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Augmenting therapy utilizing the Nintendo Wii™<br />Mr. Steven P Miller Jr.<br />http://www.google.com/<br />The RehabCare...
Agenda<br />Purpose<br />Video Games<br />Therapeutic Activities<br />Goals<br />Beginnings of a Wii™ program<br />Physiol...
Purpose<br />Awareness of Wii in therapy<br />Provide evidence <br />Received 70+ surveys in 2009<br />Get Input for futur...
Video games currently used in rehabilitation clinics<br />Wii Sports™[1, 8, 9, 10, 12, 13, 14, 15, 16, 19, 21, 24, 25, 27,...
Additional Gamesmention in my research<br />Tiger Woods PGA Tour 08<br />Mario Party 8<br />Mario Kart Wii<br />Nerf-N-Str...
Therapeutic Activities ( 1 of 3 )<br />Balance training[5, 8, 10, 12, 13, 14, 19, 24]<br />Sitting & standing [2, 5, 9, 12...
Therapeutic Activities (2 of 3)<br />Physical Movement[18, 21]<br />Motor planning/ body awareness [2, 9, 13]<br />Stretch...
Therapeutic Activities (3 of 3)<br />Cognitive Training:[5, 19, 24]<br />Timing [14, 23]<br />Following directions [19]<br...
Goals<br />Increase <br />Maintain <br />Improve<br />Reduce<br />http://www.spanish-meadows.com/Services.html<br />http:/...
Strive for an Increase<br />Upper-Extremity <br />ROM [24, 29]<br />Muscle Strength [24, 29]<br />Coordination [29]<br />F...
Targeting Improvement<br />Balance [5, 11, 14]<br />Attention [2, 9]<br />Timing  [9, 14, 23]<br />Upper-extremity coordin...
Others<br />Maintain <br />Midline, erect sitting/standing posture for a period of time [9]<br />Reduce<br />Feelings of h...
Precautions<br />“…Wii was not designed to be used for persons with physical or mental disabilities, so practitioners need...
Setting Up a Wii program<br />http://www.8bitreview.com/blog/8bitrants.php?cat=7<br /> Wii™ should augment/enhanced a pati...
Starting a Wii™ Program<br />Select individuals as Wii™ techs [15]<br />Create a multidisciplinary team to determine which...
Wii™ Work Environment<br />Utilize CRDAMC’s occupational health clinic<br />OSHA 3092: Working Safely with Video Display T...
Setting up & Configuring the Wii™<br />Connects to more that just TV<br />Projectors & computers<br />Surf the Internet<br...
Suggestion Layout<br />http://www.wiihabilitation.co.uk/adaptations.shtml<br />“Use of the Wii Fit system for the treatmen...
Optional Equipment<br />Exercise ball <br />http://www.wiifitforum.org/video-wii-hab-pelvic-clock-for-low-back-pain-t521.h...
Wii™ Safety<br />Safety First!<br />Gait belts[23, 29]<br />“Therapist monitoring is essential for client safety.” [18]<br...
Wii™ Safety<br />http://compulsivec.wordpress.com/2006/12/<br />http://www.flickr.com/photos/iconfactory/sets/721575944068...
Recommended Practices<br />Warm-up before use [4]<br />Length of sessions<br />Start at 10 mins[3]<br />30 - 45 mins[3, 4]...
Documentation Tips<br />“The response of the patient should be reflected in functional terms and not related to fun or rec...
Reported Physiological Responses (1 of 2)<br />Increased oxygen consumption (VO2 max) [37]<br />Increased energy expenditu...
Reported Physiological Responses (2 of 2)<br />Level of exertion does not differ between playing against a human or comput...
Reported Gender differences<br />Gender plays a role in video game performance<br />Heart rates were significantly higher ...
Psychological & Behavioral Responses<br />It is speculated that gamers’ behavior changes as they gain expertise in a game<...
Sources on the Web<br />LinkedIn Group “Wii-hab”<br />http://www.linkedin.com/<br />Twitter<br />http://www.twitter.com/wi...
Resources linking Wii activities to therapeutic goals<br />Deutsch, J. E., Borbely, M., Filler, J., Huhn, K., & Guarrera-B...
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WiiHab, Augmenting therapy utilizing the Nintendo Wii

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  • Add documentation usage/progress/changes here and change the last bullet on previous slide
  • OSHA 3092 is available at http://www.osha.gov/Publications/osha3092.pdf Note: The rehabilitation professional and the patient will have “sight picture” of the screen. You adjust to the patient’s liking and not your own. The patient is the one with the disability and not you.
  • EDTV – Enhanced-definition TVHelp available at http://www.nintendo.com/consumer/systems/wii/en_na/index.jsp
  • This image is from “Use of the Wii Fit system for the treatment of balance problems in the elderly: A feasibility study.” by Heidi Sugarman, PT, PhD, Aviva Weisel-Eichler, PhD, Arie Burstin BPT, &amp; Riki Brown, PT, MSc.The images of the patients using the thera-tube or thera-band are from the Hope College Lecture “Use of Video gaming in rehab” by Darryl P Conway &amp; Kala Flagg.
  • Significant greater activity using the Nintendo Wii™ when compared to using the Microsoft Xbox™. The Wii™ nunchuk controller was the device held in the non-dominant limb. Significantly greater energy expenditure using the Nintendo Wii™ when compared to the Microsoft Xbox™. A greater caloric expenditure in the Nintendo Wii™ compared to Microsoft Xbox™.
  • Achieving refers to the player’s tragedy to make the most points and have fun. Relaxing refers to the player’s tragedy to experience a sport situation for mental relaxation or sport mental training. Relaxing refers to simulation while Achieving refers to normal game play. Level of enthusiasm is from “Physiological Responses while playing Nintendo Wii Sports™”
  • The speculation is from “Motivations, Strategies, and Movement Patterns of Video Gamers Playing Nintendo Wii Boxing.”The whole idea that the game can be used to create a social event came from “Motivations, Strategies, and Movement Patterns of Video Gamers Playing Nintendo Wii Boxing.” The decreased snacking behavior as compared with the Microsoft Xbox™. This is from “Effects of video game play on snacking behavior, caloric burn, and physiology: Nintendo Wii vs. Microsoft X-box.”The higher heart rate was found in “the contribution of upper limb and total body movement to adolescents’ energy expenditure whilst playing Nintendo Wii™”. This increase is assumed to be cause by a lower volume of game play per week compared to males. The increased energy expenditure was observed in “energy expenditure in adolescents playing new generation computer games.” This increased is assumed to be cause by an enhanced interactive effects of active gaming in males and other additional advantages. The better spatial abilities and navigation is based on a study “Sex Differences in Nintendo Wii Performance as expected from Hunter-Gatherer selection.” Positive group interaction between patients was from “Virtual Rehabilitation with video games: A new frontier for occupational therapy.” The reducing of helplessness came from “Doing WiiHab” study.
  • Rebecca Redmond MSc BSc MC SP is a fully qualified state registered physiotherapist and a member of the Chartered Society of Physiotherapy. Her website is http://www.rebeccathephysio.co.uk/ .Kimberly Briggs OTR/L, CDRS is a certified driver rehabilitation specialist. Wendy Kappenman MOT, OTR/L is also a vestibular Therapist.
  • Transcript of "WiiHab, Augmenting therapy utilizing the Nintendo Wii"

    1. 1. Augmenting therapy utilizing the Nintendo Wii™<br />Mr. Steven P Miller Jr.<br />http://www.google.com/<br />The RehabCare Group<br />http://www.bayraider.tv/2007/02/nintendo_rehabi.html<br />
    2. 2. Agenda<br />Purpose<br />Video Games<br />Therapeutic Activities<br />Goals<br />Beginnings of a Wii™ program<br />Physiological Changes<br />Gender Differences<br />Psychological & Behavior Outcomes<br />Available Resources<br />http://www.wiiwii.tv/2008/02/25/calling-dr-nintendo-wii-used-in-burn-therapy/<br />http://dvice.com/archives/2009/04/nintendo-wii-pa.php<br />
    3. 3. Purpose<br />Awareness of Wii in therapy<br />Provide evidence <br />Received 70+ surveys in 2009<br />Get Input for future work <br />http://www.8bitreview.com/blog/8bitrants.php?cat=7<br />http://www.hospitalnews.com/modules/magazines/mag.asp?ID=3&IID=128&AID=1647<br />
    4. 4. Video games currently used in rehabilitation clinics<br />Wii Sports™[1, 8, 9, 10, 12, 13, 14, 15, 16, 19, 21, 24, 25, 27, 28, 29, 31, 62]<br />Tennis<br />Bowling<br />Boxing<br />Golf (rare)<br />Wii Fit™[1, 3, 8, 10, 12, 13, 14, 23, 27, 28, 30, 61, 62]<br />Table tilt<br />Bubble balance<br />Tightrope tension<br />Torso & waist twist<br />Hula hoop game<br />Ski slalom<br />Ski jump<br />Jogging <br />We Ski & Snowboard™ [28]<br />Wii Music™[28, 62]<br />Link’s Crossbow Training™ [28]<br />Blazing Angels™ [28]<br />Shaun White: Snowboarding Road Trip™[28]<br />Smarty Pants™[12]<br />Big Beach Sports™[12]<br />Wii Fit Plus™[28]<br />Kororinpa: Marble Mania™[28]<br />BOOM BLOX™[27]<br />Mario & Sonic at the Olympic Games™[8, 13, 28]<br />Wii Play™[8, 15, 19, 52, 62]<br />Wii Sports Resort™[28]<br />DECA Sports™ (a.k.a. Sports Island)[12, 28]<br />EA SPORTS Active™[28]<br />Samba De Amigo™[28]<br />Carnival Games™[12, 28]<br />Cooking Mama: Cook Off™[19, 28]<br />WarioWare: Smooth Moves™[28]<br />Big Brain Academy: Wii Degree™[19, 24, 28]<br />SSX Blur™[28]<br />We Ski™ (a.k.a. Family Ski)[28]<br />Rayman Raving Rabbids 2™ [28]<br />Trauma Center: Second Opinion™ [28]<br />Trauma Center: New Blood™[19]<br />Super Monkey Ball Banana Blitz[12]<br />Are You Smarter Than A 5th Grader? Make the Grade™ [12]<br />Cranium Kabookii™[12]<br />Game Party 2™[8]<br />Mario Kart Wii™[62]<br />All images from Nintendo.com<br />
    5. 5. Additional Gamesmention in my research<br />Tiger Woods PGA Tour 08<br />Mario Party 8<br />Mario Kart Wii<br />Nerf-N-Strike<br />Karaoke Revolution Presents American Idol Encore <br />All images from Nintendo.com<br />
    6. 6. Therapeutic Activities ( 1 of 3 )<br />Balance training[5, 8, 10, 12, 13, 14, 19, 24]<br />Sitting & standing [2, 5, 9, 12, 14, 24, 27, 28, 29]<br />Shifting weight between lower extremities [1, 23]<br />Nintendo.com<br />http://gaygamer.net/2008/06/wii_fit_eyed_for_rehab_patient.html<br />http://www.google.com/<br />
    7. 7. Therapeutic Activities (2 of 3)<br />Physical Movement[18, 21]<br />Motor planning/ body awareness [2, 9, 13]<br />Stretching [12, 13]<br />Endurance training [2, 5, 10, 12, 19, 24]<br />Strengthening training [8, 10, 13, 14, 24, 28, 29]<br />Functional movement & exercise[8, 14, 19]<br />“Using Nintendo Wii in Therapy” by Liza Jochem<br />http://blog.cleveland.com/lifestyles/2008/06/wii_fit_nintendo_game_makes_ph.html<br />http://www.heraldtimesonline.com/<br />
    8. 8. Therapeutic Activities (3 of 3)<br />Cognitive Training:[5, 19, 24]<br />Timing [14, 23]<br />Following directions [19]<br />Visual-perceptual skills [9,19]<br />Listening [19]<br />“Virtual rehabilitation with video games: A new frontier for occupational therapy” by Jonathan Halton<br />“A Wii spot of fun” by Tim Dixon<br />
    9. 9. Goals<br />Increase <br />Maintain <br />Improve<br />Reduce<br />http://www.spanish-meadows.com/Services.html<br />http://www.oefoif.va.gov/HowDoIGetHelp.asp<br />http://www.rdehospital.nhs.uk/trust/pr/2009/wii_exercise.html<br />
    10. 10. Strive for an Increase<br />Upper-Extremity <br />ROM [24, 29]<br />Muscle Strength [24, 29]<br />Coordination [29]<br />Function [18, 19]<br />Duration of participation in therapy[18, 27]<br />Attention span [2, 19]<br />Body awareness [13]<br />Dynamic balance[29]<br />Sitting and standing[5, 9, 12, 14]<br />Patient compliance[23]<br />Trunk control [24]& endurance [2, 5, 12, 13, 19, 24]<br />Hand-eye coordination [2, 12, 24]<br />Participation in group [16]<br />http://www.mississippimedicalnews.com/news.php?viewStory=1186<br />http://www.usatoday.com/tech/gaming/2008-02-08-wiihabilitations-hospitals_N.htm<br />
    11. 11. Targeting Improvement<br />Balance [5, 11, 14]<br />Attention [2, 9]<br />Timing [9, 14, 23]<br />Upper-extremity coordination [5]<br />Trunk control [24]<br />Core stability [9]<br />Self confidence<br />Hand-eye coordination [2, 5, 11, 16]<br />Social participation [11, 16]<br />Socialization skills [23]<br />Self –esteem [23]<br />http://www.tbirecovery.org/ashblog/2008/03/wii-brain-injury-rehab-therapy.html<br />http://www.zimbio.com/pictures/ujDTGDY4YZS/Medical+Center+Uses+Wii+Gaming+System+Physical/2w1-_rUL4xu<br />
    12. 12. Others<br />Maintain <br />Midline, erect sitting/standing posture for a period of time [9]<br />Reduce<br />Feelings of helplessness [16]<br />Isolation [19]<br />Stress<br />http://www.zimbio.com/pictures/ujDTGDY4YZS/Medical+Center+Uses+Wii+Gaming+System+Physical/2w1-_rUL4xu<br />
    13. 13. Precautions<br />“…Wii was not designed to be used for persons with physical or mental disabilities, so practitioners need to be alert for negative feedback and its effect on their clients.” [19]<br />“Patients not recommended for Wii therapy are those who are not medically stable, have violent tendencies, or throw things.” [15]<br />Images were from http://www.google.com/<br />
    14. 14. Setting Up a Wii program<br />http://www.8bitreview.com/blog/8bitrants.php?cat=7<br /> Wii™ should augment/enhanced a patient’s therapeutic treatment not replaced it[24]<br />
    15. 15. Starting a Wii™ Program<br />Select individuals as Wii™ techs [15]<br />Create a multidisciplinary team to determine which patients would benefit from Wii™ [15]<br />http://www.google.com<br />http://www.google.com<br />http://www.newenglandsinai.org/press_releases/nr_wii_fit.html<br />
    16. 16. Wii™ Work Environment<br />Utilize CRDAMC’s occupational health clinic<br />OSHA 3092: Working Safely with Video Display Terminals (VDT)http://www.osha.gov/<br />“To be safe, the environment needs to be arranged to accommodate the type of games being played.” [19]<br />Images were from http://www.osha.gov/<br />
    17. 17. Setting up & Configuring the Wii™<br />Connects to more that just TV<br />Projectors & computers<br />Surf the Internet<br />Can be used as an adaptive device<br />Can add a wireless keyboard<br />You can adjust its sensitivity<br />Sensor bar through Wii Settings<br />Reference: http://www.nintendo.com/<br />Other images were from Nintendo.com<br />http://www.jabulela.com/miscellaneous/twenty-most-visited-web-sites-2008<br />
    18. 18. Suggestion Layout<br />http://www.wiihabilitation.co.uk/adaptations.shtml<br />“Use of the Wii Fit system for the treatment of balance problems in the elderly: A feasibility study.” by H. Sugarman, A. Weisel-Eichler, A. Burstin, R. Brown<br />
    19. 19. Optional Equipment<br />Exercise ball <br />http://www.wiifitforum.org/video-wii-hab-pelvic-clock-for-low-back-pain-t521.html<br /> Thera-tubing/thera-band<br />http://www.hope.edu/academic/kinesiology/athtrain/dlssm/docs/Wiihab.ppt<br />Images were from Google<br />
    20. 20. Wii™ Safety<br />Safety First!<br />Gait belts[23, 29]<br />“Therapist monitoring is essential for client safety.” [18]<br />Patients should be assessed for adequate physical and mental abilities prior<br />Aggression scale [15]<br />“Those who become more aggressive after a game may need to change games or removed from the [Wii] program.” [15]<br />Images were from Google<br />
    21. 21. Wii™ Safety<br />http://compulsivec.wordpress.com/2006/12/<br />http://www.flickr.com/photos/iconfactory/sets/72157594406897342/<br />http://gizmodo.com/219119/the-japanese-wii-safety-manual-is-crazy<br />http://www.wisdump.com/design-critiques/fun-with-design-in-case-you-missed-these/<br />http://www.gamespot.com/pages/unions/forums/show_msgs.php?topic_id=25212711&union_id=11403<br />
    22. 22. Recommended Practices<br />Warm-up before use [4]<br />Length of sessions<br />Start at 10 mins[3]<br />30 - 45 mins[3, 4]<br />most people<br />20 - 30 mins[3, 4]<br />Not regularly exercise<br />http://www.mlive.com/entertainment/index.ssf/2008/08/03-week/<br />http://www.gearfuse.com/anatowii-the-anatomy-of-a-console/<br />
    23. 23. Documentation Tips<br />“The response of the patient should be reflected in functional terms and not related to fun or recreational activities.”<br />“The documentation should not indicate the use of the Wii™ as a treatment device but the outcome of coordination, balance, etc.”<br />CPT Codes: <br />97110 (Therapeutic Procedures)<br />97112 (Neuromuscular Re-education)<br />97150 (Group Therapy)<br />97530 (Therapeutic Activities)<br />Reference: “Wii habilitation, using Wii Sports in rehabilitation.” by RehabCare Group, Inc.<br />http://www.wiinoob.com/anatowii-nintendo-wii-design/<br />
    24. 24. Reported Physiological Responses (1 of 2)<br />Increased oxygen consumption (VO2 max) [37]<br />Increased energy expenditure (Jkg-1 min-1 or METS)<br />[31, 32, 33, 34, 36]<br />Increased heart rate (beats min-1)[31, 34]<br />Greater caloric expenditure[38]<br />Greater total body activity[34]<br />Especially, the upper limb<br />The game effects amount of activity in non-dominant limb [34]<br />3/10/2010<br />Images from http://www.google.com/<br />
    25. 25. Reported Physiological Responses (2 of 2)<br />Level of exertion does not differ between playing against a human or computer opponent [35, 37]<br />Impacted by player’s motivation[53]<br />“Relaxing” vs. “Achieving”<br />Impacted by player’s strategy[53]<br />“Game” vs. “Simulation”<br />Impacted by player’s level of enthusiasm<br />From flicking of wrist to fully body movement [28]<br />3/10/2010<br />Images were from http://www.google.com/<br />
    26. 26. Reported Gender differences<br />Gender plays a role in video game performance<br />Heart rates were significantly higher in females[37]<br />Energy expenditure were significantly higher in males for WiiSports™: Tennis. [32, 33]<br />Males have better navigation 3D environment skills and spatial abilities than females. [48]<br />Images from http://www.google.com/<br />
    27. 27. Psychological & Behavioral Responses<br />It is speculated that gamers’ behavior changes as they gain expertise in a game<br />Changing moods & motivations [53]<br />Decreased snacking behavior<br />Compared to Xbox[46, 47]<br />“Some [patients] report that as their focus turned to the game, there was a less negative focus on the affected limb. [18]<br />Intervention for pain management and behavior problems?<br />3/10/2010<br />http://www.google.com/<br />
    28. 28. Sources on the Web<br />LinkedIn Group “Wii-hab”<br />http://www.linkedin.com/<br />Twitter<br />http://www.twitter.com/wii_hab<br />Blog<br />http://wiihabtherapy.blogspot.com/<br />Websites<br />http://virtualsimrehab.com/<br />http://www.wiihabilitation.co.uk/<br />
    29. 29. Resources linking Wii activities to therapeutic goals<br />Deutsch, J. E., Borbely, M., Filler, J., Huhn, K., & Guarrera-Bowlby, P. (2008, October). Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Physical Therapy, 88(10), 1196-1207. Alexandria, VA: The American Physical Therapy Association.<br />Look at its appendix<br />Redmond, R. (2009). Wii Games used in WiiHabilitation Therapy. WiiHab within Therapy [Website]. http://www.wiihabilitation.co.uk/<br />Click on the games summary page<br />Briggs, K. & Kappenman, W. (2009). Serious gaming instructions and therapeutic applications for the Nintendo Wii. Innovations in VirtualSim Rehab [Website]. http://www.virtualsimrehab.com/publications_wii.html<br />Click on “Wii Therapeutic Applications” link<br />RehabCare Group, Inc. (2008, March 11). Wiihabilitation: using WiiSports in rehabilitation [Brochure]. St. Louis, MO: RehabCare Group, Inc.<br />Enam, N., & Turner, D. (2009, June 22). Nintendo Wii as a modality in TBI rehabilitation. Carlisle, PA: Brain Injury Association of Pennsylvania, Inc. http://www.biapa.org/atf/cf/%7BE07F6363-A589-41AA-B9C1-990FEE288F44%7D/Nintendo.pdf<br />
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