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Wiihabilitation: Gaming Technology Improves Strength and Coordination

Video game systems were long criticized for turning a generation of people into couch potatoes.  Fast forward to 2010 where young and old are now stretching, bending, balancing, swinging and waving their arms and getting a healthy fix from playing Wii Sports and Wii Fit. These popular video games are narrowing a generation gap that has long separated computer-crazed teens from the older generations. Now grandma and grandpa are engaging in an activity the children love.

Wiihab and Stroke Recovery

Wiihabilitation has taken physical therapy by storm. It’s being integrated into more clinics, nursing homes, rehab centers and private practices throughout the populous Golden State as a fun and useful physical therapy tool to complement more traditional physical therapy methods.An increasing number of California Physical Therapy Association members are installing their own Wii consoles and working alongside people with stroke to instruct them on Wii golf, baseball, bowling and even cooking for good physical therapy.

Physical therapist, Arlene McCarthy, PT, DPT, MS, NCS, program director of the Neurologic PT Residency and assistant director of rehabilitation services at Kaiser Permanente in the San Francisco Bay region, contends the Wii is just the tip of the iceberg when it comes to technology taking physical therapy to a whole new level.

“The Wii is great because it makes physical therapy entertaining,” she says. “Patients have fun without realizing they’re also improving and enhancing functions in areas of the body most impacted by stroke. Wii sports games require certain body movements and skills and might stimulate the brain to change and relearn movements because of the high number of repetitions that individuals are motivated to perform.”

According to McCarthy, “‘Wiihab might help with getting the brain to reorganize itself so body function can be restored. At least 400 to 600 repetitions are required to change neurons and enhance motor learning. The Wii might stimulate that change to occur because patients are motivated to concentrate on a particular task and practice it repeatedly.At the same time, they are having fun while learning.”

Wii players use the game console’s motion-sensitive controller that picks up their bodies’ movements – similar to traditional therapy-tracking devices. While playing the games, patients increase their hand-eye coordination, balance and control, strength and stability and fine- and gross-motor skills.

McCarthy says the Wii sports programs are especially popular with patients who love to watch or play sports. She often starts her patients with bowling and tennis because they are one-handed activities that encourage the use of the weaker arm and hand when holding the Wii remote controller with that hand.

“In our circuit training class, using the Wii has promoted team-building and teamwork among the stroke survivors. They laugh, cheer and support each other as well as give each other tips on how to be successful. They tell each other, ‘Go more right or more left.’One person shares what they have learned with the others. So, there is a lot of positive group dynamics going on.”

The Wii provides a way for therapists such as McCarthy to make treatment more meaningful because it simulates daily real-life activities. It goes beyond sports to appeal to a wide variety of patient interests, including cooking, outdoor activities and even music where they actually play a variety of instruments.

“We have a patient who’s a chef and can now use the Wii cooking game to practice chopping, stirring and cooking. This makes physical therapy more meaningful and engaging since my patient is very excited and motivated to work harder. He gets immediate visual feedback on how he does and can track his progress with the scores he receives.He will try stirring another way to see if doing it differently works better. Each time he tries, he shows progress.”

Wii not for Everybody

Neuroscientist, physical therapist and entrepreneur Sheryl Flynn, PT, PhD, studies the use and design of video game technology for rehabilitation at the Institute for Creative Technologies at the University of Southern California and is a founding member of a video game company that builds video games for rehabilitation. Even with all the hype over the Wii, she cautions patients who have experienced debilitating conditions from stroke to avoid trying these games at home until they have worked with a licensed physical therapist first to see if the Wii is right for them.

While there are benefits, neither the American Physical Therapy Association nor its chapters – including the California Physical Therapy Association – have formally endorsed the use of gesture-controlled video games for use in therapy. Video game technology is still a fairly new rehabilitation tool and only anecdotal evidence and small case studies are currently available to support its use. Studies are under way worldwide to test whether gaming technologies are truly effective.

Flynn emphasizes that using video games does not replace traditional physical therapy or the truly healthy benefits of engaging in actual physical exercise to get a person back on his or her feet. But, she admits physical therapy can be exhausting, mundane and boring for many patients.For that reason, the Wii and other movement-based video games are a good neutralizer in the physical therapy process.

In her view, the Wii is entertaining and motivating, and generates competitiveness to make patients want to try harder, a distinction difficult to achieve in regular physical therapy sessions.Patients get engaged by wanting to see if they win the game instead of having to focus on stretching that arm time and time again.

“Put any two patients together to try a Wii team game and you will definitely see them get more engaged than having the same two patients engage in a traditional physical therapy activity such as tossing a ball back and forth to each other,” Flynn said.

But, as Flynn warns, these characteristics also could lead to injuries if the games are not played properly.

“Sometimes people can be so deeply immersed in the game, they forget they have balance impairments and could fall or they might play the games for such a long time that an over-use injury might occur. Therefore, caution should be used any time a person uses video game technology for rehabilitation.”

Wiihabilitation a Family Affair

Another often-seen benefit of playing video games for rehabilitation is the connection that is made between the generations. Sometimes grandchildren find it difficult to connect with grandparents who have sustained a stroke. Playing video games together can offer a fun activity that serves as a common ground for these family members.

The Wii and other gesture-controlled video games offer improved balance as another positive benefit.Strokes often affect a person’s reaction time, strength, range of motion, motor control and coordination.In regular physical therapy, they have difficulty shifting their weight to their weaker side, so the WiiFit platform helps them to learn how to effectively achieve and control their balance and accrue points in the process.

In addition, the Wii remote might help a person’s fine motor skills and enhances dexterity in their hands.Visual perceptions also come into play because vision is the driving force in many games.

Technology is Only the Beginning

Often called a brain attack, stroke affects 700,000 people a year in the United States and kills 163,000 people. About 4.8 million survivors live with disabilities at an estimated medical cost of $3 billion to $4 billion a year.

Video game technology, such as the Wii, has far-reaching implications as researchers work to develop and improve technologies helpful to recovery.While the true medical impacts of Wiihab and other types of video-game therapies won’t be fully known until more studies are conducted, therapists and patients can attest to the positive camaraderie it promotes and how the games can enhance their quality of life by reconnecting families and restoring a sense fun, excitement and pride in their lives.

It’s not uncommon for people’s identities to be strongly tied to their physical health.For those who have suffered a stroke or debilitating illness or injury, the Wii can provide the impetus to re-engage with life and begin the healing process.

By: California Physical Therapy Association Members, Arlene McCarthy, PT, DPT, MS, NCS and Sheryl Flynn PT, PhD., Visit website

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"While playing the games, patients increase their hand-eye coordination, balance and control, strength and stability and fine- and gross-motor skills."
  • Stroke rehabilitation with physical therapy can be enhanced through the use of video game technology.
  • Nintendo Wii Fit and Wii Sports simulate real-life activities to make therapy more fun.
  • Video games not for everyone and can lead to injury. 
  • More studies still needed to understand video games’ true medical benefits. 
  • Consult a licensed physical therapist before trying video games for rehabilitation.
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