The document discusses using the Nintendo Wii for physical and occupational therapy treatments. Studies show the Wii can improve balance in children with Down syndrome ages 10-13 when playing games like soccer heading and tightrope walking for 6 weeks. The Wii also improved static and dynamic balance in children ages 7-12 with poor motor skills when playing balance games for 30 minutes 3 times a week for 6 weeks, but did not transfer skills to other motor tasks. Research also found the Wii can improve upper extremity function in children with cerebral palsy ages 6-15 when playing tennis and boxing games twice a week for 15 minutes each. While the Wii is low cost and enjoyable, its balance measures are not always valid or reliable

1. Nintendo Wii Treatments in
Pediatric Physical and
Occupational Therapy
Megan Dillon, SPT
University of St. Augustine

3. Physical Therapy
• Down Syndrome (10-13yrs)
• Balance:
• “Each Wii game was practiced for 5 minutes
with 5 minutes rest in-between in the
following order; foot ball heading game, the
tight rope walk game, and finally the Penguin
slide game. The program for the two groups
was applied two times per week for 6 weeks.”1

4. Results:
• “the results revealed a high significant
difference between the pre-intervention and
the post- intervention mean values of balance
for the study group (p=0.000). These results
indicate that the VR-based therapy in the form
of Wii-Fit for 6 weeks could improve balance
ability of the children with Down syndrome
who are ranging in age from 10 to 13 years.”1

5. Poor Motor Performance/
Balance Problems
• 30 children ages 7-12 who scored below the 16th
percentile
• Outcome Measures:
– M-ABC-2, BOT-2
• Methods:
– 30 min, 3x/wk for 6 weeks
– Children were allowed to choose from 18 pre-selected
balance games. These games were specifically chosen
to challenge both dynamic and static balance.
– Dynamic: ski-slalom, table tilt, snowboard slalom
– Static: tilt city and rhythm

6. Poor Motor Performance/
Balance Problems
• Results:
• “A Wii-intervention which incorporates exercises
on timing, repetitive internal modeling, near
limitless exercises, visual feedback and
motivational reinforcement seems to improve
the static and dynamic balance skills of children
with poor balance control. The results suggest no
transfer from the acquired balance skills to other
related motor skills, like running from side to side
or hopping over beam.”5

7. Occupational Therapy
• “Wii-habilitation of upper extremity function in
children with Cerebral Palsy. An explorative study”
• Methods:
– 15 children with CP, ages 6-15
– Wii Sports 2x/wk: boxing - 15 min, tennis - 15 min.
The controller in their most-affected arm.
– The Melbourne Assessment of Upper Limb Function
and ABILHAND-Kids, user satisfaction of both
children and health professionals, enjoyment in
gaming was scored on a visual analogue scale

8. • Results:
– “The mean quality of upper arm movements
measured by the Melbourne Assessment was
somewhat changed after the training, however
not significant.”2
– “Two-handed daily activities measured by the
ABILHAND-Kids were significantly more easily
performed by the children according to their
caregivers”2

9. Negatives of the Wii
• Studies have not shown improvements in gait
speed or lower extremity strength from Wii
treatments
• “Wii Fit balance activity scores had poor
concurrent validity relative to COP (center-of-
pressure) outcomes and SEBT reach distances.
In addition, the included Wii Fit balance
activity scores generally had poor intrasession
and intersession reliability.”3

10. However…
• “Multiple studies now show improvement in
balance control following reasonable periods
of training with the Wii Fit games and custom
designed applications.”4

11. Balance
• Wii Fit
– Soccer ball heading game
– Tight rope walk game
– Penguin slide game.

12. Upper Extremity Function
• Wii Sports
–Tennis
–Boxing

13. Why use the Wii?
• It has a very low chance of injury
• Low costs in the realm of virtual reality
treatments
• Can be practiced at home
• Found to be enjoyable by experimental
participants
• Studies support its use to improve balance
and upper extremity function

14. Bottom Line
• Based on available research, the
Wii can be used therapeutically
to improve balance.

15. Questions…

16. References
1. Rahman S. Efficacy of virtual reality-based therapy on balance in children with Down Syndrome.
World Appl. Sci. J. 2010; 10(3): 254-261. Available from researchgate.net. Accessed on February
13, 2015.
2. Winkkels D, Kottink A, Temmink R, Nijlant J, Buurke J. Wii-habilitation of upper extremity function
in children with Cerebral Palsy. An explorative study. Developmental Neurorehabilitation. February
2013; 16(1): 44-51. Available fromhttp://web.a.ebscohost.com.prx-
usa.lirn.net/ehost/pdfviewer/pdfviewer?sid=4db51861-bce6-4360-9fa2-
123ab6f41a3f%40sessionmgr4003&vid=1&hid=4112. Accessed on February 13, 2015.
3. Wikstrom E. Validity and reliability of Nintendo Wii Fit balance scores. J Athl Train. 2012; 47(3):
306-313. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392161/. Accessed on
February 16, 2015.
4. Goble DJ, Cone BL, Fling BW. Using the Wii Fit as a tool for balance assessment and
neurorehabilitation: the first half decade of “Wii-search”. Journal of NeuroEngineering and
Rehabilitation. 2014; 11:12. doi:10.1186/1743-0003-11-12. Available from
http://www.jneuroengrehab.com/content/11/1/12. Accessed on February 17, 2015.
5. Mombarg R, Jelsma D, Hartman E. Effect of Wii-intervention on balance of children with poor
motor performance. Res Dev Disabil. 2013; 34(9): 2996-3003. doi: 10.1016/j.ridd.2013.06.008