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WiiHab, Augmenting therapy utilizing the Nintendo Wii


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WiiHab, Augmenting therapy utilizing the Nintendo Wii

  1. 1. Augmenting therapy utilizing the Nintendo Wii™<br />Mr. Steven P Miller Jr.<br /><br />The RehabCare Group<br /><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 /><br /><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 /><br /><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<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<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 /><br /><br /><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 /><br /><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 /><br /><br /><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 /><br /><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 /><br /><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 /><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<br />
  14. 14. Setting Up a Wii program<br /><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 /><br /><br /><br />
  16. 16. Wii™ Work Environment<br />Utilize CRDAMC’s occupational health clinic<br />OSHA 3092: Working Safely with Video Display Terminals (VDT)<br />“To be safe, the environment needs to be arranged to accommodate the type of games being played.” [19]<br />Images were from<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:<br />Other images were from<br /><br />
  18. 18. Suggestion Layout<br /><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 /><br /> Thera-tubing/thera-band<br /><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 /><br /><br /><br /><br /><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 /><br /><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 /><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<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<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<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 /><br />
  28. 28. Sources on the Web<br />LinkedIn Group “Wii-hab”<br /><br />Twitter<br /><br />Blog<br /><br />Websites<br /><br /><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].<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].<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.<br />