The healing game: How Nintendo’s Wii is making the hard work of physical therapy into child’s play

June 10, 2009

The 17-year-old with cystic fibrosis had been hospitalized repeatedly during his short life, and he was angry. Angry at his disease, which confined him to a room at American Family Children’s Hospital even though he was a young man. Angry with the nurses and therapists who swept in busily at all hours, pushing breathing treatments he hated and exercises he found silly.

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Everything — from his darkened room to his downcast eyes — said, “leave me alone,” recalls UW pediatric physical therapist Wendy Stewart. Yet little by little she and her colleagues began to reach him. Stewart got him to open up about his dream of becoming a tattoo artist, while fellow physical therapist Marcella Andrews also made strides by simply talking with him.

Still, he wasn’t doing much physical therapy and getting thinner and weaker all the time. “It was troubling,” says Andrews, who first began working with the teen when he was 15. “He kept getting readmitted and you could just see this was why. He was in a vicious cycle.”

Things might have continued this way indefinitely, but then, in the fall of 2007, Stewart and Andrews got some hopeful news. The Friends of the UW Hospital and Clinics had just donated a new tool for physical therapy — so new, in fact, that the pair was puzzled about how to best use it. It was something, after all, they’d never seen in therapy before. A video game. The Nintendo Wii.

Ever since their debut in the late 1970s, video games have been knocked for promoting slack-jawed sloth. But the Wii is different. Rather than controlling the game with a complicated set of buttons, players hold a motion-sensing remote that picks up their bodies’ movements. Returning a serve in Wii tennis or hurling a Wii bowling ball requires arm swings much like those in the real games. There’s also Wii Fit, in which players stand atop a device, similar to a large bathroom scale, that detects their shifts in weight as they strike yoga poses or twirl hula-hoops.

Controlling game action with body movements, rather than complex finger maneuvers, has made video gaming accessible to all kinds of nontraditional players, such as the elderly, and helped smash gaming’s image as an activity for coach potatoes.

The console also offers traditional sit-down games, but it’s the active, easy-to-play Wii Sports and Fit that have created the biggest demand. Despite a recent slump in sales, Wii has been credited with keeping the U.S. video game industry strong during much of the past year. And in March, Nintendo announced that global sales passed 50 million, making Wii the fastest-selling video-gaming system in history.

What makes it so compelling? Video gaming is all about entering a fantasy realm where you can do things that you can’t do in real life, and here the Wii simply excels, says UW–Madison educational psychology professor David Shaffer.

“The genius of the Wii, if you will,” says Shaffer, an expert in video gaming and its impacts, “is that (Nintendo) realized if you have a chance to use your body in more realistic ways, then the illusion of being in that fantasy world is stronger.”

He adds that controlling the action with body movements, rather than complex finger maneuvers, has made video gaming accessible to all kinds of nontraditional players, such as the elderly, and helped smash gaming’s image as an activity for coach potatoes. And it wasn’t long before members of the medical community took notice.

From Rehab to Wii-hab

One of the first medical fields to latch onto the Wii was rehabilitation medicine. Veteran Affairs hospitals around the country have reportedly adopted it, including the Walter Reed Army Medical Center, where many combat veterans go to recover. And closer to home, the UW Hospital and Clinics has made Wii Sports and Fit an integral part of its in-patient rehab program.

UW rehab program supervisor Dave Maiers says he was skeptical at first that Wii would prove useful, but the console’s versatility has since won him over. Occupational therapists can use Wii bowling and tennis to help patients regain arm strength and range of motion, for example, while physical therapists often prescribe Wii Fit’s balance games, such as tightrope walking and ski-jumping, for those struggling to recover balance and coordination.

Plus, these games can easily be adapted to patients of all abilities, says UW recreational therapist Kris Kravik. People who’ve lost full use of their arms due to spinal cord injury or age, for instance, “can still get the bowling ball to roll by flicking the wrist,” she says. “And they get instant feedback, that, ‘hey, I did that.'”

The games are so enjoyable, she adds, that patients even forget sometimes that they’re doing physical therapy. Still, the fun can have a downside. “I think there’s a bit of a risk for Wii to become the focus of therapy instead of being a piece of it,” says Maiers. “Patients enjoy Wii, so they tend to want to do that, and not as much of the other things they need to do.”

To prevent this, some therapists bring out the game only for a few minutes as a reward. Maiers says his group is also developing guidelines for its use, and may participate in a study of its effectiveness down the road.

In the meantime, one rule is already firmly in place: The console is never left unattended in patients’ rooms. Otherwise, “people tend to get carried away,” says Kravik. “And if it’s not the patient, it’s the family member.”

It was for the same reasons — the lack of guidelines, the potential for overuse — that Andrews and Stewart decided in late 2007 to do a pilot study of the Wii with two groups of hospital patients: kids undergoing bone marrow transplants, and those with cystic fibrosis being treated with intravenous antibiotics. Because of their severe risk for infection, these children are confined to their rooms, making them especially prone to losing strength — and to utter boredom.

“So we saw Wii as a nice way of having some fun,” says Stewart, “and having them participate in sports they were familiar with without having to concentrate so specifically on PT as exercise.”

The group also included Stewart’s and Andrews’ reluctant 17-year-old, with whom they ended up taking a special approach. “Can you be my Wii guy?” Andrews recalls asking him, as she described the study and the help she needed learning to use the new tool. And finally, she says, he began to respond. He started making eye contact. He agreed to an assessment of his fitness level. Then he tried the Wii and found he actually liked it.

“From that point on, he was ready for us,” laughs Stewart. “I think part of it was he was helping us learn about something, he was making a contribution. And, yes, it was benefiting him, too.”

The small study eventually found that Wii did help patients regain strength and function, and got them to participate more in therapy. But there was another benefit, too, one Stewart and Andrews didn’t directly measure: a boost in self-esteem. In their 17-year-old’s case, it came from mastering an athletic activity for the first time in his life. He became an ace at tennis, smoking Stewart nearly every time. Better yet, he learned he could outplay his friends when he got home.

“For a young male, that’s a big deal,” says Andrews. “Your identity is really wrapped around your physical ability.”

Stewart has now seen similar transformations in other patients; in particular, two teen girls with hair “concealing their faces like theater curtains” who wanted absolutely nothing to do with rehab, because after undergoing chemotherapy and surviving cancer they’d simply had enough. After just a couple of sessions with Wii they started talking and making eye contact. They had their hair pulled back and shorts on. Their attitude toward therapy completely changed.

“The Wii has been wonderful,” says Stewart, “because it’s always necessary to engage someone before healing is possible.”

Where Are Wii Going?

If it seems remarkable that a mere game could do such good, Shaffer isn’t surprised. Video games have always had the power to teach us, he says; it’s just that the technological simplicity of early games restricted them to teaching mainly the wrong things, such how to shoot straight and blow up targets. But as games have become more sophisticated, so has our attitude toward them.

“As a society, we’re beginning to understand that what we need to do is not to shun games, but to figure out how to use them to teach things we value,” he says. “So I think it’s great that medical professionals and others are starting to look at the question that way, rather than just stigmatizing games based on early forms of the genre.”

Still, when the novelty of Wii Sports and Fit wears off — as it has with so many video games — won’t the medical community be left in the lurch? Novelty is definitely part of what makes games intriguing, Shaffer acknowledges. But then, the Wii is hardly just another game. By allowing players to control what happens in the virtual world with much more realistic movements of their bodies, it has transformed the entire genre and opened up new realms of possibilities.

“It’s good for all of us to understand that the potential of computer games is not limited by the games we see today or the games that were available five or ten years ago,” he says. “So I think there’s a lot of potential for the field as a whole, and the Wii represents an important step.”