Nintendo system kicking off wave of Wiihabilitation

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The Nintendo Wii, a game system that requires users to act out the game with a motion-sensor controller, has become part of the therapy routine for a growing number of providers around the country.

Although its original intent was simply to be a fun way to spend some time, therapists using the system are swearing by its results.

“I got interested in it because of my nephew, who played it all the time,” says Lane Blondheim, MSPT, MT, owner and director of Active Health and Rehab in Montgomery, AL. “One day, I started playing a game with him and realized almost immediately that I could use this with my patients and it’d be fun for them.”

The patients’ enjoyment added to the benefits of the Wii, but Blondheim especially liked the therapeutic benefits of the system. 

Making fun practical

Although it’s easy to say using a Wii for rehab works because you see patients moving their arms and being active playing “virtual” tennis, baseball, and boxing, it’s quite another thing to come up with actual plans of care involving the system.

Blondheim says it’s really not that different than developing activities for other therapy equipment.

“You’re trying to deliver therapeutic change,” he says. “So if you have a patient with shoulder impingement, you want to get [him or her] to move the affected shoulder in a particular way, but you also need to restrict certain movements.”

So, for example, Blondheim will have a patient play Wii tennis and have him or her hit constant forehands to stretch his or her shoulder little by little. “I’ve seen a patient coming off shoulder surgery go from 100º range of motion to 120º in one visit, mostly because they are overcoming fears,” he says.

Part of the appeal of the Wii is that it’s not nearly as punishing on the body as “real world” sports, so it works well for someone whose legs might not be able to take the pounding of an actual tennis court, for example. But there’s also a psychological overlay, says Blondheim. Patients are often scared to perform tasks they previously did, or maybe never did, but when they are doing it with a controller and seeing someone else play it out on the screen, it makes it easier.

Blondheim has begun adding degrees of difficulty to the games. For example, he’ll have patients stand on unstable surfaces, such as a wobble board, to work the lower halves of patients’ bodies, enhancing trunk stability.

 “Like with everything, there’s patient education, so it initially requires that constant one-on-one therapy until you can teach the patient to do the exercise,” Blondheim says. “You can manually restrict the patient from doing something or verbally cue, ‘Keep your shoulder down,’ or ‘Use only your wrist.’ ”

Appropriate for all ages

Although it might seem the Wii is most popular with younger patients used to playing video games, patients of all ages use the Wii, says Lars Oddsson, PhD, research center director at Sister Kenny Rehabilitation Institute in Minneapolis.

“We saw an 77-year-old former semiprofessional tennis player who had a stroke and hadn’t picked up a racket in years get his love for the sport back after playing tennis on the Wii,” Oddsson says. “A few months later, he was back on the court playing the real game.”

Because the Wii requires natural movements to play the games, people who may not be as familiar with using a joystick can pick up Wii games much faster than expected, Blondheim says. “It’s easy to set up. The games we use are pretty basic, and we require our therapists to have played the games to help instruct patients on ways to make the game work better for them.”

Another key asset of the Wii is that it’s relatively inexpensive when compared to high-technology rehab equipment, says Blondheim. “We’ve looked at similar virtual reality equipment designed specifically for therapy, and it costs upwards of $7,000.”

With the Wii costing about $250 for the system and $40-–$70 for games, it’s much easier for patients to buy their own system to use at home or for the facility to purchase multiple systems for clinic use or to lend to patients.

“We’re always looking for better ways to get patients to do their exercises at home, and we’ve found the Wii tends to work well as motivation,” Blondheim says.

One thing the Wii isn’t doing is taking the place of the more conventional therapy devices. “It’s just a part of our therapy and almost never something we do from the start,” he says. “Patients have to work their way up to being ready for it, and it serves as a motivational tool when they see other patients having fun in the office playing a game.”

Reaping the benefits

Another advantage of using the Wii for therapy is that it’s reimbursable under all payers, providing you use it correctly and conform to standard billing practices. You can bill under CPT codes for therapeutic exercise or neuromuscular education depending on your intent, says Blondheim, assuming the therapist is working one-on-one with the patient and providing therapeutic benefits that only a therapist can provide.

Other benefits of the Wii may soon be forthcoming as more research is conducted about its efficacy. Some of that research is being done by Oddsson and students at the University of Minnesota.

Oddsson, who heads a research team that searches for and develops progressive techniques in rehab and has looked at devices costing as much as $250,000, has already seen some of the benefits of the Wii firsthand, although he’s waiting to get outcome measure proof before saying it’s definitely the new wave of the future.

“We need some way of measuring how active the patients are when they use the Wii versus when they aren’t using the Wii,” says Oddsson. “But we have therapists using it as another tool in their rehab, and it’s been great for patients stuck in their rehab. Our evidence is anecdotal so far, but we’ve yet to see any real side effects, and everyone has liked it.”

There have been reports of overuse, but Oddsson says that’s the case with any activity if the patient does it too much. What Oddsson is really interested in is the work of some engineering students from the University of Minnesota who have designed a system to monitor patients’ activity during their therapy. The system can detect and measure motion. 

Although the study is still in its initial stages, something along these lines could go a long way in determining whether patients are better complying with their therapy from a video game or just more entertaining therapy.

However, it is clear from all circumstantial and anecdotal evidence that the Wii works at getting people active, says Oddsson. Stroke, brain injury, and amputee patients have all used the Wii in different settings across the country.

It’s also clear that this market may be endless, says Oddsson, because video game makers can manufacture this kind of technology for much less than PT equipment companies because of the sales volume. 

Already, Nintendo is looking to capitalize on the popularity of Wii rehabilitation, called “Wiihabilitation” by some, with the soon-to-be-released Wii Fit game that will allow patients to hula hoop, run, jump, and more through a different set of pressure sensors in conjunction with the original handheld motion detector controllers.

Games like this only add to the potential benefits of using the Wii as a rehab tool, Oddsson says. By the sounds of it, however, the Wii is already fairly well accepted. 

When Oddsson first went on television to discuss the research plans for the Wii, he began receiving calls from facilities all over the country wanting to help with the research by being testing facilities. 

“We need the scientific evidence before we can really recommend a more general use of the Wii for occupational and physical therapy,” Oddsson says.