Use of Nintendo(R) Wii(TM) During Postburn Rehabilitation: A Pilot Study

Journal of Burn Care & Research:
POST COPYEDIT, 5 October 2011
2011 Clinical Research Award: PDF Only

Yohannan, Sam K. PT, MS; Tufaro, Patricia OTR/L; Hunter, Hope PT; Orleman, Lauren SPT; Palmatier, Sara SPT; Sang, Canace SPT; Gorga, Delia I. PhD, OTR/L; Yurt, Roger W. MD, FACS

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Abstract
The purpose of this study was to demonstrate feasibility and measure outcomes on pain, anxiety, active range of motion (AROM), function, enjoyment, and presence (immersion into a virtual environment) with the adjunctive use of Nintendo(R) Wii(TM) (Nintendo of America Inc., Redmond, WA) during acute postburn rehabilitation. Participants were alternated and stratified based on the location of burn into Wii or control treatment groups. Joints of interest with limited AROM were the shoulder, elbow, wrist, hip, knee, and ankle. All participants received three consecutive sessions of passive range of motion and predetermined joint-specific exercises. This was followed by either designated Wii games or therapist-chosen interventions (control). The outcomes were compared between groups using t-tests (P < .05) and Cohen's d statistic. Data from 23 participants aged 20 to 78 years were analyzed. The difference in mean slopes suggested that the Wii group experienced less pain (x = -0.97, P = .07) than the control group over time. Overall, trends with anxiety (x = -0.11, P = .77), AROM (x = 0.55, P = .81), function (x = -0.38, P = .43), and enjoyment (x = 0.09, P = .73) seemed to improve at a faster rate in the Wii group. Presence minimally changed between successive treatment sessions for those in the Wii group. Although statistical significance was not reached in any category, feasibility was supported, and the overall pattern for outcomes was positive for the Wii group, the most favorable being for pain reduction. Future research with larger sample sizes is warranted to explore best practice with video game technology throughout the continuum of burn rehabilitation with appropriate prescriptions.

 (C) 2011 The American Burn Association

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

Journal of Burn Care & Research:
September/October 2010 - Volume 31 - Issue 5 - pp 768-775

Fung, Vera BSc, MSc PT; So, Ken MSc OT; Park, Esther MSc PT; Ho, Aileen BSc PT; Shaffer, Jennifer BSc PT; Chan, Elaine MSc OT; Gomez, Manuel MD, MSc

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Abstract
The objective of this study was to investigate perceptions of occupational therapists and physiotherapists on the use of Nintendo Wii™ (Nintendo of America Inc., Redmond, WA) 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 χ2 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.

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Virtual reality for stroke rehabilitation - Review

Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd

Kate E Laver, Stacey George, Susie Thomas, Judith E Deutsch, Maria Crotty

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Abstract


Background
Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness.

Objectives
To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke.

Search strategy
We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers.

Selection criteria
Randomised and quasi-randomised trials of virtual reality ('an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function.

Data collection and analysis
Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information.

Main results
We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. Primary outcomes: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. Secondary outcomes: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited.

Authors' conclusions
We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).

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Respiration Tracking Using the Wii Remote Game Controller

Studies in Health Technology and Informatics
Volume 169, 2011

Edited by Anne Moen, Stig Kjær Andersen, Jos Aarts, Petter Hurlen

Authors: J. Guirao Aguilar, J.G. Bellika, L. Fernandez Luque, V. Traver Salcedo

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ABSTRACT
Respiration exercises are an important part in the pulmonary rehabilitation of COPD (chronic obstructive pulmonary disease) patients. Furthermore, previous research has demonstrated that showing respiration pattern helps the patients to improve their breathing skills. We have developed a low cost and non-invasive prototype based on the Wii remote game controller infrared camera to provide BPM (breaths per minute) measurement as feedback. It can also be a comfortable solution without wires, batteries or any kind of electronics but just wearing passive markers. The lab evaluation with 7 healthy individuals showed that this approach is feasible when users are resting of their exercise. The BPM monitored during the tests presented less than 15% of maximum error and the RMSE (root mean square error) was lower than 6% in all the tests. Further research is needed to evaluate and adapt the system for COPD patients. In addition, more work is needed to develop applications that can be built to motivate and guide the users.

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Enabling people with developmental disabilities to actively perform designated physical activities with Nintendos Wii Balance Boards

Research in Developmental Disabilities
Volume 32, Issue 6, November-December 2011, Pages 2780-2784

Ching-Hsiang Shiha, Chiao-Chen Chunga, Ching-Tien Shihb, Ling-Che Chena

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Abstract The latest researches have adopted software technology turning the Nintendo Wii Balance Board into a high performance standing location detector. This study extended Wii Balance Board functionality to assess whether two people with developmental disabilities would be able to actively perform designated physical activities according to simple instructions by controlling their favorite environmental stimulation using Nintendo Wii Balance Boards. This study was carried out according to an A–B–A–B design. Data showed that both participants significantly increased their target response (performing a designated physical activity) by activating the control system to produce their preferred environmental stimulation during the intervention phases.


Highlights ► Commercial high-technology products can be modified in their default functions to be used as high performance assistive devices. ► The Nintendo Wii Balance Board can be used as a high performance standing location detector. ► Two people with developmental disabilities can control environmental stimulation through the Wii Balance Board by performing a designated physical activity.

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Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation

Research in Developmental Disabilities Volume 32, Issue 5, 
September-October 2011, Pages 2005-2010

Ching-Hsiang Shih, Chia-Ju Shih and Ching-Tien Shih

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The latest researches have adopted software technology by applying the Nintendo Wii Remote Controller to the correction of hyperactive limb behavior. This study extended Wii Remote Controller functionality for improper head position (posture) correction (i.e. actively adjusting abnormal head posture) to assess whether two people with multiple disabilities would be able to actively keep the upright head position by controlling their favorite stimulation using a Wii Remote Controller with a newly developed active head position correcting program (AHPCP). The study was performed according to an ABAB design, in which A represented the baseline and B represented intervention phases. Results showed that both participants significantly increased their time duration of maintaining upright head position (TDMUHP) to obtain the desired environmental stimulation during the intervention phases. Practical and developmental implications of the findings were discussed.
Highlights
Commercial high-technology products can be used as high-performance assistive devices. The Nintendo Wii Remote Controller can be used as a head posture detector. Two people with multiple disabilities can actively keep the upright head position through controlling their favorite stimuli by using a Wii Remote Controller.

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A Comparison of the Energy Cost of 6 Forms of Exergaming

Arch Pediatr Adolesc Med. 2011;165(7):597-602.

Bruce W. Bailey, PhD; Kyle McInnis, ScD

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Objective 
To determine the relative effect of interactive digital exercise that features player movement (ie, exergames) on energy expenditure among children of various body mass indexes (BMIs; calculated as weight in kilograms divided by height in meters squared).

Design Comparison study.
Setting GoKids Boston, a youth fitness research and training center located at University of Massachusetts, Boston.

Participants 
Thirty-nine boys and girls (mean [SD] age, 11.5 [2.0] years) recruited from local schools and after-school programs.

Main Exposure
Six forms of exergaming as well as treadmill walking.

Main Outcome Measures 
In addition to treadmill walking at 3 miles per hour (to convert miles to kilometers, multiply by 1.6), energy expenditure of the following exergames were examined: Dance Dance Revolution, LightSpace (Bug Invasion), Nintendo Wii (Boxing), Cybex Trazer (Goalie Wars), Sportwall, and Xavix (J-Mat). Energy expenditure was measured using the CosMed K4B2 portable metabolic cart.

Results
All forms of interactive gaming evaluated in our study increased energy expenditure above rest, with no between-group differences among normal (BMI < 85th percentile) and "at-risk" or overweight (BMI 85th percentile) children (P .05). Walking at 3 miles per hour resulted in a mean (SD) metabolic equivalent task value of 4.9 (0.7), whereas the intensity of exergaming resulted in mean (SD) metabolic equivalent task values of 4.2 (1.6) for Wii, 5.4 (1.8) for Dance Dance Revolution, 6.4 (1.6) for LightSpace, 7.0 (1.8) for Xavix, 5.9 (1.5) for Cybex Trazer, and 7.1 (1.7) for Sportwall. Enjoyment of the games was generally high but was highest for children with BMIs in the highest percentiles.

Conclusion 
All games used in our study elevated energy expenditure to moderate or vigorous intensity. Exergaming has the potential to increase physical activity and have a favorable influence on energy balance, and may be a viable alternative to traditional fitness activities for children of various BMI levels.

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Changes in physical activity and fitness after 3 months of home Wii Fit(TM) use

Journal of Strength & Conditioning Research:

25(11): 3191-3197, 

11 October 2011

Owens, SG, Garner III, JC, Loftin, JM, van Blerk, N, and Ermin, K.

Original Article: PDF Only

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Abstract 
The purpose of this study was to examine changes in physical activity and fitness variables in members of 8 volunteer families after 3 months of home use of the Wii Fit(TM) interactive video game. Pre and postintervention measurements were obtained from 21 subjects relative to physical activity (5 days of accelerometry), aerobic fitness (graded treadmill test), muscular fitness (push-ups), flexibility (sit-and-reach test), balance (composite equilibrium score), and body composition (body mass index and % body fat). Use characteristics of the Wii Fit(TM) device were also determined. A series of 2 (age group) x 2 (time) repeated measures analyses of variance were conducted to assess changes over time and between adults and children. Three months of home Wii Fit(TM) use revealed no significant age group x time interactions or main effects of group or time for daily physical activity, muscular fitness, flexibility, balance, or body composition. An age group x time interaction (p = 0.04) was observed in peak [latin capital V with dot above]O2 (ml[middle dot]kg-1[middle dot]min-1) with children displaying a significant (p = 0.03) increase after 3 months of Wii Fit(TM) use, whereas adults showed no significant (p = 0.50) change. Daily Wii Fit(TM) use per household declined by 82% (p < 0.01) from 21.5 +/- 9.0 min[middle dot]d-1 during the first 6 weeks to 3.9 +/- 4.0 min[middle dot]d-1 during the second 6 weeks. Most measures of health-related fitness in this exploratory study remained unchanged after 3 months of home use of the popular Wii Fit(TM) whole-body movement interactive video game. Modest daily Wii Fit(TM) use may have provided insufficient stimulus for fitness changes. 


 (C) 2011 National Strength and Conditioning Association 


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Is the Nintendo Wii Fit really acceptable to older people?: A discrete choice experiment

BMC Geriatrics 2011, 11:64

Kate Laver , Julie Ratcliffe , Stacey George , Leonie Burgess and Maria Crotty
Published: 20 October 2011

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Abstract (provisional)
Background Interactive video games such as the Nintendo Wii Fit are increasingly used as a therapeutic tool in health and aged care settings however, their acceptability to older people is unclear. The aim of this study was to determine the acceptability of the Nintendo Wii Fit as a therapy tool for hospitalised older people using a discrete choice experiment (DCE) before and after exposure to the intervention.

Methods A DCE was administered to 21 participants in an interview style format prior to, and following several sessions of using the Wii Fit in physiotherapy. The physiotherapist prescribed the Wii Fit activities, supervised and supported the patient during the therapy sessions. Attributes included in the DCE were: mode of therapy (traditional or using the Wii Fit), amount of therapy, cost of therapy program and percentage of recovery made. Data was analysed using conditional (fixed-effects) logistic regression.

Results Prior to commencing the therapy program participants were most concerned about therapy time (avoiding programs that were too intensive), and the amount of recovery they would make. Following the therapy program, participants were more concerned with the mode of therapy and preferred traditional therapy programs over programs using the Wii Fit.

Conclusions The usefulness of the Wii Fit as a therapy tool with hospitalised older people is limited not only by the small proportion of older people who are able to use it, but by older people's preferences for traditional approaches to therapy. Mainstream media portrayals of the popularity of the Wii Fit with older people may not reflect the true acceptability in the older hospitalised population.

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METs in Adults While Playing Active Video Games: A Metabolic Chamber Study

Medicine & Science in Sports & Exercise: June 2010 - Volume 42 - Issue 6 - pp 1149-1153 MIYACHI, MOTOHIKO; YAMAMOTO, KENTA; OHKAWARA, KAZUNORI; TANAKA, SHIGEHO +/- Click for more/less

Abstract Purpose: Active video game systems controlled through arm gestures and motions (Nintendo Wii Sports) and video games controlled through force plate (Wii Fit Plus) are becoming increasingly popular. This study was performed to determine the energy expenditure (EE) during Wii Fit Plus and Wii Sports game activities. Methods: Twelve adult men and women performed all the activities of Wii Sports (five activities: golf, bowling, tennis, baseball, and boxing) and Wii Fit Plus (63 activities classified as yoga, resistance, balance, and aerobic exercises). Each activity was continued for at least 8 min to obtain a steady-state EE. Because EE was assessed in an open-circuit indirect metabolic chamber consisting of an airtight room (20,000 or 15,000 L), subjects were freed of apparatus to collect expired gas while playing the games. MET value was calculated from resting EE and steady-state EE during activity. Results: The mean MET values of all 68 activities were distributed over a wide range from 1.3 METs (Lotus Focus) to 5.6 METs (single-arm stand). The mean MET values in yoga, balance, resistance, and aerobic exercise of Wii Fit Plus and Wii Sports were 2.1, 2.0, 3.2, 3.4, and 3.0 METs, respectively. Forty-six activities (67%) were classified as light intensity (<3 METs), and 22 activities (33%) were classified as moderate intensity (3.0-6.0 METs). There were no vigorous-intensity activities (>6.0 METs). Conclusions: Time spent playing one-third of the activities supplied by motion- and gesture-controlled video games can count toward the daily amount of exercise required according to the guidelines provided by the American College of Sports Medicine and the American Heart Association, which focus on 30 min of moderate-intensity daily physical activity 5 d·wk−1. Click for more details

Incorporating Gaming Technology into Athletic Injury Rehabilitation

Athletic Training & Sports Health Care March/April 2009 - Volume 1 · Issue 2: 79-84

David A. Middlemas, EdD, ATC; Jeffrey Basilicato, ATC; Michael Prybicien, MA, ATC; Joseph Savoia, MS, ATC; Jenna Biodoglio

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ABSTRACT
Rehabilitation of athletes presents challenges relating to proprioceptive training, reacquisition of sport-related skills, and maintaining the patient’s interest. Incorporation of video gaming technology into the rehabilitation process has been reported in physical therapy, stroke rehabilitation, geriatric exercise, and physical education. Reported feedback indicates that the technology is well received by patients. The purpose of this article is to present video gaming technology, such as the Nintendo Wii, as an alternative tool for clinicians to use in rehabilitation. We present examples of the use of video game activities from the Wii Sports software package in injury rehabilitation. The sport activities selected require patients to simulate athletic motions and skills while competing in the selected activity. In addition, examples of use of gaming activities with traditional balance and proprioceptive equipment are presented.

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Virtual reality for stroke rehabilitation: Review

Cochrane Database Syst Rev. 2011 Sep 7;9.
Laver KE, George S, Thomas S, Deutsch JE, Crotty M.
Department of Rehabilitation and Aged Care, Flinders University, Repatriation General Hospitals, Daws Road, Daw Park, Adelaide, Australia, 5041.
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Abstract
BACKGROUND:
Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness.

OBJECTIVES:
To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke.

SEARCH STRATEGY:
We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers.

SELECTION CRITERIA:
Randomised and quasi-randomised trials of virtual reality ('an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function.

DATA COLLECTION AND ANALYSIS:
Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information.

MAIN RESULTS:
We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. Primary outcomes: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. Secondary outcomes: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited.

AUTHORS' CONCLUSIONS:
We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).

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Making Things Possible: Technology plays a role in neurorehabilitation for stroke patients.

Rehab Management: The Interdisciplinary Journal of Rehabilitation Nov/Dec2010, Vol. 23 Issue 10, p10 3p.

By Sue Golden, PT, and Kathryn Sleazak, PT, MSc

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Abstract:
The article focuses on the applicability of innovative technologies in rehabilitating patients who have suffered from stroke. It highlights the technologies that can be applied in neurorehabilitation including e-stim foot drop device, computerized balance training and assessment equipment, and Tibion bionic leg robotic device. Furthermore, the technologies' benefits to several stroke patients are also mentioned.

A Kinect-based system for physical rehabilitation: A pilot study for young adults with motor disabilities.

Research in Developmental Disabilities. 2011 Jul 22. Chang YJ, Chen SF, Huang JD. Department of Electronic Engineering, Chung Yuan Christian University, Chung-Li, Taiwan
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Abstract This study assessed the possibility of rehabilitating two young adults with motor impairments using a Kinect-based system in a public school setting. This study was carried out according to an ABAB sequence in which A represented the baseline and B represented intervention phases. Data showed that the two participants significantly increased their motivation for physical rehabilitation, thus improving exercise performance during the intervention phases. Practical and developmental implications of the findings are discussed. Highlights ► To reduce staff intervention and enhance students’ motivation, interest, and perseverance to engage in physical rehabilitation, a Kinect-based system was employed with success. ► Single subject research design was used with two young adults who were diagnosed with motor disability. ► Data showed that the participants improve exercise performance during the intervention phases. Click here for more

The effects of single bouts of aerobic exercise, exergaming, and videogame play on cognitive control.

Clinical Neurophysiology. 2011 Aug;122(8):1518-25. Kevin C. O’Leary, Matthew B. Pontifex, Mark R. Scudder, Michael L. Brown, Charles H. Hillman Department of Kinesiology & Community Health, 317 Louise Freer Hall, 906 South Goodwin Avenue, University of Illinois, Urbana, IL 61801, USA

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Abstract Objective The effects of single bouts of aerobic exercise, exergaming, and action videogame play on event-related brain potentials (ERPs) and task performance indices of cognitive control were investigated using a modified flanker task that manipulated demands of attentional inhibition. Methods Participants completed four counterbalanced sessions of 20min of activity intervention (i.e., seated rest, seated videogame play, and treadmill-based and exergame-based aerobic exercise at 60% HRmax) followed by cognitive testing once heart rate (HR) returned to within 10% of pre-activity levels. Results Results indicated decreased RT interference following treadmill exercise relative to seated rest and videogame play. P3 amplitude was increased following treadmill exercise relative to rest, suggesting an increased allocation of attentional resources during stimulus engagement. The seated videogame and exergame conditions did not differ from any other condition. Conclusions The findings indicate that single bouts of treadmill exercise may improve cognitive control through an increase in the allocation of attentional resources and greater interference control during cognitively demanding tasks. However, similar benefits may not be derived following short bouts of aerobic exergaming or seated videogame participation. Significance Although exergames may increase physical activity participation, they may not exert the same benefits to brain and cognition as more traditional physical activity behaviors. Click here for more

Did too much Wii cause your patient’s injury?

The Journal of Family Practice - July 2011 · Vol. 60, No. 07: 404-409

Dorothy A. Sparks, MD, Lisa M. Coughlin, MD, Daniel M. Chase, MD

Motion-controlled game consoles like Wii may be used to play virtual sports, but the injuries associated with them are real. Here’s what to watch for—and a handy table linking specific games to particular injuries.

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Abstract
Motion-controlled game consoles like Wii may be used to play virtual sports, but the injuries associated with them are real. Here's what to watch for--and a handy table linking specific games to particular injuries.

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Feasibility and Benefit of Using the Nintendo Wii Fit for Balance Rehabilitation in an Elderly Patient Experiencing Recurrent Falls

JOURNAL OF STUDENT PHYSICAL THERAPY RESEARCH | 2010 VOLUME 2, NUMBER 1, ARTICLE 2

Tony Pigford, DPT
Director of Outpatient Physical Therapy, Duplin General Hospital – Kenansville, NC
A. Williams Andrews, PT, EdD, NCS
Associate Professor, Department of Physical Therapy Education, Elon University – Elon, N


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ABSTRACT
Introduction: The purpose of this case report was to examine whether a balance training program utilizing the
Nintendo Wii Fit platform could improve dynamic balance control in an elderly patient with balance impairments.
Also, the investigators sought to determine whether the motivational aspect of the video games would stimulate the
patient’s desire to participate in the balance rehabilitation program. Case Description: An elderly patient with a
recent history of falls underwent two weeks of balance training utilizing the Wii Fit platform along with other
traditional therapeutic interventions. Pre-intervention and post-intervention outcome measures were recorded. For
this report, the selected outcome measures were: Berg Balance Scale, Activities-specific Balance Confidence Scale,
Timed Up and Go, and gait speed. Outcomes: Post-intervention, the patient demonstrated improvements in all of
the selected balance outcome measures. During the intervention, the patient demonstrated a high level of
cooperation resulting in increased time spent performing balance activities. Conclusions: This case report gives
insight on how the Wii Fit was combined with more traditional physical therapy interventions to enhance an elderly
patient’s participation in the interventions and improve balance performance.

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On the use of the Wii Fit™ in reducing falling risk factors and improving balance for the elderly

Kinesitherapie Revue (KINESITHERAPIE REVUE), 2010 Nov(107): 41-5 (13 ref)

Grosjean, Aurélie ; Fabbri, Emmeline ; Feldheim, Eric ; Snoeck, Thyl ; Amand, Marc ; Keuterickx, Claude ; Balestra, Costantino

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Abstract
Background: The Nintendo® game console, called Wii Fit[TM], distinguishes itself from the other game consoles. In fact, it has many exercises that engage all body parts. We undertook this study to evaluate the usefulness of this type of game console by means of its included programs provided to improve balance and risk of falls among the elderly.

Method: The main evaluation tools that we used are specific tests for balance and walking, and the Nintendo® Wii Fit[TM] console. This study is based on a sample population of 21 people aged over 65 years (mean age: 85,67 ± 6,14 years) and divided into a control group and experimental group.

Results: Our results show a highly significant improvement between the control and experimental group after six weeks of training on the game console.

Level of evidence: 4 (Not randomized comparative study)

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Effects of an Interactive Video Game (Nintendo Wii™) on Older Women with Mild Cognitive Impairment

THERAPEUTIC RECREATION JOURNAL Vol,. XLIV, No. 4 • 271-287 • 2010

Elizabeth H. Weybright, CTRS
John Dattilo
Frank R. Rusch

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Abstract
Older adults with a cognitive impairment in residential care settings are often found
to be inactive throughout the day. Participation in video games holds promise for these
individuals; however, effects of video games played by older adults have not been studied
consistently and the few studies conducted have yielded mixed results. The purpose of
this study was to examine effects of an interactive video game (Nintendo Wii'" bowling)
on attention to task and positive affect of older adult women with mild cognitive impairment. A single-subject, multiple baseline design comparing a television viewing phase
and an interactive video game phase was conducted using observational measures. Results
indicated that both participants attended to task more and demonstrated higher levels of
positive affect while engaged in the interactive video game as compared to baseline. The
low-impact activity of the Nintendo Wii" bowling program may provide the appropriate amount of physical and mental challenge and stimulation for older adults with mild
cognitive impairments.

KEYWORDS: Interactive video game, mild cognitive impairment, older adult,
recreation

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Physical and Psychosocial Effects of Wii Video Game Use among Older Women

International Journal of Emerging Technologies and Society
Vol. 8, No. 2, 2010, pp: 85 – 98

Dennis Wollersheim, Monika Merkes, Nora Shields, Pranee Liamputtong, Lara Wallis,
Fay Reynolds and Lee Koh

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Abstract

This study investigated the physical and psychosocial effect of exergaming in community
dwelling older adult women. In a pilot study consisting of a six-week baseline period and a
six-week intervention period, participants (N = 11, mean age = 73.5 years, SD = 9.0) played
Nintendo Wii Sports twice weekly. We measured full body movements using accelerometers,
and assessed psychosocial effects through end-of-study focus group meetings. There were
large self-reported psychological effects related to positive changes in self perception. The
game-play deepened social connections within the group and provided a basis for shared
experiences with younger aged family members. Physically, the game-play showed
significantly higher maximum energy expenditure (t = -4.52, p < 0.05) than baseline, but no significant difference in overall energy expenditure. Findings from the quantitative data showed that Wii-play did not have substantial physical effects; nevertheless, qualitative data revealed that the participants perceived an improved sense of physical, social and psychological wellbeing.

Keywords: Wii – Older Women – Psychosocial Benefit – Australia – Exercise – Exergames

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Wii health: a preliminary study of the health and wellness benefits of Wii Fit on university students

The British Journal of Occupational Therapy, Volume 74, Number 6, June 2011 , pp. 262-268(7)

Authors: Jacobs, Karen; Zhu, Linda; Dawes, Monique; Franco, Jessie; Huggins, Alison; Igari, Cancha; Ranta, Becky; Umez-Eronini, Amarachi

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Abstract:

Objective: The aim of this preliminary study was to determine the effectiveness of the Nintendo Wii Fit as an occupation to promote weight loss in undergraduate students.

Participants: Five first-year female students living on campus at a northeastern university in the United States were recruited to participate in this study.

Method: An A-B single subject design was created where participants were separated into three groups: a typical activity group and two Wii conditions (Wii Fit individually and Wii Fit with another participant). In all conditions, participants recorded their daily food intake and daily number of steps using a pedometer. Body mass index (BMI) and weight were recorded at baseline, at 6 weeks and at 12 weeks (the conclusion of the intervention). At baseline and 12 weeks, motivation and activity level were measured.

Results: There was a significant change in BMI, weight and motivation for participants in the singles group.

Conclusion: Although the sample size was very small, the results of this preliminary study suggest that the Wii Fit should be considered by occupational therapists as a potential occupation of weight control in undergraduate students when performed individually.

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Potential Benefits of Nintendo Wii Fit Among People with Multiple Sclerosis A Longitudinal Pilot Study

International Journal of MS Care. 2011;13:21–3

Matthew Plow, PhD; Marcia Finlayson, PhD, OT(C), OTR/L

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Abstract

We examined the potential of Nintendo Wii Fit (Nintendo Co, Ltd, Kyoto, Japan) to increase physical activity (PA) behavior and health among people with multiple sclerosis (MS). The study consisted
of a repeated-measures design with a baseline control period and involved 30 people with MS who
had the ability to walk 25 feet with or without a cane (26 individuals were included in the analyses).
Nintendo Wii was set up in the homes of participants, who were prescribed a Wii Fit exercise program lasting 14 weeks, 3 days a week. The Physical Activity and Disability Survey, Modified Fatigue
Impact Scale, and 36-item Short Form Health Status Survey were administered three times before
participants gained access to Wii Fit (control period, at 2-week intervals), and three times after they
received Wii Fit (posttest 1: immediately after; posttest 2: 7 weeks after; posttest 3: 14 weeks after).
Mobility, balance, strength, and weight were assessed at the first pretest, immediately prior to obtaining access to Wii Fit, and 7 weeks after obtaining access to Wii Fit. Results from the questionnaires
indicated that PA significantly improved at week 7, but at week 14, PA levels declined relative to week
7 and the difference was no longer significant compared with the control period. Physical assessments
indicated that balance and strength significantly improved at week 7. One adverse event was reported
(repetitive knee injury). Physical assessments indicated that people with MS may be able to improve
their fitness levels by using Wii Fit. Future studies should incorporate behavior change strategies to
promote long-term use of Wii Fit, and explore whether individuals with more severe symptoms of MS
can safely use Wii Fit.

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Active Video Gaming to Improve Balance in the Elderly

Studies in Health Technology and Informatics 2011;167:159-64.

Claudine J.C. Lamoth, Simone R. Caljouw, Klaas Postema


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ABSTRACT
The combination of active video gaming and exercise (exergaming) is suggested to improve elderly people's balance, thereby decreasing fall risk. Exergaming has been shown to increase motivation during exercise therapy, due to the enjoyable and challenging nature, which could support long-term adherence for exercising balance. However, scarce evidence is available of the direct effects of exergaming on postural control. Therefore, the aim of the study was to assess the effect of a six-week videogame-based exercise program aimed at improving balance in elderly people. Task performance and postural control were examined using an interrupted time series design. Results of multilevel analyses showed that performance on the dot task improved within the first two weeks of training. Postural control improved during the intervention. After the intervention period task performance and balance were better than before the intervention. Results of this study show that healthy elderly can benefit from a videogame-based exercise program to improve balance and that all subjects were highly motivated to exercise balance because they found gaming challenging and enjoyable.

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Energy expenditure in chronic stroke patients playing Wii Sports: a pilot study

Journal of Neuroengineering and Rehabililtation. 2011; 8: 38.
Published online 2011 July 14

Henri L Hurkmans, Gerard M Ribbers, Marjolein F Streur-Kranenburg, Henk J Stam, and Rita J van den Berg-Emons

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ABSTRACT:

BACKGROUND:

Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing.

METHODS:

Ten chronic (≥ 6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (> 6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines.

RESULTS:

Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean (± SD) energy expenditure during Wii Sports game play was 3.7 (± 0.6) METs for tennis and 4.1 (± 0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures > 3 METs.

CONCLUSIONS:

With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.

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Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: A pilot study

Lupus. 2011 Jun 23

Yuen H, Holthaus K, Kamen DL, Sword D, Breland HL.

University of Alabama at Birmingham, USA.

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Abstract

Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study was to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-post test design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level, and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (p= 0.002), and body weight and waist circumference were significantly reduced (pp= 0.01). In addition, anxiety level, as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience, as measured by Short-form of the McGill Pain Questionnaire, were also significantly reduced (p < 0.05). Findings provide preliminary evidence that the Wii Fit motivates this population to exercise, which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience.

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Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

Trials. 2011; 12: 155.
Published online 2011 June 18

Boon Chong Kwok, Kaysar Mamun, Manju Chandran and Chek Hooi Wong

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Abstract

Background
Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline.

Methods
This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments.

Discussions
The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.


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‘Wii-habilitation’ and robotic exoskeletons: technology in physiotherapy - 2010

Royal College of Surgeons in Ireland Student Medical Journal 2010; 3: 70-74.

Aideen Henry(1), Aileen Barrett(2)

Author affilitations
1RCSI physiotherapy student
2Practice Education Co-ordinator, School of Physiotherapy, RCSI

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Abstract
For mobility-impaired patients, gait retraining is an integral part of the rehabilitation programme. Manual assisted body weight support treadmill training (BWSTT) has been a major focus of research and is considered one of the primary methods of gait retraining. In recent years the focus of research has shifted to robotic assisted treadmill training, which is as efficacious as manual assisted BWSTT but is considered more cost-effective with respect to personnel and labour. The Lokomat® is a machine that provides robotic assisted treadmill training by means of a robotic gait orthosis, body weight support system and treadmill. Manufactured by Hocoma in Switzerland, it has been the subject of intense media attention since it was introduced to the US in 2001. Similar attention has been given to the Nintendo WiiTM gaming system for its potential role in rehabilitation. Although not specifically designed for use in the medical arena, the Nintendo WiiTM has been linked with functional rehabilitation benefits in a variety of patient groups. The aim of this paper is to review the clinical applications of the Lokomat® and Nintendo WiiTM, and to provide an analysis of the advantages and disadvantages associated with each as a physiotherapy modality in rehabilitation.

Keywords: Physiotherapy, treadmill training, Lokomat®, virtual reality, Nintendo WiiTM, gait re-education.

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Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation. May 2011

Res Dev Disabil.

2011 May 19.

Shih CH, Shih CJ, Shih CT.

Source: Department of Special Education, National Dong Hwa University, Hualien 970, Taiwan, ROC

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Abstract
The latest researches have adopted software technology by applying the Nintendo Wii Remote Controller to the correction of hyperactive limb behavior.
This study extended Wii Remote Controller functionality for improper head position (posture) correction (i.e. actively adjusting abnormal head posture) to assess whether two people with multiple disabilities would be able to actively keep the upright head position by controlling their favorite stimulation using a Wii Remote Controller with a newly developed active head position correcting program (AHPCP).
The study was performed according to an ABAB design, in which A represented the baseline and B represented intervention phases.
Results showed that both participants significantly increased their time duration of maintaining upright head position (TDMUHP) to obtain the desired environmental stimulation during the intervention phases.
Practical and developmental implications of the findings were discussed.

Copyright © 2011 Elsevier Ltd. All rights reserved.

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Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study - April 2011

Physiotherapy : Available online 29 April 2011.

Hamid Bateni

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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Abstract

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.

Keywords: Wii Fit; Postural balance; Berg Balance Scale; Computerised gaming systems

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Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. May 2011

Journal of Neuroengineering Rehabilitation.

2011 May 23;8(1):30

Gil-Gomez JA, Llorens R, Alcaniz M, Colomer C.

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ABSTRACT:

BACKGROUND:
Acquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo Wii Balance Board (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance.

METHODS:
In this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n=9) versus standard rehabilitation (n=8). Effectiveness was evaluated by means of traditional static and dynamic balance scales.

RESULTS:
The final sample consisted of 11 men and 6 women. Mean+-SD age was 47.3+-17.8 and mean+-SD chronicity was 570.9+-313.2 days. Patients using eBaViR had a significant improvement in static balance (p=0.011 in Berg Balance Scale and p=0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group.

CONCLUSIONS:
The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed.

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Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards - May 2011

Gait Posture.

2011 May 11.

Clark RA, McGough R, Paterson K.

Source: Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, 202 Berkeley Street, Parkville, VIC 3010, Australia.

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Abstract
Weight bearing asymmetry (WBA) during dynamic tasks is prevalent in a variety of clinical populations. However, accurate measurement has previously been out of reach of the clinician due to the costly equipment and technical expertise required.

The aim of this study was to assess the test-retest reliability of WBA data obtained using an inexpensive and simple to use dual force plate system incorporating unmodified Nintendo Wii Balance Boards (NWBB) and customized software. A secondary outcome measure, individual limb COP path velocity, which represents the postural sway under each limb was also examined.

Twenty-three participants performed squats both with and without visual WBA feedback on two separate occasions. Weight-bearing asymmetry as a percentage of body mass and individual limb center of pressure (COP) path velocity were recorded during these trials, with intraclass correlation coefficient (ICC(2,1)) analysis performed to assess test-retest reliability. This system provided reliable values for both outcome measures when performed with and without real-time visual feedback of WBA (ICC(2,1) range=0.75-0.91).

In conclusion, recording WBA and COP path velocity data using NWBB is reliable. Given that tens of millions of NWBB have been sold worldwide, and that reprogramming them for clinical purposes is within the reach of most software developers, similar systems may soon become commonplace in the clinical setting.

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Wii-based movement therapy to promote improved upper extremity function post-stroke: A pilot study May 2011

Journal of Rehabilitation Medicine. 2011 May;43(6):527-33.

Mouawad MR, Doust CG, Max MD, McNulty PA.
Source

Neuroscience Research Australia and University of New South Wales.

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Abstract

BACKGROUND:

Virtual-reality is increasingly used to improve rehabilitation outcomes. The Nintendo Wii offers an in-expensive alternative to more complex systems.

OBJECTIVE:

To investigate the efficacy of Wii-based therapy for post-stroke rehabilitation.

METHODS:

Seven patients (5 men, 2 women, aged 42-83 years; 1-38 months post-stroke, mean 15.3 months) and 5 healthy controls (3 men, 2 women, aged 41-71 years) undertook 1 h of therapy on 10 consecutive weekdays. Patients progressively increased home practice to 3 h per day.

RESULTS:

Functional ability improved for every patient. The mean performance time significantly decreased per Wolf Motor Function Test task, from 3.2 to 2.8 s, and Fugl-Meyer Assessment scores increased from 42.3 to 47.3. Upper extremity range-of-motion increased by 20.1º and 14.33º for passive and active movements, respectively. Mean Motor Activity Log (Quality of Movement scale) scores increased from 63.2 to 87.5, reflecting a transfer of functional recovery to everyday activities. Balance and dexterity did not improve significantly. No significant change was seen in any of these measures for healthy controls, despite improved skill levels for Wii games.

CONCLUSION:

An intensive 2-week protocol resulted in significant and clinically relevant improvements in functional motor ability post-stroke. These gains translated to improvement in activities of daily living.

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The cardiovascular and metabolic responses to Wii Fit video game playing in middle-aged and older adults Dec 2010

The Journal of Sports Medicine and Physical Fitness
2010 December;50(4):436-42 
Guderian B. 1, Borreson L. A. 1, Sletten L. E. 1, Cable K. 1, Stecker T. P. 1, Probst M. A. 1, Dalleck L. C. 2

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Abstract
AIM: The purpose of this study was (a) to assess the cardiovascular and metabolic responses to Wii Fit video games and (b) to determine if Wii Fit video games meet the American College of Sports Medicine guidelines for improving and maintaining cardiorespiratory fitness.
METHODS: Twenty men and women (mean±SD age, height, and weight: = 58.1±8.8 years, 172.1±10.5 cm, 87.1±22.8 kg, respectively) completed a 20-min Wii Fit testing session consisting of six separate aerobic and balance games. Cardiovascular and metabolic data were collected via a portable calorimetric measurement system.
RESULTS: Mean relative exercise intensity was 43.4±16.7% of heart rate reserve. Absolute exercise intensity in metabolic equivalents (METS) was 3.5±0.96. Total net energy expenditure for the Wii Fit video game playing session was 116.2±40.9 kcal/session.
CONCLUSION: Results indicate that playing Wii Fit video games is a feasible alternative to more traditional aerobic exercise modalities for middle-aged and older adults that fulfills the American College of Sports Medicine guidelines for improving and maintaining cardiorespiratory fitness.

Link to article

The Reliability and Preliminary Validity of Game-Based Fall Risk Assessment in Community-Dwelling Older Adults.

Geriatric Nursing
2011 Apr 16. [Epub ahead of print]
Yamada M, Aoyama T, Nakamura M, Tanaka B, Nagai K, Tatematsu N, Uemura K, Nakamura T, Tsuboyama T, Ichihashi N.

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Abstract
The purpose of this study was to examine whether the Nintendo Wii Fit program could be used for fall risk assessment in healthy, community-dwelling older adults. Forty-five community-dwelling older women participated in this study. The "Basic Step" and "Ski Slalom" modules were selected from the Wii Fit game program. The following 5 physical performance tests were performed: the 10-m walk test under single- and dual-task conditions, the Timed Up and Go test under single- and dual-task conditions, and the Functional Reach test. Compared with the faller group, the nonfaller group showed a significant difference in the Basic Step (P < .001) and a nonsignificant difference in the Ski Slalom (P = .453). The discriminating criterion between the 2 groups was a score of 111 points on the Basic Step (P < .001). The Basic Step showed statistically significant, moderate correlations between the dual-task lag of walking (r = -.547) and the dual-task lag of the Timed Up and Go test (r = -.688). These results suggest that game-based fall risk assessment using the Basic Step has a high generality and is useful in community-dwelling older adults.

Copyright © 2011 Mosby, Inc. All rights reserved.

PubMed link

Geriatric Nursing journal link

Metabolic responses to wii fit™ video games : March 2011

Journal of Strength and Conditioning Research. 2011 Mar;25(3):689-93.
Metabolic responses to wii fit™ video games at different game levels.
Worley JR, Rogers SN, Kraemer RR.

Department of Kinesiology and Health Studies, Southeastern Louisiana University, Hammond, Louisiana


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From Pubmed

Abstract

-The Wii Fit™ is a form of interactive gaming designed to elicit health and fitness benefits to replace sedentary gaming.
This study was designed to determine the effectiveness of Wii Fit™ fitness games. The purpose of the study was to determine the %&OV0312;O2max and energy expenditure from different Wii Fit™ games at different levels including the step and hula games. Eight healthy young women completed a preliminary trial to determine &OV0312;O2max and later played the Wii Fit™ during 2 separate counterbalanced trials. During each session, subjects played levels of Wii Fit™ games for 10 minutes each level. One session involved beginning and intermediate hula, and the other session involved beginning and intermediate steps. The &OV0312;O2 was measured continuously via metabolic cart, and rating of perceived exertion (RPE) was assessed at the end of each game level. The lowest %&OV0312;O2max, kcal·min, and RPE occurred during the beginning step game and the highest values occurred during the intermediate hula game. Respiratory exchange ratio was significantly higher in the intermediate hula than beginning hula game but was not significantly different between step game levels. The intermediate hula and step games produced the greatest energy expenditure with an equivalent effect of a walking speed of >5.63 km·h (>3.5 miles·h). This is the first study to determine the percentage of &OV0312;O2max and caloric expenditure elicited by different Wii Fit™ video games at different game levels in adults. Findings suggest that the Wii Fit™ can be used as an effective activity for promoting physical health in this population.

Link to Pubmed reference

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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Abstract
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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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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Abstract
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
EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY Volume 111, Number 7, 1465-1472

Previously:
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, jordanm1@tcd.ie.

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Abstract
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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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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Abstract
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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Abstract
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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Abstract
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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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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Abstract
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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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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Abstract
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.

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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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Abstract

Background
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.

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.

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Exergaming Evidence Base

Wiki webpage of exergaming research.

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