a decrease in depression as well as an increase in agility. These improvements would be very beneficial to someone with Parkinson's since those with Parkinson's disease experience both depression and bradykinesia (slowing of movement).

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.

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.

  

New Wii Remote Accessory May Increase Therapeutic Value for High Level Clients

Nintendo plans to release a new accessory for the Wiimote.  The Wii MotionPlus can be easily attached to the remote. Once attatched, this device enhances the remote's ability to detect and reflect arm and wrist motions.  This increased sensitivity and accuracy may improve Wii's value as a therpeutic tool for rehabing higher functioning clients.  By enhancing the remote's ability to detect even the slightest movement of the wrist and arm, Nintendo might be making it easier to target specific muscles and to encourage increases in strength, coordination and endurance .  The release date for this attachment is June 8, 2009 for the USA markets.   

Students Enjoy "Wii-Hab - Using the Nintendo Wii in a Therapeutic Setting"

Allegany College of Maryland

hosted the most recent Wii-Hab workshops. Students learned how the games in Wii Sports and Wii Fit can be used as therapeutic activities (97530) and/or therapeutic exercises (97110) and/or Neuro-muscular re-education (97112) to achieve specific patient goals. The participants also had fun as they pacticed using Wii Sports and Wii Fit in innovative ways. Students also enjoyed applying what they learned by designing treatment plans for case study patients described as having poor endurance, weakness and lack of coordination.

Additional Wii-Hab workshops at Allegany College of Maryland are planned for October 2 or 3, 2009. Penn State Abington will host Wii-Hab: Using Nintendo Wii in a Therapeutic Setting on October 21, 2009. On Saturday, November 21, 2009, Wii-Hab: Using Nintendo Wii in a Therapeutic Setting, will take place in the Baltimore/Washington, D.C. area at Anne Arundel Community College's Arundel Mills campus.

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 Benefits of Wii from a Patient's Perspective

Occupational therapists like to utilize a patient-center approach in all aspects of treatment.  According to this article, Nintendo Wii as Therapy and Fun For Multiple Sclerosis, Wii, from a patient's perspective, is both enjoyable and therapeutic when coping with Multiple Sclerosis.  

 Problems for those with multiple sclerosis include fatigue, balance, flexibility and motor control.  Wii provides an array of activities which encourage a person to use and improve balance, flexibility and motor control.  These activities are fun and engaging, helping the participant focus on what they can do.  These self-paced activities allow for frequent rests while providing excellent feedback on improvements in a fun format.  Wii sports games, such as Bowling, baseball and Tennis help with motor control and flexibility.  The training moduals for each sport records your progress while the fitness modual calculates your Wii Age and posts it for encouragement.  Wii fit has great activities for improving balance and flexibility.  All of these games can be played for short periods with rests as needed.  Wii therapy brings a smile to all who try it.  Have you tried wiihab in your clinical setting yet?

Continuing Education Workshop featuring the "Wii OT"

Allegany College in Cumberland, Maryland  is now offering a second one-day continuing education workshop featuring the "Wii OT''.   The May 1st educational workshop is filled to capacity. So, on Saturday, May 2, 2009 another opportunity for occupational and physical therapists (and other rehabilitation professionals) to be introduced to the Nintendo Wii as a therapuetic tool will be offered. The WiiHab Therapy  Workshop offers a full day of exciting activities to help therapists and others involved in health care learn not only the great benefits of using the Wii in their clinical setting, but also the best methods to ensure that using the Wii is truly therapuetic.  

Course Description:

Rehabilitation therapists have a long history of using innovative and entertaining activities to help patients reach therapeutic goals. In this one-day course, therapists will be introduced to the Nintendo Wii as a therapeutic tool which can help patients increase strength, balance, endurance, flexibility and hand-eye coordination. Additionally, participants will learn appropriate adaptations and modification for Wii play in various patient populations, particularly older adults. Course will include case studies and practical considerations for patient safety.

Continuing Education Information:

Approved by the Maryland Board of Occupational Therapy Practice for 7 contact hours. Approved by the Maryland Board of Physical Therapy Examiners for .7 CEU’s. All other professionals will receive 7 contact hours from Allegany College of Maryland.

For more information, call:

Linda Atkinson, Director,

Institute for Health

and Human Services

(301) 784-5526

I look forward to seeing many of you there!

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.  

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.  

Share your stories!

Sensory Processing Disorders (Part 3 of 3)

(More on sensory processing disorder…)

 

School-based therapists recognize the entwined nature of the sensorimotor performance components and program plan accordingly.  The Wii provides another tool for the therapists, allowing them to challenge and grade movement through space as well as encourage targeted actions.  Are any readers using the Wii in your setting? 

 

Therapists must also identify issues in other performance areas such as cognitive and psycho-social.   Manifestations of problems within the cognition and psycho-social arenas will be discussed in future posts.

 

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

Sources:

·        The Sensory Processing Disorder Resource Center

 www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html

·        Kranowitz, CS., Miller, LJ. (2005). The Out-of-Sync Child.  New York, NY. Penguin Group.

·        Bhojne,U, Chitnis, A. (2002). VESTIBULAR DYSFUNCTION IN CHILDREN WITH PERVASIVE DEVELOPMENTAL DISORDER. The Indian Journal of Occupational Therapy. XXXIV(1).3-6. Retrieved from http://medind.nic.in/iba/t02/i1/ibat02i1p3.pdf

 

Sensory Processing Disorders (Part 2 of 3)

(Continued from last post…)

 

More on sensory processing disorder:

• Visual – Refers to the brain’s interpretation of what one sees
• Hypersensitivity – May be sensitive to bright lights and may have difficulty keeping eyes focused on work.
• Hyposensitivity – May have difficulty discriminating between similar shapes, like a square and rectangle or similarly shaped letters like “p”, “q”, “b” and “d”.  Visual processing deficits result in problems described in the previous post on perceptual processing manifestations.  
• Vestibular – Refers to the interpretation of information gathered from the inner ear about one’s position in space, movement and balance.
• Hypersensitivity – May be overly sensitive to motion, avoiding swings or slides.  May get car sick and may be fearful of escalators.   May also demonstrate poor postural control.
• Hyposensitivity – May crave motion.  May spin, jump, run into walls, or purposely fall without the expected negative reaction.  Again, look at the previous posts.  Deficits in this area are closely aligned to deficits classified as motor problems (see October 27,2008 post) as well as perceptual processing problems described in the October 31, 2008 post.
• Proprioceptive – Refers to the interpretation of information gathered from joints and muscles about one’s position in space, movement, pressure and weight.
• May use excessive force when interacting with objects, animals or other people.
• May seek out activities that provide sensory input, like jumping and banging objects. 

 

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

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.

How can a game be therapy?

Medicare reimburses for therapeutic procedures or treatments provided by a skilled and licensed therapist for the purpose of improving function and reducing disability or impairment in an individual who has been referred to therapy and has a diagnosis supporting the medical necessity for therapy.  A Therapeutic Activity (CPT 97530) is further defined on the Highmark Medicare Services website as:

Therapeutic activities are considered reasonable and necessary for patients needing a broad range of rehabilitative techniques that involves movement. Movement activities can be for a specific body part or could involve the entire body. This procedure involves the use of functional activities (e.g., bending, lifting, carrying, reaching, catching, and overhead activities) to improve functional performance in a progressive manner. The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination. They require the skills of a clinician and are designed to address a specific functional need of the patient.

In order for therapeutic activities to be covered, all of the following requirements must be met:

• The patient has a condition for which therapeutic activities can reasonably be expected to restore or improve functioning; and
  
• The patient’s condition is such that he/she is unable to perform therapeutic activities except under the direct supervision of a clinician and
  
• There is a clear correlation between the type of exercise performed and the patient’s underlying functional deficit(s) for which the therapeutic activities were prescribed.

Therapeutic activities may be medically necessary when the professional skills of a clinician are required, and the activity is designed to address a specific need of the patient. These dynamic activities must be part of a documented treatment plan and intended to result in a specific outcome. 

Therapists have traditionally used “games” such as balloon volleyball, bean bag toss, modified basketball, and obstacle courses to reach therapeutic goals. The Wii is not the first computer game or program to be used in a therapeutic setting.  Therapists have used dance programs such as Dance, Dance Revolution, and some virtual reality programs to help them meet rehab goals.  Using the Wii as a therapeutic activity is supported by the requirements set forth by Medicare. Games available on The Wii, especially those included in Wii Sports and Wii Fit, are a perfect addition to the therapeutic activity toolkit.  Through various games functional loss can be improved and restored.  Tennis for example, encourages a patient to use the shoulder through a more complete range of motion than traditional activities such as stacking cones or moving the plastic pieces along the tubular track on the shoulder arc contraption.  Patients seem to enjoy the Wii and this element of fun appears to reduce the anxiety and anticipation of the pain.  The therapist must monitor the patient, ensuring safety, pacing and appropriate rests.

Each time I use the Wii with a patient, I learn another way the Wii provides a therapeutic experience.  Recently, I used the Wii boxing training module , “Working the Bag” with an elderly patient who has difficulty dressing due to decreased range of motion in both shoulders and a decline in cognitive functioning.  The newness of a computer game required a gradual introduction and a careful explanation.  But once the patient tried out the activity, the personal exhilaration resulting from the rapid movement of both arms and the Wii’s animation and audible reinforcement was apparent.  This experience seemed to elevate this patient’s mood and create a stimulus for returning to therapy for another session later in the week.  As a result of the enthusiasm that the Wii stimulated, I was able to add to the treatment plan additional therapeutic exercises aimed at improving arm strength, range of motion and endurance to help this improve this patient’s ability to play the Wii. In this case, a game was therapeutic not only because it was a dynamic activity used to improve the functional use of both upper extremities, but also because it motivated the patient to participate in an enhanced treatment plan, hoping to improve their ability to play the Wii.

Answering your colleagues' questions about Wiihabilitation Therapy

Over the past year, conversations with colleagues have often included several questions about the therapeutic use of Wii in various clinical settings.  Below are a few of the questions I frequently encounter and the answers I provide.  What are some questions you have about incorporating Wii into your program?

Will patients take the Wii seriously?  

Initially, many patients view the Wii skeptically, not unlike the way they view any therapeutic activity.  I find that many patients in rehab often seem wary of the treatment plan and at first proceed doubtfully through 3 sets of 10 of this exercise and/or 15 minutes of bilateral upper extremity reaching activities. However, in contrast to traditional, often repetitive, exercises or activities, the patients quickly begin to enjoy the Wii activities and games.  By using activities available in the training module of Wii Sports, a therapist can design a highly effective program to meet many goals.  For example, following joint replacement surgery, the therapist may wish to encourage weight shifting and increased standing tolerance, two outcomes necessary for increased independence in self care and home management.  The Wii Sports Boxing Training Module offers 3 activity choices.  The first activity is labeled “Working the Bag”.  This activity requires the participant to hold the Wii remote in one hand and the Nunchuk in the other.  A boxing bag appears in front of the Mii and by extending the arms forward at chest height alternately, the participant punches the bag.  If enough forceful punches are thrown, the bag falls from the ceiling, a bell sounds and the next bag appears in front of the Mii. 

When using this activity therapeutically, the therapist must monitor the patient to guard against over exertion, against loss of balance, and against poor body mechanics.  During the first attempts at this activity, fatigue may prevent the patient from completing the round in a standing position. Since this activity can also be performed from a chair, the patient may continue in a seated position affording benefit by challenging the upper body, overall endurance and sitting balance.  Upon completion of this activity, skepticism will be replaced by belief that the Wii can provide a very beneficial therapeutic experience.

 

Wii in Health Promotion

A recent vacation opportunity brought to light other clinically relevant uses of the Wii.  The Wii can play a motivating role in Health Promotion and Lifestyle Modification across all ages.  For many who have a more sedentary lifestyle, the Wii proves to be useful tool in encouraging change.  The Wii stimulates those who may usually choose to only watch sports, to get up (or remain seated) and swing the remote at the tennis ball, the golf ball or the baseball.  Others swing the remote to bowl or box.

Photo by abbynormy on Flickr

In the school setting, students who might usually shy away from physical education (PE) classes rush to sign up for PE revolving around Wii Sports and other Wii programs. Teachers have found that the students who are reluctant to play team sports are more than willing to get out of their desks for some friendly Wii competition.  The students like the feedback Wii provides and are motivated by the improvement that the Wii makes readily visible.

In the clinic setting, the Wii has an application in Health Promotion.  Researchers in the area of Fall Prevention (Lachman, M., Howland, J.,& Tennstedt, A.,1998) have identified a sedentary lifestyle as a primary risk factor for falls.  In older adults, a sedentary lifestyle and a fear of falling (Edelberg, 2001) often go hand in hand, creating a reciprocal nature among fall risk factors in the elderly population.  Using Wii as a therapeutic activity with elders allows the clinician to work towards goals such as increasing standing and activity tolerance, improving dynamic balance and reducing fear and anxiety.  The fun nature of Wii along with the built-in reinforcement of improved scores encourages and motivates elders to be more active and engaged in therapy.

Another great therapeutic use of Wii is in Lifestyle Modification Programs.  Lifestyle Modification Programs help clients struggling with obesity, type 2 Diabetes, or other chronic conditions to implement changes in daily routines, reducing disease burden. Initially, the Wii gently introduces increased physical activity into the daily schedule.  For those participants with a history of computer gaming, the Wii allows them the familiar pleasure of gaming while increasing physical activity.  Wii also encourages social interaction and creates opportunity for community building through the creation of bowling leagues and baseball teams. 

Exercising in the virtual environment created through the Wii should not be considered a replacement for exercise in the real world, but Wii Gaming can be used effectively to provide additional activity throughout the day.   The Wii may help those who are extremely sedentary to take initial steps toward increasing activity.   By increasing the level of daily activity, participants may gain strength, endurance and improved balance, leading to improved well-being.

References:

Edelburg, H. (2001). Falls and function: How to prevent falls and injuries in  patients with impaired mobility. Geriatrics. 56(3). 41-45.

Lachman, M., Howland, J.,& Tennstedt, A.(1998). Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE).Journals of Gerontology: Series B: Psychological Sciences and Social Sciences. 53B(1). 43-50.