Wii Fit Nintendo game makes physical therapy fun

by jmorona

Thomas Ondrey/The Plain DealerRecovering stroke patient Marilyn Smigelski gets into the rhythm of a Wii Fit hula game with the help of physical therapist Nancy Ditzel at LakeEast Hospital in Painesville. Fit is used in conjunction with other therapy modalities.

Physical therapy is best served with a little camaraderie and light conversation, but therapist Nancy Ditzel also dished out some fun to recovering stroke patient Marilyn Smigelski recently.

The LakeEast Hospital therapist put Smigelski to work on the latest Nintendo Wii video system game, called Fit. While the American Physical Therapy Association magazine recently reported widespread use among members of Wii games that simulate sports like tennis and bowling, the Lake hospital system is the first locally to use the Fit game in physical therapy.

The $90 Fit game -- a white plastic platform motion detector operated through a $250 Nintendo Wii console -- translates a person's real-time movements onto a screen and offers 40 activities in yoga, aerobics, strength training and balance, many appropriate for therapy, Ditzel said. And with so many possibilities, therapists can tailor patient sessions, monitoring carefully to avoid the overuse common with Wii's simulated sports.

Ditzel's hoping that even patients who cannot walk or stand will also get in on the fun by sitting on the platform, called a balance board. That application has yet to be tested, though patients in wheelchairs already can use some Wii sporting games.

The game is also useful in occupational therapy, which helps patients relearn daily living skills, like getting dressed.

In addition to weakness in her right side, Smigelski, a retired ICU nurse, is frustrated by double vision. But she persevered, using her balance to steer a bubble down a river without bumping into the river bank and, later, to head-butt virtual soccer balls while dodging shoes and helmets.

She was also challenged to keep a penguin from sliding off an ice floe while helping him catch fish jumping out of the water. The fish are assigned different values based on color, so a laughing Smigelski could see her improvement in successive games.

"There's a learning curve," said Ditzel, firmly clutching a safety belt encircling Smigelski's middle. "The average person isn't excellent right away."

The Hula-Hoop game was the most physically demanding, requiring Smigelski to swivel her hips like she was using one of the toys. Slowing down too much caused the hoop to fall, thus ending the game, while speeding up increased her score, as well as her heart rate. And when another hoop was virtually thrown her way, she had to lean to the left or the right to catch it with her whole body and then resume her swiveling.

"Get those hips going! Big circles! Big circles," Ditzel coached.

Dressed for action in khaki shorts and running shoes, Smigelski was panting after a few rounds and just a tad embarrassed that some patients and staff had clustered to watch her.

"In my 15 years as a therapist, it's the coolest thing to come along," Ditzel said. "It's an interactive fun adjunct to conventional therapy."

At Smigelski's urging, Ditzel took a turn at the Hula-Hoop game. When she finished a lively performance that drew cheers from spectators, she felt for her pulse in her neck and pronounced the activity "aerobic."

The games are most challenging to patients unfamiliar with video games and computers.

"They're timid and unsure of themselves," Ditzel said. But once patients are up and running, they're happy. "Time passes quickly, and it's not drudgery. If they're scared, they forget they're doing something fearful."

Lake physical therapist Chris Haladyna said the Fit has gotten good reviews from her patients, too. "It's work, but it's fun. One grandpa bought one for home after he was discharged."

The game is slowly making its way into physical therapy around the country, said Lisa Rubin Falkenberg, the hospital's system's director of rehabilitation. She ordered it on a hunch in March, a couple months before its release, and has been delighted with the outcome.

Thomas Ondrey/The Plain DealerMarilyn Smigelski gets into the rhythm of a Wii Fit exercise under the guidance of physical therapist Nancy Ditzel at LakeEast Hospital.
"It's a way to make rehab less tedious. You're not counting repetitions. You're playing a game," she said. "The patients love it. And the therapists are thrilled with it." She plans to purchase it for the hospital's other sites.
Because Wii Fit lets the patient see how they affect the game by changing their balance, a therapist can better explain center of gravity and help patients use that knowledge. Most people in rehab have balance problems, Rubin Falkenberg said.

"Stroke patients are afraid to shift their weight. They can have a weakness on one side of their body, so they lean toward their 'good side,' and therapists are always trying to straighten them up. It's easier when they have feedback like Wii."

If she hadn't pre-ordered the game, she probably still would be waiting to buy one. They've been in very short supply, said Tom Vitko, gaming supervisor at Best Buy, Brookpark Road, Cleveland.

In the first three weeks that they were available, only 100 were delivered to the store. "The same with the Wii consoles," he said. "They're not in our warehouse. They're always on order. We have people waiting when the store opens, looking for Wiis."

It doesn't help to be a Best Buy employee. You'd still have to wait in line, Vitko said, and be "off the clock."