Posts Tagged interventions

[BLOG POST] Incorporating the Wii into Occupational Therapy Treatment

This is guest post written by Grant Mitchell, author of TheOTpreneur.com. Grant currently works in Acute Rehab and completed his Master’s thesis on using the Wii as a rehab intervention. We are happy to have him on the My OT Spot blog!

Considering the rising cost of healthcare, consumer technology can often be an effective treatment modality that can double as a home exercise program. An example of consumer technology could include a Nintendo Wii + Sports which can be usually be purchased for less than $50. Given the lack of budget most every practitioner has to deal with, it’s a great opportunity to take advantage of low cost and high tech consumer products for rehabilitation.

Effective implementation of virtual reality (VR) as a treatment modality needs to be practical, accessible, and affordable to the client. The Nintendo Wii and Xbox Kinect are two examples of systems that demonstrate those traits comparatively to the high-end VR products that can cost upwards of $75,000.

Virtual reality can be used in variety of ways across settings. The Xbox Kinect and Nintendo Wii systems have different ways of engaging participants. While the Xbox Kinect doesn’t involve use of a controller, it is played by body motions alone. The Xbox Kinect is easier with a higher functioning population.

Conversely, the Wii system involves the use of a controller and includes games that can be modified to fit a variety of lower functioning populations both cognitively and physically. This article will address Wii use for the general physical disability population. Cognition is a component in the function of clients in the physical disability setting and so will be addressed.

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Benefits of Using the Wii in Treatment

One valuable aspect of incorporating this type of technology in therapy is that it is often a familiar technology to the general public. Its accessibility extends outside that of the clinical setting. The common household, including those in the low socioeconomic bracket, might have access to a Nintendo Wii.

Even adults that have not used a Wii before, can often recall family or friends who might have one or use one. Let’s not forget, video games can be fun! Adding fun can be an effective way to make activity purposeful and meaningful.

One benefit of engaging in a therapeutic activity such as the games found on Wii Sports, is the objective based movements so that patients are focused on moving the virtual character rather than thinking about left, right, up, and down. In this way, the client receives instant visual feedback of their performance as they guide the virtual character (Sparkes-Griffin, 2013).

Wii Sports Games to Incorporate into Treatment

Wii Sports is the most common game as it comes with most Wii consoles. Wii Sports comes with five games: boxing, bowling, tennis, golf, and baseball. The following is short description of the Wii Sports games and how you can incorporate them in treatment.

 

Boxing: This activity is a great strenuous upper extremity activity. Boxing is a go-to game with the Wii due to the level of endurance it facilitates. This game can be completed with either one upper extremity or can incorporate bilateral upper extremities for a greater coordination demand. This activity is one of the least cognitively demanding, involving a repetitive back and forth (punching) motion with no button pushing.

Bowling: The arm motion of this game is similar to that of the real life sport, however this activity can be done from almost any position. The motion does not stray far from the midline but does involve a two-button press and release component increasing the motor planning demand. This can be hard if hand function is minimal, but good if you want to incorporate fine motor and gross motor planning.

Tennis: This game involves no button pressing during game play, only to start and resume. However, tennis involves the most complex upper extremity arm movements of the 5 Wii sports games. Additionally, with either a computer or an opponent (dual play involves a split-screen and can involve family or friends if available), this game is a higher functioning game requiring the player to motor plan and swing the controller according to the direction of the virtual tennis ball.

Golf & Baseball: These two games are similar in that a minimal swinging motion is the primary physical demand to play. The movement can be accomplished with a good wrist flick, and generally requires a purposeful exaggerated real life swing to get therapeutic benefits. To get significant therapeutic benefit, these activities will often have to be modified to increase the challenge.

occupational-therapy-wii-baseball

Modifying the Games

Core Related: The Wii player is moved by the controller; therefore, the actual position of the client can vary. For impaired balance, the therapist can stand behind the client or have a chair available for when the client is fatigued. All games can be completed either standing or sitting. The common high-low mats in rehabilitation gyms provide a great platform for treatment while engaging in the Wii activity. Additionally, clients can participate while sitting on a balance board for a greater challenge.

Upper Extremity Related: Boxing is the only game in Wii sports that can involve both arms with two controllers. However, boxing does allow the option of playing with only one controller. For an added challenge, weights, such as Velcro wrist weights can be utilized to increase the resistance. It is important to note that due to the design of the game system, clients can “cheat” in terms of movement, meaning using little ROM and compensating arm movements with wrist movements. If you as the therapist want good movement, you may have to cue it as little feedback is provided by the Wii.

More on the Research Behind this Post

As a thesis project to complete the requirements of graduating with a Master’s in Occupational Therapy, my classmate Kyle Nelson and I (Grant Mitchell) collected literature surrounding the Wii and Xbox use in rehabilitation.

Our poster has been accepted for display at this coming year’s 2017 AOTA conference. This information is in the process of being made available as a free resource on an independent website. Until then, the Prezi presentation of the initial poster can be viewed describing this thesis project.

For additional questions, please don’t hesitate to email me at TheOTpreneur@gmail.com.

Resources

Emerging Niche: New Technology for Rehab

http://www.aota.org/Practice/Rehabilitation-Disability/Emerging-Niche/NewTech.aspx

Prezi Presentation: Use of VR in Rehab

https://prezi.com/botxz1nkctid/virtual-reality-an-evidence-based-guide-for-occupational-therapy/

Sparkes-Griffin, C. (2013, February 25). Wii-habilitation: Using the Wii as an Effective Intervention Tool for Seniors. OT Practice, p. 18.

via Incorporating the Wii into Occupational Therapy Treatment | myotspot.com

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[Abstract] Investigation of a New Couples Intervention for Individuals with Brain Injury: A Randomized Controlled Trial

Abstract

Objective

This study aimed to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury (BI) particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention. Design: Randomized Wait-list Controlled (WC) Trial. Setting: Midwestern outpatient BI rehabilitation center. Intervention: The Couples CARE intervention is a 16 week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition and empathy training, cognitive and dialectical behavioral treatments (CBT, DBT), communication skills training, and Gottman’s theoretical framework for couples. Participants: Forty-four participants (22 persons with BI and their intimate partner) were randomized by couples to the intervention or WC group, with 11 couples in each group. Main Outcome Measures: Dyadic Adjustment Scale (DAS); Quality of Marriage Index (QMI); 4 Horsemen of the Apocalypse communication questionnaire. Measures were completed by the person with BI and their partner at 3 time points: baseline, immediate post-intervention, 3-month follow-up.

Results

The experimental group showed significant improvement at post-test and follow-up on the DAS and the Horsemen questionnaire compared to baseline and to the WC group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.

Conclusion

suggest this intervention can improve couples’ dyadic adjustment and communication after BI. High satisfaction ratings suggest this small group intervention is feasible with couples following BI. Future directions for this intervention are discussed.

 

via Investigation of a New Couples Intervention for Individuals with Brain Injury: A Randomized Controlled Trial – ScienceDirect

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[Abstract] Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice

 

Abstract

Study Design

Mapping review.

Introduction

Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice.

Purpose of the Study

The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research.

Methods

A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice.

Results

Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status.

Discussion

Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions.

Conclusions

More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes.

Source: Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice – Journal of Hand Therapy

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[Systematic Review] A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods – Full Text PDF

Objective. To develop a systematic review of the literature, to describe the different virtual reality (VR) interventions and interactive videogames applied to the lower extremity (LE) of stroke patients, and to analyse the results according to the most frequently used outcome measures.

Material and Methods. An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane) was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait) were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria.

Results.The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention.

Conclusions. Although evidence is limited, it suggests that VR intervention (more than 10 sessions) in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and
conventional physiotherapy, was used. Flexible software seems to adapt better to patients’ requirements, allowing more specific and individual treatments.

Full Text PDF

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