More Than Just Fun and Games

by Lauren
Glenn Manfuso
November 2, 2012
The unlikely role of video games in neurorehabilitation.

Tell a kid to do three repetitions of 15 pushups or 25 leg lifts or any of the other myriad exercises that physical therapists assign during a regular session, and the automatic response might be a roll of the eyes and a groan before relenting—only to tucker out and lose focus or motivation before it’s over. But hand this same kid a Nintendo Wii video game controller and tell him to play a game of basketball or a few innings of baseball, or—in the case of 6-year-old patient Maci Janiski—a round of Just Dance, and suddenly 200 repetitions are no problem.

For kids who may need up to six or seven hours of therapy a day, keeping therapy fun and motivating can be key to successful rehabilitation, because as every parent knows, if kids don’t want to do something, even if it’s good for them, they won’t. But offer a reward and make it fun, and suddenly you will see boundless enthusiasm, which is exactly what happened with Maci.

The trouble with Maci started one morning in May 2011. She’d gone to bed seemingly healthy and had never had any major illnesses or injuries. But when she woke up the next morning with an extremely swollen face, her mother, Ronda Janiski, took her straight to the hospital, where she was diagnosed with nephrotic syndrome, a condition affecting the kidneys with symptoms that include protein in the urine, low blood protein levels, high cholesterol levels, high triglyceride levels, and swelling. In most cases, the condition is not debilitating. But Maci had a bad reaction when doctors tried to wean her off a regimen of steroid medications initially prescribed to stabilize her condition. In addition to vomiting and diarrhea, she developed severe edema and could barely move. On August 27, 2011, she had a seizure and stopped breathing. She spent the next two weeks attached to a ventilator and couldn’t sit up on her own, walk, or stand.

Turning Hard Work Into Fun

 

After a 28-day hospital stay, she was discharged and referred to the Specialized Transition Program at Kennedy Krieger, a program for patients who no longer need acute care but still need intense therapy before transitioning back home. She began outpatient physical therapy for several hours a day. Her sessions included the mainstays—balance, strength training, and endurance exercises, for instance—but sometimes she would get tired and give up. So Maci’s therapists, who knew she had loved dance classes and video games before her illness, introduced her to the Wii game Just Dance, which she loved best of all.

“When Maci was playing the Wii and earning points and getting rewards, she was much more motivated,” says Ronda. “I don’t think she even realizes that it’s helping her get better. She just sees it as fun.”

For many, video games and therapy are hardly synonymous. “There are definitely people who just see kids playing video games and think, ‘How is this hard work?’” says physical therapist Erin Naber, PT, DPT, who worked with Maci. “But for these kids, even though it’s fun, it really is work.”

At Kennedy Krieger, where behavioral therapists work side by side with occupational and physical therapists, incorporating video games into therapy was a natural fit— finding out what motivates a child and adding that to therapy is what therapists do every day. “Patients get excited, and as a result, you see a better performance from them,” says Kennedy Krieger occupational therapist Scott Frampton, MS OTR/L, CPST.

Targeted Therapy With a Twist

Video games with motion-sensing systems like the Nintendo Wii and the Xbox Kinect offer games that require a lot of physical involvement, dexterity, and exertion, which can improve endurance for patients like Maci who have the capability for a wide range of motion.

Video games may be even more beneficial for patients with damage to the brain. For these patients, who may have significantly reduced strength, endurance, or cognitive abilities, even the simplest tasks—like holding a pencil or a remote and manipulating buttons and switches—can prove challenging. Researchers know that neuroplasticity—a process of brain repair in which the neurons in the brain begin forming new connections to replace the damaged ones—can be fostered through repetition, provision of feedback, and motivation. Video games provide all of these elements, making it an ideal supplement to therapy. When kids can see a cause and effect from pushing a button or they see their scores improving, they are motivated to try again, and with every repetition comes progress. A recent study found that children with cerebral palsy may benefit from the use of video games, and another study found that video games and virtual reality can help improve motor function in patients who have suffered a stroke.

For patients who need more targeted therapy for specific joints or movements, the Institute has scores of rehabilitation equipment that incorporates video game technology. Therapists use robotic devices with built-in video games, such as the MediTouch HandTutor™ and LegTutor™, to help elicit movement while tracking the patient’s progress. With the Armeo® Boom and Armeo®Spring, patients can activate video games to improve motor control of arms and hands. The Institute even uses a virtual reality–based therapeutic training system—Myomo®—that encourages brain-injured patients with upper limb motor disorders to practice physical exercises.

“One of the benefits of using video game technology is that we can incorporate different adaptations based on desired motor movements and the patient’s abilities,” says Frampton. “As a result, we can gear the game experience toward helping the patients achieve more function. We may target certain areas and be able to tell which muscles they’re using for certain movements. And because they’re more motivated, we see more effort.”

From iPads to GameCycles to Lumosity—an internet-based cognitive training program used to improve cognitive impairment—everywhere you look you can see an example of innovative rehabilitative technology at Kennedy Krieger. And it’s not hard to find a rehabilitation patient or parent who attributes their good outcomes at least in part to the incorporation of video game technology into their regular sessions.

It certainly paid off for Maci, who less than six months after her therapy began, grew fully capable of running and playing with other kids.