Nintendo “Wii-hab”: a Physiotherapy Fad?

The September issue of the journal “Physiotherapy” includes 8 peer-reviewed research publications investigating the use of the Nintendo Wii gaming system in rehabilitation.  A quick search reveals that there are currently over 100 such published studies, on topics ranging from rehabilitation of lower body injuries, to functional retraining for neurological disorders such as Parkinson’s and Multiple Sclerosis, to balance training for fall prevention.  With the growing excitement, there are now even physiotherapy clinics in North America that advertise the availability of Nintendo Wii systems in their clinics.

But does the Nintendo Wii actually improve patient rehabilitation?

The studies published to date appear to agree on one thing: use of video game devices that promote physical movement can be a useful adjuvant to a physiotherapist-directed rehabilitation program.  This is not surprising.  Exercise therapy is a routine pillar of both orthopaedic physiotherapy and neurologic rehabilitation, and participants involved in these Nintendo Wii studies received detailed guidance from physiotherapists on how to perform the various video game-based tasks.  But is use of the Wii actually better than a regular exercise program designed by a physiotherapist?  If research interest in the subject is any indication, it would appear that many researchers feel that this is definitely a possibility.  Interestingly however, the data does not support it.

A new study examining the effectiveness of the Nintendo Wii for the rehabilitation of patients with total knee replacement (Fung, V., Ho, A., et al. Physiotherapy. 2012 Sep;98(3):183-8.) suggests that not only do patients using the Wii not fair any better, use of the Wii did not even improve patient enjoyment or satisfaction with their therapy.  Similar results were observed in a study on rehabilitation post hamstring ligament reconstruction (Baltaci, G., Harput, G., et al. Knee Surg Sports Traumatol Arthrosc. 2012 Apr 29.).  Although the data doesn’t yet support it, it does seem probable that for some individuals with a particular affinity for video games and an aversion to exercise (such as most kids), using the Nintendo Wii system may improve compliance and thus outcomes.

Is “Wii-hab” a fad or a preview of things to come?

The Nintendo Wii has already been surpassed technologically by the more advanced Xbox Kinect – a game system that replaces the motion sensitive hand controllers of the Wii with a camera and depth sensors that directly watches players’ movements.  Jintronics, a start-up company in Montreal, is even creating rehabilitation-specific software for the Kinect that will enable clinicians to remotely monitor the rehabilitation programs of their patients.  But with all the hype, two key ingredients are still missing: a demonstrated advantage of such technology over existing methods, and a realistic strategy for integrating this technology into existing practices.  The pervasive “if you build it they will come” philosophy of consumer-directed technology companies (think of all those pointless smartphone apps!) does not hold water in the much more pragmatic and cost-driven industry of health care delivery.