Improving the Wii for hemiplegics

One of the most useful aspects of the Wii board for us is the ability to measure balance, how you’re distributing your weight.  If you’re placing your weight too much on one side this provides excellent onscreen feedback, useful to a hemiplegic who will tend to favour one side excessively. As far as I can see, there’s no way to call up this feature at will. It kicks in as part of the ‘Body Test’ feedback and lasts for a few seconds.  Ideally, this should be a separate feature, a mini game on its own, allowing the user to focus on the feeling of being in balance for longer.  This allows for deeper learning.

The balance tool is also useful when doing a downward-facing dog pose in yoga, where the weight should be distributed evenly between arms and legs.  But it’s impossible to look at the screen when in the position. There is some aural feedback, a small ‘bing’ when you hit the spot,  but not enough to allow you to feel how near or far you are from being correctly posed. A possible solution would be a gentle rising and falling tone to allow the user to understand when they’re getting closer and further away from it. A nice rising and falling ‘om’ might help.

The value of stillness on Wii Fit

The value of stillness is often overlooked in exercise, education and life in general. Iyengar yoga addicts know it well and it’s good to find an immersive game that encourages it in the Zazen feature of the Wii Fit. This is the last balance game to be unlocked and is a fantastic treat after so much movement. Sitting on the board and trying to achieve stillness works surprisingly well. If I could improve it I would like it to be longer than the three minutes it offers, but even in that, you can experience a sense of stillness and calm. The flickering candle, the moth and the creaking footsteps add to the sense of timelessness.
It offers an important counterpoint to the high energy activity of the other games, but it could be an excellent means of encouraging stillness and meditation in the classroom. Bizarrely, making stillness a slightly competitive game, although counter-intuitive, feels quite attractive. This is pitched well to encourage all to participate, to be a bit of fun, but ultimately to give a genuine taste of the value of stillness.

Trickster XDream

An indoor bike that could offer the motivation to use both sides of the body. Cycling is highly recommended for hemiplegia as it requires reasonably even use of both sides of the body, on both arms and legs, and improves balance as well as muscular strength. Something like the TricksterXDream could offer a very good introduction for the nervous hemiplegic. Although with a £6,000 price tag we need a more mass-produced approach to get it down to anything affordable

Right sided hemiplegia and Wii Play

One of the things Bobath suggested to us was encouraging the player to use their weaker hand. Wii Play allows you to set your preferred hand, and change it back easily when you’ve finished, so select the side you want to work on as your “dominant” hand. The score may feel dispiritingly low to begin with as it’s so different. The aim has to be to beat your own score in this, not to get a great score. Or to beat each other’s score and all play with the alternative hand.

X Box gets an eye toy style game

Just watching BBC World news on the new X Box offering- the new game looks like it will also add to the physical immersive experiences already offered by Eye Toy. All games that extend the ideas in this area and the possibilities for interactive physical play for people of all abilities can only be good news. While they are useful for general entertainment my main interest is in how they can be used for physiotherapeutic reasons with kids and adults with cerebral palsy, especially right or left-sided hemiplegia. This one looks like it’s worth keeping an eye on.

Hemiplegia: Free games

This looks like a nice bit of software to create an Eye Toy style experience

http://cam.playdo.com/

If you have a webcam set up you can try out these games which will give you an idea of how it might help.

Wii Fit and balance (Hemiplegia)

Tonight we tried out how it works out balance. The issue for someone who has right or left-sided hemiplegia caused by a brain injury to one side of the brain, is that it can leave a leg or arm underdeveloped, so that muscles and bone may not grow evenly with the limbs on the other side of the body. What is needed is a way of encouraging balance. And balance really requires that both feet be planted evenly on either side of the board. After a series of attempts to cheat at this – eg by trying to balance with tip toes on one side and flat foot on the other (as some hemiplegics will do left unattanded) it seemed that the Wii could pick up the lack of evenness in the body and feed that back through the on screen display. Which suggests it could be useful for hemiplegics

Wii, Eye Toy and Literacy

The wonderful literacy expert Sue Palmer drew my attention to the way the alphabet can be taught using movement, with kids using their whole bodies to learn the shapes of letters – a bit like a massive use of the Magic pencil technique used by Clare Elstow in the BBC Words and Pictures series before she took over Cbeebies. Sue saw this technique used in scandinavian primary schools. The Wii and Eye Toy technology seems to me to be made for this.

Eye Toy and Wii Fit 2

And the Wii Fit takes this possibility a step further.  Another issue for mild cerebral palsy cases – and for many people without the condition – is posture and balancing the weight evenly on both sides of the body – the kind of balance you strive to achieve in an Alexander Technique class. A board that gives you accurate feedback about whether you are using both sides evenly is a significant development. The Wii Fit seems able to do this with an onscreen display to give you your level of wobble. Using this should in theory train you into recognising what your body feels like when you’re standing evenly. But does it know whether you have both feet flat on the board while you do this? Only one way to find out . . . 

Eye Toy and Wii Fit 1

I was cynical but the Wii fit is a great bit of kit. Like its relatively unsung predecessor, the PS2 Eye Toy, its potential for educational use is the most exciting thing about it. I first saw Eye Toy Play in 2003 on a six-hour stop-over in the otherwise barren airport lounge at Doha. No idea what it was. No instructions, but three bored boys taught my 8-year-old to use it and he taught me. At first simple games like Kung Fu and Wishi Washi seemed a harmless way of passing the time, but observing and playing them myself it seemed to me it was capable of development into a formidable tool for the rehabilitation of stroke victims and for other physiotherapeutic uses. The way the games motivate effort chimes with the kind of approach a Bobath therapist uses.

http://www.bobath.org.uk/TheBobathApproach.html

Briefly, a child with cerebral palsy may have limited movement from an early age. In order to improve, the child must be encouraged and enticed to use the parts of the body affected by the early brain injury. Otherwise, the longer a part of the body goes unstimulated, the more it loses its potential – use it or lose it applies in a major way to very young children with this condition. A child, whose right arm is affected will favour their left arm overmuch, and may ignore the right completely, leaving it to atrophy and greatly magnifying the consequences of the brain injury for the adult they become. Conversely, actively using affected limbs will reap big rewards. Cerebral palsy is a physical disability, not a mental disability and it can be alleviated and overcome by physical activity. Making very small children appreciate that is difficult if not impossible. But it’s in the early months and years that huge gains are possible.

Looked at in this light Wishi Washi and Kung Fu could be the perfect tool for making a child work both sides of the body evenly and spontaneously, as that’s the most efficient way to get the high score. So whether the child appreciates its benefits or not, it’s potentially an excellent way of getting a small child to literally play along with a physiotherapist. Or even possibly without one.

More to come on this subject