15 Dec Adapting Nintendo Wii To Enhance Stroke Rehabilitation
MedicalResearch.com Interview with:
Dr. Emmanuel Tsekleves
Senior Lecturer in Design Interactions
ImaginationLancaster
LICA |Lancaster University
Medical Research: What is the background for this study? What are the main findings
Dr. Tsekleves: The study was influenced by the anecdotal use of the Nintendo Wii in therapy in NHS physiotherapy clinics back in 2010/11. This led to the need for conducting a study with therapists and patients (33 questionnaires and 10 interviews were completed) to explore the current use of the Nintendo Wii console technology in physical rehabilitation programmes across four NHS Trusts in London. The study revealed that although respondents felt the Wii helped with rehabilitation, over half of them reported difficulty using equipment (such as using the hand-held remote controls). Therapists believed use of standard Wii was limited due to the high level of dexterity, movement and coordination necessary to operate the system.
The results of the aforementioned study informed the development of a personalised stroke treatment, using adapted Wii technology, for arm re-education post-stroke (that is reported in the article http://informahealthcare.com/doi/abs/10.3109/17483107.2014.981874). The developed system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed (Fugl-Meyer Assessment, Nine Hole Peg Test, Motor Activity Log – Amount of Use sub-scale] and the Modified Ashworth Scale), with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated.
Medical Research: What should clinicians and patients take away from your report?
Dr. Tsekleves: In a nutshell, using adapted video game systems and specially designed games for stroke survivors is not a panacea, nevertheless it is a most useful motivational and adherence tool.
Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, Kinect, etc are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement.
Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Tsekleves: I would summarise these in the following:
- The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence – key issues in rehabilitation.
- With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.
For readers interested in the research around the Wii, I would recommend a book chapter I ve recently co-authored on the subject ‘The Use of the Nintendo Wii in Motor Rehabilitation for Virtual Reality Interventions: A Literature Review’ – available at http://link.springer.com/chapter/10.1007%2F978-3-642-54816-1_17)
Citation:
Emmanuel Tsekleves, Ioannis Theoklitos Paraskevopoulos, Alyson Warland, Cherry Kilbride
Disability and Rehabilitation: Assistive Technology : 1–10.
Last Updated on February 4, 2015 by Marie Benz MD FAAD