Wednesday, 22 December 2010

A standing location detector enabling people with developmental disabilities to control environmental stimulation through simple physical activities with Nintendo Wii Balance Boards.

Res Dev Disabil. 2010 Dec 13. [Epub ahead of print]

Shih CH.

Department of Special Education National Dong Hwa University, Taiwan

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This study evaluated whether two people with developmental disabilities would be able to actively perform simple physical activities by controlling their favorite environmental stimulation using Nintendo Wii Balance Boards with a newly developed standing location detection program (SLDP, i.e., a new software program turning a Nintendo Wii Balance Board into a standing location detector). This study was carried out using to an ABAB design. The data showed that both participants significantly increased their simple physical activity (target response) to activate the control system to produce environmental stimulation during the B (intervention) phases. The practical and developmental implications of the findings are discussed.

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Tuesday, 21 December 2010

Development of an interactive game-based rehabilitation tool for dynamic balance training.

Top Stroke Rehabilitation. 2010 Sep-Oct;17(5):345-52.

Lange B, Flynn S, Proffitt R, Chang CY, Rizzo AS.

Medical Virtual Reality Group, Institute for Creative Technologies, University of Southern California, Playa Vista, California.

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Conventional physical therapy techniques have been shown to improve balance, mobility, and gait following neurological injury. Treatment involves training patients to transfer weight onto the impaired limb to improve weight shift while standing and walking. Visual biofeedback and force plate systems are often used for treatment of balance and mobility disorders. Researchers have also been exploring the use of video game consoles such as the Nintendo Wii Fit as rehabilitation tools. Case studies have demonstrated that the use of video games may have promise for balance rehabilitation. However, initial usability studies and anecdotal evidence suggest that the current commercial games are not compatible with controlled, specific exercise required to meet therapy goals. Based on focus group data and observations with patients, a game has been developed to specifically target weight shift training using an open source game engine and the Nintendo Wii Fit Balance Board. The prototype underwent initial usability testing with a sample of clinicians and with persons with neurological injury. Overall, feedback was positive, and areas for improvement were identified. This preliminary research provides support for the development of a game that caters specifically to the key requirements of balance rehabilitation.

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Only lower limb controlled interactive computer gaming enables an effective increase in energy expenditure.

Now published: Link

Eur J Appl Physiol. 2010 Dec 17. [Epub ahead of print]

Jordan M, Donne B, Fletcher D.

Department of Physiology, Trinity College, Dublin 2, Ireland,

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Limited research documents if new and existing interactive computer gaming "exergaming" increase energy expenditure and cardio-respiratory costs comparable to common exercise modalities. To address this, healthy male volunteers (n = 15) completed six by 12-min test elements: PlayStation2 (PS2(hand)), Nintendo Wii boxing, walk at 5.6 km h(-1), cycle at 120 W, playing an adapted lower limb controlled PS2 (PS2(limb)) and run at 9.6 km h(-1). In addition, they played PS2(limb) for 30 min and performed an incremental treadmill test to exhaustion. Data were analysed using repeated measures ANOVA with post hoc Tukey tests, P < 0.05 inferred significance. PS2(limb) increased energy expenditure (EE) and post-exercise blood lactate (BLa) significantly higher (P < 0.001) than PS2(hand), Wii gaming or walking at 5.6 km h(-1) (EE: 30.3 ± 4.9 vs. 4.7 ± 1.1, 22.0 ± 6.1 and 17.9 ± 1.9 kJ h(-1) kg(-1); BLa: 2.4 ± 1.5 vs. 1.0 ± 0.3, 1.8 ± 0.8 and 0.9 ± 0.2 mmol L(-1)), playing the PS2(limb) raised mean EE over six times greater than PS2(hand). Mean fat and carbohydrate oxidation rates during the 9- to 12-min period playing the PS2(limb) were five and ten times greater than PS2(hand) (0.25 ± 0.10 vs. 0.05 ± 0.10, 1.69 ± 0.52 vs. 0.15 ± 0.14 g min(-1), respectively). PS2(limb) met ACSM guidelines for cardiovascular fitness; however, current Wii technology failed. In conclusion, gaming interactive technology must be adapted or designed to include the lower limbs in order to provide a significant exercise stimulus.

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Friday, 3 December 2010

Lessons learned: Staff perceptions of the Nintendo Wii as a health promotion tool within an aged-care and disability service.

Health promotion journal of Australia, 2010 Dec;21(3):189-95.

Higgins HC, Horton JK, Hodgkinson BC, Muggleton SB.

Blue Care, Milton, Queensland.

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Issue addressed: Enhancing opportunities for all older people to be physically and mentally active is an imperative in our ageing society. Lessons learned from the use of the Nintendo Wii within Queensland agedcare and disability services were assembled through eliciting staff perceptions regarding the usefulness of Wii technology within their centres.

Methods: Telephone interviews were conducted with direct care staff in 53 centres that had been using the Wii technology for at least three months. Content analysis of interview data identified the major response patterns raised by staff.

Results: Staff noted that Wii activities were easy to master for more able clients and that there was minimal risk to clients. Staff reported that these activities provided health promoting physical benefits (mobility, range of motion, dexterity, coordination, distraction from pain) and psychosocial gains (social engagement, self-esteem, mastery, ability to pacify challenging behaviours) and were a useful adjunct to other care practices within these aged-care and disabilities services.

Conclusions: Staff believed that Wii activities provided purposeful and meaningful opportunities to promote wellbeing for aged and disabled clients within an aged-care and disability service. However, Wii activities were less successful with clients who had significant cognitive and/or physical disabilities.

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Feasibility of congestive heart failure telemanagement using a wii-based telecare platform.

Engineering in Medicine and Biology Society (EMBC)
2010 Annual International Conference of the IEEE 2010;1:2211-4.

Finkelstein J, Wood J, Cha E, Orlov A, Dennison C.

Chronic Disease Informatics Program, Johns Hopkins University, USA.

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A gaming platform has been used to implement a Home Automated Telemanagement (HAT) system for chronic disease management in the patient's home. The system questions patients with congestive heart failure (CHF) to monitor symptoms, weight changes, and quality of life while educating the patient on their disease. The system is designed to run on the Nintendo Wii videogame console using an active internet connection and the console's built in internet browser. It questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3 zone CHF action plan. The system is designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. This telemanagement system has been successfully designed and implemented to optimize the care of patients with CHF.

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Assessing and training standing balance in older adults: A novel approach using the 'Nintendo Wii' Balance Board.

Gait Posture. 2010 Nov 17. [Epub ahead of print]

Young W, Ferguson S, Brault S, Craig C.

The School of Psychology, The Queen's University Belfast

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Older adults, deemed to be at a high risk of falling, are often unable to participate in dynamic exercises due to physical constraints and/or a fear of falling. Using the Nintendo 'Wii Balance Board' (WBB) (Nintendo, Kyoto, Japan), we have developed an interface that allows a user to accurately calculate a participant's centre of pressure (COP) and incorporate it into a virtual environment to create bespoke diagnostic or training programmes that exploit real-time visual feedback of current COP position. This platform allows researchers to design, control and validate tasks that both train and test balance function. This technology provides a safe, adaptable and low-cost balance training/testing solution for older adults, particularly those at high-risk of falling.

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Thursday, 18 November 2010

The physiological cost and enjoyment of Wii Fit in adolescents, young adults and older adults.

Journal of Physical Activity and Health. 2010 May;7(3):393-401.

Graves LE, Ridgers ND, Williams K, Stratton G, Atkinson G, Cable NT.

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BACKGROUND: Active video games (exergames) increase energy expenditure (EE) and physical activity (PA) compared with sedentary video gaming. The physiological cost and enjoyment of exergaming in adolescents, and young and older adults has not been documented, nor compared with aerobic exercise. This study compared the physiological cost and enjoyment of exergaming on Wii Fit with aerobic exercise in 3 populations.

METHODS: Cardiorespiratory and enjoyment measurements were compared in 14 adolescents, 15 young adults, and 13 older adults during handheld inactive video gaming, Wii Fit activities (yoga, muscle conditioning, balance, aerobics), and brisk treadmill walking and jogging.

RESULTS: For all groups EE and heart rate (HR) of Wii Fit activities were greater than handheld gaming (P < .001) but lower than treadmill exercise. Wii aerobics elicited moderate intensity activity in adolescents, young adults, and older adults with respective mean (SD) metabolic equivalents of 3.2 (0.7), 3.6 (0.8), and 3.2 (0.8). HR during Wii aerobics fell below the recommended intensity for maintaining cardiorespiratory fitness. Group enjoyment rating was greater for Wii balance and aerobics compared with treadmill walking and jogging. CONCLUSIONS: Wii Fit appears an enjoyable exergame for adolescents and adults, stimulating light-to-moderate intensity activity through the modification of typically sedentary leisure behavior. Click here for more

Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome.

Research in Developmental Disabilities. 2010 Nov 9. [Epub ahead of print]

Wuang YP, Chiang CS, Su CY, Wang CC.

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This quasi-experimental study compared the effect of standard occupational therapy (SOT) and virtual reality using Wii gaming technology (VRWii) on children with Down syndrome (DS). Children (n=105) were randomly assigned to intervention with either SOT or VRWii, while another 50 served as controls. All children were assessed with measures of sensorimotor functions. At post-intervention, the treatment groups significantly outperformed the control group on all measures. Participants in the VRWii group had a greater pre-post change on motor proficiency, visual-integrative abilities, and sensory integrative functioning. Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS. It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS.

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Friday, 29 October 2010

Energy expenditure in adults with cerebral palsy playing Wii Sports.

Hurkmans HL, van den Berg-Emons RJ, Stam HJ.

Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC–University Medical Center, Rotterdam, The Netherlands

Arch Phys Med Rehabil. 2010 Oct;91(10):1577-81.

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OBJECTIVE: To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing.

DESIGN: Cross-sectional study.

SETTING: University medical center.

PARTICIPANTS: Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers.

INTERVENTION: Participants played Wii Sports tennis and boxing, each for 15 minutes in random order.

MAIN OUTCOME MEASURE: By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting.

RESULTS: Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing.

CONCLUSIONS: Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels.

More info on PubMed

Thursday, 30 September 2010

EXercising with Computers in Later Life (EXCELL) - pilot and feasibility study of the acceptability of the Nintendo® WiiFit in community fallers

BMC Research Notes 2010, 3:238

Marie A Williams , Roy L Soiza , Alison McE Jenkinson and Alison Stewart

Published: 13 September 2010

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Falls management programmes have been instituted to attempt to reduce falls. This pilot study was undertaken to determine whether the Nintendo® WiiFit was a feasible and acceptable intervention in community-dwelling older fallers.

Community-dwelling fallers over 70 years were recruited and attended for computer-based exercises (n = 15) or standard care (n = 6). Balance and fear of falling were assessed at weeks 0, 4 and 12. Participants were interviewed on completion of the study to determine whether the intervention was acceptable.

Eighty percent of participants attended 75% or more of the exercise sessions. An improvement in Berg Score was seen at four weeks (p = 0.02) and in Wii Age at 12 weeks (p = 0.03) in the intervention group. There was no improvement in balance scores in the standard care group.

WiiFit exercise is acceptable in self-referred older people with a history of falls. The WiiFit has the potential to improve balance but further work is required.

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Monday, 27 September 2010

Exergaming Evidence Base

Wiki webpage of exergaming research.

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Friday, 24 September 2010

Exploring children's movement characteristics during virtual reality video game play.

Hum Mov Sci. 2010 Aug 17.

Levac D, Pierrynowski MR, Canestraro M, Gurr L, Leonard L, Neeley C.

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There is increasing interest in the use of commercially-available virtual reality video gaming systems within pediatric rehabilitation, yet little is known about the movement characteristics of game play. This study describes quantity and quality of movement during Nintendo Wii and Wii Fit game play, explores differences in these movement characteristics between games and between novice and experienced players, and investigates whether motivation to succeed at the game impacts movement characteristics. Thirty-eight children (aged 7-12) with and without previous game experience played Wii (boxing and tennis) and Wii Fit (ski slalom and soccer heading) games. Force plate data provided center of pressure displacement (quantity) and processed pelvis motion indicated smoothness of pelvic movement (quality). Children rated their motivation to succeed at each game. Movement quantity and quality differed between games (p<.001). Children with previous experience playing Wii Fit games demonstrated greater movement quantity during Wii Fit game play (p<.001); quality of movement did not differ between groups. Motivation to succeed did not influence the relationship between experience and outcomes. Findings enhance clinical understanding of this technology and inform the development of research questions to explore its potential to improve movement skills in children with motor impairments. Link to Pubmed

A "Wii" bit of fun: The effects of adding Nintendo Wii Bowling to a standard exercise regimen for residents of long term care.

Physiother Theory Pract. 2010 Aug 10.

Hsu JK, Thibodeau R, Wong SJ, Zukiwsky D, Cecile S, Walton DM.

Physiotherapist, Merivale Professional Physiotherapy Centre, Ottawa, Ontario, Canada.

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The aims of this randomized, single-blind crossover trial were to investigate the effect of adding a simulated bowling video game via the Nintendo Wii((R)) gaming system to the standard exercise regimen of cognitively intact residents of long-term care (LTC) with upper extremity dysfunction and to identify individual characteristics that might predict improvement. Residents (n=34) were recruited through two LTC facilities in southwestern Ontario and were randomized into a standard exercise (SG) or standard exercise plus Wii bowling (Wii) arm. After 4 weeks of intervention, the groups were crossed over to the opposite arm. Outcomes included measures of pain intensity and bothersomeness, physical activity enjoyment, and a six-item measure of functional capacity designed specifically for residents of LTC. Results suggest that subjects improved on all outcomes from pre- to postintervention but that only enjoyment of activity showed a significant difference between the SG and Wii groups. Effect sizes (Cohen's d) ranged from small (0.30 for bothersomeness) to large (1.77 for functional capacity). Responders, defined as those subjects who reported any degree of improvement following the Wii intervention, were less likely to complain of stiffness or shoulder symptoms and were more likely to complain of hand symptoms than non-responders. Limitations in interpretation and recommendations for future research are presented.

Link to website

Energy expended by boys playing active video games.

J Sci Med Sport. 2010 Aug 30.

White K, Schofield G, Kilding AE.

Centre for Physical Activity and Nutrition Research, AUT University, Auckland, New Zealand.

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The purpose of this study was to: (1) determine energy expenditure (EE) during a range of active video games (AVGs) and (2) determine whether EE during AVGs is influenced by gaming experience or fitness. Twenty-six boys (11.4+/-0.8 years) participated and performed a range of sedentary activities (resting, watching television and sedentary gaming), playing AVGs (Nintendo((R)) Wii Bowling, Boxing, Tennis, and Wii Fit Skiing and Step), walking and running including a maximal fitness test. During all activities, oxygen uptake, heart rate and EE were determined. The AVGs resulted in a significantly higher EE compared to rest (63-190%, p/=0.001) and sedentary screen-time activities (56-184%, p/=0.001). No significant differences in EE were found between the most active video games and walking. There was no evidence to suggest that gaming experience or aerobic fitness influenced EE when playing AVGs. In conclusion, boys expended more energy during active gaming compared to sedentary activities. Whilst EE during AVG is game-specific, AVGs are not intense enough to contribute towards the 60min of daily moderate-to-vigorous physical activity that is currently recommended for children.

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EXercising with Computers in Later Life (EXCELL) - pilot and feasibility study of the acceptability of the Nintendo WiiFit in community.

BMC Res Notes. 2010 Sep 13;3(1):238.

Williams MA, Soiza RL, Jenkinson AM, Stewart A.

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BACKGROUND: Falls management programmes have been instituted to attempt to reduce falls. This pilot study was undertaken to determine whether the Nintendo(R)WiiFit was a feasible and acceptable intervention in community-dwelling older fallers.

FINDINGS: Community-dwelling fallers over 70 years were recruited and attended for computer-based exercises (n=15) or standard care (n=6). Balance and fear of falling were assessed at weeks 0, 4 and 12. Participants were interviewed on completion of the study to determine whether the intervention was acceptable. Eighty percent of participants attended 75% or more of the exercise sessions. An improvement in Berg Score was seen at four weeks (p = 0.02) and in Wii Age at 12 weeks (p = 0.03) in the intervention group. There was no improvement in balance scores in the standard care group.

CONCLUSION: WiiFit exercise is acceptable in self-referred older people with a history of falls. The WiiFit has the potential to improve balance but further work is required. Trial Registration - NCT01082042.

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Thursday, 12 August 2010

The effects of Nintendo Wii exercise training in adults with cystic fibrosis

The effects of Nintendo Wii exercise training in adults with cystic fibrosis
Author : Hall, K. Peasey, M. Wood, M. Cobb, R. Bell, S. C. Kuys, S.
2010, VOL 9; SUPP/1, pages S71

Thursday, 5 August 2010

The Utility of a Video Game System in Rehabilitation of Burn and Nonburn Patients: A Survey Among Occupational Therapy and Physiotherapy Practitioners

Fung V, So K, Park E, Ho A, Shaffer J, Chan E, Gomez M.

From the St John's Rehab Hospital, Toronto, Ontario, Canada.

J Burn Care Res. 2010 Jul 12.

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The objective of this study was to investigate perceptions of occupational therapists and physiotherapists on the use of Nintendo Wii in rehabilitation. Occupational therapists and physiotherapists in a rehabilitation hospital trialed four Wii games that addressed physical movement, balance, coordination, and cognitive performance. Then, they completed an opinion survey on the utility of Wii in rehabilitation. The results were compared between burn care therapists (BTs) and nonburn care therapists, using chi with a P < .05 considered significant. The participation rate was 79% (63/80), and they agreed that Wii was easy to set up (71%), operate (68%), and safe to use (76%). Participants agreed that Wii would be beneficial in outpatient (76%) and inpatient (65%) settings and that it could improve treatment compliance (73%). Participants recommended 15 to 30-minute Wii intervention (59%) daily (81%) and twice per week (43%). Participants believed that neurologic (71%), trauma (68%), burn (59%), and musculoskeletal (49%) patients would benefit from Wii intervention but not cardiac (43%) or organ transplant patients (18%). Participants believed that outcomes using Wii could be measured reliably (49%), and skills learned while playing could be transferable to daily function (60%). The significant differences between BTs and nonburn care therapists' perceptions are that BT-treated younger patients (21-40 years vs >60 years, P < .05) and BT favored the therapeutic benefit of Wii in rehabilitation (93% vs 58%, P = .02), specifically in burn rehabilitation (85% vs 39%, P = .001). Occupational therapists and physiotherapists favored the use of Wii in rehabilitation as an adjunct to traditional therapy because it is therapeutic, engaging, and may increase patient participation in rehabilitation. More

Brain activity in goal-directed movements in a real compared to a virtual environment using the Nintendo Wii.

Baumeister J, Reinecke K, Cordes M, Lerch C, Weiss M.

Exercise & Brain Lab, Institute of Sports Medicine, Department of Exercise & Health, University of Paderborn, Warburger Str. 100, 33098 Paderborn, Germany.

Neurosci Lett. 2010 Aug 30;481(1):47-50. Epub 2010 Jun 25.

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Low budget virtual environments like the Nintendo Wii increased in popularity and may play a role in motor learning related to sports and exercise. But nothing was known about the comparability of cortical activity of motor tasks in real and virtual environments. The aim of the study was to examine cortical differences between real and Wii based virtual sports performances using the golf putt as a model. Ten male golfers (26.0 +/- 0.7 years; 81.8 +/- 5.6 kg; 184.5 +/- 6.0 cm; handicap 30.0+/-10.0; 2.9+/-1.0 years of golf experience) were asked to putt for 3 min in random order in the real and the virtual Wii condition. A rest in sitting position (3 min) followed each performance. The score and cortical activity (EEG) were recorded continuously. The participants performed with a significant better score in the real condition (p < or = 0.01). Compared to virtual putting Theta spectral power showed a significant increase during real performance at F3 and F4 (p < or = 0.05). Significantly increased Alpha-2 power was demonstrated during real putting compared to the virtual putting performance at P3 (p < or = 0.05). The findings suggested that putting performance and brain activity was influenced by the choice of a real or virtual environment. The results were discussed based on the concept of the working memory where increased frontal Theta power indicated higher focused attention and higher Alpha-2 power was inversely related to the quantity of sensory information processing in the real putting compared to the virtual condition. 2010 Elsevier Ireland Ltd. All rights reserved. More

Lean on Wii: physical rehabilitation with virtual reality Wii peripherals.

Stud Health Technol Inform. 2010;154:229-34.

Anderson F, Annett M, Bischof WF.

Department of Computing Science, University of Alberta, Edmonton, Canada.

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In recent years, a growing number of occupational therapists have integrated video game technologies, such as the Nintendo Wii, into rehabilitation programs. 'Wiihabilitation', or the use of the Wii in rehabilitation, has been successful in increasing patients' motivation and encouraging full body movement. The non-rehabilitative focus of Wii applications, however, presents a number of problems: games are too difficult for patients, they mainly target upper-body gross motor functions, and they lack support for task customization, grading, and quantitative measurements. To overcome these problems, we have designed a low-cost, virtual-reality based system. Our system, Virtual Wiihab, records performance and behavioral measurements, allows for activity customization, and uses auditory, visual, and haptic elements to provide extrinsic feedback and motivation to patients.


Nintendo Wii video-gaming ability predicts laparoscopic skill

Badurdeen S, Abdul-Samad O, Story G, Wilson C, Down S, Harris A.

University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Box 111, Hills Road, Cambridge CB2 2SP, UK.

Surg Endosc. 2010 Aug;24(8):1824-8. Epub 2010 Jan 28.

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BACKGROUND: Studies using conventional consoles have suggested a possible link between video-gaming and laparoscopic skill. The authors hypothesized that the Nintendo Wii, with its motion-sensing interface, would provide a better model for laparoscopic tasks. This study investigated the relationship between Nintendo Wii skill, prior gaming experience, and laparoscopic skill.

METHODS: In this study, 20 participants who had minimal experience with either laparoscopic surgery or Nintendo Wii performed three tasks on a Webcam-based laparoscopic simulator and were assessed on three games on the Wii. The participants completed a questionnaire assessing prior gaming experience.

RESULTS: The score for each of the three Wii games correlated positively with the laparoscopic score (r = 0.78, 0.63, 0.77; P < 0.001), as did the combined Wii score (r = 0.82; P < 0.001). The participants in the top tertile of Wii performance scored 60.3% higher on the laparoscopic tasks than those in the bottom tertile (P < 0.01). Partial correlation analysis with control for the effect of prior gaming experience showed a significant positive correlation between the Wii score and the laparoscopic score (r = 0.713; P < 0.001). Prior gaming experience also correlated positively with the laparoscopic score (r = 0.578; P < 0.01), but no significant difference in the laparoscopic score was observed when the participants in the top tertile of experience were compared with those in the bottom tertile (P = 0.26). CONCLUSIONS: The study findings suggest a skill overlap between the Nintendo Wii and basic laparoscopic tasks. Surgical candidates with advanced Nintendo Wii ability may possess higher baseline laparoscopic ability. More

Wednesday, 4 August 2010

Neuropsychological Testing Through a Nintendo Wii® Console

Gamberini L, Cardullo S, Seraglia B, Bordin A.

University of Padova, Department of General Psychology, Padova, Italy.

Stud Health Technol Inform. 2010;154:29-3

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In recent years, videogames have demonstrated their positive effects in the psychological treatments and cognitive training of the old population. In this paper we present a pilot study in which a group of elderly people in an old people's home was requested to play a set of cognitive tasks administered through a popular videogames console, the Nintendo Wii. The results obtained by comparing the Wii cognitive games with traditional paper and pencil tests are described and discussed to orient further improvements.


Thursday, 22 July 2010

Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. (2008)


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BACKGROUND AND PURPOSE: The purpose of this retrospective and prospective case report is to describe the feasibility and outcomes of using a low-cost, commercially available gaming system (Wii) to augment the rehabilitation of an adolescent with cerebral palsy.
PATIENT AND SETTING: The patient was an adolescent with spastic diplegic cerebral palsy classified as GMFCS level III who was treated during a summer session in a school-based setting.
INTERVENTION: The patient participated in 11 training sessions, 2 of which included other players. Sessions were between 60 and 90 minutes in duration. Training was performed using the Wii sports games software, including boxing, tennis, bowling, and golf. He trained in both standing and sitting positions.
OUTCOMES: Three main outcome measures were used: (1) visual-perceptual processing, using a motor-free perceptual test (Test of Visual Perceptual Skills, third edition); (2) postural control, using weight distribution and sway measures; and (3) functional mobility, using gait distance. Improvements in visual-perceptual processing, postural control, and functional mobility were measured after training.
DISCUSSION AND CONCLUSION: The feasibility of using the system in the school-based setting during the summer session was supported. For this patient whose rehabilitation was augmented with the Wii, there were positive outcomes at the impairment and functional levels. Multiple hypotheses were proposed for the findings that may be the springboard for additional research. To the authors' knowledge, this is the first published report on using this particular low-cost, commercially available gaming technology for rehabilitation of a person with cerebral palsy.

Assisting people with multiple disabilities actively correct abnormal standing posture with a Nintendo Wii balance board through controlling environmental stimulation. (2010)

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Res Dev Disabil. 2010 Jul-Aug;31(4):936-42. Epub 2010 Apr 9.

Shih CH, Shih CT, Chu CL.


The latest researches adopted software technology turning the Nintendo Wii Balance Board into a high performance change of standing posture (CSP) detector, and assessed whether two persons with multiple disabilities would be able to control environmental stimulation using body swing (changing standing posture). This study extends Wii Balance Board functionality for standing posture correction (i.e., actively adjust abnormal standing posture) to assessed whether two persons with multiple disabilities would be able to actively correct their standing posture by controlling their favourite stimulation on/off using a Wii Balance Board with a newly developed standing posture correcting program (SPCP). The study was performed according to an ABAB design, in which A represented baseline and B represented intervention phases. Data showed that both participants significantly increased time duration of maintaining correct standing posture (TDMCSP) to activate the control system to produce environmental stimulation during the intervention phases. Practical and developmental implications of the findings were discussed.

Exergaming: virtual inspiration, real perspiration (2009)


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Young Consumers: Insight and Ideas for Responsible Marketers Volume 10, Number 1, 2009 , pp. 35-45(11)

Klein, Matthew J.; Simmers, Christina S.

Purpose - The USA is facing an obesity crisis so large that for the first time in history, this generation of children may have a life span that does not exceed that of its parents. Simultaneously, the gaming industry has introduced a form of video gaming (e.g. Nintendo Wii) that requires the participant to be physically involved in the game. For example, a live player will have a tennis racquet that he/she swings to compete with a virtual opponent on screen. This form of entertainment has been termed "exergaming." People are buying these games for the purpose of entertainment. However, this paper aims to propose that there are possible unanticipated physical benefits of this new gaming technology.
Design/methodology/approach - A survey method is used to examine attitudes about exercise, video gaming and exergaming. Findings - Results indicate a positive attitude toward exergaming, particularly with the more self-identified sedentary respondents. Research limitations/implications - This topic would benefit from a longitudinal study examining the adoption rate of this technology by previously inactive individuals and how its use translates into increased physical activity both with the video game system and other outside fitness activities.
Practical implications - The findings support exergaming as one way to get children to exercise.
Originality/value - The exercise potential of new gaming technology, i.e. "exergaming" is researched.

Wednesday, 21 July 2010

Nintendo Wii Fit Board used like a tool in biomechanical studies? (2009)


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Computer Methods in Biomechanics and Biomedical Engineering Volume 12, Supplement 1, August 2009 , pp. 125-125(1)

Geronimi, M.; Pouydebat, E.; Gorce, P.

There is no abstract for this article.

Avatars mirroring the actual self versus projecting the ideal self: the effects of self-priming on interactivity and immersion in an exergame, Wii Fit. (2009)

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Cyberpsychol Behav. . 2009 Dec;12(6):761-5.

Jin SA.

As exergames are increasingly being used as an interventional tool to fight the obesity epidemic in clinical studies, society is absorbing their impact to a more intense degree. Interactivity and immersion are key factors that attract exergame consumers. This research asks, What are the effects of priming the actual self versus the ideal self on users' perceived interactivity and immersion in avatar-based exergame playing? and What are important moderators that play a role in exergame users' self-concept perception? To answer these research questions, this study leveraged the Wii's avatar-creating function (Mii Channel) and exergame feature (Wii Fit) in a controlled, randomized experimental design (N = 126). The results of a 2 x 2 factorial design experiment demonstrated the significant main effect of self-priming on interactivity and the moderating role of the actual-ideal self-concept discrepancy in influencing immersion during exergame playing. Game players who created an avatar reflecting the ideal self reported greater perceived interactivity than those who created a replica avatar mirroring the actual self. A two-way ANOVA demonstrated the moderating role of the actual-ideal self-concept discrepancy in determining the effects of the primed regulatory focus on immersion in the exergame play. The underlying theoretical mechanism is derived from and explained by Higgins's self-concept discrepancy perspective. Practical implications for game developers and managerial implications for the exergame industry are discussed.

Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance (2010)

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Gait & Posture, Volume 31, Issue 3, March 2010, Pages 307-310

Ross A. Clarka, Adam L. Bryanta, Yonghao Puab, Paul McCrorya, Kim Bennella and Michael Hunta


Impaired standing balance has a detrimental effect on a person's functional ability and increases their risk of falling. There is currently no validated system which can precisely quantify center of pressure (COP), an important component of standing balance, while being inexpensive, portable and widely available. The Wii Balance Board (WBB) fits these criteria, and we examined its validity in comparison with the ‘gold standard’—a laboratory-grade force platform (FP). Thirty subjects without lower limb pathology performed a combination of single and double leg standing balance tests with eyes open or closed on two separate occasions. Data from the WBB were acquired using a laptop computer. The test–retest reliability for COP path length for each of the testing devices, including a comparison of the WBB and FP data, was examined using intraclass correlation coefficients (ICC), Bland–Altman plots (BAP) and minimum detectable change (MDC). Both devices exhibited good to excellent COP path length test–retest reliability within-device (ICC = 0.66–0.94) and between-device (ICC = 0.77–0.89) on all testing protocols. Examination of the BAP revealed no relationship between the difference and the mean in any test, however the MDC values for the WBB did exceed those of the FP in three of the four tests. These findings suggest that the WBB is a valid tool for assessing standing balance. Given that the WBB is portable, widely available and a fraction of the cost of a FP, it could provide the average clinician with a standing balance assessment tool suitable for the clinical setting.

Keywords: Balance; Motor control; Movement disorder; Rehabilitation; Force plate; Biomechanics; Gait; Posture

A new standing posture detector to enable people with multiple disabilities to control environmental stimulation by changing their standing posture through a commercial Wii Balance Board (2010)


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Research in Developmental Disabilities Volume 31, Issue 1, January-February 2010, Pages 281-286

Ching-Hsiang Shiha, Ching-Tien Shihb and Ming-Shan Chianga


This study assessed whether two persons with multiple disabilities would be able to control environmental stimulation using body swing (changing standing posture) and a Wii Balance Board with a newly developed standing posture detection program (i.e. a new software program turns a WiiBalance Board into a precise standing posture detector). The study was performed according to an ABAB design, in which A represented baseline and B represented intervention phases. Both participants significantly increased their target response (body swing) to activate the control system to produce environmental stimulation during the intervention phases. Practical and developmental implications of the findings were discussed.

Keywords: Standing posture detector; Wii Balance Board; Multiple disabilities

Motivation and Physiologic Responses of Playing a Physically Interactive Video Game Relative to a Sedentary Alternative in Children

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Penko AL, Barkley JE.

The School of Exercise Leisure and Sport, Kent State University, Kent, OH, 44240, USA,


Background While there is emerging research outlining the physiologic cost of the physically interactive Nintendo Wii, there are no evaluations of the relative reinforcing value (RRV) of the Wii versus a sedentary alternative.

Purpose The purpose of this study is to evaluate the physiologic cost, RRV, and liking of playing Wii Sports Boxing (Wii) versus a traditional sedentary video game (SVG) in 11 lean and 13 overweight/obese 8- to 12-year-old children.

Methods Heart rate (HR) and VO2 were assessed during rest, treadmill walking, and playing an SVG and Wii using a counterbalance design. Liking was assessed during treadmill walking and video game play. RRV was assessed for Wii versus SVG.

Results Average HR, VO2, and liking were significantly greater for Nintendo Wii (p ≤ 0.001 for all) than all other conditions. Lean children displayed a greater (p < 0.001) peak responding for access to Wii relative to the SVG while overweight/obese children did not (p ≥ 0.16). Conclusion Wii was a well-liked activity of greater physiologic intensity than both the SVG and treadmill walking. Lean children were more motivated while overweight/obese children were equally as motivated to play Wii relative to the SVG. Keywords Exertainment - Nintendo Wii - Reinforcing value - Liking - Hedonics

Effectiveness of Virtual Reality Exercises in Stroke Rehabilitation (EVREST) (2010)

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Int J Stroke. 2010 Feb;5(1):47-51.

Saposnik G, Mamdani M, Bayley M, Thorpe KE, Hall J, Cohen LG, Teasell R; EVREST Steering Committee; EVREST Study Group for the Stroke Outcome Research Canada Working Group.


Evidence suggests that increasing intensity of rehabilitation results in better motor recovery. Limited evidence is available on the effectiveness of an interactive virtual reality gaming system for stroke rehabilitation. EVREST was designed to evaluate feasibility, safety and efficacy of using the Nintendo Wii gaming virtual reality (VRWii) technology to improve arm recovery in stroke patients.
Pilot randomized study comparing, VRWii versus recreational therapy (RT) in patients receiving standard rehabilitation within six months of stroke with a motor deficit of > or =3 on the Chedoke-McMaster Scale (arm). In this study we expect to randomize 20 patients. All participants (age 18-85) will receive customary rehabilitative treatment consistent of a standardized protocol (eight sessions, 60 min each, over a two-week period).
The primary feasibility outcome is the total time receiving the intervention. The primary safety outcome is the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, will be measured by the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at the four-week follow-up visit. From November, 2008 to September, 2009 21 patients were randomized to VRWii or RT. Mean age, 61 (range 41-83) years. Mean time from stroke onset 25 (range 10-56) days.
EVREST is the first randomized parallel controlled trial assessing the feasibility, safety, and efficacy of virtual reality using Wii gaming technology in stroke rehabilitation. The results of this study will serve as the basis for a larger multicentre trial.

The effects of Nintendo Wii on physical health

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The Wii and Occupational Therapy (2009)

OT Practice Magazine
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"The Wii and Occupational Therapy" by Nathan B. Herz
OT Practice, April 20, 2009; pgs 19 - 25
Published by The American Occupational Therapy Association


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A Game A Day Keeps the Doctor Away: A Short Review of Computer Games in Mental Healthcare
by: Luciano Gamberini, Giacinto Barres, Alice Majer, and Fabiola Scarpetta
Journal of CyberTherapy & Rehabilitation,
Summer 2008, Volume 1, Issue 2 pages 127 – 145

Wiihabilitation: Rehabilitation of Wrist Flexion and Extension Using a Wiimote-Based Game System (2009)

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Wiihabilitation: Rehabilitation of Wrist Flexion and Extension Using a Wiimote-based game system.
by: Jilyan Decker, Harmony Li, Dan Losowyj, and Vivek Prakash
Rutgers University, GSET 2009

Potential of Wii-Rehabilitation for Persons Recovering From Acute Stroke (2009)

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The Potential of Wii-Rehabilitation for Persons Recovering From Acute Stroke by: Sinead Brosnan, OTR/L
Published in Special Interest Section Quarterly: Physical Disabilities
Vol 32, No 1, March 2009
Published by The American Occupational Therapy Association, Inc

Playing Active Video Games Increases Energy Expenditure in Children (2009)

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Authors: Graf DL, Pratt LV, Hester CN, Short KR. Department of Pediatrics. Source: Pediatrics. 2009 Jul 13.

Objective: To compare energy expenditure rates in children playing the physically active video games, Dance Dance Revolution (DDR) and Nintendo's Wii Sports in relation to treadmill walking.
Methods: Energy expenditure, heart rate, step rate, and perceived exertion were measured in 14 boys and 9 girls (ages 10-13 years; BMI at 3-98th percentile for age and gender) while watching television at rest, playing DDR at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/h. Arterial elasticity was measured at rest and immediately after gaming.
Results: Compared with watching television, energy expenditure while gaming or walking increased 2- to 3-fold. Similarly, high rates of energy expenditure, heart rate, and perceived exertion were elicited from playing Wii boxing, DDR level 2, or walking at 5.7 km/h. This occurred despite variations in step rate among activities, reflecting greater use of upper body during Wii play (lowest step rate) than during walking (highest step rate) or DDR play. Wii bowling and beginner level DDR elicited a 2-fold increase in energy expenditure compared to television watching. Large-artery elasticity declined immediately after both DDR and Wii. The change was inversely related to the increment in energy expenditure above rest achieved during the activity.
Conclusions: Energy expenditure during active video game play is comparable to moderate-intensity walking. Thus, for children who spend considerable time playing electronic screen games for entertainment, physically active games seem to be a safe, fun, and valuable means of promoting energy expenditure.


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Mark ET Willems, Timothy S Bond
Faculty of Sport, Education & Social Sciences, University of Chichester, College Lane, Chichester,

Introduction: Regular moderate-intensity exercise, such as brisk walking, provides health benefits. We compared the
energy expenditure during brisk treadmill walking and playing new generation active computer games (i.e. Nintendo Wii
Sports tennis, baseball and boxing).
Methods: Ten participants (mean±SD, 21±1 years; 73.9±12.0 kg; 1.76±0.06 m) walked at a brisk pace on a treadmill
(3x10 min, 5 min rest periods) or played tennis, baseball and boxing (Wii sports) in similar time sequence. Energy expenditure
was measured with the portable Cosmed K4b2 indirect calorimetry system and expressed in metabolic equivalents
(METs). A within-subjects crossover design was used with repeated measures two-way ANOVA and post-hoc paired samples
t-test for analysis.
Results: METs during brisk treadmill walking (5.7±1.2 range: 4.4 - 8.5) were significantly higher (P<0.05) than during Wii Sports boxing (4.7±1.4, range: 2.7-6.8), tennis (3.1±1.2, range: 2.0-4.0) and baseball (2.8±0.7, range: 1.6-3.8). The MET values of boxing were higher than for tennis and baseball (P<0.05). Conclusions: Guidelines for physical activity required to get health benefits could be met by young adults playing Wii Sports but are activity-specific. Playing a combination of Wii Sports tennis, baseball, and boxing may not necessarily be a substitute for a moderate-intensity exercise session as part of a programme to promote and maintain health. Key words: indirect calorimetry, public health, boxing, brisk walking, video games


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Samuel Benveniste, Pierre Jouvelot, Renaud Michel

We present a first, proofofconcept
experiment of the MAWii music therapy system, which uses Wiimotes as virtual
instruments. This experiment involves four groups of children suffering from behavioral disorders and currently treated
in a day hospital in Paris. Preliminary analysis shows that the system is robust, that patients were strongly motivated by it
and that their behaviors and verbal expressions had rich psychodynamic content. Future work will entail further
experimentation to explore new venues for game technology in music therapy, to assess the therapeutic value of our
approach and to automatically extract pertinent data from therapy session recordings.

Group music therapy, behavioral disorders, serious games, Wiimote, motivation

Activity-Promoting Video Games and Increased Energy Expenditure (2009)

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Objectives To test the hypothesis that both children and adults would expend more calories and move more while playing activity-promoting video games compared with sedentary video games.
Study design In this single-group study, 22 healthy children (12 ± 2 years; 11 male, 11 female) and 20 adults (34 ± 11 years; 10 male, 10 female) were recruited. Energy expenditure and physical activity were measured while participants were resting, standing, watching television seated, sitting and playing a traditional sedentary video game, and while playing an activity-promoting video game (Nintendo Wii Boxing). Physical activity was measured with accelerometers, and energy expenditure was measured with an indirect calorimeter.
Results Energy expenditure was significantly greater than all other activities when children or adults played Nintendo Wii (mean increase over resting, 189 ± 63 kcal/hr,P < .001, and 148 ± 71 kcal/hr, P < .001, respectively). When examining movement with accelerometry, children moved significantly more than adults (55 ± 5 arbitrary acceleration units and 23 ± 2 arbitrary acceleration units, respectively, P < .001) while playing Nintendo Wii. Conclusion Activity-promoting video games have the potential to increase movement and energy expenditure in children and adults.

Exergaming: virtual inspiration, real perspiration (2009)

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Authors: Klein, Matthew J.; Simmers, Christina S. Source: Young Consumers: Insight and Ideas for Responsible Marketers, Volume 10, Number 1, 2009 , pp. 35-45(11) Publisher: Emerald Group Publishing Limited

Purpose - The USA is facing an obesity crisis so large that for the first time in history, this generation of children may have a life span that does not exceed that of its parents. Simultaneously, the gaming industry has introduced a form of video gaming (e.g. Nintendo Wii) that requires the participant to be physically involved in the game. For example, a live player will have a tennis racquet that he/she swings to compete with a virtual opponent on screen. This form of entertainment has been termed "exergaming." People are buying these games for the purpose of entertainment. However, this paper aims to propose that there are possible unanticipated physical benefits of this new gaming technology.
Design/methodology/approach - A survey method is used to examine attitudes about exercise, video gaming and exergaming. Findings - Results indicate a positive attitude toward exergaming, particularly with the more self-identified sedentary respondents.
Research limitations/implications - This topic would benefit from a longitudinal study examining the adoption rate of this technology by previously inactive individuals and how its use translates into increased physical activity both with the video game system and other outside fitness activities.
Practical implications - The findings support exergaming as one way to get children to exercise.
Originality/value - The exercise potential of new gaming technology, i.e. "exergaming" is researched.

Monitoring 3D movements for the rehabilitation of joints in physiotherapy (2008)

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Authors: Martin-Moreno J, Ruiz-Fernandez D, Soriano-Paya A, Jesus Berenguer-Miralles V.
Department of Computer Technology, University of Alicante, SPAIN. Source: Conf Proc IEEE Eng Med Biol Soc

This article tackles several problems faced by professionals in physiotherapy: the performance of the rehabilitation exercises by the patients, the control of the course of the illness and the patient's ignorance about whether or not he is properly performing the exercises. We propose a solution based on the use of the Wii Controller to control the exercise movements, along with software that provides the patient with an easy, intuitive and interactive control system. Finally, web services are used to allow the remote monitoring of the treatment by physiotherapy professionals.

Comparison of the effect of Cyriax cross friction massage and a Nintendo Wii-exercise program for the treatment of pain in chronic lateral epicondylit

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Aviv Hidrian and Indah Weyler
Professional Assignment Project (2008)

Objective: The aim of this pilot study is to compare the effectiveness of a supervised exercise program using the Nintendo Wii tennis game, to Cyriax cross friction massage in the treatment of lateral epicondylitis.
Methods: 10 subjects participated in the study (5 males, 5 females; mean age 50.4 (SD 3.5). Six subjects followed the Wii exercise program and four subjects received cross-friction massage according to the Cyriax method. Subjects in the Wii exercise group (Wii) received 25 min. and the Cross friction massage group (CF) received eight min. of treatment. Both groups were treated twice a week during six weeks. Using the Visual Analogue Scale (VAS), pain levels were assessed at baseline and after completion of the program at six weeks. Outcomes were analyzed using the independent, dependent and paired sample t-test.
Results: The difference in pre and post VAS scores was only significant within the Wii exercise group (p=.02), there was no significant difference found in pre and post VAS scores between the two intervention groups.
Conclusion: The Nintendo Wii exercise program had a significant effect on pain reduction in treatment of lateral epicondylitis

Virtual rehabilitation with video games: A new frontier for occupational therapy (2008)

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TELE-OCCUPATIONAL THERAPY Column Editors: Lili Liu and Masako Miyazaki Author: Jonathan Halton : January 2008

As science and technology change, so do our occupational
therapy practice methods - this is shown not
only within our field, but also within health care.
Certainly, technological advancements continually
influence our current practice and occasionally they
create new tools for intervention. Virtual rehabilitation
is one of these areas of advancements, where
changes have driven new and unique treatment

Energy expenditure in adolescents playing new generation computer games.

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Little research documents the contribution of upper limb and total body movement to energy expenditure (EE) during active video gaming. To address this, EE, heart rate (HR), and, upper limb and total body movement were assessed in 11- to 17-year-old adolescents whilst playing three active (Nintendo Wii) and one sedentary (XBOX 360) video games. Non-dominant upper limb activity, EE and HR were significantly greater during Wii Sports boxing [mean 267.2 (SD 115.8) J kg(-1) min(-1); 136.7 (24.5) beats min(-1)] than tennis or bowling.

For all active games hip activity best predicted EE (R (2) > or = 0.53), with two-measure models of HR and single-site activity data, and multi-site activity data, similarly explaining the variance in EE (R (2) > or = 0.64). The physiological cost of upper-body orientated active video games increased when movement of both upper limbs was encouraged. Improvements in EE explanatory power provide support for multi-site activity monitoring during unique, non-ambulatory activities.

Motivations, Strategies, and Movement Patterns of Video Gamers Playing Nintendo Wii Boxing (2008)

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Video game consoles that employ physical activity as an
interaction mode can benefit from using the gamer’s
movement as feedback and adapt to it. But to be able to
design such systems we need to know how gamers actually
move and what we can infer from this. This paper reports
preliminary, qualitative results of a study that aims at
identifying playing styles and related movement patterns
of gamers that play the Nintendo Wii Boxing game.
Interviews of video gamers revealed that they approach
the game with two different motivations (to achieve and to
relax) that lead to different strategies (game and
simulation). A movement analysis study using motion
capture data, video recordings, and observer ratings
identified three different movement patterns that relate to
these strategies.

Doing WiiHab: Experience With the Wii Video Game System in Acquired Brain Injury Rehabilitation.With the Wii Video Game System in A

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North American Brain Injury Society's Sixth Annual Conference on Brain Injury Journal of Head Trauma Rehabilitation. 23(5):350, September/October 2008. Goldberg, Gary; Rubinsky, Hillel; Irvin, Erin; Linneman, Emily; Knapke, Jennifer; Ryan, Manijeh

Games for physical activity: A preliminary examination of the Nintendo Wii (2007)

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Parker, J. R. (2007). Games for physical activity: A preliminary examination of the Nintendo Wii. Proceedings from 6th International Symposium on Computer Science in Sport, Calgary.

Experience in the design and development of a game based on head-tracking input (2008)

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Tracking technologies, such as eye and head-tracking, provide novel techniques for interacting with video games. For instance, players can shoot with their eyes in a first person shooter using gaze-based input. Head-tracking systems allow players to look around a virtual cockpit by simply moving their head.

However, tracking systems are typically based on expensive specialized equipment. The prohibitive costs of such systems have motivated the creation of low-cost head-tracking solutions using simple web cameras and infrared light detection. In this paper, we describe our experience developing a simple shooting game which incorporates such low-cost head-tracking technology.

As Good as the Real Thing? (2008)

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Wii-habilitation increases participation in therapy

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Ramchandani, A. Carroll, K. Buenaventura, R. Douglas, J. Justin Liu Stanford Univ., Stanford, CA.

'Wii' can work it out.

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Peltier, M (2007).Wii can work it out Nursing Homes: Long Term Care Management, 56(9) pp.72-73.

Energy expenditure in adolescents playing new generation computer games

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Graves, L., Stratton, G., Ridgers, N.D. and Cable, N.T. (2007) Energy Expenditure in adolescents playing new generation computer games, British Journal of Sports Medicine vol. 42, pg. 592-594.


Objective: To compare the energy expenditure of adolescents when playing sedentary and new generation active computer games. Design Cross sectional comparison of four computer games. Setting Research laboratories.

Participants: Six boys and fi ve girls aged 13-15 years. Procedure Participants were fi tted with a monitoring device validated to predict energy expenditure. They played four computer games for 15 minutes each. One of the games was sedentary (XBOX 360) and the other three were active (Wii Sports). Main outcome measure Predicted energy expenditure, compared using repeated measures analysis of variance.

Results: Mean (standard deviation) predicted energy expenditure when playing Wii Sports bowling (190.6 (22.2) kJ/kg/min), tennis (202.5 (31.5) kJ/kg/min), and boxing (198.1 (33.9) kJ/kg/min) was signifi cantly greater than when playing sedentary games (125.5 (13.7) kJ/kg/min). Predicted energy expenditure was at least 65.1 (95% confi dence interval 47.3 to 82.9) kJ/kg/min greater when playing active rather than sedentary games.

Conclusions: Playing new generation active computer games uses signifi cantly more energy than playing sedentary computer games but not as much energy as playing the sport itself. The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children.

Evaluating the potential of the Nintendo Wii to support disabled students in education

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Elaine Pearson and Chris Bailey
Accessibility Research Centre, School of Computing
University of Teesside

This paper describes a new project aimed at identifying the potential of the new generation
of games consoles to support learners with disabilities. The Nintendo Wii represents an
innovation in the way players interact with games through the use of a remote control
device that provides a more intuitive and realistic means of control and interaction. By
selecting simulations, team and adventure games and evaluating them with focus groups
based on students with particular types of disability, the objective is to evaluate and identify
the accessibility of this type of games console and evaluate its potential for supporting
disabled learners in an educational context.

You're never too old for a Wii.

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Nurs Older People. 2007 Oct;19(8):8.

You're never too old for a Wii.
Allen D.
Comment in:
Nurs Older People. 2007 Nov;19(9):12.

Effects of a Wobble Board-Based Therapeutic Exergaming System for Balance Training on Dynamic Postural Stability and Intrinsic Motivation Levels

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J Orthop Sports Phys Ther 2010;40(1):11-19, Epub 7 December 2009. December 2009.

Diarmaid Fitzgerald, Nanthana Trakarnratanakul, Barry Smyth, Brian Caulfield

STUDY DESIGN: Randomized controlled trial.

OBJECTIVES: To compare the effects of wobble board exercises with and without feedback provided through integrating the wobble board movement into a computer game system, by comparing changes in postural stability and motivation.

BACKGROUND: Therapeutic exergaming systems may offer a solution to poor adherence to postural control exercise regimes by improving motivation levels during exercise performance.

METHODS: Twenty-two healthy adults, randomly assigned to an exergaming group (n = 11) and a control group (n = 11), completed 12 exercise sessions. Dynamic postural stability was quantified at baseline and follow-up using the star excursion balance test and the dynamic postural stability index during a jump-landing task. Intrinsic motivation was measured at baseline using the Self-Motivation Inventory and at follow-up using the Intrinsic Motivation Inventory.

RESULTS: Star excursion balance test scores showed a statistically significant (P<.008) improvement in the posteromedial and posterolateral direction for both groups. No within-group change for the dynamic postural stability index or between-group difference for star excursion balance test or dynamic postural stability index scores were observed. The ìinterest and enjoymentî category of the Intrinsic Motivation Inventory showed significantly higher scores (P<.001) in the exergaming group at follow-up, which was 1 of the 5 Intrinsic Motivation Inventory categories evaluated. CONCLUSIONS: The findings suggest that exercising with the therapeutic exergaming system showed similar improvements in dynamic postural stability and showed a greater level of interest and enjoyment when compared to a group doing similar balance training without the game system. KEY WORDS: computer games, exercise adherence, intrinsic motivation, postural stability training, rehabilitation

Comparison of acute exercise responses between conventional video gaming and isometric resistance exergaming.

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J Strength Cond Res. 2009 Dec 4.

Bonetti AJ, Drury DG, Danoff JV, Miller TA.

Exergaming is a relatively new type of entertainment that couples physical activity and video gaming. To date, research that has focused on the physiologic responses to exergaming has been focused exclusively on aerobic-type activities. The purpose of this project was to describe the acute exercise responses (i.e., oxygen uptake [&OV0312;O2], heart rate, and rate of perceived exertion [RPE]) to exergaming using full-body isometric muscle resistance and to determine whether these responses are different during single- versus opponent-based play. Male subjects (n = 32) were randomly and equally divided into either an experimental (EXP) or control (CON) group. Acute exercise responses (&OV0312;O2, heart rate, and RPE) were measured in all subjects during both solo- and opponent-based video game play. Subjects in the EXP group played using a controller that relied on full-body isometric muscle resistance to manipulate the on-screen character, whereas CON subjects used a conventional handheld controller. During solo play, the EXP group exhibited significantly higher values for &OV0312;O2 (9.60 +/-0.50 mL/kg/min) and energy expenditure (3.50 +/- 0.14 kcal/min) than the CON group (&OV0312;O2 5.05 +/- 0.16 mL/kg/min; energy expenditure 1.92 +/- 0.07 kcal/min). These changes occurred with no significant differences in RPE or heart rate between the groups. These results suggest that whole-body isometric exergaming results in greater energy expenditure than conventional video gaming, with no increase in perceived exertion during play. This could have important implications regarding long-term energy expenditure in gamers.

Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children?

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Daley AJ. Primary Care and General Practice, Medical School, University of Birmingham, Birmingham, United Kingdom. Pediatrics. 2009 Jul 13.

Physical inactivity among children is a serious public health problem. It has been suggested that high levels of screen time are contributory factors that encourage sedentary lifestyles in young people. As physical inactivity and obesity levels continue to rise in young people, it has been proposed that new-generation active computer- and video-console games (otherwise known as "exergaming") may offer the opportunity to contribute to young people's energy expenditure during their free time. Although studies have produced some encouraging results regarding the energy costs involved in playing active video-console games, the energy costs of playing the authentic versions of activity-based video games are substantially larger, highlighting that active gaming is no substitute for real sports and activities. A small number of exergaming activities engage children in moderate-intensity activity, but most do not.

Only 3 very small trials have considered the effects of exergaming on physical activity levels and/or other health outcomes in children. Evidence from these trials has been mixed; positive trends for improvements in some health outcomes in the intervention groups were noted in 2 trials. No adequately powered randomized, controlled trial has been published to date, and no trial has assessed the long-term impact of exergaming on children's health.
We now need high-quality randomized, controlled trials to evaluate the effectiveness and sustainability of exergaming, as well as its clinical relevance; until such studies take place, we should remain cautious about its ability to positively affect children's health.

Rationale, design and methods for a randomised and controlled trial to investigate whether home access to electronic games decreases children's physical activity

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Straker LM, Abbott RA, Piek JP, Pollock CM, Davies PS, Smith AJ. School of Physiotherapy, Curtin University of Technology, Perth, Australia.
Source:BMC Public Health. 2009 Jun 29;9:212.

BACKGROUND: Many children are reported to have insufficient physical activity (PA) placing them at greater risk of poor health outcomes. Participating in sedentary activities such as playing electronic games is widely believed to contribute to less PA. However there is no experimental evidence that playing electronic games reduces PA. There is also no evidence regarding the effect of different types of electronic games (traditional sedentary electronic games versus new active input electronic games) on PA. Further, there is a poor understanding about how characteristics of children may moderate the impact of electronic game access on PA and about what leisure activities are displaced when children play electronic games. Given that many children play electronic games, a better understanding of the effect of electronic game use on PA is critical to inform child health policy and intervention.
METHODS: This randomised and controlled trial will examine whether PA is decreased by access to electronic games and whether any effect is dependent on the type of game input or the child's characteristics. Children aged 10-12 years (N = 72, 36 females) will be recruited and randomised to a balanced ordering of 'no electronic games', 'traditional' electronic games and 'active' electronic games. Each child will participate in each condition for 8 weeks, and be assessed prior to participation and at the end of each condition. The primary outcome is PA, assessed by Actical accelerometers worn for 7 days on the wrist and hip. Energy expenditure will be assessed by the doubly labelled water technique and motor coordination, adiposity, self-confidence, attitudes to technology and PA and leisure activities will also be assessed. A sample of 72 will provide a power of > 0.9 for detecting a 15 mins difference in PA (sd = 30 mins).
DISCUSSION: This is the first such trial and will provide critical information to understand whether access to electronic games affects children's PA. Given the vital importance of adequate PA to a healthy start to life and establishing patterns which may track into adulthood, this project can inform interventions which could have a profound impact on the long term health of children.
TRIAL REGISTRATION: This trial is registered in the Australia and New Zealand Clinical Trials Registry (ACTRN 12609000279224).

Reinforcing motor re-training and rehabilitation through games: a machine-learning perspective.

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Schmid M (2009). Reinforcing motor re-training and rehabilitation through games: a machine-learning perspective. Front. Neuroeng. 2,3 : doi:10.3389/neuro.16.003.2009

Energy Expenditure and Cardiovascular Responses to Seated and Active Gaming in Children

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Objective: To examine energy expenditure and cardiovascular
responses in children during seated and active
Design: Comparison study.
Setting: Children’s Exercise Laboratory, University of
Hong Kong.
Participants: Eighteen children (aged 6-12 years) recruited
from local primary schools.
Main Exposure: Active and seated computer games
played by all participants.
Main Outcome Measures: Resting energy expenditure
and heart rate measured before gaming, during
seated gaming, and during use of 2 active gaming formats
(XaviX bowling and XaviX J-Mat; SSD Company
Ltd, Shiga, Japan). We used repeated-measures analyses
of variance to compare the outcome measures.
Results:The energy expenditurewas significantly higher
during seated gaming (mean [SD], 1.31 [0.19] kcal/
min−1; P<.001), XaviX bowling (1.89 [0.45] kcal/min−1; P<.001), and XaviX J-Mat gaming (5.23 [1.63] kcal/ min−1; P<.001) compared with rest. The energy expended above rest was significantly higher for the 2 active gaming formats (P<.001 for both) compared with seated gaming.The heart ratewas significantly higher during XaviX bowling (mean [SD, ]102 [20] beats/min−1; P<.001) and XaviX J-Mat gaming (160 [20] beats/ min−1; P<.001) compared with rest. Heart rate during theXaviXJ-Mat gaming was significantly higher than during seated gaming (P<.001). Conclusions: This study has shown that using active gaming media results in meaningful increases in energy expenditure and heart rate compared with the seated screen environment. Manipulating the gaming environment can provide children with appealing activity alternatives, and further development of “exertainment” interventions is warranted,

Let’s Get Physical: How Physical Control Methods Make Games Fun

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Despite their widespread acceptance, traditional computer gaming interfaces such as the monitor and keyboard fundamentally serve to separate players from their games. In this paper, we examine how physically-based control methods - which leverage the physical movement of their players as a method for playing games - can be used to foster player immersion, creating games which are intuitive, accessible and fun. An examination of how a mixed reality interfaces support (and even encourage) physical controls follows, where we discuss two of our mixed reality game implementations - Save 'Em and Napkin Chess.

Short-Term Psychological Effects of Interactive Video Game Technology Exercise on Mood and Attention

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Russell, W. D., & Newton, M. (2008). Short-Term Psychological Effects of Interactive Video Game Technology Exercise onMood and Attention. Educational Technology & Society, 11 (2), 294-308

ABSTRACT Recent interest in interactive video game technology (IVGT) has spurred the notion that exercise from this technology may have meaningful physiological and psychological benefits for children and adolescents.
The purpose of this study was to examine the short-term psychological effects of interactive video game exercise inyoung adults and whether IVGT participation was capable of improving mood as has been shown for traditional forms of exercise.
In addition, we were interested in comparing both actual physical exercise output and perceived exertion of that output across the exercise conditions. One-hundred and sixty-eight college students were assigned to one of three 30-minute conditions: (1) interactive video game cycle ergometer exercise, (2)regular cycle ergometer exercise, or (3) a video game-only control condition.
Positive and negative mood(PANAS; Watson, Clark, & Tellegen, 1988) was assessed before and twice-after experimental conditions, andmeasures of actual and perceived physical exertion were collected at five-minute intervals across exerciseconditions. Participants in the video-game control had higher post-activity negative affect immediately and 10-minutes post activity than either exercise group.
In addition, exercise condition participants had higher positive mood at 10-minutes post activity compared to the video game control participants. Results do not support IVGT mood benefits over other forms of exercise, but do support immediate affective benefits of exercise compared to sedentary activity. It is concluded that while there is potential for interactive video-game based applications toelicit affective benefits, there is a need to examine circumstances under which these benefits are most likely to occur.

Does Body Movement Engage You More in Digital Game Play? and Why?

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Bianchi-Berthouze, N., Kim, W.W., Darshak, P. (2007).
Does Body Movement Engage You More in Digital Game Play? and Why? Affective Computing and Intelligent Interaction, Springer, LNCS 4738, 102-113.

In past years, computer game designers have tried to increase player engagement by improving the believability of characters and environment. Today, the focus is shifting toward improving the game controller. This study seeks to understand engagement on the basis of the body movements of the player. Initial results from two case-studies suggest that an increase in body movement imposed, or allowed, by the game controller results in an increase in the player's engagement level. Furthermore, they lead us to hypothesize that an increased involvement of the body can afford the player a stronger affective experience. We propose that the contribution of full-body experience is three-fold: (a) it facilitates the feeling of presence in the digital environment (fantasy); (b) it enables the affective aspects of human-human interaction (communication); and (c) it unleashes the regulatory properties of emotion (affect).

Enhancing the control of force in putting by video game training

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Fery, Y.A., & Ponserre, S. (2001). Enhancing the control of force in putting by video game training. Ergonomics, 44, 1025-1037.

Even if golf video games provide no proprioceptive afferences on actual putting movement, they may give sufficient substitutive visual cues to enhance force control in this skill. It was hypothesized that this usefulness requires, however, two conditions: the video game must provide reliable demonstrations of actual putts, and the user must want to use the game to make progress in actual putting. Accordingly, a video game was selected on the basis of its fidelity to the real-world game. It allowed two different methods of adjusting the virtual player's putting force in order to hole a putt: an analogue method that consisted of focusing on the virtual player's movement and a symbolic method that consisted of focusing on the movement of a gauge on a scale representing the virtual player's putting force. The participants had to use one of these methods with either the intention of making progress in actual putting or in a second condition to simply enjoy the game. Results showed a positive transfer of video playing to actual putting skill for the learning group and also, to a lesser degree, for the enjoyment group; but only when they used the symbolic method. Results are discussed in the context of how vision may convey force cues in sports video games.

The influence of virtual reality play on children’s motivation

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Harris, K. and Reid, D. (2005) The influence of virtual reality play on children's motivation, The Canadian Journal of Occupational Therapy vol. 72 (1) pg. 21-29.

Purpose.This study explored the degree of motivation children exhibit during virtual reality (VR) play sessions.Method. Sixteen
children with cerebral palsy aged 8 to 12 years participated. They were observed during a variety of VR environments that were
video recorded. The Pediatric Volitional Questionnaire (PVQ) was used to measure children’s motivation. The PVQ provides
insights into children’s inner motives as well as how the virtual environment enhances or attenuates children’s motives. Nine VR
environments were randomly selected to score with the PVQ.Results.Data were analyzed and descriptive statistics were calculated
for modes and medians of total volition scores for each VR environment.Different environments produced varying levels of
volitional behaviour. The features of environments that produced higher levels of volition included challenge, variability and
competition. Practice Implications. The overall volitional scores of children with cerebral palsy in the current study indicate
that VR play is a motivating activity and thus has potential as a successful intervention tool.

Might virtual reality promote the mood benefits of exercise?

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Plante, T.G., Aldridge, A., Bogden, R., & Hanelin, C. (2003). Might virtual reality promote the mood benefits of exercise? Computers in Human Behavior, 19, 495-509.

This study sought to investigate if virtual reality technology enhances the psychological benefits of aerobic exercise in a laboratory setting. In this study, 88 university faculty and staff (44 females, 44 males) were randomly assigned to one of three 30-min conditions including: (1) bicycling at a moderate intensity (60-70% maximum heart rate) on a stationary bicycle, (2) playing a virtual reality computer bicycle game, or (3) an interactive virtual reality bicycle experience on a computer while exercising on a stationary bike at moderate intensity (60-70% maximum heart rate). The Activation-Deactivation Adjective Check List (AD-ACL) was administered immediately before and after the laboratory session. Results suggest that virtual reality enhances some of the mood benefits when paired with exercise. Virtual reality when paired with exercise enhances enjoyment, energy, and reduces tiredness. Virtual reality without exercise was discovered to increase participants' tension, tiredness, and lower their energy level. Results suggest that the combination of virtual reality and exercise might improve some of the beneficial psychological effects of exercise compared with virtual reality or exercise alone.

Cortical reorganization induced by virtual reality therapy in a child with hemiparetic cerebral palsy

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You, S.H., Jang, S.H., Kim, Y.H., Kwon, Y.H., Barrow, I. and Hallett, M. (2005) Cortical reorganization induced by virtual reality therapy in a child with hemiparetic cerebral palsy. Developmental Medicine & Child Neurology vol. 47, pg. 628–635.

Abstract: Virtual reality (VR) therapy is a new, neurorehabilitation intervention aimed at enhancing motor performance in children with hemiparetic cerebral palsy (CP).
This case report investigated the effects of VR therapy on cortical reorganization and associated motor function in an 8-year-old male with hemiparetic CP.
Cortical activation and associated motor development were measured before and after VR therapy using functional magnetic resonance imaging (fMRI) and standardized motor tests. Before VR therapy, the bilateral primary sensorimotor cortices (SMCs) and ipsilateral supplementary motor area (SMA) were predominantly activated during affected elbow movement.
After VR therapy, the altered activations disappeared and the contralateral SMC was activated. This neuroplastic change was associated with enhanced functional motor skills including reaching, self-feeding, and dressing.
These functions were not possible before the intervention. To our knowledge, this is the first fMRI study in the literature that provides evidence for neuroplasticity after VR therapy in a child with hemiparetic CP.

"Video fitness games: If you can’t beat ‘em, join ‘em"

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Yang, S., Vasil, J., & Graham, G. (2005). Video fitness games: If you can’t beat em, join em. Paper presented at the American Alliance for Health, Physical Education, Recreation, and Dance conference, April 2005, Chicago, IL.

Correlation of the Pediatric Volitional Questionnaire with the Test of Playfulness in a virtual environment: the power of engagement

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Reid, D. (2005) Correlation of the Paediatric Volitional Questionnaire with the Test of Playfulness in a virtual environment: the power of engagement, Early Child Development and Care vol. 175 (2), pg. 153 - 164.

The Pediatric Volitional Questionnaire (PVQ) was used along with the Test of Playfulness (TOP) to
assess 16 children with cerebral palsy who took part in a study of virtual reality play intervention. Both
observational measures are designed to assess children as they are engaged in occupations in one or
more environments. Virtual reality offers an alternative play environment for children who have
disabilities. It eliminates several physical barriers usually encountered in real life. It also is a powerful
medium for engaging and providing a sense of control and enjoyment with the tasks engaged with.
Several virtual environments and activities were offered to the children over an eight-week period.
The purpose of this paper is to examine the relationship between these two measures that were used
to assess aspects of motivation and playfulness, and to explore which aspects of these measures are
most correlated when assessing children in virtual environments. The Pearson correlation calculated
between the average motivation score of the TOP and the average PVQ score was significant (r = .47,
p = .05). The item correlations were all non-significant except for two. These were item 6 ‘stays
engaged’ (r = .51, p = .03) and item 9 ‘tries to produce effects’ (r = .55, p = .02). There is some
evidence that these two measures are tapping into similar constructs. These results will be discussed.
Keywords: Playfulness; Volition; Correlation; Virtual reality

The role of virtual reality technology in the asse... [Disabil Rehabil. 2002 Jul 20-Aug 15]

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Harrison, A.G., Derwent, G., Enticknap, A., Rose, F.D., & Attree, E.A. (2002). The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users. Disability and Rehabilitation, 24, 599- 606.

The current paper provides quantitative and qualitative data concerning the application of two virtual environments to the assessment and training of inexperienced powered wheelchair users, both in terms of the ability to control the chair accurately without hitting objects in the environment (manoeuvrability) and in terms of being able to find ones way around a complex environment without becoming lost (route-finding).
Method: Six novice powered wheelchair users participated in the project, completing either the manoeuvrability or route finding components of the study. Performance measures were taken in real life pre and post training and throughout virtual reality sessions. Participants also completed a questionnaire regarding the aesthetics of the virtual environments and aspects of the powered wheelchair simulation.
Results: The participants rated the aesthetics of the virtual environments positively and engaged well with the virtual system. However, they found the manoeuvrability tasks considerably more difficult in virtual reality (VR) than in real life. Some difficulties with controlling the simulated wheelchair were apparent. Some improvements on virtual and real life manoeuvrability tasks and route finding were noted following conventional and virtual training.
Conclusions: The study indicated that the two virtual environments represent a potentially useful means of assessing and training novice powered wheelchair users. The virtual environments however must become less challenging if they are to represent a motivating and effective means of improving performance. Further development of the way in which wheelchair movement is controlled and simulated represents a key element in this multi stage project.