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Can Pediatric Patients Wii-habilitate?

Can Pediatric Patients Wii-habilitate?

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Wii in hand, patient Ja'Carlo Matthews goes for a spare with physical therapist Kerry Peterson.

Pediatric resident Karen Robbins recalled an asthma patient who just couldn’t find the motivation to get up and out of bed. “Just lying in bed, he wasn’t taking good breaths,” Robbins said. “I said to the attending, ‘If we could get him a Wii, maybe that would be the motivation for him to get up and start moving again.’”

Robbins recalled the anecdote during her recent Grand Rounds presentation at Hopkins Children’s on the value of video games as a tool for improving patient care, particularly physical rehabilitation for immobilized patients. Robbins noted that video games like Nintendo’s Wii and Wii Fit, which can be used sitting or standing, are designed to simulate real activities and interaction with others, trigger movement of multiple muscle groups, and provide immediate feedback, all aspects of physical therapy. But do they motivate and engage patients, increase their energy expenditure, build their confidence and self-esteem? Do they have therapeutic value?

In setting out to find the answers and conduct a retrospective review of existing research, Robbins found significant use of gaming systems by health-care providers but not many studies on their potential therapeutic benefits. Most of what she found was case report after case report on injuries related to gaming – including chest and head injuries due to thrown remote controls.

“It looks like a lot of doctors and physical therapists are using video games like Wii,” Robbins said, “but there’s not a lot of data in the literature.”

In one study, Robbins reported that the virtual reality aspect of gaming – which allows individuals to perform tasks they are unable to perform in real life – proved a useful tool in neuro-rehabilitation of cerebral palsy and stroke patients (Dev Med Child Neurol 2005;47:628-35; Arch Phys Med Rehabil 2005;86:2218-23). In another, the use of Wii augmented the rehabilitation plan for a cerebral palsy patient: 11 sessions with the Wii sports package led to improvements in visual perception processing, postural control and functional mobility (Physical Therapy 2008; 88:1196-1207).

What does all this mean for pediatricians? Robbins noted that they shouldn’t necessarily recommend their regular patients get more screen time as there’s no substitute for real activity and exercise. But she added that video gaming is showing itself to be a safe and feasible tool for patients who are immobilized or experience prolonged hospital stays – oncology and stroke patients, for example, or those with conditions like asthma and cystic fibrosis. More studies need to be done, she concluded, but “Gaming is an accessible, cost-effective alternative to help motivate immobilized patients in physical rehabilitation."

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