Over the next several weeks, I’m going to feature the specific aspects on how video games can fit into different treatment settings. Today’s focus will be on upper extremity orthopedics and range of motion. Video games have had a small place in the rehab world for quite a while but saw a huge bump in 2005 when the Nintendo Wii hit the market. When the Wii was released, it was going up against two way more powerful systems in the Xbox 360 and the Playstation 3. Both were projected to destroy the Wii in sales because of its weak processing power and gimmicky controller. The actual numbers revealed quite the opposite. 
The Wii outsold both of the consoles in a landslide much due to the potential that it brought to the world of people who weren’t gamers. Nintendo marketed the product as something that could be played throughout the lifespan and encouraged families to interact together through gaming. It encouraged people to get out of their typical gaming postures and interact with the game using life-mimicking movements to control the characters on the screens. Having been the first to hit the market with this motion sensor technology, Nintendo opened the doors for the medical world to explore a new way to treat patients. The most obvious of these therapeutic options include the potential to increase Range of Motion for injured limbs. At it’s core, occupational therapy engages people in purposeful activity during treatment to achieve optimal therapeutic results. Said simply, people typically do better in therapy if the enjoy it. That’s the “occupation” part of occupational therapy. If you focus on things that occupy or fill your time, you’ll achieve the goals you have for recovery. As an Army OT, I jumped on the potential that it could bring to the Soldiers I worked with. There was so much I could with this new modality. First and foremost: Range of Motion. In regards to ROM with the upper extremities, I look at a bunch of different things.
Who is the patient I’m working with? It doesn’t make sense to prescribe a game for somebody who doesn’t have the cognitive skills to engage in the game or has no interest.
What specific motion are we trying to achieve? Just because I want to play a specific game doesn’t mean that it’s going to work for the therapeutic goals I have set for them. For example, if a patient needs to work on supination or pronation (turning your palms up or down) I probably wouldn’t throw them on a boxing game as it’s primary range of motion components are elbow flexion and extension. I would probably look at a game like tennis or baseball that would encourage the movements I’m looking for.
Is there something that I need to be careful of? The biggest problem with video game therapy is it’s to control. If a patient had a recent surgery and you don’t want them to re-injure themselves, you may want to hold off on video games until later in their therapy. When people play games, we want to do the best, swing the hardest, go all out regardless of what stand in our way. That can be great for optimizing range of motion, but could also be a disaster if an injury isn’t ready to be pushed that hard.
The Xbox and the Playstation both followed suit with motion censor technology as they introduced the Kinect and Playstation Move respectively. Neither system saw the success that the Wii did, but opened up a ton of more options for therapy. When I approach a patient for treatment, I want to make sure I’m engaging them in an activity they like. So the more content the better! I eventually want to have a patient engage in the actual activity but gaming give me a good place to start. For example, if a patient wants to be able to bowl again but can’t handle the weight of an actual bowling ball, the Wii controller would be a perfect medium to get back to the game. You can use the same movement patterns and still simulate the game. As games continue to progress in their ability to engage with the player, we should see continued potential with the end user especially in the world of virtual reality and augmented reality. For therapists, this should help you open up your mind to a world of possibilities when you’re working with a challenging environment that has little space and a limited budget.
You can pretty much take a video game system into any practice setting and see results. A hand clinic would be the most common area for upper extremity range of motion success. Gaming can provide results for every articulating joint and is especially a good medium for finger thumb opposition, shoulder abduction and adduction, elbow flexion and extension and of course supination and pronation. I would also encourage you to explore the huge availability of peripherals that can be used with them as well. Anything from driving simulators to actual sports equipment and even fishing poles. If you look deep enough, you’ll be able to find a good option for any activity you’re looking to engage a patient in. The challenge is really getting the therapist to see the potential. As I stated before, this is another tool in the box of therapeutic options for patients.
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