1. POSTER TEMPLATE BY: www.PosterPresentations.com Effectiveness of Wii Gaming Technology for Children with Down Syndrome Carolyn Little and Genny Tibbs Bellarmine University DPT Program Introduction  Virtual reality (VR) gaming systems are becoming increasingly popular in physical rehabilitation services  VR gaming can foster motor development, spatial awareness, and social interaction  Promotes physical activity with its interactive sports and fitness games  A popular gaming virtual reality system is the Nintendo Wii What is a Wii? 5  Gaming consult that is motion controlled  Sensor activated that encourages active play  Uses a Wii avatar to interact with virtual environment  Variety of games suited for all age groups and fitness level  Popular based on affordability, availability of system and variety of games. Rahman, SA. 2010 6  Randomized Control Trial  30 children with DS randomly assigned to treatment and control groups  Participant met twice a week for six weeks  Control group: traditional physical therapy for 1 hour interventions: strengthening exercises, walking on uneven surfaces, and climbing stairs  Treatment group: same protocol as control group with addition of Wii. A football heading game, tight rope walk game, and Penguin slide game  Results: o Significant improvements in balance both groups (p = 0.000) o Treatment group had a higher p-value between pre and post measures (p =0.000) than control (p = 0.017) Down Syndrome Conclusion Clinical Relevance References  Wii training was found to be a feasible, safe, and beneficial addition to treatment for young children with developmental delays 7  Wii allows the player to practice skills that otherwise could not be fully experienced in a “real world” environment 1  Augmented feedback is known to enhance motor skill learning 6  Multimodal sensory feedback with the avatar can allow children to self-observe and make adjustment while perform task 10  VR systems may be a beneficial supplement to traditional treatment feedback methods 6  Repeated practice of VR games may be accompanied by improvements in balance, postural stability, manual dexterity, and upper limb coordination 1  Future Research Suggestions:  Trials with larger sample sizes  Include participants with wider ranges of intellectual disabilities  Longitudinal studies to assess longevity of results  Gaming systems should not be a replacement for a physical therapy program, instead gaming systems should be used to increase the intensity of exercises and to complement traditional exercises 7  Increases child’s motivation during therapy  Low cost and commercially available gaming system  Potential application of the Wii to home exercise programs  Since adolescents with DS are at higher risk of obesity and sedentary lifestyle physical activity should be encouraged 2 1.Berg P, Becker T, Martian A, Primrose KD, Wingen J. Motor control outcomes following nintendo wii use by a child with down syndrome. Pediatric Physical Therapy. 2012; 24(1):78-84. http://dx.doi: 10.1097/pep.0b013e31823e05e6. 2.Lin HC, Wuang YP. Strength and agility training in adolescents with down syndrome: a randomized controlled trial. Research in Developmental Disabilities. 2012;33:2236-2244, http://dx.doi.org/10.1016/j.ridd.2012.06.017 3.Mayo Clinic Staff. Down syndrome. Mayo Clinic. http://www.mayoclinic.com/health/down- syndrome/DS00182/DSECTION=causes 4.National Down syndrome Society. What is down syndrome? http://www.ndss.org/Down- Syndrome/What-Is-Down-Syndrome/ 5.Nintendo Wii. What is Wii? http://www.nintendo.com/wii/what-is-wii/ 6.Rahman, SA. Efficacy of virtual reality-based therapy on balance in children with down syndrome. World Applied Sciences Journal. 2010;10(3): 254-261. ISSN1818-4952. 7.Salem Y, Gropack SJ, Coffin D, Godwin EM. Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomized single-blind controlled trial. Physiotherapy. 2012; 98 (3): 189-195, ISSN 0031-9406, http://dx.doi.org/10.1016/j.physio.2012.06.003. 8.Suzann CK, Robert PJ, Margo ON. Physical therapy for children. 4 th Edition. St. Louis, MO: Elsevier Saunders; 2012 9.Tarantola A. Scientists may have found a genomic off switch for down syndrome. Gizmodo. http://gizmodo.com/scientists-may-have-found-a-genomic-off-switch-for-down-826032755 10.Wuang YP, Chiang CS, Su CY, Wang CC. Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Research in Developmental Disabilities. 2011; 32(1): 312-321, ISSN 0891-4222, http://dx.doi.org/10.1016/j.ridd.2010.10.002. 11.Xu, E. Wii Active – Shape Up Your Body! The Cool Gadgets. http://thecoolgadgets.com/wii-active- shape-up-your-body/  In the US one in every 691 babies is born with Down syndrome 4  Approximately 400,000 Americans have Down syndrome 4  About 6,000 babies with Down syndrome are born in the United States each year 4 What is Down Syndrome? 3  Genetic disorder caused by abnormal cell division of chromosome 21  Congenital disorder that is non-progressive  Varies in severity with developmental delays ranging from moderate to severe  Intellectual and learning disabilities are typically present Common Characteristics of Down Syndrome 8  Problems with postural control and balance  Hypotonia  Hyperflexibility  Delayed gross motor development  Delayed fine motor skills  Requires more time to perform coordinated movements  Better performance with visual than verbal instructions Typical Physical Therapy Interventions  Balance  Core strengthening and postural awareness  General muscle strengthening Evidence Salem Y, Gropack SJ, Coffin D, Godwin EM. 2012 7  Randomized Control Trial  40 children with developmental delay (age 39 to 58 months)  Two 30- minute weekly sessions for 10 weeks  Control group: Individualized traditional rehabilitation focused on movement transitions, balance, walking, and gross and fine motor control  Experimental group: Wii training using Nintendo Wii Sports and Nintendo Wii Fit focused on balance, walking, strength, weight bearing, and aerobics  Results: o Experimental group showed significant improvements in single leg stance test, right grip strength and left grip strength o Although changes in other outcome measures were not significant between the study groups, there were trends towards greater improvements in the experimental group 7 11 5 Berg P, Becker T, Martian A, Primrose KD, Wingen J. 2012 1  Case report  8 week intervention conducted at subject’s home  Wii used for at least 4x/week for 20 min/session; Parents asked to keep an activity log  Outcome measures: o Self-Perception Profile for Children (SPPC), Athletic Competence, Physical Appearance subscales, Perceived Physical Ability (PPA), Bruininks-Oseretsky Test of Motor Proficiency, Test of Visual Perceptual Skills, Biodex BioSway Balance System, BodyStat QuadScan 4000  Results: o Improvements in BOT-2 manual dexterity, balance, running speed, and agility scores o Decreased in anterior/posterior sway, increase in medial/lateral sway, overall stability index showed improvement, better dynamic control in all directions except backward and backward right