How Wii-habilitation can get Patients on the Road to Recovery.

Many techniques are used in the rehabilitation of patients. Some, as you might expect, are more traditional and commonplace than others. However, did you know that some NHS health trusts are now using the Nintendo Wii to assist in the care of patients recovering from fractures, strokes and other brain injuries?

It may sound a little unconventional, but the hand-eye coordination, concentration and movement involved in playing Wii games are all hugely effective in helping rebuild muscle memory and other cognitive skills. As the road to recovery can be lengthy for some, it’s important to incorporate a number of rehabilitative exercises that will help patients to regain their strength. By making these activities varied, accessible and even entertaining, many believe that they can speed up the process.

This is certainly the theory behind the Nintendo Wii initiative.

The variable movements allow for a gradual rehabilitation within the home. As a result, this is convenient for both the patient and the healthcare professionals looking after them. After all, with a Wii, you can play anywhere (as long as there is a television) and at any time. Whilst it’s important that usage is monitored and restricted in cases where damage may be done, it’s a more engaging and entertaining method of recuperation.

This is certainly the view of the Birmingham Community Healthcare trust, which has been using the Nintendo Wii as a part of its patients’ rehabilitation for a number of months. Using games like Wii Sports and Wii Fit, helps to build strength, mental agility and can also be a distraction from the often painful recovery process.

One of the many benefits of using the Nintendo for “Wii-habilitation” is that the user can control the level of movement. If unable to swing arms or move about fully, patients can simply use cursors or select a less strenuous game. Equally, it’s easy to track individual progress. As the body recovers, it should become easier to perform certain activities, which will be reflected in the level of difficulty and ability to score.

Consequently, people can assign targets and build confidence without having to leave the house. Alastair Gordon, an Occupational Therapist that works closely with Birmingham Community Healthcare and a wide range of patients, explains why the Wii has become a vital part of the treatment process; "There are many techniques which clinicians use while helping patients, but 'Wii-habilitation' certainly bring some fun and enjoyment to the day-to-day activities which help patients on their road to recovery."

This element of fun is a key part of the process. Rehabilitation from serious injuries and strokes is time consuming, frustrating and sometimes painful. Therefore having an activity that patients can look forward to and engage with is a great alternative for community healthcare officials when dealing with patients. Combined with other exercises, it can have a profound effect on the speed and success of rehabilitation.

This post was provided by the Birmingham Community Healthcare NHS Trust. For more information about patient recovery, please visit their website.

On-line Wiihabilitation course

Click here for on-line Wiihabilitation course, courtesy of Care2Learn

Written by Geoff Mosley, PT, NCS

OTs Wii too

The vast majority of emails, queries or comments received through the Wiihabilitation are either members of the public or physiotherapists.  A handful of Occupational Therapists have been in touch and it would be inaccurate not to acknowledge them.  The website is written by a physiotherapist, so perhaps doesn't focus on the functional/occupational tasks that OTs work towards.  It is not a criticism of the OT profession that there use of the Nintendo Wii is less published- their roles are diverse and can easily be fulfilled without the aid of technology.

There is no doubt that there are a good number of OTs who use the Nintendo Wii regularly within their practice to help people develop hand function skills, cognitive abilities, perception or sequencing skills. Their work is difficult to find without a

The links below show case some work carried out by OTs and their work with the Nintendo Wii.  If you know of other work, please add using the comments box below to share with other readers.

Occupational Therapy case study (2008)

Use of the Nintendo Wii in Occupational Therapy (2008)

Wii OT blog site (regularly updated)

Using the Nintendo Wii in Occupational Therapy (2010)

Wii-HAB: Using the Wii Video Game System as an Occupational Therapy Intervention with Patients in the Hospital Setting (2010)

OCCUPATIONAL THERAPISTS UNITE: WIIHABILITATION IS MORE FUN THAN PRESCRIBED EXERCISES! (2008)

From reading any of the blogs, articles or websites above, the similarities between OT and physio is all too apparent.  It only goes to prove how closely related the professions are in their aims to promote movement and independence.  The information available for Occupational Therapists is as valuable to physiotherapists as the physiotherapy information is for Occupational Therapists.  The research found listed within this blog can be applied to an movement based therapy and provides a growing library of evidence reporting the Nintendo Wii's value within therapy in general.

Wii Game Box Inlay - summary for quick therapy reference

Through using the Nintendo Wii at work I am aware that whilst I can navigate around the games with ease and from memory many of my colleagues don't have the same level of familiarity and therefore struggle to choose appropriate games.  This either causes the set up of the console and game lengthy or it leads them to abandon the idea of using the console for a more conventional therapeutic activity.

To try and assist I created a template that I have summarised individual games and then print out.  The information then fits within the game sleeve and is viewable as a quick reference - listing the most common/most beneficial games for therapy.

You can find a word document to download with two examples of the Wii game prompts here.  If you feel they are beneficial and have a particular game that you want to use it with please feel free to email me, as I may have it already written up and formatted.

Technology within therapy - Biometrics E-Link vs Nintendo Wii

For those who recognise the value of computers within therapy, they probably won't need to be told about the Nintendo Wii but its not the only use of computer gaming within rehabilitation, nor will it be the last.  One criticism of the Nintendo Wii is its lack of specificity, in that there isn't a piece of software that fully meets the needs of therapy.  It doesn't allow you to easily record progress in a manner that is in keeping with therapeutic need and it doesn't let you configure the software that you are using to allow the patient to work at a level and pace which is both suitable and comfortable alongside being therapeutically beneficial.

There are other alternatives on the market though and, unlike the Wii, The E-Link may not be as well known but similarly to the Wii it uses games to support therapeutic activities.  Produced by Biometrics, the E-Link is far more robust tool and treatment for therapists and does all that the Nintendo Wii currently does not.  It records  progression, prints charts, allows the therapist to set goals, targets, offers feedback, saves patient information securely, can be used as an outcome measure in its own right and significantly doesn't allow the patient to 'cheat' or not fully complete the required task/movement.

Its control mechanisms, used by the patient/client are interchangeable and are controlled by several devices.  The first measures angles (angle-x) produced by joint movements,  the second measures EMG muscle activity (myo-x device), the third is mechanical (upper limb kit) requiring patients to physically control a rotating wheel with a choice of handles or grips for hand function and finally a set of pressure plates that measure forces.   It is incredibly versatile and has few limitations, meaning that any joint can be exercised and worked in the way that is therapeutically beneficial.

On the downside the E-Link has two weaknesses - the graphics and the price.  Through discussion with colleagues, and use of the E-Link, the graphics are an obvious comment to make.  They don't come close to the detail or fluency that many have become accustomed to when playing mainstream console games - but developing console style games requires a phenomenal amount of financing which would only ever serve to increase the over all cost of the E-Link system.  From experience its worth mentioning that it shouldn't matter what the game looks and feels like - its the function and the achievements that count.  I still have very fond memories of ZX Spectrum games and would still happily play 'Colin the Cleaner' or 'Dizzy - Treasure Island' purely because I enjoyed the game despite the graphics being grittier than a bucket of course sand.  With the release of E-Links software - version 12 in the New Year the graphics are said to be one focus of improvement within the system and whilst the current graphic could be considered a weakness they certainly are not a flaw.

The price is the second contentious point.  With the Nintendo Wii now at an off the shelf affordable price of around £120 the E-Link, in contrast, costs considerably more.  The difference comes from the two systems being made for very different reasons.  The Wii is a gaming console that has, as an unintended offshoot, been commandeered by therapists and patients alike to enhance their physical well being and abilities.  The E-Link is a purposely designed piece of kit that demands high standards of precision in order to be reliably and specifically used within rehabilitation.

It is easy to comment and state that the Nintendo Wii does all that the E-Link doesn't, it justs costs less and has better graphics - but when the 'rose coloured Nintendo Wii glasses' are removed the Wii isn't so perfect.  The graphics may be exceptional but the games are never specifically designed for rehabilitation, you can't adjust the game play time or the level of difficulty to meet your patients needs.  The movements that are required are too forgiving, in that they don't need to be exact, creating the opportunity for imperfections in the control, and a reduction in the quality, of active movements.  It won't allow you to save specific achievements made by specific patients, or chart their progress and allow you to print out reports.

Often (especially in the early stages of rehabilitation) the games are too 'busy', colourful and so graphically interesting that they distract the patient from the therapeutic purpose of using the game.  Because the games are not designed for the use within therapy they are often quite difficult, setting up for failure, disappointment and potential disinterest from the patient.

Currently the Nintendo Wii can/should only be considered as a therapeutic tool, but those willing to pay the premium and purchase an E-Link system will find themselves offering computer gaming as an assessment tool and/or treatment.

For more information on the E-Link please visit the following website.