Stroke Smart Magazine

Fall 2010
THE WEB

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Gaming for Stroke
Should Patients Be Wii-Habilitating?

By Stephen J. Page, PhD

Stroke is a leading cause of adult disability in the U.S. Stroke survivors most often have movement problems that affect their ability to do daily activities, such as writing, walking and eating. Conventional stroke rehabilitation can be repetitive and therapists sometimes are not able to provide the attention or time that patients need.

Game-based approaches have recently been discussed as a possible way to overcome some of these limitations. In most cases, these approaches are unlikely to replace supervised therapy by a licensed clinician. But, gaming offers several benefits over conventional rehab approaches.

Often the amount of time that patients have to practice with a therapist is limited to a set number of visits, depending on the insurance plan. Games offer unlimited chances to practice with the affected limb in the comfort of one’s home or room. Because studies show that repetitive practice is basic to learning and returning function, adding games to rehab could be useful.

And games add an element of fun, motivation and even competition to one’s regimen. Practice time passes more quickly and research shows that patients who are interested in their exercises are more likely to gain from them. Games also provide feedback. They show the position of the arm or leg, display how well the patient is performing and show previous scores. Such feedback not only acts as motivation, but improves future learning and performance.

So should patients go out and buy video games? Not so fast, trigger finger. First there are a few things to know. Many of the games that are available are not fully adapted for stroke survivors. For instance, some rehab clinics have rushed to buy Wii game systems by Nintendo^® and Go Go TV by Manley, which can both be played online as well as on a player’s television. Yet they soon found that the game controllers require finger movements that only 20 percent of all stroke survivors have. More importantly, we do not have evidence that most available game systems improve movement in survivors. We do not know how many minutes per day or how many days per week we should prescribe the games. And we do not know which survivors are most likely to benefit from games.

So what can patients do until the evidence supporting games is more available and the prices of these games go down? They can purchase non-electronic games available at toy stores. Many games that parents buy children can be used to improve the movements of stroke survivors. For example Perfection^® and Don’t Spill the Beans by Milton Bradley might improve fine motor skills in the arm. Toss Across by Mattel works on gross arm motor skills. If survivors are interested in low-cost electronic games, there are many that encourage balance and weight shifting. Some systems, available at local toy stores, come with motion-sensitive  “balance boards.  “Shifting body weight on the board causes adjustments in the direction of a surfboard, which might help a survivor’s balance. Before starting a new activity, patients should first consult with their occupational or physical therapist. 

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