The yin and yang of wi hab and aging.pdf


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The yin and yang of wi hab and aging.pdf

  1. 1. Acknowledgements The UNC Institute on Aging The Yin & Yang of Wii-hab • Bringing Basic Scientist To Aging and Older Adults • Gina Ugrinsky, SPT Are we singing the body electric? Tiffany Shubert, PhD, MPT UNC Institute on Aging Chapel Hill, North Carolina Background Background • The Silver Tsunami • 35 million Americans > 65 in 2000 • 77 million Americans > 65 in 2050 • The Gamers Are Graying! • 25% of gamers age 50 and over • Chronic Disease Epidemic • Aging gamers are the fastest growing demographic • Average older adult has 3+ diseases • 68% of American households own a gaming console • Focus on health promotion and prevention • The Cost • Exercise interventions to improve health • $468 Billion for Medicare in 2010 • Identify alternative methods for broad dissemination • $768 Billion for Medicare by 2017 • Maybe gaming is an option for the elderly? ESA report, 2008, accessed 5/20/10 Background Purpose • Describe therapists use of health games • Health games and aging with older patients • Popular press, Wii, and nursing homes • Identify facilitators and barriers for using • Health games and rehabilitation health games with older adults • Eyetoy and Wii for Stroke (Yavuser, 2008, Flynn 2007, Rand, 2008) • Inventory suggestions for improvements • Wii for balance (Nichols, 2009) • Describe older adults impressions of • NIH/RWJF Funded studies health games • Health games and physical therapy • Describe the potential role of the Wii as a • ? health promotion intervention 1
  2. 2. Questionnaire Demographics • “Commercial Health Games for the • 69 respondents Rehabilitation of Older Adults” • 43 used health games (100% Wii, 5% Eye Toy) • 20 interested in using health games • 35 question online survey (Survey Monkey) • 10 no interest • Distribution (November 2009 – January 2010) • Practice Settings • APTA Geriatrics Listserv • 12% Acute care • APTA Games for Rehab Group • 32% Inpatient Rehab • Local therapists in North Carolina • 37% Outpatient • Two large home health companies • 19% Home Health Demographics Wii-hab Time as Therapy Patient Considerations Systems Used • 72% Diagnosis • All respondents (42) use the Wii • 88% Cognition • 60% use the Wii Fit • 97% Physical Impairment • 5% use the Eye Toy • 63% Vital Signs • 83% Interest • 75% Motivation 2
  3. 3. Games Played With Older Patients Games Avoided • 28% avoid certain games • Balance board games are too challenging (4) • Tennis, baseball too fast (3) • Bowling, too difficult to coordinate release (1) “ I avoid many since they are too busy/too fast for many patients not familiar with video games” Do You Modify the Wii Fit? How do you assess progress? 50.0% • 72% Yes 45.0% 40.0% • HomeBrew 35.0% • Sitting 30.0% 25.0% • Set aim for patient 20.0% • Guard rails 15.0% 10.0% • Swiss ball 5.0% • Chairs for balance 0.0% Wii Fit balance Wii Fit age Time able to Performance I don't use the • Multiple Miis assessments play playing games Wii to assess progress “Modifications based on impairment, not age” “ I have seen wild fluctuations and there is a steep learning curve” Home Exercise? PT Goals for the Wii • 63% recommend patients continue to play • 100% Improve balance after discharge • 81% Improve endurance, increase • 20% indicate patients increase compliance activity level, enhance body with HEP when using the Wii awareness • 89% stated < 10% of patients have • 50% Increase range of motion, improve purchased a Wii strength • 30% Improve adherence to HEP “I see more compliance in the roughly 45-55 range…Those over 65 seem to like it in clinic but, report they wouldn't know how to hook it up or access the games at home” 3
  4. 4. Safety Concerns Why Do Patients Like the Wii? • Falls • 90% Fun • Overexertion • 42% Meaningful activity • Hitting something with • 35% Easier to see improvement Wii-mote “It's something new to most of them and they really enjoy it the first couple of times so I use it as a bit of a break from regular routine. I don't focus my treatment on it”. Why Don’t They Like It? Why Don’t They Like It? • Games need more instruction Frustration (73%) “The Ski Jump is like Greek” 70.0% 60.0% • Too many distractions – difficult to focus on the 50.0% task at hand 40.0% 30.0% • Even lower levels of the Fit are often too 20.0% 10.0% challenging, resulting in frustration 0.0% Games are Games are Too much Don’t know Don't Don’t like • Starting over at level 1 after achieving level 5 is too fast too difficult visual how to set up understand feedback stimulation the system how to get to from game a problem the games they want to play • Feedback is too negative “My patient is mad at her Mii” What PTs Want Summary – Physical Therapists • The ability to change the speed of a game • Therapists enjoy using the Wii and are • A more practical or functional game excited about the potential • Walking a perceived obstacle course • Disconnect between goals of therapy and • Less distractions how the Wii is used • Consistent and correct feedback • The Wii currently may pose challenges for older adults BUT there is potential for it to • The ability to start at any level of game be a viable adjunct to therapy 4
  5. 5. Older Adult’s Experiences Why we like playing! • 3 Focus groups of older adults (n = 15) “I see it as a challenge for myself, and to • 74.5 years average age, range 62 – 92 keep my mind going strong” • Mix of Wii naïve and Wii users • Common Themes • Competition • Why we like playing the Wii • Socialization • What physical abilities are needed to play • Be able to play with family • Fears and frustrations • Playing but also getting some exercise • Games for older adults What do we need to play? Fears and Frustrations • Wii Naïve Wii naïve • Vision • Incompetence/embarrassment • Coordination • Balance • Frustration with the game • Fear of falling • Wii Users • Mistrust of game progressing too fast • Balance • Too absorbed in play • Coordination • Patience Fears and Frustrations Interest in a Health Game Wii Users • 100% of participants indicated interest • Public humiliation • Lack of consistency in feedback ‘It would need to be clear that it was not a • Frustration at progress and then starting over “game” but to improve an aspect of health’ • Disappointment at negative feedback ‘It can keep you awake from the boredom of 10x this, 10x that, that is wonderful!’ “Most every game is too fast and requires more eye-hand coordination than we have, so we ‘The convenience, the option to exercise at play bowling” home’ 5
  6. 6. What Older Adults Want What Older Adults Want • Simplicity – use, graphics, game • Should not be exclusive • Choice in music • Games should tell you what aspect of • Forgiveness of mistakes health you are trying to improve • Ways to keep up with the game • Positive feedback on performance • Interest in games to improve a specific • Ability to enter own goals and see progress aspect of function • Interest in cognitive benefits “Doing something fun and getting results? “ I want to see a donut when I have burned Yes sure!” that many calories” Conclusion The Potential is Endless! • Older adults are interested in health games, especially if they were tailored to their needs • Physical therapists like Wii-hab, and may increase use as an adjunct to therapy if products were tailored to patients needs • A potential way to create a continuum of care 6