The document discusses using the Nintendo Wii gaming console to augment physical and occupational therapy. It provides an overview of the types of Wii games that have been used therapeutically, including Wii Sports, Wii Fit, and others. It also discusses the various therapeutic activities and goals that Wii games can target, such as balance, coordination, range of motion, and cognitive skills. Precautions for safely setting up and implementing a Wii therapy program are also reviewed.

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

2. AgendaPurposeVideo GamesTherapeutic ActivitiesGoalsBeginnings of a Wii™ programPhysiological ChangesGender DifferencesPsychological & Behavior OutcomesAvailable Resourceshttp://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. PurposeAwareness of Wii in therapyProvide evidence Received 70+ surveys in 2009Get Input for future work http://www.8bitreview.com/blog/8bitrants.php?cat=7http://www.hospitalnews.com/modules/magazines/mag.asp?ID=3&IID=128&AID=1647

4. Video games currently used in rehabilitation clinicsWii Sports™[1, 8, 9, 10, 12, 13, 14, 15, 16, 19, 21, 24, 25, 27, 28, 29, 31, 62]TennisBowlingBoxingGolf (rare)Wii Fit™[1, 3, 8, 10, 12, 13, 14, 23, 27, 28, 30, 61, 62]Table tiltBubble balanceTightrope tensionTorso & waist twistHula hoop gameSki slalomSki jumpJogging 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 researchTiger Woods PGA Tour 08Mario Party 8Mario Kart WiiNerf-N-StrikeKaraoke 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.comhttp://gaygamer.net/2008/06/wii_fit_eyed_for_rehab_patient.htmlhttp://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 Jochemhttp://blog.cleveland.com/lifestyles/2008/06/wii_fit_nintendo_game_makes_ph.htmlhttp://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. GoalsIncrease Maintain ImproveReducehttp://www.spanish-meadows.com/Services.htmlhttp://www.oefoif.va.gov/HowDoIGetHelp.asphttp://www.rdehospital.nhs.uk/trust/pr/2009/wii_exercise.html

10. Strive for an IncreaseUpper-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 [13]Dynamic balance[29]Sitting and standing[5, 9, 12, 14]Patient compliance[23]Trunk control [24]& endurance [2, 5, 12, 13, 19, 24]Hand-eye coordination [2, 12, 24]Participation in group [16]http://www.mississippimedicalnews.com/news.php?viewStory=1186http://www.usatoday.com/tech/gaming/2008-02-08-wiihabilitations-hospitals_N.htm

11. Targeting ImprovementBalance [5, 11, 14]Attention [2, 9]Timing [9, 14, 23]Upper-extremity coordination [5]Trunk control [24]Core stability [9]Self confidenceHand-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.htmlhttp://www.zimbio.com/pictures/ujDTGDY4YZS/Medical+Center+Uses+Wii+Gaming+System+Physical/2w1-_rUL4xu

12. OthersMaintain Midline, erect sitting/standing posture for a period of time [9]ReduceFeelings of helplessness [16]Isolation [19]Stresshttp://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 programhttp://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™ ProgramSelect individuals as Wii™ techs [15]Create a multidisciplinary team to determine which patients would benefit from Wii™ [15]http://www.google.comhttp://www.google.comhttp://www.newenglandsinai.org/press_releases/nr_wii_fit.html

16. Wii™ Work EnvironmentUtilize CRDAMC’s occupational health clinicOSHA 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 TVProjectors & computersSurf the InternetCan be used as an adaptive deviceCan add a wireless keyboardYou can adjust its sensitivitySensor bar through Wii SettingsReference: http://www.nintendo.com/Other images were from Nintendo.comhttp://www.jabulela.com/miscellaneous/twenty-most-visited-web-sites-2008

18. Suggestion Layouthttp://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 EquipmentExercise ball http://www.wiifitforum.org/video-wii-hab-pelvic-clock-for-low-back-pain-t521.html Thera-tubing/thera-bandhttp://www.hope.edu/academic/kinesiology/athtrain/dlssm/docs/Wiihab.pptImages were from Google

20. Wii™ SafetySafety First!Gait belts[23, 29]“Therapist monitoring is essential for client safety.” [18]Patients should be assessed for adequate physical and mental abilities priorAggression 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™ Safetyhttp://compulsivec.wordpress.com/2006/12/http://www.flickr.com/photos/iconfactory/sets/72157594406897342/http://gizmodo.com/219119/the-japanese-wii-safety-manual-is-crazyhttp://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 PracticesWarm-up before use [4]Length of sessionsStart at 10 mins[3]30 - 45 mins[3, 4]most people20 - 30 mins[3, 4]Not regularly exercisehttp://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 limbThe game effects amount of activity in non-dominant limb [34]3/10/2010Images 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 enthusiasmFrom flicking of wrist to fully body movement [28]3/10/2010Images were from http://www.google.com/

26. Reported Gender differencesGender plays a role in video game performanceHeart 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 ResponsesIt is speculated that gamers’ behavior changes as they gain expertise in a gameChanging moods & motivations [53]Decreased snacking behaviorCompared 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?3/10/2010http://www.google.com/

28. Sources on the WebLinkedIn Group “Wii-hab”http://www.linkedin.com/Twitterhttp://www.twitter.com/wii_habBloghttp://wiihabtherapy.blogspot.com/Websiteshttp://virtualsimrehab.com/http://www.wiihabilitation.co.uk/

29. Resources linking Wii activities to therapeutic goalsDeutsch, 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 appendixRedmond, R. (2009). Wii Games used in WiiHabilitation Therapy. WiiHab within Therapy [Website]. http://www.wiihabilitation.co.uk/Click on the games summary pageBriggs, 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.htmlClick on “Wii Therapeutic Applications” linkRehabCare 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