The effect of Nintendo Wii console on rehabilitation

The prevalence of serious neurological cases is increasing year after another. A prospective community-based study done in United Kingdome (UK) showed that the incidence of underlined neurological cases like Cerebral Palsy (CP), Multiple Sclerosis (MS), and Cerebro-vascular Accident (CVA) is about 0.6% of UK population in six years while 0.6% of the affected cases had recovered from the neurological case (Macdonald et. al 2000). Not only the neurological incidence has its remarkable effect on the patients and societies, but also the phase after it that is more challenging and time and money consuming. It has been revealed that up to 85% of stroke patients experience a stage of motor and sensory control loss that affects the quality of their life. (Sponik et al 2010).It was reported that a chronic need for intensive rehabilitation session is highly required for children with any neurological defects. (Golomb et al 2010). People with other neurological problems require different kinds of rehabilitation and treatment protocol including balance training, motor learning and sensory integration. The ideal rehabilitation protocol is known to have low feasibility, high affects and can extend into home and working areas. (Clark et al. 2010). It is also preferred to be amusing and motivating the patients while training. Therefore, a new system called Nintendo Wii console is being introduced and studied for rehabilitation from neurological problems. Wii, which is a home video gaming system, is based on engaging the patient into a 3-dimensional world and encouraging him or her to interact with this world. By this procedure, the patient will be achieving high levels of rehabilitation in a simple, low cost, and amusing way. For example, the patient will regain his motor control of upper limbs and lower limbs by playing basket ball or tennis in the virtual reality world by interacting with the wii console. Patient may also regain his or her balance and physical activities by playing a skate board game at the Wii Balance Board (WBB). (Deutsch et al 2009). In this report, the rationale of Nintendo Wii console will be presented, followed by the multi-usages of Wii console in rehabilitation from neurological problems. The report will summarize literature related to the effect of Wii on many neurological defects including stroke, cerebral palsy, balance problems, multiple sclerosis and aphasia. In particular, the report review some of the physiological and psychological effect of this gaming system when being introduced into medical intervention.

Body of knowledge:

Literature review:

As the medical intervention proceed to develop better and more efficient treatment protocols for better health and rehabilitation, advances in the world of technology could be used to achieve the same goal. The world of virtual reality (VR) and 3-dimensional world are first on the list of modern technology and as well, medical interventions. Virtual reality is a new computer technology that stimulates learning by engaging in a 3-dimensional semi-real life cooperated with visual, sensory or auditory feedback. (Sponik et al 2010). It has been noticed that the rationale behind VR is being used in medical field and physical therapy goals. It has been found that better and efficient outcomes could be achieved through engaging a patient into the VR world to perform a task that enhances his/her impairment, encouragement and motivation. (Sugarman, et al 2009). Based on the idea behind VR, a gaming system called (Wii) was invented and released at the end of 2006. (Loureiro et al. 2010). The commercially gaming system, Nintendo wii console, is reported as one of the top-selling video game which is easy to use interactive game. (Plow et al 2011). Many researches are interested on knowing the optimal effect of engaging the Nintendo Wii in a rehabilitation and treatment intervention. One of the Wii gaming systems, the Wiimote (fig. 1), was selected for study to be used in a medical field. The wiimote is hand held controller connected by the wii game with an-infrared camera. This connection allows the player to achieve tracking of the game showed on the computer screen by the hand motion that is holding the controller,stimulate the upper limb control and hence, treat impairments as shown in this research. (Decker et al 2009).

Fig. 1: the Wiimote hand held controller

Another wii- gaming system that engages a higher physical activity is the Wii Fit (fig. 2) . Wii fit is a game that interacts about 40 games including dancing, running, and yoga using a platform called the Wii Balance Board (WBB) which is placed on the floor controlling an on-screen action. The benefits of this game is not limited to its usage as a treatment for increasing the level of balance, strengthening, and general physical activities suiting all ages, (Plow et al 2011)., but also it is considered as an assessment tool for rating the balance level of the patients. The reason for this usage is that WBB consists of the transducers used to assess the force distribution and the Center Of Pressure (COP) movements. (Clark et al. 2010).

Fig 2. The Wii Fit game

The effect of Wii on stroke rehabilitation

Many studies have been conducted to the study the effectiveness of virtual reality (VR) as treatment and rehabilitation system for stroke and all kinds of cerebro-vascular accidents. The first randomized single blinded study with two parallel groups to compare the influence of virtual reality using Nintendo Wii & gaming technology (VRWii), versus recreational therapy (RT) on motor function of the upper extremity was conducted in Canada in 2010. Two groups of 18-85 years old participants and six-month from first-time stroke were included in the study. The first group had 8 intensive Wii 60-min sessions of over a 14 day period whereas the other group had a recreational therapy including playing pingo, playing cards and playing “jenga”. Measuring the Primary Safety and the efficacy outcomes using the Wolf Motor Function Test (WMFT) showed significant improvement of the post stroke patient’s upper limb function. (Sponik et al 2010). Another research studied the Wii- rehabilitation or (Wii-habilitation) among regaining the function of wrist extension and flexion prior to stroke and wrist fractures. Wiimote which was released by Nintendo as the hand held game controller for its sixth game console named the Wii. The Wiimote is held in the hand like a remote control that tracks motion and hand movement by an infrared (IR) camera. Based on the fact that the main reason of the lost flexion and extension of the wrist is due to the range of motion of each, the participants’ ROM was measured after and before the Wii training. It was concluded that the range of motion rehabilitation through the use of a Wiimote technology based system is very much feasible, effective, and inexpensive option. (Decker et al 2009). The usability of Nintendo Wii has been studied also in a pilot study at the Royal Berkshire NHS Foundation Trust Hospital. The study focused on the gaming and social interaction in the rehabilitation session upon all kinds of brain injuries including stroke, traumatic brain injuries (TBI), Berri Berri and korsakoff’s syndrome when using Nintendo Wii console. A sample of nine acute cases undergoing rehabilitation was selected to play with the Nintendo Wiimote games including bowling, golf, boxing and baseball. After a demonstration lecture provided by an occupational therapist to show them how to use the gaming system, each patient picked a suitable game and play for one session. Questionnaires were then provided to the participant to rate their opinion and self evaluation of the Wii-habilitation session. Analysis of the collected data found that there are significant positive feedbacks and comments and that Wii in general has a positive effect upon the brain injury rehabilitation. (Loureiro et al. 2010).

The effect of Wii on cerebral palsy

Talking about the importance of the visual reality and Wii-rehabilitation among the Cerebral Palsy (CP), a study was conducted in 2010 to study the outcomes and effectiveness of Wii. In this study, a 15-years old boy with hemiplegic CP and epilepsy, due to perfumed perinatal stroke, was kept under observation while spending 14 months virtual reality using videogame hand tele-rehabiltation intervention. The tele-rehabilitation system incorporated an Ultra Glove, a high-definition TV, a keyboard, and a PlayStation3 game console programmed with custom rehabilitation game. Measurements and outcomes of the hand function were measured using grip strength and the Jasben test for hand function. The Jasben test measures the different hand functions including writing, stimulated page turning, pick up small objects, simulated feeding, staking checkers, lifting large, light objects and lifting large and heavy objects. The study showed a significant increase and improvement in the child’s hand function after conducting a training course. (Golomb et al 2010). Another study was conducted to examine the use of a low-cost and commercially available gaming console (Wii) for rehabilitation of an Adolescent with CP. In this study, an adolescent with spastic diplegic CP classified as GMFCS level III,