Since the introduction of the Nintendo Wii in 2006, dozens of studies and case reports have commented on the potential benefits and risks of “exergaming”. A recent example is a University of Toronto pilot study, EVREST (Effectiveness of Virtual Reality Exercises in STroke Rehabilitation), on the feasibility of using Wii in stroke rehabilitation (Saposnik et al. Stroke 2010; 41: 1477-1484; Saposnik et al. Int J Stroke 2010; 5: 47-51).

The single-blinded parallel-group trial randomized 22 post-stroke patients to Wii versus recreational therapy (playing cards, bingo or “jenga”, in which players build towers out of blocks of wood). The feasibility outcome was the time receiving the intervention. Efficacy was assessed with the Wolf Motor Function test, the Box and Block test, and the Stroke Impact Scale.

Mean age of subjects was 61.3 years. The intervention was received in 9 of 10 in the Wii group versus 8 of 10 in the recreational therapy group. Two patients dropped out during training. The difference in mean total session time was not significant: 364 minutes in the Wii group versus 388 minutes in the recreational therapy group. Mean improvement in the Wolf Motor Function test was 7.4 seconds with Wii relative to recreational therapy, suggesting that Wii may be a feasible and effective alternative to recreational therapy. No adverse effects occurred in either group.

A separate study has also reported that Wii is a feasible alternative to conventional upper limb rehabilitation in post-stroke patients (Yong et al. J Rehabil Med 2010; 42: 437-441).

The impact of “Wiihabilitation” (Anderson et al. Stud Health Technol Inform 2010; 154: 229-234) has been evaluated in patients with cerebral palsy (Deutsch et al. Phys Ther 2008; 88: 1196-1207), burn injuries (Fung et al. J Burn Care Res 2010; epublished July 12), geriatric depression (Rosenberg et al. Am J Geriatr Psychiatry 2010; 18: 221-226), and elderly patients with multiple disabilities (Shih et al. Res Dev Disabil 2010; 31: 936-942). Additional studies are planned in Alzheimer dementia (NCT01002586; clinicaltrials.gov) and Parkinson’s disease (NCT01162226; NCT00802191; NCT01120392).

In the clinical assessment of patients’ standing balance and risk of falls, the Wii balance board has been proposed as a lower-cost alternative to the force platform and a preliminary study has suggested that the two methods have comparable validity (Clark et al. Gait Posture 2010; 31: 307-310). Recent studies have further suggested that Wii proficiency is associated with laparoscopic skill, and have proposed it as a useful tool for surgical training (Badurdeen et al. Surg Endos 2010; 24: 1824-1828; Bokhari et al. Am Surg 2010; 76: 583-586).

However, intervention is not without some degree of risk (“Wii problem”; Fysh & Thompson. J R Soc Med 2009; 102: 502). Most notable are repetitive strain injuries (“Nintendonitis; Siegel. Orthopaedics 1991; 14: 745), patellar dislocation (“Wii knee”; Robinson et al. Emerg Radiol 2008; 15: 255-257), and fractures (Eley. N Engl J Med 2010; 362: 473-474; Brown & McKenna. Sci World J 2009; 9: 1190-1191). A review of self-reported injuries found that injuries most frequently occurred while playing Wii tennis (Sparks et al. Inform Prim Care 2009; 17: 55-57). Case reports included tendon rupture (Bhangu et al. J Hand Surg Eur Vol 2009; 34: 399-400), and traumatic hemothorax, which occurred after a woman overswung and fell on her Wii console (Peek et al. Ann R Coll Surg Engl 2008; 90: W9-10; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC2647267/?tool=pubmed).

Comment:
Dr. Selchen: Dr. Saposnik’s very interesting pilot study raises the possibility that gaming may be of value in rehabilitation.  This study is of particular interest given the lack of evidence for many rehab interventions.  A larger, more definitive study is planned which may open new avenues in rehabilitation therapy for stroke victims (and others).