Thursday, 25 October 2012

Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study.

Physiotherapy. 2012 Sep;98(3):211-6. Epub 2011 Apr 29.

Bateni H.

School of Allied Health and Communicative Disorders, Physical Therapy Program, Northern Illinois University, 1425 W. Lincoln Hwy, DeKalb, IL 60115-2828, USA

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OBJECTIVES: To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training.
DESIGN: Quasi-experimental design.
PARTICIPANTS: Eight males and nine females aged 53 to 91 years.
MATERIALS AND METHODS: Participants were divided into three groups: one group received both physical therapy training and Wii Fit training (PW group), one group received Wii Fit training alone (WI group), and one group received physical therapy training alone (PT group). Training consisted of three sessions per week for 4 weeks.
MAIN OUTCOME: Berg Balance Scale (all groups) and Bubble Test (PW and WI groups) scores.
STATISTICAL ANALYSIS: Descriptive statistics, medians, interquartile ranges and 95% confidence intervals are reported to identify trends in balance control as a result of different types of training.
RESULTS: All subjects showed improvement in the Berg Balance Scale and Bubble Test scores. The PT and PW groups tended to perform better than the WI group on the Berg Balance Scale following treatment. Although the differences in the Bubble Test score were not substantial between the PW and WI groups, the PW group performed slightly better than the WI group on the Berg Balance Scale.
CONCLUSIONS: Wii Fit training appears to improve balance. However, physical therapy training on its own or in addition to Wii Fit training appears to improve balance to a greater extent than Wii Fit training alone.

Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

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Wednesday, 24 October 2012

Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study.

Physiotherapy. 2012 Sep;98(3):217-23. Epub 2012 Jul 9.

dos Santos Mendes FA, Pompeu JE, Modenesi Lobo A, Guedes da Silva K, Oliveira Tde P, Peterson Zomignani A, Pimentel Piemonte ME.

Department of Neuroscience and Behaviour, Institute of Psychology, University of São Paulo, São Paulo, Brazil.

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OBJECTIVES: To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit™ training in patients with Parkinson's disease and healthy elderly people.
DESIGN: Longitudinal, controlled clinical study.
PARTICIPANTS: Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people.
INTERVENTIONS: Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer.
MAIN OUTCOME MEASURES: Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test.
RESULTS: Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task.
CONCLUSIONS: The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.

Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

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Tuesday, 23 October 2012

The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy.

Dev Neurorehabil. 2012 Oct 3.

Jelsma J, Pronk M, Ferguson G, Jelsma-Smit D.

 Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town , South Africa.

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Objective: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy.

Methods: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given for 3 weeks. Outcome measures included modified balance and running speed and agility (RSA) scales of the Bruininks-Oserestky test of Motor Performance 2 and the timed up and down stairs (TUDS).

Results: Balances score improved significantly (F(2, 26) = 9.8286, p = 0.001). Changes over time in the RSA (F(2, 26) = 0.86198, p = 0.434) and the TUDS (F(2, 26) = 1.3862, p = 0.268) were not significant. Ten children preferred the intervention to conventional physiotherapy.

Conclusion: Most children preferred the IVG but as the effect did not carry over into function, IVG should not be used in place of conventional therapy and further research is needed into its use as an adjunct to therapy.

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Monday, 22 October 2012

A Wii virtual activity severe thumb metacarpal injury.

BMJ Case Rep. 2012 Oct 10;2012

Galanopoulos I, Garlapati AK, Ashwood N, Kitsis C.

Department of Trauma and Orthopaedics, Queen's Hospital, Burton-on-Trent, UK.

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In this paper we present a case of a severe thumb bone injury sustained during simulated sporting activity using a Wii games console. Although several types of injury related to this form of physical activity have been encountered during the last few years with increasing frequency, this particular basal thumb fracture has not been reported in the literature yet. This was a complex Rolando type of fracture similar to those obtained doing the actual activity mimicked by the game. Ensuring a safe environment and adequate preparation before undertaking sport is key to prevent injury and the same principles are needed when undertaking virtual sport.

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Thursday, 20 September 2012

Validity of the Nintendo Wii(R) balance board for the assessment of standing balance in Parkinson's disease.

Clinical Rehabilitation 2012 Sept 7 (Epub ahead of print)

 Holmes JD, Jenkins ME, Johnson AM, Hunt MA, Clark RA.

School of Occupational Therapy, The University of Western Ontario, Canada.

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Background:Impaired postural stability places individuals with Parkinson's at an increased risk for falls. Given the high incidence of fall-related injuries within this population, ongoing assessment of postural stability is important.

Objective:To evaluate the validity of the Nintendo Wii(®) balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson's.

Subjects:Twenty individuals with Parkinson's participated.

Intervention:Subjects completed testing on two balance tasks with eyes open and closed on a Wii(®) balance board and biomechanical force platform.Main

Measures:Bland-Altman plots and a two-way, random-effects, single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data.

Results:Concurrent validity was demonstrated to be excellent across balance tasks (intraclass correlation coefficients = 0.96, 0.98, 0.92, 0.94).

Conclusions:This study suggests that the Wii(®) balance board is a valid tool for the quantification of postural stability among individuals with Parkinson's.

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Wednesday, 19 September 2012

Energy expended playing Xbox Kinect™ and Wii™ games: a preliminary study comparing single and multiplayer modes.

Physiotherapy. 2012 Sep;98(3):224-9. Epub 2012 Jul 25.

O'Donovan C, Hirsch E, Holohan E, McBride I, McManus R, Hussey J.

Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.

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OBJECTIVES: It has been reported that a higher galvanic skin response is seen when playing video games against another human player than when playing alone, which suggests increased effort. The objectives of this study were to compare energy expenditure when playing two popular active video game consoles, and to compare energy expenditure when playing in single and multiplayer modes.
DESIGN: Crossover trial with randomised playing order.
PARTICIPANTS: Fourteen healthy adults with a mean age of 21 [standard deviation (SD) 3] years.
METHODS AND INTERVENTIONS: Energy expenditure was measured using an indirect calorimeter at rest, during 10minutes of play on Xbox Kinect™ Reflex Ridge in both single and multiplayer modes, and during 10minutes of play on Wii™ Sports Boxing in both single and multiplayer modes.
MAIN OUTCOME MEASURES: Metabolic equivalents (METs), heart rate, oxygen consumption and kilocalories expended.
RESULTS: The energy expenditure during all gaming conditions was of a light intensity. Playing on the Xbox Kinect elicited greater energy expenditure than playing on the Wii [mean difference=0.9 METs, 95% confidence interval (CI) 0.2 to 1.5]. Playing games in multiplayer mode led to greater energy expenditure (mean difference=0.5 METs, 95% CI 0.1 to 0.9) and heart rate (mean difference=7.9 beats/minute, 95% CI 2.0 to 13.8) than playing in single player mode.
CONCLUSIONS: No gaming condition required moderate-intensity activity in this group of young healthy adults. Potential explanations for the difference in energy expenditure seen between consoles and modes are discussed.

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Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. 

Tuesday, 18 September 2012

Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study.

Physiotherapy. 2012 Sep;98(3):238-42. Epub 2012 Jul 23.
Gordon C, Roopchand-Martin S, Gregg A.

Source:Section of Physical Therapy, University of the West Indies, Kingston, Jamaica.

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To explore the possibility of using the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy (CP) in a developing country, and determine whether there is potential for an impact on their gross motor function.

Pilot study with a pre-post-test design.

Sir John Golding Rehabilitation Center, Jamaica, West Indies.

Seven children, aged 6 to 12years, with dyskinetic CP were recruited for the study. One child dropped out at week 4.

Training with the Nintendo Wii was conducted twice weekly for 6weeks. The games used were Wii Sports Boxing, Baseball and Tennis.

Percentage attendance over the 6-week period, percentage of sessions for which the full duration of training was completed, and changes in gross motor function using the Gross Motor Function Measure (GMFM).

All six participants who completed the study had 100% attendance, and all were able to complete the full 45minutes of training at every session. Those who were wheelchair bound participated in two games, whilst those who were ambulant played three games. The mean GMFM score increased from 62.83 [standard deviation (SD) 24.86] to 70.17 (SD 23.67).

The Nintendo Wii has the potential for use as a rehabilitation tool in the management of children with CP. Clinical trials should be conducted in this area to determine whether this could be an effective tool for improving gross motor function.

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Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Saturday, 4 August 2012

Can exergames increase physical activity?

Posted by John Ferrara on June 7, 2012

Earlier this year, a study published in the journal Pediatrics found that five games that are marketed with the promise of increasing players' physical fitness produced no actual difference in activity. 78 kids between 9 and 12 were given Wii consoles, and then one group was given a couple of exergames while a control group was given "inactive" games like Madden and Mario Kart. The kids wore devices to measure their physical activity, and they kept logs of when they played.

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To be certain, the study was performed by a very accomplished group of researchers. The lead author, Tom Baranowski of Baylor College, is one of the most widely published researchers of health games. And this was a very well-designed study, printed in the foremost journal on children's health. Nevertheless, the study should not be read to mean that games can't affect physical activity and can't have a positive impact on public health. That's because it didn't account for the most influential factor in a health game's impact -- its design.

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Friday, 3 August 2012

Assessment of the postural control strategies used to play two Wii Fit™ videogames

Gait Posture. 2012 Jul;36(3):449-53.

A. Michalski, C.M. Glazebrook, A.J. Martin, W.W.N. Wong, A.J.W. Kim, K.D. Moody, N.M. Salbach, B. Steinnagel, J. Andrysek, R. Torres-Moreno, K.F. Zabjek

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The Nintendo Wii Fit™ may provide an affordable alternative to traditional biofeedback or virtual reality systems for retraining or improving motor function in populations with impaired balance. The purpose of this study was to evaluate postural control strategies healthy individuals use to play Wii Fit™ videogames. Sixteen young adults played 10 trials of Ski Slalom and Soccer Heading respectively. Centre of pressure (COP) excursion and three-dimensional movement data were acquired to determine variability in medial–lateral COP sway and shoulder–pelvic movement. While there was no difference in medial–lateral COP variability between games during trial 1, there was a significant difference after 10 trials. COP sway increased (59–75mm) for Soccer Heading while it decreased (67–33mm) for Ski Slalom from trial 1 to trial 10. During Ski Slalom participants demonstrated decreased shoulder and pelvic movement combined with increased pelvic–shoulder coupling. Conversely, participants demonstrated greater initial shoulder tilt when playing Soccer Heading, with no reduction in pelvic rotation and tilt. Participants decreased pelvic and trunk movements when skiing, suggesting a greater contribution of lower extremity control while they primarily used a trunk strategy to play Soccer Heading.

► We evaluated the balance control strategies adopted when participants played the Wii Fit™.
► Distinct strategies emerged with increased experience playing the Soccer Heading and Ski Slalom games. ► With experience centre of pressure variability increased for Soccer Heading and decreased for Ski Slalom games.
► When playing Soccer Heading participants demonstrated greater shoulder tilt.
► When playing Ski Slalom participants demonstrated increased pelvic–shoulder coupling.

Keywords: Balance control, Balance training, Centre of pressure

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Thursday, 2 August 2012

The heart rate response to nintendo wii boxing in young adults.

Cardiopulmonary Physical Therapy Journal 2012 Jun;23(2):13-29.

Pamela R. Bosch, PT, DPT, PhD; Joseph Poloni, DPT; Andrew Thornton, DPT; James V. Lynskey, PT, PhD
Department of Physical Therapy, A.T. Still University, Mesa, Arizona

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PURPOSE: To determine if 30 minutes of Nintendo Wii Sports boxing provides cardiorespiratory benefits and contributes to the daily exercise recommendations for healthy young adults.
METHODS: Twenty healthy 23- to 27-year-olds participated in two sessions to measure maximum heart rate (HR(max)) via a treadmill test and heart rate (HR) response to 30 minutes of Wii Sports boxing. Heart rate in beats per minute (bpm) was measured continuously, and exercise intensity during each minute of play was stratified as a percentage of HR(max). Mixed designs analysis of variance (ANOVA) and Pearson product moment correlations were used to analyze the data.
RESULTS: Mean (SD) HR response to boxing was 143 (15) bpm or 77.5% (10.0%) of HR(max). The mean HR response for experienced participants was significantly lower than inexperienced participants, P = .007. The ANOVA revealed a significant interaction between experience and time spent at various intensities, P = .009. Experienced participants spent more time in light to vigorous intensities, inexperienced participants in moderate to very hard intensities. Fitness was not correlated with mean HR response to boxing, P = .49.
CONCLUSION: Thirty minutes of Nintendo Wii Sports boxing provides a moderate to vigorous aerobic response in healthy young adults and can contribute to daily recommendations for physical activity.

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Monday, 23 July 2012

A game-console to improve balance in Parkinson Disease: preliminary results using the Nintendo Wii

Italian Journal of Physiotherapy 2012 June;2(2):45-9

Pelosin E., Avanzino L., Trompetto C., Marinelli L., Marchese R., Abbruzzese G.

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AIM: Balance impairment is a common problem in idiopathic Parkinson’s disease (PD) often responsible for increased risk of falls, mobility restriction and loss of independence. Conventional exercises are often repetitive and may induce patients to lose their interest and to interrupt physical therapy at home. This study was aimed at evaluating theeffect of 5 days training with a low-cost, commercially available playing system, the Nintendo Wii® (NW), in improving balance in PD.

METHODS: Ten patients with PD and ten aged-match normal subjects (NS) were recruited and performed 30 minutes exercises playing with NW every day for one week. Subjects were evaluated by means of static posturography and Berg Balance Scale (BBS) before and after training.

RESULTS: The 5-day training, based on video-game system, induced a significant decrease in all the posturographic parameters in both groups improving postural stability of PD to a level comparable to baseline condition in NS. BBS score improved after training in PD patients.

CONCLUSION: These preliminary results suggest that a video game-based approach can exert a positive effect improving postural stability in PD patients. Because the NW device promotes better compliance, has wide applicability and is enjoyable to use, this treatment concept holds promise for PD rehabilitation

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Thursday, 5 July 2012

WiiFit™ Plus balance test scores for the assessment of balance and mobility in older adults

Gait and Posture
Rebecca J. Reed-Jones, Sandor Dorgo , Maija K. Hitchings , Julia O. Bader

► WiiFit™ balance tests do not correlate with standardized functional balance, mobility and fitness tests. ► Wii balance score does correlate with visual processing speed as measured by Useful Field of View. ► WiiFit™ may provide advantageous information supplementary to standard functional mobility and balance tests. ► Caution should be used when using the WiiFit™ balance tests in isolation to test balance ability.


The Nintendo Wii™ is becoming an increasingly popular technology for the training and assessment of balance in older adults. Recent studies have shown promising results for its use in fall prevention. However, it is not clear how scores on the WiiFit™ balance games relate to current standardized tests of balance and mobility. The purpose of this study was to evaluate the relationship between WiiFit™ Plus balance tests, and standardized tests of older adult fitness, balance, mobility, self-reported balance confidence, and visual attention and processing. Results from 34 older adult participants indicate that WiiFit™ balance tests do not correlate well with standardized functional balance, mobility and fitness tests. However, the Wii balance score, as measured by the Basic Balance Test of the WiiFit™, does correlate with visual processing speed as measured by the Useful Field of View (UFOV®) test. These results indicate that WiiFit™ balance tests may provide advantageous information supplementary to information obtained through standard functional mobility and balance tests; however, caution should be used when using the WiiFit™ balance tests in isolation. Further research is necessary as these technologies become widely used in clinical and home settings for balance training and assessment.

Monday, 25 June 2012

Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study.

Ylva E Nilsagård, Anette S Forsber and Lena von Koch
Multiple Sclerosis Journal, 2012 June 6

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Background: The use of interactive video games is expanding within rehabilitation. The evidence base is, however, limited.
Objective: Our aim was to evaluate the effects of a Nintendo Wii Fit® balance exercise programme on balance function and walking ability in people with multiple sclerosis (MS).
Methods: A multi-centre, randomised, controlled single-blinded trial with random allocation to exercise or no exercise. The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games, twice a week for 6–7 weeks. Primary outcome was the Timed Up and Go test (TUG). In total, 84 participants were enrolled; four were lost to follow-up.
Results: After the intervention, there were no statistically significant differences between groups but effect sizes for the TUG, TUGcognitive and, the Dynamic Gait Index (DGI) were moderate and small for all other measures. Statistically significant improvements within the exercise group were present for all measures (large to moderate effect sizes) except in walking speed and balance confidence. The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI.
Conclusion: In comparison with no intervention, a programme of supervised balance exercise using Nintendo Wii Fit® did not render statistically significant differences, but presented moderate effect sizes for several measures of balance performance.

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Sunday, 17 June 2012

Impact of an Active Video Game on Healthy Children's Physical Activity

Tom Baranowski, Dina Abdelsamad, Janice Baranowski, Teresia Margareta O'Connor, Debbe Thompson, Anthony Barnett, Ester Cerin and Tzu-An Chen
Originally published online February 27, 2012;

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OBJECTIVE: This naturalistic study tests whether children receiving a new (to them) active video game spontaneously engage in more physical activity than those receiving an inactive video game, and whether
the effect would be greater among children in unsafe neighbourhoods, who might not be allowed to play outside.

METHODS: Participants were children 9 to 12 years of age, with a BMI .50th percentile, but ,99th percentile; none of these children a medical condition that would preclude physical activity or playing video
games. A randomized clinical trial assigned children to receiving 2 active or 2 inactive video games, the peripherals necessary to run the games, and a Wii console. Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment. Neighbourhood safety was assessed with a 12 item validated questionnaire.

RESULTS: There was no evidence that children receiving the active video games were more active in general, or at any time, than children receiving the inactive video games. The outcomes were not moderated
by parent perceived neighborhood safety, child BMI z score, or other demographic characteristics.

CONCLUSIONS: These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children.

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Wednesday, 6 June 2012

Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction

Gul Baltaci, Gulcan Harput, Bunyamin Haksever, Burak Ulusoy andHamza Ozer

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The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction.
Methods Thirty volunteer subjects were enrolled in either Wii Fit (n = 15; mean age, 29 ± 7 years) or conventional rehabilitation (n = 15; mean age, 29 ± 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine.
Results There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation.
Conclusion Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual–perceptual processing, coordination, proprioception and functional mobility.

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Sunday, 6 May 2012

Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

BMC Ear, Nose and Throat Disorders Published: 26 March 2012

Dara Meldrum, Susan Herdman, Roisin Moloney, Deirdre Murray, Douglas Duffy, Kareena Malone, Helen French, Stephen Hone, Ronan Conroy and Rory McConn Walsh

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Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus (R) (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy.

In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months.

Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated.

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Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii® Fit Plus, Disability and Rehabilitation

Disability and Rehabilitation: Assistive Technology

May 2012, Vol. 7, No. 3 , Pages 205-210

Dara Meldrum, Aine Glennon1, Susan Herdman, Deirdre Murray, Rory McConn-Walsh

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Purpose: The aim of this study was to investigate the usability of the Nintendo Wii Fit Plus® (NWFP) in the treatment of balance impairment in vestibular and other neurological disease.
Methods: This was a cross-sectional, quasi-experimental study. Participants (n = 26; mean age 43 ± 14, M13:F13) with quantified balance impairment took part in a 30-minute session on the NWFP using exercises and games that challenge balance. Outcomes included the System Usability Scale (SUS), a numerical rating scale of enjoyment and a post treatment questionnaire.
Results: The mean SUS score was high (mean 82 ± 18%) with only two participants rating below 50%. There was a negative correlation of age with SUS scores (r = −0.54; p = 0.004). Mean numerical rating scale score (/10) for enjoyment of the NWFP session was 8.4 ± 3. Of the participants, 88.5% said that they would like to use the NWFP in future treatment. Seventy-three percent reported more enjoyment and motivation than usual physiotherapy. No falls occurred during testing.
Conclusions: This study has quantified the usability of the NWFP as a treatment for balance impairment showing high levels of usability and enjoyment with no serious adverse effects. The results of this study may assist physiotherapists in devising novel balance rehabilitation programmes.

Implications for Rehabilitation
The Nintendo Wii Fit Plus® virtual reality system has the potential to improve balance rehabilitation, but usability of this system requires investigation.

In this study, patients with balance impairment as a result of neurological disease reported very high levels of usability and enjoyment when performing selected Nintendo Wii Fit Plus® balance exercises and games.

The majority of patients preferred the Nintendo Wii Fit Plus to conventional treatment which may have implications for patient compliance with exercise.

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Saturday, 28 April 2012

Postural activity and motion sickness during video game play in children and adults


Volume 217, Number 2 (2012), 299-309,
Chih-Hui Chang, Wu-Wen Pan, Li-Ya Tseng and Thomas A. Stoffregen

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Abstract Research has confirmed that console video games give rise to motion sickness in many adults. During exposure to console video games, there are differences in postural activity (movement of the head and torso) between participants who later experience motion sickness and those who do not, confirming a prediction of the postural instability theory of motion sickness. Previous research has not addressed relations between video games, movement and motion sickness in children. We evaluated the nauseogenic properties of a commercially available console video game in both adults and 10-year-old children. Individuals played the game for up to 50 min and were instructed to discontinue immediately if they experienced any symptoms of motion sickness, however mild. During game play, we monitored movement of the head and torso. Motion sickness was reported by 67% of adults and by 56% of children; these rates did not differ. As a group, children moved more than adults. Across age groups, the positional variability of the head and torso increased over time during game play. In addition, we found differences in movement between participants who later reported motion sickness and those who did not. Some of these differences were general across age groups but we also found significant differences between the movement of adults and children who later reported motion sickness. The results confirm that console video games can induce motion sickness in children and demonstrate that changes in postural activity precede the onset of subjective symptoms of motion sickness in children.

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Friday, 27 April 2012

Determining intensity levels for selected Wii Fit activities in college aged individuals.

By Joshua D. Grieser
Master of Science in Exercise and Sports Studies thesis
May 2010

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Introduction: Physical activity is important to the proper growth, development, and overall health of an individual. Current physical activity trends show declines in activity level throughout aging. To counteract inactivity many physical activity interventions have been implemented in different age groups and yet very little change in activity level has been seen. The Nintendo Wii® offers a popular technological intervention tool with its movement oriented game play. The physiological costs and intensity of the Nintendo Wii Fit® game have not been thoroughly researched, yet the Wii is being used as a physical activity tool in many arenas.

Purpose: The purpose of this study was to determine the intensity level of playing selected Nintendo Wii Fit® games using indirect calorimetry. Using the intensity information, it was determined if playing Wii Fit® (an exercise themed game) on the Nintendo Wii® video game console is an adequate activity for meeting the ACSM moderate physical activity guidelines threshold. Participants: Twenty-five participants, 5 males and 20 females, aged 22 ± 2 years (M ± SD) with little previous Wii experience were recruited for this study.

Method: Participants randomly completed two different Wii Fit activity sessions with two difficulty levels within the strength, endurance, and yoga categories. A resting metabolic rate and exercise VO2were measured on each participant with a TrueMax 2400 metabolic cart. Oxygen consumption was then converted into metabolic equivalents to estimate activity intensity level. SPSS18.0 (Chicago, IL, USA) was use for statistical analysis.

Results: Results indicated that VO2 of the selected Wii Fit activities was significantly higher than resting 2 VO levels. For example, the least intense activity was the Yoga Warrior activity, which had a mean intensity of 2.30 ± 0.42 METs and was still significantly higher than resting 2 VO levels, t (24) = 15.5, p < .001. The calculated MET values ranged from 3.28 ± 0.71 METs to 3.43 ± 0.60 METs for the strength activities, and ranged from 4.98 ± 1.22 METs to 5.73 ± 1.36 METs for the aerobic Basic Run exercises, indicating that the intensity levels of these activities met or exceeded the ACSM moderate intensity threshold of 3 METs. In contrast, the yoga exercises were significantly lower (from 2.30 ± 0.42 METs to 2.6749 ± .48 METs) than the recommended 3 METs, t (24) = -3.347, p= .003 for moderate intensity physical activity. Finally, the results showed that the medium difficulty level aerobic exercises (5.73 ± 1.36 METs) had significantly higher MET values than the easy aerobic exercises (4.98 ± 1.22 METs), t (24) = 5.00, p < .001.

Discussion: The findings of this study illustrate the potential of the Nintendo Wii Fit® game to be an adequate physical activity tool. Furthermore, these findings will allow for the further advancement of exercise themed video games to become satisfactory replacements for traditional physical activities in future interventions.

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Wednesday, 25 April 2012

Interactive virtual reality Wii in geriatric day hospital: A study to assess its feasibility, acceptability and efficacy.

Geriatrics & Gerontology International
2012 Apr 2

Chan TC, Chan F, Shea YF, Lin OY, Luk JK, Chan FH. Source Department of Medicine, Division of Geriatrics, Queen Mary Hospital, The University of Hong Kong, Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong, China

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Aim:  Rehabilitation using interactive virtual reality Wii (Wii-IVR) was shown to be feasible in patients with different medical problems, but there was no study examining its use in a geriatric day hospital (GDH). The aim of the present study was to test the feasibility, acceptability and efficacy of Wii-IVR in GDH.

Methods:  It was a clinical trial with matched historic controls. Patients of a GDH were recruited to participate in Wii-IVR by playing "Wii Fit". Participants used a Wii controller to carry out movements involved in an arm ergometer. Each participant received eight sessions of Wii-IVR in addition to conventional GDH rehabilitation. Feasibility was assessed by the total time receiving Wii-IVR, the percentage of maximal heart rate reserve (%MHR) and Borg perceived exertion scale (BS) after participating in Wii-IVR. %MHR and BS were compared with those after carrying out an arm ergometer for the same duration. Acceptability was assessed by an interviewer-administered questionnaire. Efficacy was assessed by comparing improvements in Functional Independence Measure (FIM) between participants and matched historic controls, who received conventional GDH rehabilitations only.

Results:  A total of 30 patients completed the study. Participants completed a total of 1941 min of event-free Wii-IVR. The mean %MHR was 15.9% ± 9.9% and the mean BS was 7.9 ± 2.3. There was no significant difference in %MHR and BS between participating in Wii-IVR and arm ergometer. Most participants found Wii-IVR similar to the arm ergometer, and would like to continue Wii-IVR if they had Wii at home. Improvements in FIM of participants were significantly more than that of historic controls.

Conclusions:  Wii-IVR in GDH was feasible and most participants accepted it. Participants had more improvements in FIM.

Thursday, 5 April 2012

Comparison Between Nintendo Wii Fit Aerobics and Traditional Aerobic Exercise in Sedentary Young Adults

Douris, PC, McDonald, B, Vespi, F, Kelley, NC, and Herman, L.
Journal of Strength and Conditioning Research
26(4): 1052–1057, 2012

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Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit, an active video game console, vs. an equal duration of moderate-intensity brisk walking. Twenty-one healthy sedentary college-age students (mean age 23.2 ± 1.8 years) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit “Free Run” program. Physiologic parameters measured included heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants' positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii Fit (142.4 ± 20.5 b·min−1) was significantly greater (p = 0.001) compared with exercising on the treadmill (123.2 ± 13.7 b·min−1). Rate pressure product was also significantly greater (p = 0.001) during exercise on the Wii Fit. Participants' rating of perceived exertion when playing Wii Fit (12.7 ± 3.0) was significantly greater (p = 0.014) when compared with brisk walking on the treadmill (10.1 ± 3.3). However, psychologically when playing Wii Fit, participants' positive well-being decreased significantly (p = 0.018) from preexercise to postexercise when compared with exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate-intensity exercise when playing Nintendo Wii Fit “Free Run” with a self-selected intensity. We concluded that Nintendo Wii Fit “Free Run” may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.

© 2012 National Strength and Conditioning Association

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Wednesday, 4 April 2012

Clinical Use of Nintendo Wii(TM) Bowling Simulation to Decrease Fall Risk in an Elderly Resident of a Nursing Home: A Case Report

Journal of Geriatric Physical Therapy: 2009 - Volume 32 - Issue 4 - p 174–180 Case Report

 Authors: Clark, Robert PT, ; Kraemer, Theresa PT, PhD,

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Purpose:: Of the estimated 1.7 million residents of nursing homes in the United States, approximately half fall annually; and 11% of these sustain injury. This is twice the rate for persons dwelling in the community. By addressing fall risk, physical therapists have an opportunity to reduce falls which are the leading cause of injury deaths, as well as the most common cause of nonfatal injuries for older adults in the United States. This case report examines the effect of a novel interactive video game intervention to address balance dysfunction in an elderly resident of a nursing home who was at risk for falls.

Case Description:: The patient is an 89‐year‐old resident diagnosed with an unspecified balance disorder and a history of multiple falls. Self reports of gait abnormalities, scores on several clinical measures, and her fall history classified her as having substantial risk for future falls.

Intervention:: A nontraditional approach to balance training, employing the Nintendo Wii bowling simulation, was used as intervention for this patient's balance disorder.

Outcomes:: After 6 one‐hour treatment sessions, the patient's Berg Balance Score improved from 48 to 53. On the Dynamic Gait Index, the patient improved her score from 19 to 21. The patient's Timed Up and Go Test improved from 14.9 to 10.5 seconds, all suggesting a reduced risk of falling. The patient's ABC Score improved from 88 to 90%.

Conclusion:: Physical therapy intervention, using the Nintendo Wii bowling simulation, may have decreased fall risk for this individual.

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Saturday, 17 March 2012

Activity-promoting gaming systems in exercise and rehabilitation

Matthew J. D. Taylor, PhD; Darren McCormick, BSc; Teshk Shawis, MBChB, FRCP; Rebecca Impson,
MSc; Murray Griffin, PhD

Journal of Rehabilitation Research & Development
Volume 48, Number 10, 2011 Pages 1171–1186

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Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation.

Key words: activity-promoting, Dance Dance Revolution,
exercise, falls, games, gaming systems, injury, Nintendo Wii,
rehabilitation, Sony EyeToy, Xbox Kinect.

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Friday, 2 March 2012

Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii Balance Boards

Research in Developmental Disabilities, Volume 33, Issue 4, July–August 2012, Pages 983-989
Ching-Hsiang Shih, Man-Ling Chang
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The latest researches have adopted software technology to modify the Nintendo Wii Balance Board functionality and used it to enable two people with developmental disabilities to actively perform physical activities. This study extended the latest research of the Wii Balance Board application to assess whether four people (two groups) with developmental disabilities would be able to actively improve their physical activities collaboration – walking to the designated location following simple instructions, by controlling their favorite environmental stimulation through using three Nintendo Wii Balance Boards. We employed an A–B–A–B design, with A represented the baseline and B represented intervention phases. Data showed that both groups of participants significantly increased their collaborative target response (collaboratively performing designated physical activities) by activating the control system to produce their preferred environmental stimulation during the intervention phases. Practical and developmental implications of the findings are discussed.

-Commercial high-technology products can be used as high performance assistive devices.

-The Nintendo Wii Balance Board can be used as a high performance standing location detector.

-Four people (two groups) with developmental disabilities can control environmental stimulation through the Wii Balance Board by performing collaborative physical activities.

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Wednesday, 29 February 2012

ReWiiRe: Research for Wii Rehabilitation

Text taken from the ReWiire website

ReWiiRe stands for Research for Wii technology in Rehabilitation. The project aim is twofold. Firstly to investigate therapist use and the patient experience of using the Nintendo Wii console technology in physical rehabilitation programmes in four NHS Trusts across hospital and community settings.

Please click on the link below for comprehensive and detailed information about the project.

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Motor Control Outcomes Following Nintendo Wii Use by a Child With Down Syndrome

Case Study

Pediatric Physical Therapy: Spring 2012 - Volume 24 - Issue 1 - p 78–84

Berg, Patti PT, MA, MPT, NCS; Becker, Tiffany PT, DPT; Martian, Andrew PT, DPT; Danielle, Primrose Kimberly PT, DPT; Wingen, Julie PT, DPT

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Purpose: The purpose of this work was to examine motor outcomes following an 8-week intervention period of family-supported Nintendo Wii use by a child with a diagnosis of Down syndrome (DS).

Summary of Key Points: A 12-year-old child with a diagnosis of DS and with limited Wii exposure was asked to play Wii games in the home 4 times each week for 20 minutes each session for 8 weeks. Family members were encouraged to participate. The participant chose what games to play and selected 4 different games. Repeatedly practicing the skills involved in these games resulted in improvements in the child's postural stability, limits of stability, and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition balance, upper-limb coordination, manual dexterity, and running speed and agility standard scores.

Conclusions: Wii game use by a child with DS may elicit improvements in highly practiced motor skills and postural control.

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Tuesday, 28 February 2012

Home-based balance training programme using Wii Fit with balance board for Parkinsons’s disease: A pilot study

Journal of Rehabilation Medicine 2012 Feb;44(2):144-50.

Esculier JF, Vaudrin J, Bériault P, Gagnon K, Tremblay LE.
Faculty of Health Sciences, School of Rehabilitation, University of Ottawa, Québec, Canada.

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Objectives: To evaluate the effects of a home-based balance training programme using visual feedback (Nintendo Wii Fit game with balance board) on balance and functional abilities in subjects with Parkinson’s disease, and to compare the effects with a group of paired healthy subjects.

Subjects: Ten subjects with moderate Parkinson’s disease and 8 healthy elderly subjects.

Methods: Subjects participated in a 6-week home-based balance training programme using Nintendo Wii Fit and balance board. Baseline measures were taken before training for the Sit-to-Stand test (STST), Timed-Up-and-Go (TUG), Tinetti Performance Oriented Mobility Assessment (POMA), 10-m walk test, Community Balance and Mobility assessment (CBM), Activities-specific Balance and Confidence scale (ABC), unipodal stance duration, and a force platform. All measurements were taken again after 3 and 6 weeks of training.

Results: The Parkinson’s disease group significantly improved their results in TUG, STST, unipodal stance, 10-m walk test, CBM, POMA and force platform at the end of the 6-week training programme. The healthy subjects group significantly improved in TUG, STST, unipodal stance and CBM.

Conclusion: This pilot study suggests that a home-based balance programme using Wii Fit with balance board could improve static and dynamic balance, mobility and functional abilities of people affected by Parkinson’s disease.

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Monday, 27 February 2012

Wii Fit® training vs. Adapted Physical Activities: which one is the most appropriate to improve the balance of independent senior subjects? A randomized controlled study

Clinical Rehabilation 2012 Feb 9. [Epub ahead of print]

Toulotte C, Toursel C, Olivier N.
Universite Lille Nord de France, Faculte des sciences du sport et de l'education physique, France.

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Objective: To compare the effectiveness of three protocols (Adapted Physical Activities, Wii Fit(®), Adapted Physical Activities + Wii Fit(®)) on the balance of independent senior subjects. Design: Case comparison study.Settings: Healthy elderly subjects living in independent community dwellings. Subjects: Thirty-six subjects, average age 75.09 ± 10.26 years, took part in this study, and were randomly assigned to one of the four experimental groups: G1 followed an Adapted Physical Activities training programme, while the second group (G2) participated in Wii Fit(®) training and the third one (G3) combined both methods. There was no training for the fourth group (G4). All subjects trained once a week (1 hour) for 20 weeks and were assessed before and after treatment. Main measures: The Tinetti test, unipedal tests and the Wii Fit(®) tests. Results: After training, the scores in the Tinetti test decreased significantly (P < 0.05) for G1, G2 and G3 respectively in static conditions and for G1 and G3 in dynamic conditions. After training, the performance in the unipedal tests decreased significantly (P < 0.05) for G1 and G3. The position of the centre of gravity was modified significantly (P < 0.05) for G2 and G3. Conclusion: After 20 training sessions, G1 (Adapted Physical Activities), G2 (Wii Fit(®)) and G3 (Adapted Physical Activities and Wii Fit(®)) improved their balance. In addition, G1 and G3 increased their dynamic balance. The findings suggest that Adapted Physical Activities training limits the decline in sensorial functions in the elderly.

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Click for PubMed entry

Sunday, 26 February 2012

Using the Nintendo Wii as an Intervention in a Falls Prevention Group

Journal of American Geriatrics Society. 2012 Feb;60(2):385-7

Griffin M, Shawis T, Impson R, McCormick D, Taylor MJ.
Department of Biological Sciences, University of Essex.

No abstract is available for this article.

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Saturday, 25 February 2012

The Use of Nintendo Wii with Long-Term Care Residents

Journal of the American Geriatrics Society
Volume 59, Issue 12, pages 2393–2395, December 2011
Kirsten Brandt AB, Miguel A. Paniagua MD, FACP

No abstract available

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Stroke patients' experiences with Wii Sports® during inpatient rehabilitation

Scandinavian Journal of Occupational Therapy
Posted online on February 20, 2012
Authors: Dora Celinder & Hanne Peoples
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Introduction: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy in a controlled hospital setting.

Materials and methods: The study had a qualitative triangulation design that included semi-structured interviews and field notes. Nine Danish stroke patients participated, receiving between one and nine interventions with Wii Sports® during a three-week period. Responses were coded by qualitative content analysis.

Results: Analysis revealed one overarching category, “Connecting to past, present, and future occupations”, and three categories that encompassed patients' experiences with Wii: (i) variety, (ii) engagement, and (iii) obstacles and challenges. Interview findings were confirmed by field notes that included observations of engagement and challenges.

Discussion: Stroke patients in hospital settings may experience Wii Sports® as a beneficial and challenging occupation for both rehabilitation and leisure. Incorporation of Wii Sports® into conventional occupational therapy services may benefit patient rehabilitation directly or provide motivation for alternative leisure activities.

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Thursday, 2 February 2012

Video Games in Health Care: Closing the Gap

Review of General Psychology
2010, Vol. 14, No. 2, 113–121

Pamela M. Kato
University Medical Center Utrech

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Although a great deal of media attention has been given to the negative effects of playing video games,
relatively less attention has been paid to the positive effects of engaging in this activity. Video games in
health care provide ample examples of innovative ways to use existing commercial games for health
improvement or surgical training. Tailor-made games help patients be more adherent to treatment
regimens and train doctors how to manage patients in different clinical situations. In this review,
examples in the scientific literature of commercially available and tailor-made games used for education
and training with patients and medical students and doctors are summarized. There is a history of using
video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus
on making tailor-made games for different disease groups, which have been evaluated in scientific trials
more recently. Commercial video games have been of interest regarding their impact on surgical skill.
More recently, some basic computer games have been developed and evaluated that train doctors in
clinical skills. The studies presented in this article represent a body of work outlining positive effects of
playing video games in the area of health care.

Keywords: video games, interventions, technology, health

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