Benefits of using Wii Rehabilitation with Balance Specific

1. Benefits of using Wii Rehabilitation with Balance Specific Physio to Improve Balance in Palliative Patients: Case Studies. Katie Bryan, Therapy Assistant, Isabel Hospice. katie.bryan@isabelhospice.org.uk Objective The objective of this study is to see whether using the Wii Balance Board along with balance specific exercises is able to improve the balance in palliative care patients. Introduction The focus of this study is to look at whether the Wii Fit Plus Balance Board can help improve the balance of the participants. Studies have previously looked at fall rates in elderly patients and how the Wii Fit could benefit them however no study as yet has specified a palliative care group of patients as the case descriptions. This study involved two palliative patients who are of fairly good fitness but have impaired balance, each patient was given a second factor to try and improve on, centre of gravity (COG), strength and co-ordination. COG, strength and co-ordination are all contributing factors that affect balance. Therefore these three factors along with balance made up the 6 week programmes. Each participant had previously been involved with the physio department and had undertaken gym sessions once a week, these gym sessions were used for general fitness and strength and were not specific to balance. Many studies have looked at the use of the Wii Fit on elderly patients who are at risk of falls (Bainbridge, Bevans, Keeley & Oriel, 2011; Williams, Doherty, Bender, Mattox & Tibbs, 2011; Pigford & Andrews, 2010). These studies show an improvement in balance proven through the increase in score of the Berg Balance Scale. Other studies have focussed on patients with brain injuries and other issues such as cerebral palsy and stroke sufferers (Brown, Sugarman & Burstin, 2009; Imazumi, 2011; Deutsh, Borbely, Filler, Huhn & Guarrera-Bowlby, 2008). These studies show a lot of motivation from the patient to use the Wii, improvements in posture and static balance are also shown. Methodology A 6 week exercise programme incorporating both balance specific exercises and exercises on the Wii Balance Board was used. Each participant was given an individual programme which included a personal Wii Fit programme plus general balance exercises (appendix 1a, b, c). At the beginning of the 6 weeks tests were done to allow for continual measurement of any improvement. The tests done were, the Wii Fit Basic Body test this showed the participants centre of gravity (COG), weight distribution over both legs and weight shifting, tests from a modified version of the Balance Assessment Handbook (Hart-Hughes, 2001), including a Functional Strength Test and 8ft Up and Go Test. These tests were measured and recorded in the first week of the programme and then re-recorded at interval during the study. The Activities-specific Balance Confidence Scale (ABC) (Powell & Myers, 1995) was also done for an objective test. During the weeks the exercises were done, the general physio exercises were done by both participants whereby the Wii Fit exercises differed slightly for each participant. Each Wii exercise was done three times and the mean taken, where it could be, from the scores and recorded. All exercises were done within parallel bars for safety. Discussion/Conclusion The verbal feedback from the patients regarding the visual aspect of the gaming system was positive; it brings an aspect of fun into the Wii Fit exercises and can be related to the balance exercises, such as Tightrope Tension is similar to using the wobble board. It also allowed them to correct their COG, balance etc through sight so when it was at the correct angle not only could they see it but they were also able to take the feeling from that and use it in the physio exercises and in their functional activities. The patients found that as the weeks went on not only did their balance improve but their confidence both on and off the Wii increased. Due to the nature of palliative care there were weeks when the participant, possibly after chemo or an infusion, were feeling too unwell or in pain and therefore couldn’t attend the session, taking this into account we could work the 3 weeks on 1 week off programme which allowed the participants that week off to recover without the pressure of missing a session. There were also unfortunate incidents where the patients became more ill and therefore could not complete the study in this instance there were a couple of patients who had agreed to be understudies for the study and so it could continue. This is the main reason why it was cut from 8weeks to 6weeks to give enough time to complete the study with new patients.