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.

Active Videogaming and Children

A recent study in the Journal of Pediatrics indicated the benefits of exergaming for children.  The researchers studied 15 children, ages 9-11 years old, participating in high intensity exergaming, low intensity exergaming and a graded exercise test on a treadmill.  The results indicated the following:

• high intensity exergaming (Kinect hurdles) was equivalent to moderate intensity exercise
• low intensity exergaming (Kinect bowling) was equivalent to low intensity exercise
• high intensity exergaming significantly reduced flow mediated dilation (vascular response) 
• high intensity gaming increased heart rate and the amount of energy burned.

Reference:  Andrew Mills, BSc, Michael Rosenberg, PhD, Gareth Stratton, PhD, Howard H. Carter, BSc, Angela L. Spence, BSc, Christopher JA Pugh, PhD, Daniel J. Green, PhD, and Louise H. Naylor, PhD. "The Effect of Exergaming on Vascular Function in Children," The Journal of Pediatrics, DOI 10.1016/j.jpeds.2013.03.076

Wiihab and Balance

A recent study was published in Developmental Neurorehabilitation regarding the use of the Nintendo Wii to improve balance, motivation and function in children participating in acute rehabilitation following acquired  brain injury.

A multiple baseline, single study research design was used with three subjects who received daily Wii balance training.  The results indicated that two participants were equally motivated by traditional balance training and one participant was more motivated using the Wii.  Improvements were seen in dynamic balance and functional ability.  The results for static balance were inconclusive.

The researchers concluded that using the Wii is a safe and motivating tool for balance therapy for children with acquired brain injury.  Further research was recommended  regarding the use of the Wii for balance therapy.

Do you use the Wii in therapy sessions?  I have before and wish I could bring one with me for so many students that I see, particularly older students.

Here are the positives:

• The motivation level is high
• there is wonderful visual and occasionally tactile feedback
• challenges motor planning skills
• excellent feedback for weight shifting of the lower extremities

The negatives are:

• motor planning skills can be very challenging for some children on certain games
• difficult to travel with as a school based therapist
• cost for the entire system is a bit pricey if you are paying out of your own pocket

I have considered putting together a Wii kit to include a small television or monitor, the Wii and the Wii Fit balance board.  If I tossed it into a small suitcase on wheels I could transport it to different schools.  Perhaps I will look for a second hand television set and Wii (now that the WiiU has come out I am sure there are plenty of people willing to unload the old Wii for cheap).  The Wii can be set up in a snap (unlike the Kinect that takes some time to calibrate to the room you are playing the game in).  I will be keeping my eyes out.

So back to the question do you use the Nintendo Wii in therapy sessions?      

Reference:Wii-habilitation as balance therapy for children with acquired brain injury Sandy K. Tatla, Anna Radomski, Jessica Cheung, Melissa Maron, and Tal Jarus Developmental Neurorehabilitation 0 0:0, 1-15 doi=10.3109%2F17518423.2012.740508

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 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]

Kinect versus the Wii?

image from Microsoft

I recently was able to try out the new Kinect on the Xbox. It was an interesting experience. The Kinect is able to detect your motions without any remote or game controller. Not only does it detect upper extremity motion (like the Wiimote) it also can detect lower extremity motion. I played soccer and did several track and field events. It was definitely very different from the Wii. The first step is to get the Kinect to register your motions. It was hard to match up my hands or feet exactly where the Kinect wanted me to. I found it to be difficult to follow which person I even was. In addition, the motor planning and body awareness required to kick the ball or jump a hurdle was challenging. I am sure if I practiced more I would be able to plan and execute my virtual motor actions better. For now though I am sticking with the Wii.

I do see amazing possibilities for the reasonably priced technology though. I imagine therapeutic home exercise programs where therapists can remotely track how a client is doing with regards to range of motion, reaction time, balance skills and more.

If you have tried the Kinect, what did you think of it?

Wii Motion Analysis

Now this is really cool, especially if you are a nerdy, techie therapist. This physical education teacher, Mr. Robbo, explains how to use your Wii remote to do some simple motion analysis. You download a program, connect your Wii remote to your computer with blue tooth capability and 'voila' instant motion analysis. Give someone the Wii remote and start collecting data.

Unfortunately, I could not test this out because my computer is not blue tooth enabled. But... if it worked I could see many uses for therapists:

1. Place the Wii remote on a child's belt to get a simple analysis of pelvic motion during gait training.

2. Track a child's motion using different assistive devices i.e. anterior versus posterior rolling walker.

3. Track upper extremity active motion.

4. Analyze the forces on the child's motion when walking on different surfaces

5. In the comments section of the blog one reader says he/she used the Wiimote inside a ball to collect data on throwing and catching.

Would love to hear if you get it to work in the clinical setting.
Read on how to turn the Wii Remote into a data logger.

Read Wearing a Wiimote During Sport

Watch his videos below:

Visual Impairment and Wii

Here is an interesting free download to adapt two Wii games for use with children who are visually impaired - VI Fit.

This adapts Wii Tennis and Bowling. The VI Fit download provides audio and vibrotactile cues to direct the players where to hit and direct the balls.

VI Tennis was tested on a group of 13 children who were blind and resulted in increased active energy expenditure. VI Bowling was tested on 6 adults who also increased active energy expenditure during the game.

Go to www.vifit.org to get the download and directions.

If you need off the shelf adaptations for the Wii check out this website for available products - http://www.broadenedhorizons.com/wiimote.htm