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.
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
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.
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