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Should Patients Be Wii-Habilitating?
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.
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.
Stephen J. Page, PhD is Associate Professor at The
University of Cincinnati Academic Medical Center, Cincinnati, OH. Dr. Page is
also Director of the Neuromotor Recovery and Rehabilitation Laboratory (NmRRL)
at Drake Center. Dr. Page and his team develop and test new therapies to
restore movement after stroke.
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