Steven Browne, O.T. Reg. (N.B.) Brad Holley, O.T.Reg. (N.B.) Wii™ habilitation - Using the Nintendo Wii as a Complimentary Modality in Stroke Rehabilitation 2009 Stroke Conference Fredericton, NB Steven Browne, O.T. Reg. (N.B.) Brad Holley, O.T.Reg. (N.B.)

Outline Background of the Nintendo Wii The Wii as a therapeutic tool Implementation of the Wii in Occupational Therapy Practice Identification of Occupational performance issues (OPI’S) Identification of Occupational performance components (OPC’s) Goal setting Case study Conclusion Questions

Background of the Wii Made commercially available in 2006 Infra red remote responds to movement in three axis and acceleration Feedback – visual, auditory, tactile “Non gamer” target market Active & social

The Wii as Therapeutic Tool Not designed to be a rehabilitation tool Complimentary to traditional therapy Originally used in long term care setting Ease of use for therapists and clients Sports package– familiar games that focus on rote memory Games and controller can be graded to client’s ability

Therapeutic Process OT identify occupational performance issue Identify occupational performance components Define the goal Measurable outcomes: as defined by goals

Targeting OPC’s Select an activity Identify activity demands (task analysis) Consider client’s abilities and interests Modify environment and/or activity demands to target component. Modify task demands (grading) or environmental components to maintain challenge.

Case study 68 yo Female Left Parietal lobe CVA Prior to CVA independent for all ADL’s and IADL’s working as personal care worker. Deficits noted on assessment: General right sided weakness, poor balance / ataxia Significant perceptual changes (temperature, Stereognosis, proprioception, abnormal movement patterns and intergation issues.) Learned non use of right upper extremity side No cognitive issues noted

Therapeutic Process

Intervention Plan Occupational performance Issue (OPI) Occupational Performance Component (OPC’s) Treatment Plan Demonstrates challenges completing small meal preparation and clean up independently Decreased balance in standing Engage in standing tasks to challenge balance Decreased sensation and impaired knowledge of self in space. Education sessions regarding safety and setup Decreased grip strength of right hand to hold and manipulate heavy objects U/E strengthen and in hand manipulation program Decreased fine motor coordination when handling utensils Engage in fine motor and in hand manipulation tasks Difficulty integrating upper and lower extremity during tasks Engage in simple standing tasks to create self awareness Decreased shoulder strength and movement patterns Task specific ADLs and IADLs graded for success

Rehabilitation Session (Bowling) Targeted OPIs: Balance Coordination Motor planning Integration of upper and lower body Normalized movement patterns

Grading the Task

Conclusion Different therapies & modalities come and go Theoretical background remains the same Choosing any therapeutic tool relies on sound reasoning that supports the client’s desired outcome It requires the expertise of a skilled therapist to monitor, modify and evaluate

Questions or Comments