The document discusses using the Nintendo Wii gaming console to augment physical and occupational therapy. It provides an overview of the Wii games and exercises that have been used therapeutically, including for balance training, physical movement, and cognitive training. Goals of Wii-assisted therapy are also outlined, such as increasing patients' strength, balance, and functional abilities. The document reviews reported physiological and psychological benefits of Wii therapy and provides best practice recommendations. Resources for further information on applying Wii activities to therapeutic goals are also referenced.

1. Augmenting therapy utilizing the Nintendo Wii™ Mr. Steven P Miller Jr. http://www.google.com/ The RehabCare Group http://www.bayraider.tv/2007/02/nintendo_rehabi.html

2. Agenda Purpose Video Games Therapeutic Activities Goals Beginnings of a Wii™ program Physiological Changes Gender Differences Psychological & Behavior Outcomes Available Resources http://www.wiiwii.tv/2008/02/25/calling-dr-nintendo-wii-used-in-burn-therapy/ http://dvice.com/archives/2009/04/nintendo-wii-pa.php

3. Purpose Awareness of Wii in therapy Provide evidence Received 70+ surveys in 2009 Get Input for future work http://www.8bitreview.com/blog/8bitrants.php?cat=7 http://www.hospitalnews.com/modules/magazines/mag.asp?ID=3&IID=128&AID=1647

4. Video games currently used in rehabilitation clinics Wii Sports™[1, 8, 9, 10, 12, 13, 14, 15, 16, 19, 21, 24, 25, 27, 28, 29, 31, 62] Tennis Bowling Boxing Golf (rare) Wii Fit™[1, 3, 8, 10, 12, 13, 14, 23, 27, 28, 30, 61, 62] Table tilt Bubble balance Tightrope tension Torso & waist twist Hula hoop game Ski slalom Ski jump Jogging We Ski & Snowboard™ [28] Wii Music™[28, 62] Link’s Crossbow Training™ [28] Blazing Angels™ [28] Shaun White: Snowboarding Road Trip™[28] Smarty Pants™[12] Big Beach Sports™[12] Wii Fit Plus™[28] Kororinpa: Marble Mania™[28] BOOM BLOX™[27] Mario & Sonic at the Olympic Games™[8, 13, 28] Wii Play™[8, 15, 19, 52, 62] Wii Sports Resort™[28] DECA Sports™ (a.k.a. Sports Island)[12, 28] EA SPORTS Active™[28] Samba De Amigo™[28] Carnival Games™[12, 28] Cooking Mama: Cook Off™[19, 28] WarioWare: Smooth Moves™[28] Big Brain Academy: Wii Degree™[19, 24, 28] SSX Blur™[28] We Ski™ (a.k.a. Family Ski)[28] Rayman Raving Rabbids 2™ [28] Trauma Center: Second Opinion™ [28] Trauma Center: New Blood™[19] Super Monkey Ball Banana Blitz[12] Are You Smarter Than A 5th Grader? Make the Grade™ [12] Cranium Kabookii™[12] Game Party 2™[8] Mario Kart Wii™[62] All images from Nintendo.com

5. Additional Gamesmention in my research Tiger Woods PGA Tour 08 Mario Party 8 Mario Kart Wii Nerf-N-Strike Karaoke Revolution Presents American Idol Encore All images from Nintendo.com

6. Therapeutic Activities ( 1 of 3 ) Balance training[5, 8, 10, 12, 13, 14, 19, 24] Sitting & standing [2, 5, 9, 12, 14, 24, 27, 28, 29] Shifting weight between lower extremities [1, 23] Nintendo.com http://gaygamer.net/2008/06/wii_fit_eyed_for_rehab_patient.html http://www.google.com/

7. Therapeutic Activities (2 of 3) Physical Movement[18, 21] Motor planning/ body awareness [2, 9, 13] Stretching [12, 13] Endurance training [2, 5, 10, 12, 19, 24] Strengthening training [8, 10, 13, 14, 24, 28, 29] Functional movement & exercise[8, 14, 19] “Using Nintendo Wii in Therapy” by Liza Jochem http://blog.cleveland.com/lifestyles/2008/06/wii_fit_nintendo_game_makes_ph.html http://www.heraldtimesonline.com/

8. Therapeutic Activities (3 of 3) Cognitive Training:[5, 19, 24] Timing [14, 23] Following directions [19] Visual-perceptual skills [9,19] Listening [19] “Virtual rehabilitation with video games: A new frontier for occupational therapy” by Jonathan Halton “A Wii spot of fun” by Tim Dixon

9. Goals Increase Maintain Improve Reduce http://www.spanish-meadows.com/Services.html http://www.oefoif.va.gov/HowDoIGetHelp.asp http://www.rdehospital.nhs.uk/trust/pr/2009/wii_exercise.html

10. Strive for an Increase Upper-Extremity ROM [24, 29] Muscle Strength [24, 29] Coordination [29] Function [18, 19] Duration of participation in therapy[18, 27] Attention span [2, 19] Body awareness Dynamic balance[29] Sitting and standing [5, 9, 14] Patient compliance[23] Trunk control [24]& endurance [2, 5, 13, 19, 24] Hand-eye coordination [2, 24] Participation in group [16] http://www.mississippimedicalnews.com/news.php?viewStory=1186 http://www.usatoday.com/tech/gaming/2008-02-08-wiihabilitations-hospitals_N.htm

11. Targeting Improvement Balance [5, 11, 14] Attention [2] Timing [14] Upper-extremity coordination [5] Trunk control [24] Core stability Self confidence Hand-eye coordination [2, 5, 11, 16] Social participation [11, 16] Socialization skills [23] Self –esteem [23] http://www.tbirecovery.org/ashblog/2008/03/wii-brain-injury-rehab-therapy.html http://www.zimbio.com/pictures/ujDTGDY4YZS/Medical+Center+Uses+Wii+Gaming+System+Physical/2w1-_rUL4xu

12. Others Maintain Midline, erect sitting/standing posture for a period of time Reduce Feelings of helplessness [16] Isolation Stress http://www.zimbio.com/pictures/ujDTGDY4YZS/Medical+Center+Uses+Wii+Gaming+System+Physical/2w1-_rUL4xu

13. Precautions “…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] “Patients not recommended for Wii therapy are those who are not medically stable, have violent tendencies, or throw things.” [15] Images were from http://www.google.com/

14. Setting Up a Wii program http://www.8bitreview.com/blog/8bitrants.php?cat=7 Wii™ should augment/enhanced a patient’s therapeutic treatment not replaced it[24]

15. Starting a Wii™ Program Select individuals as Wii™ techs [15] Create a multidisciplinary team to determine which patients would benefit from Wii™ [15] http://www.google.com http://www.google.com http://www.newenglandsinai.org/press_releases/nr_wii_fit.html

16. Wii™ Work Environment Utilize CRDAMC’s occupational health clinic OSHA 3092: Working Safely with Video Display Terminals (VDT)http://www.osha.gov/ “To be safe, the environment needs to be arranged to accommodate the type of games being played.” [19] Images were from http://www.osha.gov/

17. Setting up & Configuring the Wii™ Connects to more that just TV Projectors & computers Surf the Internet Can be used as an adaptive device Can add a wireless keyboard You can adjust its sensitivity Sensor bar through Wii Settings Reference: http://www.nintendo.com/ Other images were from Nintendo.com http://www.jabulela.com/miscellaneous/twenty-most-visited-web-sites-2008

18. Suggestion Layout http://www.wiihabilitation.co.uk/adaptations.shtml “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

19. Optional Equipment Exercise ball http://www.wiifitforum.org/video-wii-hab-pelvic-clock-for-low-back-pain-t521.html Thera-tubing/thera-band http://www.hope.edu/academic/kinesiology/athtrain/dlssm/docs/Wiihab.ppt Images were from Google

20. Wii™ Safety Safety First! Gait belts[23, 29] “Therapist monitoring is essential for client safety.” [18] Patients should be assessed for adequate physical and mental abilities prior Aggression scale [15] “Those who become more aggressive after a game may need to change games or removed from the [Wii] program.” [15] Images were from Google

21. Wii™ Safety http://compulsivec.wordpress.com/2006/12/ http://www.flickr.com/photos/iconfactory/sets/72157594406897342/ http://gizmodo.com/219119/the-japanese-wii-safety-manual-is-crazy http://www.wisdump.com/design-critiques/fun-with-design-in-case-you-missed-these/ http://www.gamespot.com/pages/unions/forums/show_msgs.php?topic_id=25212711&union_id=11403

22. Recommended Practices Warm-up before use [4] Length of sessions Start at 10 mins[3] 30 - 45 mins[3, 4] most people 20 - 30 mins[3, 4] Not regularly exercise http://www.mlive.com/entertainment/index.ssf/2008/08/03-week/ http://www.gearfuse.com/anatowii-the-anatomy-of-a-console/

23. Documentation Tips “The response of the patient should be reflected in functional terms and not related to fun or recreational activities.” “The documentation should not indicate the use of the Wii™ as a treatment device but the outcome of coordination, balance, etc.” CPT Codes: 97110 (Therapeutic Procedures) 97112 (Neuromuscular Re-education) 97150 (Group Therapy) 97530 (Therapeutic Activities) Reference: “Wii habilitation, using Wii Sports in rehabilitation.” by RehabCare Group, Inc. http://www.wiinoob.com/anatowii-nintendo-wii-design/

24. Reported Physiological Responses (1 of 2) Increased oxygen consumption (VO2 max) [37] Increased energy expenditure (Jkg-1 min-1 or METS) [31, 32, 33, 34, 36] Increased heart rate (beats min-1)[31, 34] Greater caloric expenditure[38] Greater total body activity[34] Especially, the upper limb The game effects amount of activity in non-dominant limb [34] 3/10/2010 Images from http://www.google.com/

25. Reported Physiological Responses (2 of 2) Level of exertion does not differ between playing against a human or computer opponent [35, 37] Impacted by player’s motivation[53] “Relaxing” vs. “Achieving” Impacted by player’s strategy[53] “Game” vs. “Simulation” Impacted by player’s level of enthusiasm From flicking of wrist to fully body movement [28] 3/10/2010 Images were from http://www.google.com/

26. Reported Gender differences Gender plays a role in video game performance Heart rates were significantly higher in females[37] Energy expenditure were significantly higher in males for WiiSports™: Tennis. [32, 33] Males have better navigation 3D environment skills and spatial abilities than females. [48] Images from http://www.google.com/

27. Psychological & Behavioral Responses It is speculated that gamers’ behavior changes as they gain expertise in a game Changing moods & motivations [53] Decreased snacking behavior Compared to Xbox[46, 47] “Some [patients] report that as their focus turned to the game, there was a less negative focus on the affected limb. [18] Intervention for pain management and behavior problems? 3/10/2010 http://www.google.com/

28. Sources on the Web LinkedIn Group “Wii-hab” http://www.linkedin.com/ Twitter http://www.twitter.com/wii_hab Blog http://wiihabtherapy.blogspot.com/ Websites http://virtualsimrehab.com/ http://www.wiihabilitation.co.uk/

29. Resources linking Wii activities to therapeutic goals 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. Look at its appendix Redmond, R. (2009). Wii Games used in WiiHabilitation Therapy. WiiHab within Therapy [Website]. http://www.wiihabilitation.co.uk/ Click on the games summary page 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 Click on “Wii Therapeutic Applications” link RehabCare Group, Inc. (2008, March 11). Wiihabilitation: using WiiSports in rehabilitation [Brochure]. St. Louis, MO: RehabCare Group, Inc. 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