UTILIZATION OF THE NINTENDO WII IN SCHOOL SYSTEM
- Slides: 29
UTILIZATION OF THE NINTENDO WII IN SCHOOL SYSTEM PHYSICAL THERAPY Allison Rowe, SPT Presented Wednesday, April 17 th 2013
Potential of the Nintendo Wii. TM as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study
Inclusion Criteria 2 • Children between the ages of 6 and 12 years • Adequate cognition to understand the interaction required for use of the gaming system • Visible shoulder and elbow movement
Participants
Intervention 2 • Each participant assessed using the Gross Motor Function Measure (GMFM) prior to the start of the intervention. • 2 days/week on set days for 6 -weeks • 45 minutes in an open room with others being treated in the same area. • Wheelchair-dependent participants trained on a stool in unsupported sitting, ambulant participants were trained while standing.
Intervention 2 • For participants who did not have a grasp strong enough to hold the Wii remote in their hand for the duration of the study, a crepe bandage was used to secure it. • Training was initiated with Wii Sports Boxing. • Progression was made to Wii Baseball and then finally Wii Tennis. • Participants were then re-assessed using the GMFM by one of the same two evaluators from the pre-assessment.
Results 2
Results • GMFM has been validated for CP 3 • The use of the GMFM determined whether or not there was a change in a child’s motor function, rather than the quality of a skill that was learned from the virtual reality therapy 3 • Has been proven to be reliable in all dimensions of the measure • The use of virtual reality did impact overall gross motor function following the 6 -week training program 2
Use of a Low-Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent With Cerebral Palsy
Case Description 1 • 13 year old adolescent attending a summer program at school for children with developmental disabilities. • Spastic diplegic CP and delayed development • Poor motor planning, poor ability to sustain attention and poor ability to complete tasks.
Case Description 1 • 3 months prior to intervention: • Active motion in all extremities, with better isolated movement of UEs vs LEs. • L UE dominant functional arm. • Posture in supported standing semicrouched with hip internal rotation and ADD. • Sitting posture included posteriorly tilted pelvis, laterally flexed trunk with convexity to R and flexed posturing of R UE. • Decreased ROM in hip EXT, ER, knee FLX and ankle PF • Poor abdominal strength, lacked core stability • Ambulating independently with B AFOs and a posterior rolling walker
Case Description 1 • Projected PT goals for upcoming school year: • Independent standing for 5 minutes using one forearm crutch while performing an activity • Ambulating 200 ft using forearm crutches with CGA without LOB • Upright midline sitting on a bench or bolster for up to 10 minutes, requiring fewer than 2 verbal cues.
Outcome Measures 1 • Quality of Upper Extremity Skills Test (QUEST) • GMFM • Subtests D (standing) and E (walking, running, and jumping) • Visual-perceptual processing: • The Test of Visual Perceptual Skills, third edition (TVPS-3) • Postural control: • Measures of weight distribution and sway collected during static stance with eyes open and with eyes closed on a Posture Scale Analyzer • Functional mobility: • Retrospective data from chart review for walking distance
Intervention 1 • Wii Sports selected based on patient interest and applicability to goals • Games played in training or game mode in both sitting and standing • 11 sessions over 4 weeks, ranging from 60 to 90 minutes • Treatment administered during summer session in addition to his regular therapies.
Results: Visual-perceptual Processing 1
Results: Postural Control 1
Results: Functional Mobility 1
Discussion Points • Feasibility • Television access • Financial cost • Cognition and motivation • Low IQ rating, reported attention deficits • Multi-player function • Long term use
Explanations for improvement 1: • Intensity of treatment • Duration, repetitions • Training was task driven and required problem solving* • Known to promote behavioral changes and neural plasticity in children with CP • Multisensory feedback provided by the system translates to learning and performance improvements • Auditory, visual and haptic information along with provision of KP and KR
Wii Games
Wii Sports 1 • Golfing: • Requires judgment of force, distance, and figure-ground discrimination, with high accuracy constraints. • Boxing: • Requires midline trunk orientation and endurance of trunk muscles. • Requires bilateral upper extremity reciprocal movements that promote midline trunk alignment
Wii Sports 1 • Bowling: • Requires trunk stabilization while moving a single upper extremity with varying degrees of force. • Standing games: • Emphasize balance with weight transfer between the lower extremities • All games: • Upper-extremity control • Trunk control • Timing • Hand-eye coordination
Wii Fit • Balance training • Visual feedback • Body awareness • Balance board can be used with many assistive devices • Weight shifting • Balance Reactions • Potential to work on head control
Dance Revolution • Strength and endurance • Following sequences • Vestibular/movement input • Allows therapist to adjust speed and level of activity • Timing of movements • Placement of lower extremities
Guitar Hero • Hand eye coordination • Reaction timing • Concentration and coordination • Hand function and movement
Adaptation Ideas • UE Strengthening • ‘Dumbbells’ come in 2 or 5 pounds!
Benefits of Wii utilization • Working with peers: Turn taking, strategy sharing, encouragement, improved form • Excitement of using a ‘video game’ during therapy • Feedback, competition, self efficacy 4 • Visual Reality System Potential Benefits 1: • Improve reaching behaviors • Produce cortical reorganization • Improved visual-perceptual processing • Requires hand use and finger dexterity to continue 4 • Potential therapeutic reward
Questions?
References 1. Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P. Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther. 2008; 88(10): 1196– 1207. doi: 10. 2522/ptj. 20080062. 2. Gordon C, Roopchand-Martin S, Gregg A. Potential of the Nintendo Wii. TM as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study. Physiotherapy. 2012 -09; 98: 238 -42. 3. Russell D, Rosenbaum P, Cadman D, Gowland C, Hardy S, Jarvis S: The Gross Motor Funciton Measures: A means to evaluate the effects of physical therapy. Dev Med Child Neurol. 1989; 31; 341352. 4. Mouawad MR. et al. Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study. J Rehabil Med. 2011; 43(6): 527– 533. doi: 10. 2340/16501977 -0816. 5. You SH, Jang SH, Kim YH, Kwon YH, Barrow I, Hallett M. Cortical reorganization induced by virtual reality therapy in a child with hemiparetic cerebral palsy. Dev Med Child Neurol. 2005; 47(9): 628– 635.
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