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Nintendo Wii x Effective Therapeutic Interventions in the Older Adult Population

Nintendo Wii
Photo: Nintendo Wii
Introduction
The oldest members of the “Baby Boomer Generation” are now senior citizens and beginning to face the physical and cognitive challenges associated with aging [1] . Since this group makes up nearly one-third of the US population, healthcare professionals are faced with the challenge of finding strategies and interventions to improve health and wellness, while appealing to the culture of this unique generation. The needs of those aged 65 and older include mental, social, and physical promotion to maintain and/or improve levels of functioning, which are compromised naturally by the aging process.

Decreased functioning can be a direct result of the body’s declining physiological changes that are typically seen in older adults. Changes in the nervous system and the musculoskeletal system can lead to impairments in gait, balance, body structures, and other client factors such as strength, endurance, and coordination. Impairments, even in the absence of disease, leave the older adult population at high risk for falls, functional impairment and decreased independence. Falls are among the leading causes of disability, injury, and death among the elderly [2] . Even without falling, natural impairments lead to undesirable consequences such as fear of falling, loss of confidence, loss of independence, and lowered quality of life [3] .

Although functional decline is a part of the natural aging process, evidence shows that participating in physical activity promotes healthy aging and delays functional loss [4] . However, Heath & Stuart[5] found that “only 30% of those aged 65 and older report any regular exercise”. Increasing activity levels in this population is important to slow age-related health decline, increase wellness, reduce safety risks, and maintain the ability to participate in everyday activities. Physical activity is defined as any musculoskeletal body movement that results in energy expenditure and includes categories such as leisure, recreation, work, caregiver duties, household chores, yard work, sports, and planned exercise [6] . Given the wide range of physical activity possibilities, it is important to understand what physical activity routines address the needs of the older adult population.

In the past ten years a new form of physical activity has been increasing in popularity. Virtual reality gaming systems are bringing physical activity right into our living rooms. One of the advantages to using these gaming systems is that the players use the same cognitive and physical skills that are used in everyday activities [7] . The Nintendo® Wii™, which is one example of a virtual reality gaming system, is an ideal therapeutic intervention tool for occupational therapists because of its “ability to facilitate client participation in activities that they want or need to do, while controlling the physical environment in which this takes place” [7] . Although there has been a significant increase in the use of the Nintendo® Wii™ for rehabilitation purposes in the older adult population, there is limited research and evidence on the efficacy as a therapeutic intervention.

The purpose of this study was to investigate the effectiveness of two different physical activity programs for adults aged 65 and older. The two types of physical activity programs were the Nintendo® Wii™ and a video exercise routine, representing a “new era” type of physical activity and a more traditional approach respectively. The two forms of physical activity were studied to address the following questions: 1) Are the Nintendo® Wii™ gaming system and a video exercise routine effective therapeutic interventions for the older adult population to improve functional skills (activities of daily living), balance skills, and overall extremity function? 2) Is the Nintendo® Wii™ gaming system a more effective therapeutic intervention than a traditional physical activity routine?

Discussion
As with any study using human participants, there are variables that researchers are unable to control. For example, posttest results may have been negatively impacted due to some participants feeling ill during the designated data collection period. There were also individuals who were demonstrating gains in function, but due to extenuating circumstances, had to withdraw from the study. Researchers acknowledge that further investigation with longer duration time frame and frequency of the study would yield more meaningful data. While the duration for this study was restricted to an eight week period in which all data collection and interventions were completed the data yielded trends that correlate with previous studies. It is believed that by increasing the frequency and duration of the study, a greater positive increase in posttest results may have been seen.

Some of the major disadvantages of using the Nintendo® Wii™ include the lack of control over the gaming system, difficulty operating the hand-held remote, technical problems with the game and remote, and the participants’ lack of familiarity with virtual reality. Several of the participants in the Nintendo® Wii™ intervention group had conditions that involved tremors, upper extremity weakness, and impaired coordination, thus making it difficult for them to manipulate the hand-held remote of the gaming system. This difficulty impacted their ability to participate and increased their frustration and motivation.

Further research is needed in order to understand the effectiveness of the Nintendo® Wii™ compared to a more traditional exercise routine, as a therapeutic intervention and the impact it has on functional skills, balance, and upper extremity function. Based on data analysis and observations, recommendations for future research studies are to: 1) include a larger sample size; 2) increase the frequency and duration of the interventions; and 3) document and consider any changes in the participants’ medical status during the research study.

Conclusions
Results indicate that participating in either a Nintendo® Wii™ activity or a video exercise routine contribute to gains regarding functional status. However, results did not determine which type of intervention was more advantageous to positively impact functional skills, balance, and upper extremity function.

Researchers conclude that engaging in physical activity does improve functional status when compared to a more sedentary lifestyle.

The Nintendo® Wii™ continues to be used as a therapeutic intervention tool with the older adult population despite the lack of evidence to support its utility and effectiveness. Therefore, when considering the continued and increasing utilization of the Nintendo® Wii™ and the significant results obtained from this study, further research is imperative to support this technology in the therapeutic setting.

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This article is adapted from Elizabeth A. Fain, Brenda Kennell, Nintendo® Wii™ and a Physical Activity Routine: Effective Therapeutic Interventions in the Older Adult Population?. Source article. This work is licensed under a Creative Commons Attribution 4.0 License.

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