TY - JOUR
AU - MSc, Manuel Gomez, MD,
AB - Abstract The objective of this study was to investigate perceptions of occupational therapists and physiotherapists on the use of Nintendo Wii™ (Nintendo of America Inc., Redmond, WA) in rehabilitation. Occupational therapists and physiotherapists in a rehabilitation hospital trialed four Wii games that addressed physical movement, balance, coordination, and cognitive performance. Then, they completed an opinion survey on the utility of Wii in rehabilitation. The results were compared between burn care therapists (BTs) and nonburn care therapists, using χ2 with a P < .05 considered significant. The participation rate was 79% (63/80), and they agreed that Wii was easy to set up (71%), operate (68%), and safe to use (76%). Participants agreed that Wii would be beneficial in outpatient (76%) and inpatient (65%) settings and that it could improve treatment compliance (73%). Participants recommended 15 to 30-minute Wii intervention (59%) daily (81%) and twice per week (43%). Participants believed that neurologic (71%), trauma (68%), burn (59%), and musculoskeletal (49%) patients would benefit from Wii intervention but not cardiac (43%) or organ transplant patients (18%). Participants believed that outcomes using Wii could be measured reliably (49%), and skills learned while playing could be transferable to daily function (60%). The significant differences between BTs and nonburn care therapists' perceptions are that BT-treated younger patients (21–40 years vs >60 years, P < .05) and BT favored the therapeutic benefit of Wii in rehabilitation (93% vs 58%, P = .02), specifically in burn rehabilitation (85% vs 39%, P = .001). Occupational therapists and physiotherapists favored the use of Wii in rehabilitation as an adjunct to traditional therapy because it is therapeutic, engaging, and may increase patient participation in rehabilitation. Virtual reality (VR) and video gaming technology allow users to manipulate different aspects of the game and navigate computerized settings through the detection of physical movement. These systems can be used in rehabilitation to provide distraction during painful procedures and physical movement aimed at restoring joint motion.1 Challenges in using such treatment interventions might include limited availability of the technology and the cost of such equipment.2 Current commercially available video games that use motion detection technology are becoming increasingly popular in rehabilitation.1,–3 Compared with VR equipment, video game systems such as the Nintendo Wii™ (Nintendo of American Inc., Redmond, WA) and the Playstation EyeToy (Sony Computer Entertainment America, LLC, Los Angeles, CA) are less expensive (VR >$9000,4 Wii ≥$200,5 and EyeToy ≥$1506,7), more accessible to the public, and still use the same principles of motion capture currently believed to be benefits of VR programs in rehabilitation.2 Games and software for commercially available systems also come at a lower cost and with a greater variety, making it possible to adapt their use to different rehabilitation needs.3 Various game applications offer potential benefits in achieving treatment goals such as increasing joint movement, stimulating cognitive functions such as concentration, and stimulating functional activities such as driving and cooking. Gaming systems can introduce additional motivators to generate interest in therapeutic activities2,3 and can be intended for an enjoyable method of encouraging physical movement.8 VIDEO GAMES AND VR IN BURN REHABILITATION It is recognized that management of a burn injury often involves painful procedures and therapies aimed at maintaining the integrity and optimizing the mobility of the burned skin and surrounding joints.1,9 A pilot study of seven subjects by Das et al9 comments on the challenges of achieving sufficient pain control in the pediatric patient during procedures such as dressing changes, using only traditional pharmacological methods. VR was investigated as a distraction intervention during these procedures. Results indicated that VR-based games have a role in acute pain management for children and are advantageous because they are accompanied with minimal side effects, reusable, and versatile.9 Sharar et al10 conducted a randomized, controlled, within-subject trial and found that when used in conjunction with standard analgesic therapy, immersive VR provided pain relief for burn patients during passive physiotherapy (PT) range of motion interventions. The Sony PlayStation II EyeToy was described by Haik et al1 to be a potentially useful system in burn rehabilitation. The video capture and movement detection capability of this system allow users to become immersed within a virtual setting, using physical movement to achieve the objectives of the game played. With the use of movement-driven VR and video games, patients might engage in active movements for longer periods of time1 and might participate in mobility-restoring exercises more frequently.10 These studies strongly suggest that video games and VR as distraction tools or motion capture devices have the potential to provide burn patients with adjunct therapies to interventions that are traditionally known to cause pain and anxiety.1,9,10 RATIONALE After reviewing the available literature and resources, the investigators of this study believed that a trial using the Nintendo Wii (Nintendo of America Inc., Redmond, WA) and its available games was an appropriate option for study consideration. At the time that this study was conducted, the Nintendo Wii was already in use as an adjunct to occupational therapy (OT) and PT treatment programs, with benefits congruent to those highlighted in the aforementioned studies. Clinicians reported that patients received added enjoyment and demonstrated increased interest in their therapy programs when Nintendo Wii was included, without compromising on the quality of active movement. Although a close review of its effects on the burn population has yet to be conducted, preliminary, anecdotal reports of the benefits of Nintendo Wii in physical rehabilitation seem favorable toward using it to address therapy goals in burn rehabilitation. PURPOSE The purpose of this study was to determine the perceptions of OT and PT professionals, within a specialty rehabilitation hospital about the utilization of the Nintendo Wii as an adjunct to existing rehabilitation interventions. Data were analyzed to determine whether there was a difference in perspectives between OT and PT professionals and between burn care therapists (BTs) and nonburn care therapists (NBTs). The results collected from this study will be used to guide further treatment and research decisions within this organization surrounding this technology. METHODS Video Game System Trial Hospital staff within OT and PT disciplines were eligible for this study. Age, gender, practice in inpatient wards or outpatient clinics, years of clinical experience, primary patient population, and average patient age range were collected as demographic data. Each participant was asked to read over the summarized setup instructions for the Nintendo Wii and safety recommendations related to its use. All participants completed a trial of four Nintendo Wii games identified by investigators as having potential to influence various patient outcomes. The bowling and tennis games in Wii Sports, Cooking Mama: Cook off, Big Brain Academy, and GT Pro Series were chosen for their potential to influence physical movement, functional movement, cognitive functioning, and driving, respectively. Each game was trialed for 15 minutes in duration. Video Game System Survey A survey designed to capture perspectives regarding each game and the Nintendo Wii system in relation to its potential use in rehabilitation was completed by each participant following the game trials. Potential risks and benefits to patients engaging in rehabilitation were listed, and participants were asked to identify those that were applicable to each game. Perceptions regarding statements related to aspects of potential Nintendo Wii use in rehabilitation were measured using a 5-point Likert scale (strongly disagree/disagree/neutral/agree/strongly agree). There was also opportunity to submit comments supporting each response in the survey. Information collected from the survey was entered into an SPSS program, and χ2 analysis was applied. Qualitative comments were coded to identify recurring themes within the responses. Data Analysis The results of the information collected from the survey were compared between OT and PT professionals and between BTs and NBTs to determine whether there were differences in participant demographic characteristics, years of clinical experience, and their perspectives regarding the potential use of the Nintendo Wii system and each game in rehabilitation. These analyses were made using χ2 with a P < .05 considered significant. Also, qualitative comments were coded to identify recurring themes within the responses. RESULTS Sixty-three of 80 possible OT and PT practitioners responded the survey, representing a 79% participation rate. The majority of respondents were women (88.9%), and their professional qualifications are shown in Table 1. Sixty-seven percent of participants were aged between 21 and 40 years (Figure 1). The majority of participants (64%) had between 1 and 10 years of clinical experience (Figure 2). The majority (66%) of respondents had no previous experience using the Nintendo Wii, whereas a few (3%) of them were already using Nintendo Wii in their treatment programs. Participants agreed that the Nintendo Wii was easy to set up (71.4%), easy to operate (68.3%), and safe to use (76.2%) (Table 2). Table 1. Participant qualifications View Large Table 1. Participant qualifications View Large Figure 1. View largeDownload slide Participant age (years). Figure 1. View largeDownload slide Participant age (years). Figure 2. View largeDownload slide Clinical experience (years). Figure 2. View largeDownload slide Clinical experience (years). Table 2. Perspectives regarding general use of Nintendo Wii View Large Table 2. Perspectives regarding general use of Nintendo Wii View Large The majority of participants agreed that Nintendo Wii should be used as an adjunct to individual rehabilitation therapy (55%), in both outpatient (76%) and inpatient (65%) settings (Table 3). For the purposes of providing patient treatment, most (70%) deemed that the start-up instructions were adequate and recommended treatment frequency of twice weekly (42.9%), with a 15- to 30-minute duration for each session (58.7%), and an intensity of once per day (81.0%). The majority (73.0%) believed that Nintendo Wii can improve treatment compliance with therapy-related activities, because it is engaging and fun. Less than half (49.2%) of the participants believed that outcomes using Nintendo Wii could be measured reliably but agreed that skills learned while playing are potentially transferable to daily function (60.3%). Table 3. Suitable treatment setting View Large Table 3. Suitable treatment setting View Large Patient Populations to Potentially Benefit From Nintendo Wii Participants agreed that neurologic (71%), trauma (68%), burn (59%), and musculoskeletal (49%) patients would benefit from Nintendo Wii intervention (Table 4). However, participants were in agreement that it would be inappropriate for cardiology (43%), and organ transplant patients (18%) (Table 5). Table 4. Patient population to potentially benefit View Large Table 4. Patient population to potentially benefit View Large Table 5. Patients deemed inappropriate View Large Table 5. Patients deemed inappropriate View Large Perceptions of Occupational Therapists vs Physiotherapists The survey was conducted among occupational therapist, OT assistant, OT student, physiotherapist, PT assistant, and PT student. For the purposes of this study, results were compared between the two disciplines only. Twenty-six (41%) participants identified themselves as associated with the OT profession and 37 (59%) reported that they were associated with the PT profession. There were no differences in responses regarding general use (Table 2) and treatment setting (Table 3). The most notable differences were in the agreement that Nintendo Wii had the potential to benefit the acquired brain injury population (OT: 69% vs PT: 38%, P = .014) and with respect to potential side effects of the game for driving simulation (OT: 69% vs PT: 41%, P = .025) (Table 6). A borderline difference was found between OT and PT agreement toward benefit to patients with burn injuries (OT: 73%, PT: 49%, P = .053) and toward the potential for the driving simulation game to benefit upper extremity range of motion (OT: 54%, PT: 30%, P = .054). Table 6. Nintendo Wii use—occupational therapists vs physiotherapists View Large Table 6. Nintendo Wii use—occupational therapists vs physiotherapists View Large Perceptions of BTs vs NBTs Of the 63 participants, 27 (43%) were BTs and 36 (57%) were NBTs. This identifier was delineated by whether the therapist's usual practice included a patient load consisting of burn injuries. The most notable differences included patient age range (BT: 21–40 years, NBT: >60 years, P < .05), participants' belief of the therapeutic benefit of Nintendo Wii in rehabilitation (BT: 96%, NBT: 65%, P = .029), and its benefit specifically to the burn population (BT: 85%, NBT: 41%, P = .001) (Table 7). An ad hoc analysis comparing OT and PT professionals within the BT and NBT groups was performed, but no significant differences were found. Table 7. Nintendo Wii Use—burn therapists vs nonburn therapists View Large Table 7. Nintendo Wii Use—burn therapists vs nonburn therapists View Large DISCUSSION Overview Current studies looking at the use of commercially available video gaming systems in rehabilitation are primarily case reports describing how the technology was integrated into patient therapy programs and its benefits for that patient population.1,2,11 Perceived benefits achieved from these games are limited to the views of the investigators and to the conditions of the patient subset used. This study is the first to investigate clinical perspectives regarding the use of a commercially available video gaming system as a therapy adjunct in a rehabilitation hospital setting, looking at its potential use in multiple patient groups. It is also the first to investigate the difference in perspectives between therapists that treat burn injuries and those that are not involved in burn care. Games With Potential Benefit This study demonstrated an interest in the utilization of the Nintendo Wii as a therapy adjunct. According to a case report by Betker et al,12 patients experienced fewer falls and improved balance after task-specific balance training using video game equipment developed by the investigators. They also reported in a prior single-subject study that the patient found the use of this video game to be an enjoyable treatment approach.13 This concept can be applied to the utilization of video games to recover physical movement and skills required for functional activities. This study was conducted to determine whether therapists recognized that using video games to enhance therapy enjoyment, while recovering task-specific function, would be a beneficial treatment modality. Favorable results from clinicians would facilitate the implementation of video games as a treatment adjunct and participation in future research to determine its efficacy in specific patient populations. The intention of the games chosen was to address various functions commonly involved in therapy goals. Cooking Mama: Cook Off incorporates cooking concepts with upper extremity movements that mimic functional movements such as stirring and chopping. It was discussed that this application might be useful in reintroducing movements related to meal preparation in patients with upper extremity injuries. Big Brain Academy challenged memory, concentration, reaction time, and simple computational skills. It was thought that such an application had the potential to be an adjunct to cognitive retraining after neurologic injury. Wii Sports, bowling and tennis, requires the user to mimic movements used in playing these sports and was thought to have the potential to encourage upper extremity movement while challenging dynamic standing balance. Finally, the ability to combine the video game remote to a steering wheel attachment enabled the game GT Pro Series to stimulate driving. Previous studies investigating the therapeutic use of commercially available video games did not attempt to match the game objective with the functional deficit.1,–3 Although previous studies also used video game systems that detected movement, it did not seem that the games used were task specific.1,–3 Potential Advantages Improving Overall Function. It was recognized that because the movements required to play the games mimicked those used in actually performing the task, the games trialed had the potential to address functional goals such as returning to driving and cooking activities. In addition, playing any of the available video games while in a standing position can serve as a distraction method to improve standing tolerance. Recovering Motor Deficits. The movements encouraged while playing Nintendo Wii indicated a potential for improvement of body awareness and proprioception, which are often impaired after injury, amputation, or surgical intervention. The weight shifting involved with playing the tennis and bowling games in standing can potentially influence the recovery of balance. Subjective comments indicated, however, that participants did not agree that the game chosen to address cognitive deficits would be effective or appropriate to recover cognitive functions after neurologic insult. In a case study of five subjects by Broeren et al,8 VR was found to improve upper extremity motor outcomes in patients after stroke. The PlayStation EyeToy is a commercially available video game system that, similar to the Nintendo Wii, requires physical movement to achieve the gaming objectives. A clinical trial conducted by Yavuzer et al3 found that in subacute stroke patients, the PlayStation EyeToy has the potential to positively influence the recovery of upper extremity motor function. These studies offer indication that the role of the Nintendo Wii in the rehabilitation of neurologic conditions might have more benefit in the recovery of motor deficits rather than cognitive impairment.3,8 Because participants of this study did not agree that the puzzles or memory game features in the game Big Brain Academy would be beneficial to patients with neurologic conditions, the utilization of Nintendo Wii in the rehabilitation of these patients could instead focus on retraining motor control. Distraction From Pain. Participants agreed that using video games to encourage range of motion exercise has the potential to provide distraction from pain while performing therapeutic activities. Immersive VR as a distraction tool has been identified as having a role in providing pain relief during painful procedures in patients with burn injury.14,15 It is then conceivable that a video game system requiring physical movement has the potential to distract from symptoms of performing activities in a usually painful range. Increasing Motivation. Congruent with the findings of Warburton et al16 and the hypothesis of Betker et al,12 participants in this study believed that because of the enjoyable nature of the activity, using an interactive video game might increase patient motivation to attend and participate in therapy. Achieving higher scores and improving game performance might also serve as an initiative to participate in therapy activities involving video games. Participants also recognized that this technology has the potential to increase the social aspect of therapy when played in an interactive setting of multiple patients. Potential Disadvantages Decreased Interest in Other Interventions. Participants subjectively commented that some of their patients already using Nintendo Wii expressed preference toward using it over participating in other therapeutic interventions. Therefore, it might be beneficial to determine a time limit or other relevant boundaries to each Nintendo Wii therapy session to avoid taking time away from other interventions. Space and Safety. Adequate space for patients to engage in the full movements of the video game was identified as a barrier to its use within a hospital setting. Abrupt full range movements in an area crowded with equipment and other patients increase the risk of the user hitting other objects or other people while playing. Excess noise generated with the excitement of competition or achievement could also be distracting to others in the treatment area. Fatigue and Soreness. Some participants subjectively commented that completing a full race using the driving game trialed might increase risk of upper extremity fatigue and soreness in patients with upper extremity deficits. Subjective recommendations were made to provide appropriate elbow or forearm support for patients wishing to use this application. If, for example, shoulder fatigue was preventing the patient from achieving the elbow and wrist movements required to benefit from the driving game, playing with the elbows propped up on a table will still allow for the required movements, without as much shoulder fatigue or related soreness. However, this fatigue and soreness may not be more severe than what one would expect from traditional therapy. Therefore, it might be worthwhile to compare clinician perspectives regarding video game-related fatigue and soreness with that resulting from traditional therapy. Perhaps, fatigue and soreness are side effects not commonly associated with video gaming activity and were, therefore, highlighted as potential disadvantages of Nintendo Wii use in rehabilitation. Patient Populations Because of the nature of the movements encouraged by some of the games used in the trial, populations with motor or joint movement deficits were considered to potentially benefit from the use of Nintendo Wii as a rehabilitation adjunct (Table 4). Patients after cardiac or organ transplant surgery, with significantly compromised aerobic endurance might not tolerate Nintendo Wii-related activities, such as Wii Sport tennis, that require rapid and repetitive upper extremity movement. Therefore, it would be important to closely monitor these patients should the therapist choose to use the Nintendo Wii as a therapy adjunct. Subjective comments noted that although upper extremity incisions might be absent in cardiology or organ transplant patients, the rapid and high-amplitude movements required for some of the games trialed might put these patients at risk of strain on the sternal or truncal incision site. Similarly, all patients with acute incisions might experience greater risk of wound aggravation or incisional pain if movements during play involve the incisional region (Table 5). Comparison Between Occupational Therapists and Physiotherapists The differences identified between the perspectives of OT and PT professionals do not suggest that there would be many contradicting approaches or considerations regarding Nintendo Wii use in therapy. However, there seems to be the potential for disagreement between the two disciplines regarding certain populations that would be considered appropriate for this intervention. More OT professionals agreed that the acquired brain injury population would benefit from therapy, and a borderline significance was found indicating that more OT professionals believed that the burn population could potentially benefit from Nintendo Wii intervention. At this time, it can only be speculated that the contributor to these differences might be the difference in treatment focus between the two disciplines. Comparison Between BTs and NBTs A significantly larger proportion of therapists with experience in treating burn injuries agreed that using the Nintendo Wii as trialed is safe to use in a rehabilitation setting, has the potential to be therapeutic in rehabilitation, and whose influence on recovery can be reliably measured. More BTs agreed that using the Nintendo Wii as trialed is appropriate for patients receiving treatment for orthopedic trauma and burn injuries (Table 6). These differences can be attributed to a larger proportion of BT practicing and providing treatment in outpatient settings and to more patients younger than 50 years. The outpatient treatment setting can indicate that the patients are at a higher level of physical function and can better tolerate the movement required to achieve the game objective. The ambulatory patient is also able to approach the equipment, therefore eliminating the need for portability and providing the opportunity to have dedicated space to use it. The younger age group of patients treated by BT can imply increased familiarity and interest in video game technology, forming less of a barrier to introducing this equipment as a potential treatment intervention. Parameters of Use The majority of clinicians surveyed agreed that providing Nintendo Wii activity as a treatment adjunct two times per week for 15- to 30-minute treatment sessions was appropriate. Its use could be safely monitored by OT and PT assistants. The majority of clinicians surveyed did not recommend providing Nintendo Wii within a group therapy session, as increased noise level and increased risk of injuries would be prevalent with multiple players in a small space. However, it was recognized that the use of a video game might enhance the valued social aspect of rehabilitation. Considerations for Use in a Rehabilitation Setting It was recognized that special considerations would be required for patient use, as decreased stamina, standing tolerance, and altered physical function would likely be an issue. Chairs and other nearby supports should be available for patients who require rest or balance support. Recommendations regarding potential modifications to the hardware included increased remote girth for those with grip limitations, increased remote button size for those with visual impairment and hand limitations, and other attachments to mimic the activity the patient is trying to recover. Space considerations were also recommended for patients mobilizing in wheelchairs or with other assistive devices. A portable and lockable cabinet that enabled the entire equipment configuration to be transportable between units could help minimize the coordination and time required to bring the patient to a designated space to receive Nintendo Wii activity. However, finding available space to safely store and use the Nintendo Wii and related equipment was identified to be a challenge to implementing its regular use within this organization. Considerations for Home Exercise The commercial availability of the Nintendo Wii makes it possible for patients to use it as part of a home exercise program to address therapeutic goals. Participants of the study did not believe that they would recommend it in this manner because its use could not be safely monitored by the responsible therapist. However, it was recognized that patients might use the Nintendo Wii in the community independent of any clinical recommendations, of which responsible therapists had no control. Limitations of the Study The survey design did not have an option for clinicians to select if they did not wish at all to use Nintendo Wii as an adjunct to therapy. Therefore, it operated on the assumption that all clinicians would recommend its use at least once per week. Starting instructions were provided as a printed document, which the clinicians were asked to review before engaging in the game trial. The navigation of the player through the initial menus of each game, however, was conducted by student volunteers, and the participants, therefore, were not able to attempt the start-up process as part of the trial. The majority perception that the starting instructions were adequate could be considered speculative. CONCLUSION A trial of commercially available video games by OT and PT clinicians demonstrated that there was a favorable perception toward using Nintendo Wii as a potential treatment adjunct to OT and PT interventions. Delivering treatment using motion detection video game equipment can offer an enjoyable therapy experience for the patient and can provide distraction from symptoms otherwise limiting the motivation to participate in therapy. The relatively low cost of such equipment facilitates implementation as a therapy treatment adjunct. When incorporating such equipment as a treatment adjunct in a rehabilitation hospital setting, it is important to consider the availability of space, the condition that the patient is recovering from, the session length, and the frequency of use. There might be a larger role in addressing orthopedic or movement deficits than cognitive impairments. BTs seem more favorable in agreeing to the potential efficacy of Nintendo Wii use in the rehabilitation of patients with burn injuries compared with NBTs. Future studies can investigate patient outcomes in response to the utilization of specific motion detection gaming protocol, as existing games and applications have the potential to be adapted to address condition-specific deficits. ACKNOWLEDGMENTS We thank all participants for their collaboration and support for this project. Additional appreciation is extended to all student volunteers for their assistance, Terrence Yuen for providing the additional equipment required to conduct this trial, and Tanya Ramsey for assisting with the organization, conduction, and data management of this study. We also acknowledge clinicians, Dianne Beynon, John Cho, Catherine Chuang, Gina Lam, Karen Leong, Jeff Scott, Gary Siu, Jessica Sy, and Lawrence Yu, whom in complement to the authors, provided creative and logistical input in the initial stages of this study. REFERENCES 1. Haik J, Tessone A, Nota A, et al.   The use of video capture virtual reality in burn rehabilitation: the possibilities. J Burn Care Res  2006; 27: 195– 7. Google Scholar CrossRef Search ADS PubMed  2. Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther  2008; 88: 1196– 207. Google Scholar CrossRef Search ADS PubMed  3. Yavuzer AS, Atay MB, Stam HJ “Playstation eyetoy games” improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Eur J Phys Rehabil Med  2008; 44: 237– 44. Google Scholar PubMed  4. Fifth Dimension Technologies. Price list. Available at: http://www.5dt.com/pricelist.html#land. Updated March 24, 2010. Accessed March 24, 2010. 5. Falcone JP. Nintendo drops Wii price to $199. Available at: http://news.cnet.com/8301-17938_105-10360550-1.html. Updated September 23, 2009. Accessed March 24, 2010. 6. PC. EyeToy: Kinetic. Available at: http://www.pcmag.com/article2/0,2817,1902636,00.asp. Updated December 21, 2005. Accessed March 24, 2010. 7. Best Buy. Sony-Playstation 2 console. Available at: http://www.bestbuy.com/site/Sony+-+Playstation+2+Console/7266638.p?id=1117177358855&skuId=7266638&st=ps2. Accessed March 24, 2010. 8. Broeren J, Rydmark M, Bjorkdahl A, Stibrant Sunnerhagen K Assessment and training in a 3-dimensional virtual environment with haptics: a report on 5 cases of motor rehabilitation in the chronic stage after stroke. Neurorehabil Neural Repair  2007; 21: 180– 9. Google Scholar CrossRef Search ADS PubMed  9. Das DA, Grimmer KA, Sparnon AL, McRae SE, Thomas BH The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial. BMC Pediatr  2005; 5: 1. Google Scholar CrossRef Search ADS PubMed  10. Sharar SR, Carrougher GJ, Nakamura D, Hoffman HG, Blough DK, Patterson DR Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Arch Phys Med Rehabil  2007; 88: suppl 2 S43– 9. Google Scholar CrossRef Search ADS PubMed  11. Graves LE, Ridgers ND, Stratton G The contribution of upper limb and total body movement to adolescents' energy expenditure whilst playing Nintendo Wii. Eur J Appl Physiol  2008; 104: 617– 23. Google Scholar CrossRef Search ADS PubMed  12. Betker A, Desai A, Nett C, Kapadia N, Szturm T Game-based exercises for dynamic short-sitting balance rehabilitation of people with chronic spinal cord and traumatic brain injuries. Phys Ther  2007; 87: 1389– 98. Google Scholar CrossRef Search ADS PubMed  13. Betker AL, Szturm T, Moussavi ZK, Nett C Video game-based exercises for balance rehabilitation: a single-subject design. Arch Phys Med Rehabil  2007; 87: 1141– 9. Google Scholar CrossRef Search ADS   14. Carrougher GJ, Hoffman HG, Nakamura D, et al.   The effect of virtual reality on pain and range of motion in adults with burn injuries. J Burn Care Res  2009; 30: 785– 91. Google Scholar CrossRef Search ADS PubMed  15. Morris LD, Louw QA, Grimmer-Somers K The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. Clin J Pain  2009; 25: 815– 26. Google Scholar CrossRef Search ADS PubMed  16. Warburton DE, Bredin SS, Horita LT, et al.   The health benefits of interactive video game exercise. Appl Physiol Nutr Metab  2007; 32: 655– 63. Google Scholar CrossRef Search ADS PubMed  Footnotes 1 Presented in part at the 41st Annual Meeting of the American Burn Association, San Antonio, Texas, March 25, 2009. Copyright © 2010 by the American Burn Association
TI - The Utility of a Video Game System in Rehabilitation of Burn and Nonburn Patients: A Survey Among Occupational Therapy and Physiotherapy Practitioners
JF - Journal of Burn Care & Research
DO - 10.1097/BCR.0b013e3181eed23c
DA - 2010-09-01
UR - https://www.deepdyve.com/lp/oxford-university-press/the-utility-of-a-video-game-system-in-rehabilitation-of-burn-and-0JwY3Mu5Ep
SP - 768
EP - 775
VL - 31
IS - 5
DP - DeepDyve
ER -