darnall wii hab feb 2010
DESCRIPTION
TRANSCRIPT
Mr. Steven P Miller Jr.
Augmenting therapy utilizing the Nintendo Wii™
http://www.bayraider.tv/2007/02/nintendo_rehabi.html
http://www.google.com/
The RehabCare Group
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
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=7http://www.hospitalnews.com/modules/magazines/mag.asp?ID=3&IID=128&AID=1647
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
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
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]
http://gaygamer.net/2008/06/wii_fit_eyed_for_rehab_patient.html
http://www.google.com/
Nintendo.com
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]
http://www.heraldtimesonline.com/
http://blog.cleveland.com/lifestyles/2008/06/wii_fit_nintendo_game_makes_ph.html
“Using Nintendo Wii in Therapy” by Liza Jochem
Therapeutic Activities (3 of 3)
• Cognitive Training: [5, 19, 24]
– Timing [14, 23]
– Following directions [19]
– Visual-perceptual skills [9, 19]
– Listening [19]
“A Wii spot of fun” by Tim Dixon
“Virtual rehabilitation with video games: A new frontier for occupational therapy” by Jonathan Halton
Goals
• Increase • Maintain • Improve• Reduce
http://www.rdehospital.nhs.uk/trust/pr/2009/wii_exercise.htmlhttp://www.oefoif.va.gov/HowDoIGetHelp.asp
http://www.spanish-meadows.com/Services.html
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=1186http://www.usatoday.com/tech/gaming/2008-02-08-wiihabilitations-hospitals_N.htm
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.htmlhttp://www.zimbio.com/pictures/ujDTGDY4YZS/Medical+Center+Uses+Wii+Gaming+System+Physical/2w1-_rUL4xu
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
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/
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]
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.newenglandsinai.org/press_releases/nr_wii_fit.html
http://www.google.com
http://www.google.com
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/
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
http://www.jabulela.com/miscellaneous/twenty-most-visited-web-sites-2008Other images were from Nintendo.com
Reference: http://www.nintendo.com/
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
Optional Equipment
• Exercise ball – http://www.wiifitforum.org/video-wii-hab-pelvic-c
lock-for-low-back-pain-t521.html
• Thera-tubing/thera-band– http://www.hope.edu/academic/kinesiology/athtr
ain/dlssm/docs/Wiihab.ppt
Images were from Google
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
Wii™ Safety
http://compulsivec.wordpress.com/2006/12/
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
http://www.flickr.com/photos/iconfactory/sets/72157594406897342/
http://gizmodo.com/219119/the-japanese-wii-safety-manual-is-crazy
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/
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)
http://www.wiinoob.com/anatowii-nintendo-wii-design/
Reference: “Wii habilitation, using Wii Sports in rehabilitation.” by RehabCare Group, Inc.
04/09/2023
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] Images from http://www.google.com/
04/09/2023
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]
Images were from http://www.google.com/
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/
04/09/2023
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?
http://www.google.com/
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/
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