Benefits of the WiiFit on Motor Performance in Children with Cerebral Palsy

The Journal of Physical Therapy Science published research on the effect of training with Nintendo Wii Fit games on motor performance in 40 children with spastic cerebral palsy (6-10 years old and GMFCS Level III).  Participants were divided randomly into equal groups: experimental group that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and the control group that underwent no training. The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance.

The results indicated the following:

1.  significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes.

The researchers concluded that using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.

Reference: AlSaif AA, Alsenany S.. Effects of interactive games on motor performance in children with spastic cerebral palsy.  J Phys Ther Sci. 2015 Jun;27(6):2001-3. doi: 10.1589/jpts.27.2001. Epub 2015 Jun 30.

Postural Control in Very Preterm Children

Recent research assessed the postural control of 90 very preterm (VPT) children (<30 weeks gestation) and 36 full term children (>37 weeks gestation) at four years old. Using a Wii Balance Board, various tasks were assessed including static two-limbed standing with eyes open, eyes closed, eyes open on a foam mat, eyes closed on a foam mat, single leg standing on each limb and a cognitive dual task (involved showing the participants a series of pictures that appeared on screen at 2-second intervals). Functional performance was assessed during dynamic jumping and hopping tasks using the outcome measure of flight time, with shorter time indicating worse performance.

The results indicated the following: 1

1. VPT children had impaired static and dynamic balance, with increased postural sway under all conditions.

2. VPT children had reduced flight times compared with children born at term.

3. When adjustments were made for body weight the only group differences in postural control were in the cognitive dual task and flight times (jumping and left leg hopping).

The researchers concluded that: "VPT children demonstrated reduced postural control at 4 years of age compared with term-born children when presented with a cognitive dual task. They also performed worse during jumping and hopping tasks".

Reference: Lorefice, L. E., Galea, M. P., Clark, R. A., Doyle, L. W., Anderson, P. J. and Spittle, A. J. (2014), Postural control at 4 years in very preterm children compared with term-born peers. Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.12550

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Need postural control activities?  Check out some yoga for kids videos and resources at http://yourtherapysource.com/yoga.html

Recent Wii and Kinect Research

Gait and Posture recently published two articles on the use of the Wii and the Kinect.  The research indicated the following:

1. When compared to multiple camera 3D motion analysis, the Microsoft Kinect was able to validly assess kinematic strategies of postural control.  The forward reach, lateral reach and single limb stance eye closed were used for postural control tests.
2.  Postural control was evaluated when using the WiiFit Soccer Heading game and the Ski Slalom game.  The results indicated that participants primarily used a trunk strategy to play Soccer Heading and a great contribution of lower extremity control to play Ski Slalom. 

References: Ross A. Clark | Yong-Hao Pua | Karine Fortin | Callan Ritchie | Kate E. Webster | Linda Denehy | Adam L. Bryant Validity of the Microsoft Kinect for assessment of postural control Gait & Posture, Available online 23 May 2012 

A. Michalski | C.M. Glazebrook | A.J. Martin | W.W.N. Wong | A.J.W. Kim | K.D. Moody | N.M. Salbach | B. Steinnagel | J. Andrysek | R. Torres-Moreno | K.F. Zabjek Assessment of the postural control strategies used to play two Wii Fit videogames Gait & Posture, Available online 19 May 2012

Active Video Games Not So Active

A recent study published in Pediatrics compared activity levels of two groups of children given a Wii.  There was 78 children, ages 9-12, who participated.  Each child was given a new Wii console of which none had previously owned.  One group of children were asked to choose one game that was fitness focused ie Wii Fit Plus.  The other group of children were asked to choose one inactive game ie Mario Kart.  The children wore accelerometers for 6 weeks.  At the end of 6 weeks, they were allowed to choose one new game for an additional 6 weeks.  At the end of the 12 week study, there was no difference in the level of activity between the two groups.

Reference:  Marcus, M.   Active' video games may not boost kids' fitness: study. Retrieved from Medical Xpress on 2/29/12 at http://medicalxpress.com/news/2012-02-video-games-boost-kids.html

Need ideas to get children moving?  Check out the Sensory Motor Activity ideas from Your Therapy Source.

Wii Use and Down Syndrome

A case study was published in Pediatric Physical Therapy regarding a 12 year old with a diagnosis of Down Syndrome who followed a home program using the Wii. The 12 year old used the Wii 4 times per week for 20 minute sessions over a period of 8 weeks. The family was encouraged to participate. The 12 year old choose 4 different games to play. Following the 8 week period, the child exhibited improvements in "in the child's postural stability, limits of stability, and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition balance, upper-limb coordination, manual dexterity, and running speed and agility standard scores".

Would love to see this study replicated with a larger sample size. The Wii is so much fun and engaging. In my opinion, home programs could be easily set up with increased follow through with the Wii. More fun for the individual and less set up time for the parents.

Do you use the Wii in your practice?

Curious to hear if anyone is using Kinect and what your opinion is?

Reference: Berg, P et al. Motor Control Outcomes Following Nintendo Wii Use by a Child With Down Syndrome. Pediatric Physical Therapy: Spring 2012 - Volume 24 - Issue 1 - p 78–84. doi: 10.1097/PEP.0b013e31823e05e6

Wii Jogging for Individuals with Cerebral Palsy

I am highly interested in the Wii and its use in rehabilitation. In a high priced market of therapy products the Wii comes in at a dirt cheap price. There are many university students who are working on "hacking" in the Wii remotes to be able to adapt them for different activities and motion analysis. I also read recently that Microsoft is opening up the Kinect to some developers to see how it can be used in terms of motion analysis. For now though there are some great simple way to use the Wii at home for children and I have discussed some of them in previous blog posts. Just type Wii into the search box on the right of this blog to read previous posts.

I came across this video on You Tube and wanted to share how motivating the Wii could be at home. Here is a young man who is holding onto a standing frame (built by his Dad it says in the comments). Using the Wii Jogging from Wii Fit he is able to track his progress on the screen which keeps him motivated to keep working. Check it out.

Wii and Head Control

Here is an interesting but very small study on using the Wii controller to assist with head control. Two subjects with multiple disabilities used the Wii remote controller to control their favorite stimulation by actively keeping their head in an upright position. The results showed that both participants significantly increased their time maintaining the head in an upright position.

Reference: Shih CH, Shih CJ, Shih CT. Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation. Res Dev Disabil. 2011 Sep-Oct;32(5):2005-10. Epub 2011 May 20.

Cerebral Palsy, Computer Games and Sitting

Research was published to investigate whether sitting balance could be improved in children with cerebral palsy following the use of motion activated computer games. After using the center of gravity game controller in sitting for three months, "statistically significant improvements were seen in two elements of box sitting using the Chailey levels (shoulder girdle position and spinal profile) and in five elements of the Sitting Assessment for Children with Neuromotor Dysfunction across both reach and rest phases of the assessment". The researchers recommend further research in this area.

Have you ever tried using Wii fit in a sitting position for children with cerebral palsy? There is one game on the Wii Fit, Lotus Focus, that is meant to be used in sitting. The individual is supposed to sit on the board and maintain stillness. There is a candle flame flickering for visual feedback. If you move too much, the candle goes out.

Today we tried sitting on the Wii Fit balance board to see if you could still activate the controls for other games. Using the Soccer Heading game, you could control moving the Mii side to side to hit the soccer ball. Of course it was not as accurate as in standing, but it would be viable to use in sitting just don't expect the same scores. We also tried moving the Mii side to side in quadruped only using the upper extremities. This worked as well but was quite fatiguing on the neck muscles. It would work for short periods of time to work on upper extremity weight bearing. I would recommend keeping the TV at a low level to prevent neck hyperextension. I would assume you could also try skiing or other games in sitting that require weight shifting. What have you done to adapt the Wii for children?

Reference: Wade W, Porter D. Sitting playfully: does the use of a centre of gravity computer game controller influence the sitting ability of young people with cerebral palsy? Disabil Rehabil Assist Technol. 2011 Oct 4. [Epub ahead of print]

Wii Games for Different Abilities

Without trying out each of the Wii games, it can be hard to determine specific games to recommend for children. Ability Technology has provided an overview of the skills that 6 popular Wii games require. The table describes each game and then rates the following areas: cognitive, physical/sensory, psychosocial, adaptation, set up and general ease of use. Wii Music scored the highest. They have also reviewed X-Box360, PlayStation 3, and games for the computer. View the Wii ratings.