Nintendo Wii – New Rehabilitation Tool for Physical Therapy

The Nintendo Wii game system offers virtual reality scenarios in which gamers who have cerebral palsy use it as the centrepiece of their physical therapy.

Whoever thought that the Nintendo Wii could be used as a rehabilitation tool for children with cerebral palsy? Physical Therapy researchers made this discovery a few years ago and use of this virtual reality training system is being integrated in treatment clinics in Europe, North America, Australia and the UK. More recently, the system has become a focus for research being conducted by the Section of Physical Therapy at The University of the West Indies, Mona Campus.

The Nintendo Wii gaming system forms part of the world of virtual reality—a computer simulated environment which might be a replica of a real environment or an imaginary or fictitious world. Released in 2006, the gaming system was manufactured with the intent of making children more active. It operates by responding to body movements and comes with a hand-held wireless remote which can detect movement in three dimensions. This allows individuals to engage in games like boxing, golf, baseball, bowling and canoeing while viewing themselves on a screen. As the individual moves, the 'Mi' on the screen, which represents the player, also moves, so the player is in tune with the results of his/her performance and can modify strategies accordingly.

Research on the integration of this virtual reality device into rehabilitation therapy for children with cerebral palsy began at The UWI, Mona in 2009 when Dr. Sharmella Roopchand-Martin, lecturer in the Section of Physical Therapy, Department of Basic Medical Sciences, UWI, Mona, along with a team of researchers, conducted a pilot project on six children from the Sir John Golding Rehabilitation Centre. Diagnosed with cerebral palsy (a lifelong disability caused from brain damage due to loss of oxygen during the birthing process), these children, aged six to ten, attended one-hour training sessions, three days per week for six weeks, at the Physiotherapy Department of the Sir John Golding Rehabilitation Centre.

The children varied in their functional level, some able to walk with rollators (walkers with wheels), others wheelchair bound, and some able to hold the wireless remote, while others had to have the remote bandaged to their hands. They all participated in a variety of games including boxing, baseball, tennis, bowling and golf. According to Roopchand-Martin, “The intention was to get these children up and physically active. Children with cerebral palsy are dominated by spasticity, which causes the muscles to be slow and weak. There are also problems with strength and coordination. In the fun of the game, the children force themselves to do movements that they would not normally do as they focus on trying to win the game.

Prior to the start of training, the children’s gross motor skills were evaluated by two experienced paediatric therapists and the same therapists reassessed the children at the end of the six weeks. The evaluation showed that the children improved in all categories of motor functions—lying, rolling, sitting, crawling, kneeling, standing, walking, running and jumping, with the most significant changes observed in crawling and kneeling. This pointed to the potential of the Nintendo Wii as an excellent rehabilitation tool. “In comparison to what obtained at the start of training, significant improvement was seen in the gross motor functions of the six participants at the end of the project,” Roopchand- Martin said. However, she feels that more clinical trials and longer-term training are needed to further explore the efficacy of this device.

One of the advantages of using the Wii as a rehabilitation tool is that parents can purchase it and continue the training at home, reducing the cost of daily, private therapy, as well as the ‘hassle’ in public hospitals where staff complement is inadequate to provide effective treatment. “A major idea behind the research was for parents to implement the trials at home. When working with patients who have neurological disorders, the main focus is to teach the unused areas of the brain to take over the function that was previously done by the damaged area. This can only be accomplished through intense training,” Roopchand-Martin said. The initial burden is the cost of getting a Wii, but once parents can afford it all that is required is teaching the children how to use it and helping them to select appropriate games. “The Wii is a fun activity for the children. They are moving the arms and making the brain work to perfect the movements of the body. What we are trying to do is retrain movement and the only way to retrain movement is by doing movement. The gaming system is a fun way of accomplishing that,” she added.

Future Projects

Subsequent to her research on children with cerebral palsy, Roopchand-Martin continued to examine the use of the Nintendo Wii on other populations. In 2010, she initiated a second project using the boxing game on the Nintendo Wii to improve sitting balance in patients with paraplegia (those affected with spinal cord injuries). Currently, she is working on a project using the Wii as a form of aerobic exercise training to improve the cardiopulmonary function of persons with paraplegia, along with Dr. Carron Gordon, head of the Physical Therapy Section, and Gail Nelson, lecturer in Physical Therapy at Mona. Another of her current work involves comparing the oxygen consumption and exertion level when doing the free run activity on the Nintendo Wii with running on a treadmill from among a sample of healthy UWI students. In June the team of researchers will begin a new project which is being led by Nelson. This project will explore the effectiveness of a training programme using the Nintendo Wii on cardiovascular outcomes in patients who require cardiac rehabilitation.

In addition to trying to increase the available equipment for conducting research with the Nintendo Wii, the section of Physical Therapy has also acquired the X-Box Kinnect with an aim to explore rehabilitation applications for this gaming system. “My primary focus is trying to develop virtual reality research at UWI, as that is where I believe the future is,” said Roopchand- Martin.When their research started in 2009, there were only a few articles published in North America on the use of the Wii as a treatment for stroke patients. “But things have progressed, and what we are doing in terms of research here at UWI is in keeping with current rehabilitation research occurring on the international scene. There are a lot of articles out now on gaming systems,” she affirmed.

Another interest is combining robotics with virtual reality, an area of research which is being actively pursued in parts of Asia, Europe and North America. There, therapists integrate the robots and virtual reality into clinical treatment to achieve the kind of intensity of training required for patients with neurological disorders. “Today’s technology offers amazing possibilities for rehabilitation, and physical therapists, biomedical engineers, computer scientists and patients working together can change visions into reality to create a better future for persons with disabilities.” she said.