Wii Fit as an Intervention for LE Prosthetic Training - Level II OT Student Fieldwork Presentation Gretchen Lowden OT/S December 2014
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Wii Fit™ as an
Intervention for LE
Prosthetic Training
Level II OT Student Fieldwork Presentation
Gretchen Lowden OT/S
December 2014
Overview Prosthetic Training Virtual Reality Interventions for Rehab Wii Fit Current Evidence Case Study Future Directions
Prosthetic Training Prosthetic management Donning/doffing prosthesis Sock management Cleaning and caring for prosthesis and supplies Resuming roles and routines at ambulatory level Standing balance (static and dynamic) Standing tolerance and endurance Weight bearing through prosthetic side Functional Ambulation
Virtual Reality Interventions Increased engagement, motivation, and enjoyment Visual biofeedback Saving data to show response to intervention
Wii Fit™ System Balance Board 4 scales 2.25-2.5 inch step
Wii Fit™ Activities Body Test Training BMI Aerobics Center of Balance Balance Body Control Strengthening Wii Fit Age Yoga
BMI
Center Of Balance
Basic Balance Test
Wii Fit Age
Soccer
Downhill Skiing
Table Tilt
Using the Wii Fit and Balance Board as Intervention Stepping up and down from balance board Staticstanding balance as board registers user for body test Dynamic balance during balance tests and balance activities
Upgrading and Downgrading Weight shifting progression: Lateral (Soccer) Lateral + forward weight shifting (Skiing) Lateral + forward/backward (Tabletilt) Using RW for stabilization vs. none, amount of physical A Different levels: Beginner, Advanced
Populations Used With
Prosthetic training
B/L knee replacement
Deconditoned, generalized weakness
Vision to see the game
Step up and down 2-3 inches
Decreased frustration tolerance
Cognitive ability to follow directions cues, however with
visual feedback allows natural reactions to control activitiesDocumentation for Using Wii Fit
Therapeutic balance activity
Amount of assistance during step up vs. down from
balance board, technique
Standing tolerance, amount of rest breaks
Type of ambulatory device used for stabilization
Amount of physical A needed, any loss of balance
Center of balance measurements from Body Test
Clinical observations with body mechanics and
weight shifting during activitiesWii Fit with Prosthetic Training Research starting to look at using Wii Fit as an intervention for prosthetic trainers Additional research has looked at it as an intervention for weight bearing with other populations
Accuracy of a Digital Weight Scale Relative to Nintendo Wii in Measuring Limb Load Asymmetry Cross sectional study 24 participants 12 with OA, 12 healthy 3 standing trials with eyes open Measured asymmtery index between the two scales No significant difference between digital weight scale and Wii Fit Balance board Kumar N.S., Omar, B., Joseph, L.H., Hamdan, N., Htwe, O. & Hamidun, N. (2014). Accuracy of a Digital Weight Scale Relative to the Nintendo Wii in Measuring Limb Load Asymmtery. Journal of Physical Therapy Science, 26(8), 1205-7.
Using the Wii Fit as a tool for balance assessment and
neurorehabilitation: the first half decade of “Wii-search”
Review of literature of using Wii Fit as balance
tool/intervention in rehab
Wii balance board valid/reliable for measuring COP
Using Wii Fit as intervention tool has shown some positive
balance outcomes, advocating for their use in
neurorehabilitative training
Need more studies that are randomized controlled trials,
larger sample sizes
Goble, D.J., Cone, B.L. & Fling, B.W. (2014). Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the
firs half decade of “Wii-search”. Journal of Neuroengineering and Rehabilitation, 11(12).Feasibility of Nintendo Wii Fit for improving walking in individuals with a lower limb amputation Multiple baseline single subject research design 6 subjects (4 TTA, 2 TFA), >19 years old Safety, fatigue, pain, adherence, subjects acceptance Results No adverse affects Found it enjoyable Statisitcal improvement on 2 minute walk test Small sample size but basis for further research Imam, B., Miller, W.C., McLaren, L., Chapman, P. & Finlayson, H. Feasibility of the Nintendo WiiFit for improving walking in individuals with a lower limb amputation. (2013). SAGE Open Medicine, 1.
Wiihabilitation.uk http://www.wiihabilitation.co.uk/?page_id=393
Case Study CZ 67 year old male Diagnosis: s/p L TTA PMH: DM, PVD, Dementia, Depresison, Anxiety, HTN, HLD, chronic urinary incontinence, prostate cancer s/p rsxn Presents for outpatient prosthetic training decreased IADL, leisure, community mobility participation at ambulatory level
Person Factors Decreased balance, standing tolerance, endurance Decreased sensation Impaired recall and problem solving skills Feelings of anxiety
Environment Lives in multistory home Wife and family support Uses SPC for household ambulation
Occupations Husband, father Self-care Light household/kitchen management Social participation Community mobility
Using Wii Fit with CZ
CZ Mii CZUsing Wii Fit with CZ
Began with step up and step down on balance board using
RW and UE support on stable surface
Body tests every session
Incorporated soccer game for lateral weight shifting
Progressed to skiing and table tilt
Decreased use of RW for stabilization
Most recently, step up/down with CS and no AD; balance
activities at CS with intermittent A for stabilityResponse to Intervention
Subjective response to intervention
Mild improvement with weight shifting
Objective response to intervention
Increased time with fewer rest breaks
10 minutes increased to >20 minutes
Center of Balance coming more to center
11/5: 26.8% L, 73.2% R
12/15: 51.8% L, 48.2% RCenter of Balance Measurements Nov 5 Nov 19
December 3 December 10
Center of Balance Measurements
December 15Successes and Difficulties Successes with using With increased tactile cueing, able to more effectively shift weight during games Demonstrated enjoyment, engagement Difficulties Decreased reaction time and motor planning Poor carry over of technique
Future Directions Further research at higher levels using Wii Fit with LE prosthetic trainers Research relating improvements with gameplay to clinically significant outcomes
References Goble, D.J., Cone, B.L. & Fling, B.W. (2014). Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the firs half decade of “Wii-search”. Journal of Neuroengineering and Rehabilitation, 11(12). Imam, B., Miller, W.C., McLaren, L., Chapman, P. & Finlayson, H. Feasibility of the Nintendo WiiFit for improving walking in individuals with a lower limb amputation. (2013). SAGE Open Medicine, 1. Kumar N.S., Omar, B., Joseph, L.H., Hamdan, N., Htwe, O. & Hamidun, N. (2014). Accuracy of a Digital Weight Scale Relative to the Nintendo Wii in Measuring Limb Load Asymmtery. Journal of Physical Therapy Science, 26(8), 1205-7. http://www.wiihabilitation.co.uk/?page_id=393
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