By Katy O'Grady
Work is play for New Jersey physical therapist Marc Suznovich, PT, DPT. By bowling, playing ring-toss on the boardwalk, golfing, and making music—all using the Nintendo Wii system—Suznovich helps his subacute geriatric patients stand longer, improve balance, and expand their range of motion.
"You want to get patients to increase their standing time, which makes them able to walk longer. Patients find the Wii enjoyable and motivating; they will stand twice as long as if you just have them reach for cones or another activity," Suznovich says. He uses the Wii as he deems appropriate as an adjunct to more traditional treatments and limits its use to one hour per day in the afternoon.
As the designated "Wii Champion" for Genesis Rehab Services, Suznovich works directly with patients and serves as a resource for physical therapists (PTs) at the 20 Genesis facilities across New Jersey. Genesis PTs who are considering the Wii in patient treatments can call on Suznovich for game recommendations to help patients achieve specific objectives, such as improving balance or increasing strength or range of motion. Suznovich rents and tests games to determine their usefulness in physical therapy.
"I try them with a couple of my patients to see whether they like the game, if it's good with geriatric populations," he said. "I find good games that everyone enjoys."
Suznovich was introduced to the concept of using the Wii in physical therapy practice by his professor, Judith E. Deutsch, PT, PhD, of the University of Medicine and Dentistry of New Jersey. Deutsch led a research project that augmented a rehabilitation program with use of the Wii, as an alternative to motion-capture virtual reality systems that are designed for rehabilitation. In the intervention, researchers guided an adolescent with spastic diplegic cerebral palsy in playing the Wii Sports games.
Treatment objectives included improvement in visual-perceptual processing, postural control, and functional mobility.1 The study provides details on the therapeutic application of the various Wii activities. For example, "The boxing activity required bilateral upper extremity reciprocal movements that promoted midline trunk alignment. The boxing activity was selected early to establish good postural control before playing more challenging unilateral upper extremity activities such as bowling or tennis."
Researchers measured improvement in all three of the objectives, with functional mobility continuing to increase even after the training ended. They emphasized that "essential clinical decisions were made by the therapist throughout the training, and—at least for this patient—it would not have been advisable or safe to have him train on his own."
Suznovich says Deutsch's was the first published research project on this topic. Like the research subject, Suznovich's patients respond well to incorporating Wii Sports into their treatment, he says. The wireless Wii remotes make the system a tool that is particularly suitable for use with older patients. The system also allows PTs to easily track patients' individual progress, and it can be used with patients at many levels of ability. "I have people at a higher level sit on the physio balls and play the Wii," he said. Low-level patients who have a hard time sitting up in bed can be placed on a mat, "and they play the boxing game, moving their arms, working on sitting balance."
For standing balance, Suznovich suggests that PTs can use the Wii as a tool with a patient "who has a rolling walker, as long as they can stand with a little bit of assistance and can let go with one hand. I'll be on one side helping them to stand up, and they can use the remote with their other arm." The oldest patient with whom Suznovich has used the Wii was 88 and recovering from a hip fracture. He became the top bowler at the facility.
What's next for Suznovich and his gaming patients? His facility plans to buy a Wii Fit, which uses a balance board in games focused on strength training and balance, and for aerobics and yoga.
1Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P. Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther. 2008;88:1196-1207.
Perspectives for New Professionals of the American Physical Therapy Association, Supplement to Physical Therapy, May 2009, page 28