Can the Nintendo WII improve balance and quality-of-life in recurrent fallers?

1. Dr Matthew Taylor, Dr Murray Griffin . University of Essex Dr TeshkShawis, Ms Rebecca Impson. CHUFT, Care of the Elderly Can the Nintendo WII improve balance and quality-of-life in recurrent fallers?

2. Falls • “an unexpected event in which the participant comes to a rest on the ground, floor or a lower level“ (ProFaNE) • 22-60 % of older people suffer injuries from falls • 10-15% suffer serious injury • 0.2-1.5% suffer hip fractures

3. Falls • Falls can result in: • Restriction of activity • Fear of falling • Loss of independence • Death • Economic cost of falls (Scuffham et al 2003) • Total cost to UK government in 1999 was approx. £1 Billon • Hospital admissions = 49.4% of cost • Long term care = 41% of costs

4. Falls – Well being & Quality of Life • Falls negatively effect well being and quality of life • Poor well being & poor QOL increases illness, shortens life, prolongs hospitalisation • Health related quality of life can express the personal dimension. • Any loss of ability to live independently inthe community has a considerable detrimental effect on their qualityoflife. • 80 % of women surveyed would rather be dead than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home (Salkeld et al 2000)

5. The Nintendo Wii • ‘Exergaming’ • Wii™ boxing results in greater energy expenditure (EE) compared to other Wii™ games. • However, at best Wii™ games appear to result in moderate increases in EE and at worst Haddock et al (2009) compared the EE of playing Wii™ tennis to that of folding laundry or driving a car. • ‘Injur-Wiis’ • Generally repetitive/prolonged game play • Inappropriate game play

6. ‘Wii-habilitation’ – anecdotal use • Being used in a number of patient populations (stroke, amputation and Parkinson’s disease, and the elderly) within the NHS (www.wiihabilitation.co.uk) • VA centres (www.va.gov) in the US

7. ‘Wii-habilitation’ (Sugerman et al.,2009) • 86 year old female with vertebro-basilar CVA which took place 5 weeks prior to the intervention. • Played four games for 45 minutes on four consecutive training days plus normal physical therapy. • Enjoyed the Wii sessions and felt as though she was receiving up to date treatment and enjoyed the Wii. Also reported that she felt more successful in ’catching herself’’. •  After training improve TUG by 10 seconds, able to play the games with no external support after the 4th session, ambulation improved.

8. ‘Wii-hab’ and fallers (Fraser et al., 2009) • Community-dwelling fallers over 70 years of age. • Four week training session (twice a week, session duration 12.46 ± 4.0 min) . • Significant improvement in mean Berg score compared to baseline. • The games played by the Wii group and also the results of the control group and indeed the activity if any of the control group were not reported.

9. What is missing from these?....potential areas of research….. • Effectiveness of the Wii as complementary rehabilitation tool • Home based exercise • 3 groups • ‘Traditional’ hospital • Wii home • Extra ‘traditional’ home • Measures • Functional mobility/balance/psychological/physical activity • Gaming progression

10. The Demo !!!! Dr Matthew Taylor, Dr Murray Griffin . University of Essex mtaylor@essex.ac.uk , mgriffin@essex.ac.uk Dr TeshkShawis, Ms Rebecca Impson. CHUFT, Care of the Elderly Teshk.Shawis@colchesterhospital.nhs.uk, Rebecca.Impson@colchesterhospital.nhs.uk Can the Nintendo WII improve balance and quality-of-life in recurrent fallers?