Two of the projects I’m working on at the moment are wholeheartedly embracing the notion that physiotherapy, movement and brain plasticity are deeply connected. Gaming could be ideal for exploiting this learning, especially now so many games are using big body movements for motion control. Most of my interest has been in early years, looking at how the treatment of children with cerebral palsy can create new connections. Norman Doidge has made this even more interesting by looking at how older brains can be changed through physical exercise. He cites the case of the 50-year old surgeon after a stroke left his arm ‘useless’. The surgeon regained excellent use after agreeing to master tasks using his affected hand. He recovered well enough to practice surgery again.
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.
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
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.
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.
The physical learning aspects of Guitar Hero, Eye Toy and Wii Fit type games also point the way to more physical ways of learning abstract ideas. Could we see games develop that help children to calculate using very large spaces and movements, rather than sitting in one spot and tapping a keyboard or wielding a pen? Given big enough screens and classroom, learners could be put into situations that require whole body movements to generate data, so they interact physically with the academic curriculum. A mathematical series, or the periodic table could become part of the world that must be physically navigated for a successful outcome. It’s been happening for a while for fun on the streets of Akihabara and on entertainment venue screens, as players compete on Dance Mats and virtual instruments. Does it have something we can exploit in the classroom?
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