Wii-hab

Virtual reality systems have long existed for patients requiring arm, leg, and other forms of rehabilitation. For the most part, these systems were complex, custom built, and very expensive.

More recently, off-the-shelf gaming systems such as Nintendo Wii and PlayStation 2 have become so sophisticated and powerful that they are now being tested for use by these patients, leading to terms like 'Wii-hab' and 'Wii-habilitation'.

This big leap from fun to therapy is possible because these two systems detect the patient's movements, allowing them to feel as if they are actually playing games like tennis, bowling, and golf. However, there are other advantages.

"Gaming systems offer a way to keep motivations high," says Judith Deutsch, PhD, a physical therapist and Professor, Rehabilitation and Movement Sciences at the University of Medicine and Dentistry of New Jersey in Newark. Instead of what may often be repetitive rehabilitation exercises used during typical sessions, gaming systems offer kids and teens a higher level of excitement, particularly when playing with other players. "I think it will be a useful tool, not to replace, but to augment [existing rehabilitation systems]," says Dr. Deutsch, adding players are more motivated to complete their exercises. And, "the Wii is so inexpensive," when compared with other programs.

Tips to increase more than just game scores

Dr. Deutsch recently published a case report about a patient with spastic diplegic cerebral palsy (SDCP) who had dramatic improvements when using the Wii. Patients with SDCP have tight leg and hip muscles and their legs often cross at the knees, making it difficult to walk.

One of the patient's biggest challenges was doing any activity during the standing period, explains Dr. Deutsch. He also had challenges with posture and trunk control in the sitting position when using both extremities.

Dr. Deutsch and her research colleagues chose games that would fill his rehabilitation needs. For example, bowling required him to keep his trunk, or midsection, still while he moved his arms. "The strategy was to design a program that would place a demand on him, but not so much that it discouraged him to do things," says Dr. Deutsch.

While playing the games, the therapists then offered pointers, which served two functions: the patient was pleased because his scores improved, and the movements became more focused and beneficial in terms of the physical therapy. 

High score in standing, posture, and walking

The results were surprising.

Before the therapy, the patient could stand for no more than five minutes at a time and was often easily distracted. Following therapy, "he was able to stand for half an hour and he had he tremendously improved his walking," says Dr. Deutsch. 

As therapy continued and the patient's abilities improved, Dr. Deutsch brought in her son, whom she describes as a "Wii expert." "It was nice to see the turn taking, talking about the games, and seeing them interact," says Dr. Deutsch. Mimicking her son's play, the patient surprised everyone with a "humungous jump in his scores," says Dr. Deutsch.

Although the patient did start to lose interest in some games as time went by, Deutsch says playing with other people "really motivated him to work longer and harder."

Don't try this at home -- yet

If your child requires rehab, it is not as easy as going out and buying a Wii. "One possible problem is they could develop maladaptive behaviours," says Dr. Deutsch, explaining that using the 'wrong' movements while playing would be counterproductive to rehabilitation. Instead, she envisions patients first being properly instructed on using the Wii, then doing the exercises at home.

Another challenge is that "off-the-shelf gaming systems are not designed for rehab, and games may prove difficult to play if the patient does not have good motor control," warns Dr. Deutsch. This could also lead to frustration and disappointment for both the child and parents. She suggests making therapeutic controls that could be set according to the patient's needs is another step that might increase the therapeutic potential of the devices.

Dr. Deutsch also recognizes that Wii needs testing in more patients, and she plans to do just that with her patients recovering from stroke. Similarly, other programs are testing the system in patients with brain and spinal cord injuries.

Perhaps the biggest challenge is already behind Dr. Deutsch. Simply purchasing a system proved difficult.

It took persistence for Deutsch to even find a store that had a Wii in stock. And, after buying one for her son, the store made her get back in the long line to purchase the second Wii for her clinic. Yet the time spent paid off for her patient. And even more are likely to benefit in the future.