Post on 14-May-2018
transcript
3/11/2010
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Wii For Me
Applications for the use of Wii
Mary Saylor, MPT: mary.saylor@aegistherapies.com
Rebecca Setaro, OTR/L: rebecca.setaro@aegistherapies.com
Lynn Freeman, PT/MS/WCC: lynn.freeman@aegistherapies.com
Barb Christensen, OTR: barb.christensen@aegistherapies.com
Nintendo Wii™ Gaming System
Wii Sports Starter package
Accessories
Games
Memory card(s)
Wii remote
Wii Fit
Precautions/Safety Concerns
Fall prevention
Use of wrist strap
Monitoring vital signs
Physician clearance
Pacemakers
Seizure disorders
Wii Fit weight limitations
Benefits of Wii Gaming
Wii game participation improve
Balance & posture
Strength, range of motion (ROM), &
coordination
Problem solving & decision making
Cognition & attention span
Balance & Posture
Wii Sports
Wii FitBalance tests
Weight shifting activitiesTable tilt
Bubble course
Soccer ball heading
Penguin slide
Snowboarding/skiing
Yoga
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Strength, ROM, & Coordination
Wii Fit
Strength training
Yoga
Hula hoop
Tightrope
Step aerobics
Rhythm boxing
Problem Solving & Decision Making
Wii Fit
Wii Sports
Wii Resort
Photo Channel
Puzzles
Drawing
Cognition and Attention span
Mii Development
Wii Fit
Wii Sports
Wii Resort
Photo Channel
Puzzles
Drawing
Modifications
Activity planning
Intensity
Upper extremity activities, lower extremity activities, upper & lower extremity activities
Number of players
Wii remote accessories
Use of assistive devices
Modifications of floor surface
Sitting vs standing
Allen Cognitive Disability Model
Regardless of the activity in question,
we want to provide residents with successful experiences.
We need a model and tools which help determine not what a resident
can’t do, but what they can do.
Allen Cognitive Disability Model
The Allen Cognitive Disability Model helps identify the severity of the cognitive deficit of a person.
It measures cognitive ability and then classifies it in to 6 different levels.
The cognitive level is a measure of what the person can do.
Knowing the cognitive level of function, helps us with realistic goal setting for our residents.
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Allen Model cont.
A hierarchical scale of 0 to 6 where level 0 indicates profound cognitive deficit and 6 indicates normal cognitive functioning.
Allen levels 4,3 and 2 map to the early, middle and late stages of dementia, respectively.
The 6 levels are further classified in to 26 performance modes.
Early, Middle and Late
It’s helpful to start with the
classifications of early, middle and late stages of Dementia.
Once determined, this will help caregivers to establish programs
based upon the resident’s abilities.
Early Stage Dementia
Relies on procedural memory to make associations for new learning.
Capable of new learning related to things that are important to them.
Responds well to structure and routine.
Understands left/right and back/front.
Often very social
Needs cues for thoroughness
Activity is goal directed
Early Stage Dementia
In this stage of dementia, electronic gaming could be a viable activity.
The repetitive nature of the movements and the familiarity of some of the activities would ensure success for many.
The movements of many of the games could also assist with balance issues and falls prevention.
Middle Stage Dementia
At the stage repetitive actions and the
handling of objects are seen.
Manual actions are prevalent but
often random
Visual field of 12-14 inches
Follows one step directions
Frequent or constant cues are
needed.
Middle Stage Dementia
The desire to hold and manipulate
objects could make some aspects of electronic gaming successful.
The limited visual field and limited attention span would require
adaptations to most gaming
programs.
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Late Stage Dementia
Postural insecurity with a fear of
falling.
Cognitive processing is 2-3 times
slower.
Generally enjoys reciprocal
movement.
Responds better to visual cues
Becomes agitated if hurried.
Late Stage Dementia
The intense visual cues of some
electronic games may appeal to this resident.
Postural concerns and severely limited attention span may interfere
with this being a successful endeavor.
However, observing the game may be enjoyable.
References For Allen Tools
Allen, C.K. (1999). Structures of the cognitive performance modes. Ormond Beach, FL: Allen Conferences, Inc.
Allen, C.K., & Blue, T. (1995). Understanding the modes of performance. Ormond Beach, FL: Allen Conferences, Inc.
Earhart, C. (2006). Allen diagnostic module manual (2nd edition). Colchester, Connecticut: S&S Worldwide.
Howell, T. (1998) An interdisciplinary approach to using the model of cognitive disability. Workshop. West Palm Beach Florida
Clinical Benefits of Wii
Increased motivation
Promotes healthy competition and camaraderie
Increased confidence/sense of
accomplishment
Family involvement
Improved strength, endurance, function, motor planning, cognition, hand-eye
coordination, balance, reaction time
Early Stage Dementia & Wii Use
Develop Mii
Single or multiple players
New or familiar activities
Improved ability for button and arm
movement coordination
Middle Stage Dementia & Wii Use
May need assistance to develop Mii
Multiple player activities may be more
difficult
New activities may be more difficult
Decreased ability for button and arm movement coordination
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Late Stage Dementia & Wii Use
Increased difficulty with timed/scored
activities
Single player activity
Rely on familiarity of task or image
Limited ability for button and arm movement coordination
Bowling examples for early, middle,
and late stage dementia
EarlyManual Mode
Optional features (100 pin, barriers in path, etc)
MiddleAutomatic mode
Traditional 10 pin
LatePhoto channel bowling options
Documentation in the clinical setting
Recommended documentation componentsActivity performedAssistance level (physical assistance and cueing)Score achieved or duration toleratedVital signs (if applicable)Frequency of useIndividual’s response to treatmentClinical rationale for activity/treatment
GoalsCombine desired Wii performance with anticipated functional outcome
Case Studies
Gladys
Jim
Ruth
Research Review
Allen D. You're never too old for a Wii. Nurs Older People. 2007 Oct;19(8):8.
The “proof” is in
the evidence…
“You’re Never too old for a Wii”
Evidence
Epidemiology/Impact68% of American households have gaming consoles in their home1
More than 25% of gamers are age 50 and over1
Nursing home chains and senior centers now offer health gaming as part of their programming2
Over 85% of games on market are labeled “E” = Everyone3
Gaming industry has evolved to include a new area of research called “Health Games”4
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EvidenceEpidemiology/Impact
Cognitive rehabilitation improves functional performance5
“Adding a treatment regiment that stimulates cognitive function might further enhance functional level or prevent decline of functional status compared with an exercise intervention alone”5
Commercially available health games can provide cognitive stimulation and potentially increase an older adults physical activity levels5
EvidenceCurrent and Future Research
Most published studies are in pediatric or adolescent care6-9
Funding for gaming projects in senior care10
– Interactive Games for Individuals with Chronic Mobility and Balance Deficits Post-Stroke USC
– Seniors Cyber-Cycling with a Virtual Team:
Effects on Exercise Behavior,
Neuropsychological Function, and Physiological Outcomes at Union College
– Action Games to Improve Cognitive Function in
Older Adults University of Florida
– Game to Enhance Cognitive Health in Older
Adults at University of California, San Francisco
EvidenceCurrent and Future Research
Brains of Expert Video Gamers
Improve hand-eye coordination24
Increased processing in the periphery25
Greater divided attention abilities
Faster reaction times26
Enhanced contrast sensitivity27
Improved visual processing (attentional blink) (multiple object tracking Paradigm)28
EvidenceCurrent and Future Research
Training with Action Video Games can enhance
Visuo-spatial attention25
Dynamics of visual attention25
Number of objects of attention29
Video game players have faster reaction time26
Integrate sensory information more efficiently
EvidenceCurrent and Future Research
Wii
Individuals in their 90s and 100s are using the system11
The most popular senior game is bowling6
Early publications focused on overuse injuries in youths12-15
Three recent publications (2 case reports and pilot study) demonstrated improvements with strength, balance, and fall risk in older adults16-18
Erickson Living/Nintendo “Bowling Championships”
EvidenceCurrent and Future Research
Wii
Funded studies (NIH and Medical College of Georgia)
– Wii Mote reliability and validity19
– Wii gaming vs recreational activity stroke rehab20
– Effect of Wii on movement and depression in
Parkinson’s21
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Efficacy
Ten (10) women ages 30-58 with balance and QOL
limitations received pre-programmed Wii Fit regimes
determined for age and physical ability or a sham treatment for 30 minutes, 2 times weekly, for 10 weeks.
Balance and lower limb muscle strength showed
significant improvement. CV endurance, mobility,
weight change, activity level and well-being were not
clinically, but not statistically significant. Authors report
the need to confirm findings through statistically powered studies. 17
Efficacy
89 year old female with unspecified balance disorder
resulting in multiple falls. Hx included controlled bipolar
disease and schizophrenia. Intervention consisted of 6 one hour Wii bowling simulation sessions over a 2
weeks. Game aligned meaningful recreation with
rehab of impaired physiological systems (visual,
somatosensory, vestibular). Subject played 2 games
per session competing against the investigator. Berg
Balance Scale improved from 48 to 53, Dynamic Gait Index improved from 14.9 to 10.5 seconds, and
Activities-specific Balance Confidence score improve
from 88 to 90%. Subjects overall fall risk was reduced
by 30-40% and likelihood of falling decreased by 12-
16%.16
Other Systems for Older Adults
DanceTown
Slower dance steps and grab bars
Incorporates valid, senior-specific
assessments
Senior Fitness Test
Timed Up and Go
Tinetti
Six Minute Walk Test
Generates performance reports
Its precursor, Dance, Dance, Revolution, is
equivalent to moderate intensity walking in children 6-9, 22
Other Systems for Older Adults
DanceTown
References1. Gaudiosi J. Health Games Become Serious Business.
Reuters.com, 2009.
2. Gaudiosi J. Health games become serious business. Reuterscom. 2009
3. Allen D. You're never too old for a wii. Nurs Older People.
2007;19 (8)
4. Essential facts about the computer and software gaming
industry. Entertainment Software Association; 2008.
5. Shubert TE. The use of commercial health video games to promote physical activity in older adults. Annals of Long-
Term Care Clinical Care and Aging. 2009;In Press:1-15
6. Morala DT, Shiomi T, Maruyama H. Factors associated
with the functional status of community-dwelling elderly. J Geriatr Phys Ther. 2006;29:101-106
References7. Graf DL, Pratt LV, Hester CN, Short KR. Playing active
video games increases energy expenditure in children. Pediatrics. 2009
8. Lanningham-Foster L, Jensen TB, Foster RC, Redmond
AB, Walker BA, Heinz D, Levine JA. Energy expenditure
of sedentary screen time compared with active screen time for children. Pediatrics. 2006;118:e1831-1835
9. Sell K, Lillie T, Taylor J. Energy expenditure during
physically interactive video game playing in male college
students with different playing experience. J Am Coll Health. 2008;56:505-511
10. Maloney AE, Bethea TC, Kelsey KS, Marks JT, Paez S,
Rosenberg AM, Catellier DJ, Hamer RM, Sikich L. A pilot
of a video game (ddr) to promote physical activity and decrease sedentary screen time. Obesity (Silver Spring).
2008;16:2074-2080
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References11. Health games research: Advancing the effectiveness of
interactive games for health. http://www.healthgamesresearch.org/. Accessed January
30, 2010.
12. Parker A. Oaps say nurse, i need a wii. The Sun. 2007
13. Sparks D, Chase D, Coughlin L. Wii have a problem: A
review of self-reported wii related injuries. Inform Prim Care. 2009;17:55-57
14. Robinson RJ, Barron DA, Grainger AJ, Venkatesh R. Wii
knee. Emerg Radiol. 2008;15:255-257
15. Bhangu A, Lwin M, Dias R. Wimbledon or bust: Nintendo
wii related rupture of the extensor pollicis longus tendon. J Hand Surg Eur Vol. 2009;34:399-400
16. Peek AC, Ibrahim T, Abunasra H, Waller D, Natarajan R.
White-out from a wii: Traumatic haemothorax sustained
playing nintendo wii. Ann R Coll Surg Engl. 2008;90:W9-10
References17. Clark R, Kraemer T. Clinical use of nintendo wii bowling
stimulation to decrease fall risk in an elderly resident of a nursing home: A case report. J Geriatr Phys Ther.
2009;32:174-179
18. Nitz JC, Kuys S, Isles R, Fu S. Is the wii fit a new-
generation tool for improving balance, health and well-being? A pilot study. Climacteric. 2009
19. Nichols B. Case review: Use of the nintendo wii fit and
outdoor challenge for rehabilitation of an elderly female
patient with age-related balance impairments. J Geriatr Phys Ther. 2009;33 (3):123
20. Wiimote game controller as a device to study movement
disorders. 2009
21. Effectiveness of virtual reality exercises in stroke
rehabilitation (evrest). 2009
References22. Hinley P. Wii-hab may enhance parkinson's treatment.
Medical College of Georgia News. 2009
23. Murphy EC, Carson L, Neal W, Baylis C, Donley D, Yeater R. Effects of an exercise intervention using dance dance
revolution on endothelial function and other risk factors in
overweight children. Int J Pediatr Obes. 2009:1-10
24. Griffith JL, Voloschin P, Gibb GD, Bailey JR. Differences in eye-hand motor coordination of video-game users and
non-users. Percept Mot Skills. 1983;57:155-158
25. Green CS, Bavelier D. Enumeration versus multiple object
tracking: The case of action video game players. Cognition. 2006;101:217-245
26. Castel AD, Pratt J, Drummond E. The effects of action
video game experience on the time course of inhibition of
return and the efficiency of visual search. Acta Psychol (Amst). 2005;119:217-230
References27. Li R, Polat U, Makous W, Bavelier D. Enhancing the
contrast sensitivity function through action video game training. Nat Neurosci. 2009;12:549-551
28. Pylyshyn ZW, Storm RW. Tracking multiple independent
targets: Evidence for a parallel tracking mechanism. Spat
Vis. 1988;3:179-197
29. Green CS, Bavelier D. Action video game modifies visual selective attention. Nature. 2003;423:534-537