CATEA.orgassistivetech.netATWiki
Personal tools
Views

Interested in disability history? Check out what happened Today in AT History!

Wii rehab applications (wiihab)

From ATWiki

Jump to: navigation, search

Using an inexpensive gaming console to provide results in rehabilitation! image:Wiihabsign.jpg

The Nintendo Wii is a video game system that makes use of participant movement to control the game. As of recently it has become increasingly popular in the area of rehabilitation. It is used in clinics all across the United States including the Walter Reed Army Medical Center, UPMC Mercy Hospital, University of Alabama Rehabilitation Department, Herrin Hospital in southern Illinois, Hines Veterans Affairs Hospital west of Chicago, WakeMed Health in Raleigh, North Carolina, and Sister Kenny Research Center at Abbott Northwestern Hospital in Minneapolis.[1]

Contents

Who can use the Wii?

Just about anyone can use the Wii from young children to senior citizens. There are some physical requirements necessary, but even some of them, such as, the ability to grasp a controller can be accommodated for (see Wii_accessibility). A patient will need to have some control of upper extremity movement to use the games requiring the Wii remote. In order to use the Wii Fit Balance Board the patient will need some lower extremity strength (enough to stand) if they are going to stand on the board, or some core strength if they are going to sit on the board.

Why does Wiihab work?

Wiihab creates an environment for the patient in which they can take their mind off the burden of the rehabilitation process while they are participating in it. The patient is motivated by either accomplishing goals in the games they participate in or by competing with another patient in rehab. The game draws the patient in and within time they forget they are exercising. A therapist that is careful choosing which games to play can plan a successful workout.

Setup

The equipment is easy to set up and once all of the cords are plugged in the patient or therapist can control the game from the Wii remote. The only time someone would need to help the patients with the console is if a game disk needed to be changed out. By choosing a game like Wii Sports or Wii fit there are multiple games on one disk to keep the patients challenged.

Exercise programs

There are a variety of games for the Wii that are specifically designed for exercise. Wii sports includes tennis, bowling, boxing, golf, and baseball. Some of the sports are more physically challenging than others just as they are in real life. Bowling requires more coordination than physical exertion. While boxing requires a lot of movement but does not rely on a high degree of accuracy. Someone that is interested in using a Wii for rehab should play the games and decide which games would work best for the particular patient and muscle groups they are trying to strengthen.

Wiihab different parts of the body

The Arms

Most games for the Wii are great for exercising the arms. Games that are sports related tend to focus on using real life movements required in those sports to make the characters in the game move. Boxing and tennis games require a lot of quick movements. Patients that need upper extremity strengthening can start out playing the game with just a controller and then move up to having weights added to their arms to provide more resistance.

Repetitive motion games such as running require the subject to shake the Wii remote. The shaking motion strengthens the endurance of the patient. It is important that the physical therapist or person in charge of the rehabilitation watches the amount of repetition that various joints receive. There have been tendinitis injuries caused by children playing the Wii for to many hours at a time.

Mini games seen in games like Mario Party offer a good balance of repetitive motion activities. While the patient is navigating the game board they are essentially resting their arms, but during a mini game they are experiencing a little session of intense exercise.

The Legs

The legs can be exercised in a couple of ways. First they can be exercised by simulating movements such as running or jumping as required by a game. An example of this would be Jillian Michael's Fitness Ultimatum game for the Wii. In this game the patient is asked to jog from one exercise station to the next. The Wii does not actually know if the patient is jogging. It detects movement through the Wii remote and attached Nunchuk. So the patient can stand and jog or pretend to jog by just moving their arms.

The legs can also be exercised through the use of the Wii Fit balance board. The Wii Fit balance board can detect changes in force which translate into center of pressure movements. Movements in the center or pressure control the character on the screen. In Wii fit the game that comes with the balance board there are a variety of games that contribute to leg strengthening such as: step aerobics, balance games, yoga, and strength training exercises.

The Core

The core can be strengthened by a lot of the balance games and yoga positions in Wii Fit. The game starts out on easy and even analyzes a patients initial balance. As the patient gets better the games become harder or longer thus requiring an increased response from the patient.

The Mind

The games are also mentally stimulating. They sometimes require logic and problem solving skills. There are a variety of mini games included in Mario Party and Carnival Games for the Wii which require the patient to memorize patterns and then repeat the pattern back. These same games can also help with patient's dexterity and coordination by requiring the patient to conduct fine movements of objects on the screen using the Wii remote. One such mini game in Carnival games requires the subject to move a ring through a wire maze without touching the ring to the wire. If they do then the Wii remote vibrates and they have to start over again.

Using the Wii to chart progress

Inherently built into the Wii is the ability to save game data for multiple players, depending on the game. The nice thing about saving progress and recording high scores is the ability to compare scores from the same patient over a particular time period. A patient that has never used a Wii will first have to get comfortable with the controller and how it responds to their movements. After this initial learning curve is overcome the patients true coordination and strength progress can be assessed. As a patient improves harder levels can be tried or new games can be added to the workout.

Wii Fit Plus comes with a built in personal training schedule which allows the player to choose a custom workout schedule that they can do everyday. The software tracks their score and times to complete certain activities and gives the patient workout activities based on their current abilities. If a patient is able to sit or stand on the balance board then software is also able to calculate changes in their body weight and graph it on the screen. A patient that may need to lose weight can input a weight loss goal and the Wii Fit software can track their progress.

One downside is that while progress can be tracked not all games have this feature. Another problem is that currently if the data needs to be stored in the patients chart it needs to be hand written, unlike a computer there is not a way to send the data to a printer.

The use of Wiihab with different disabilities

Stroke

In a case study published in the International Journal of Rehabilitation Research, investigators found that Wii fit was beneficial for an 86 year old poststroke patient. It improved her balance and improved her gait confidence. They used the Timed Up and Go (TUG) outcome measure and found a 10 second time improvement after the patient exercised using four of the balance games in Wii fit during four training sessions.[4]

Cerebral Palsy

Researchers used three outcome measures to determine if Wiihab was helpful in rehabilitation. The three outcome measures used were:

1. Visual-perceptual processing, using a motor-free perceptual test (Test of Visual Perceptual Skills, third edition)

2. Postural control, using weight distribution and sway measures 3. Functional mobility, using gait distance.

All three outcomes showed improvements after training.[2]

Traumatic Brain Injury (TBI)

Acquired brain injury therapists at UPMC Mercy Hospital found that 1 hour Wiihab sessions with Traumatic Brain Injury patients helped in three ways:

1. Improved hand eye coordination.

2. Improved social participation.

3. Reduced feelings of helplessness.

They did not report on outcome measures used, but expressed their clinical observation.[5]

Amputees

Ossur conducted a study using Wii fit to determine which exercises would be helpful or difficult for a transtibial or transfemoral amputee to participate in. A manual specific to lower extremity amputees was designed.[3]

image:Ossurchart1.JPG

Precautions and things to watch for

Injuries related to the Wii

-Injuries due to repeated movement have been seen in excessive use of the Wii. They also occur from participants hyperextending joints during exaggerated movements. These injuries can occur in the wrist and elbow.

-Eye strain is another problem than can occur. Make sure patients are not left unattended for long periods of time with the Wii.

-Seizures may occur among people with epilepsy due to the inherent nature of flashing lights that are involved with video games. Typically this is a low possibility 1 in 4000 patients.

-Motion Sickness may also occur especially in games in which the environment moves quickly. If the patient feels dizzy then stop use for a while.

Equipment failure and damage

-The Wii console and Wii Remote can interfere with electronics such as pacemakers or other nearby equipment.

-The Wii remote may not respond well in outdoor settings or bright rooms with natural lighting. This is due to the infrared cameras in the Wii remote picking up infrared light in natural light.

-Patients should always have a strap around the wrist while using the Wii remote and Nunchuk; otherwise it could come out of the patients hand and hit someone or something like the TV.

References

[1] "Doctors use Wii games for rehab therapy". USA Today. http://www.usatoday.com/tech/science/2008-02-08-wii-rehabilitation_N.htm.

[2] Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P. Use of a Low-Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent With Cerebral Palsy. Phys Ther October 1, 2008;88(10):1196-1207.

[3] "Using the Wii Fit with Lower Limb Prothetics". Ossur. http://pdfuue.org/k-51108620.html

[4] Brown R, Sugarman H, Arie Burstin. Use of the Nintendo Wii Fit for the Treatment of Balance Problems in an Elderly Patient with Stroke: A Case Report. International Journal of Rehabilitation Research 2009 V32 S109-S110.

[5] G Goldberg, H Rubinsky, E Irvin, E Linneman, J Knapke, M Ryan. Doing WiiHab: Experience with the Wii Video Game System in Acquired Brain Injury Rehabilitation. Journal of Head Trauma Rehabilitation 23(5): 350-350 SEP-OCT 2008.