Nintendo Wii Treatments in Pediatric Physical and Occupational Therapy

Megan Dillon, SPTUniversity of St. Augustine

Physical Therapy

• Down Syndrome (10-13yrs)• Balance:• “Each Wii game was practiced for 5 minutes

with 5 minutes rest in-between in the following order; foot ball heading game, the tight rope walk game, and finally the Penguin slide game. The program for the two groups was applied two times per week for 6 weeks.”1

Results:

• “the results revealed a high significant difference between the pre-intervention and the post- intervention mean values of balance for the study group (p=0.000). These results indicate that the VR-based therapy in the form of Wii-Fit for 6 weeks could improve balance ability of the children with Down syndrome who are ranging in age from 10 to 13 years.”1

Poor Motor Performance/Balance Problems

• 30 children ages 7-12 who scored below the 16th percentile

• Outcome Measures:– M-ABC-2, BOT-2

• Methods:– 30 min, 3x/wk for 6 weeks – Children were allowed to choose from 18 pre-selected

balance games. These games were specifically chosen to challenge both dynamic and static balance.

– Dynamic: ski-slalom, table tilt, snowboard slalom– Static: tilt city and rhythm

Poor Motor Performance/Balance Problems

• Results: • “A Wii-intervention which incorporates exercises on

timing, repetitive internal modeling, near limitless exercises, visual feedback and motivational reinforcement seems to improve the static and dynamic balance skills of children with poor balance control. The results suggest no transfer from the acquired balance skills to other related motor skills, like running from side to side or hopping over beam.”5

Occupational Therapy

• “Wii-habilitation of upper extremity function in children with Cerebral Palsy. An explorative study”

• Methods: – 15 children with CP, ages 6-15– Wii Sports 2x/wk: boxing - 15 min, tennis - 15 min. The

controller in their most-affected arm. – The Melbourne Assessment of Upper Limb Function and

ABILHAND-Kids, user satisfaction of both children and health professionals, enjoyment in gaming was scored on a visual analogue scale

• Results: – “The mean quality of upper arm movements

measured by the Melbourne Assessment was somewhat changed after the training, however not significant.”2

– “Two-handed daily activities measured by the ABILHAND-Kids were significantly more easily performed by the children according to their caregivers”2

Negatives of the Wii

• Studies have not shown improvements in gait speed or lower extremity strength from Wii treatments

• “Wii Fit balance activity scores had poor concurrent validity relative to COP (center-of-pressure) outcomes and SEBT reach distances. In addition, the included Wii Fit balance activity scores generally had poor intrasession and intersession reliability.”3

However…

• “Multiple studies now show improvement in balance control following reasonable periods of training with the Wii Fit games and custom designed applications.”4

Balance

• Wii Fit – Soccer ball heading game– Tight rope walk game– Penguin slide game.

Upper Extremity Function

• Wii Sports –Tennis–Boxing

Why use the Wii?

• It has a very low chance of injury • Low costs in the realm of virtual reality

treatments • Can be practiced at home • Found to be enjoyable by experimental

participants • Studies support its use to improve balance

and upper extremity function

Bottom Line

• Based on available research, the Wii can be used therapeutically

to improve balance.

Questions…

References1. Rahman S. Efficacy of virtual reality-based therapy on balance in children with Down Syndrome.

World Appl. Sci. J. 2010; 10(3): 254-261. Available from researchgate.net. Accessed on February 13, 2015.

2. Winkkels D, Kottink A, Temmink R, Nijlant J, Buurke J. Wii-habilitation of upper extremity function in children with Cerebral Palsy. An explorative study. Developmental Neurorehabilitation. February 2013; 16(1): 44-51. Available fromhttp://web.a.ebscohost.com.prx-usa.lirn.net/ehost/pdfviewer/pdfviewer?sid=4db51861-bce6-4360-9fa2-123ab6f41a3f%40sessionmgr4003&vid=1&hid=4112. Accessed on February 13, 2015.

3. Wikstrom E. Validity and reliability of Nintendo Wii Fit balance scores. J Athl Train. 2012; 47(3): 306-313. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392161/. Accessed on February 16, 2015.

4. Goble DJ, Cone BL, Fling BW. Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the first half decade of “Wii-search”. Journal of NeuroEngineering and Rehabilitation. 2014; 11:12. doi:10.1186/1743-0003-11-12. Available from http://www.jneuroengrehab.com/content/11/1/12. Accessed on February 17, 2015.

5. Mombarg R, Jelsma D, Hartman E. Effect of Wii-intervention on balance of children with poor motor performance. Res Dev Disabil. 2013; 34(9): 2996-3003. doi: 10.1016/j.ridd.2013.06.008