Upper Limb Therapy

Using the Wii to promote Upper Limb activity

This section offers a selection of ways that the Nintendo Wii can be used to promote and improve a variety of upper limb movements and skills.

The Nintendo Wii can be used to exercise the upper limbs and promote functional movement. The use of the Wii Remote and Nunchuk are used within games to control the movements of activities in a more realistic way than computer consoles have done so previously. The main controllers for the Wii are used by the hands, with the movement of the hands and controllers simulating the actions within the game. There are several main ways that movement is used within the Nintendo Wii games.

Sporting activities – boxing and tennis being two of the more energetic. Plays use the controls to replicate holding a racket and swinging to hit a ball or using both controllers to swing punches at a computer opponent. There is a wide selection of sport activity and simulation games available for the Wii.

Shaking of remote – the faster they are shaken the more power is created for the character to perform the activity. The Running within Wii Fit can be also be achieved through shaking the remote in a smooth and regular fashion. The repetitive movement works the muscles hard and contributes to promoting increased strength.

Mini Games – Many Wii games advertise as containing ‘Mini Games’, these are often small and short games that require the player to explore a variety of skills. Many of these mini games will require bursts of upper limb energy whilst others will require more skill and fine control. The mixture of activity content within these types of games can be good as the slower games offer time to rest from the more energetic.

Another method of exercising upper limbs with the Wii is to press and lean on the fit board with your hands. When playing the Wii Fit balance games it will work arm muscles in the same way that resistance exercises would. For more information click here.

The Wii can be a beneficial tool within therapy and can be used more specifically to improve the following upper limb motor skills.

Fine movement  By working on basic elements of games it is possible to work towards maintaining steady control of the upper limb – e.g. Wii Play Fishing. These tasks are generally best achieved with the use of just the WiiMote.

Gross movement  These tasks encourage increased range of movement and increased activity – e.g. Wii Boxing, Sonic & Mario Olympics. They can be by just using the WiiMote or using both controllers.

Combined and co-ordinated movements  Combined, and therefore co-ordinated movements, can be worked on in the following ways, using the more challenging elements of the games that require: – a sequence of buttons to be pressed or a sequence of movements to be performed; – one or more buttons to be pressed at the same time – the use of both the Nunchuk and Wiimote

Dexterity To hold the remote and press a button may be easy to those with full grip and range of movement, but can prove challenging and frustrating for those with limited dexterity. The Wii provides motivation to practice this control as well as being an entertaining activity which may deter from frustrations (or may not – this will greatly depend on the person using the Wii for this purpose as assessed by a therapist).

Bilateral control of movement Games requiring the use of both controllers can often the opportunity to develop improved control of both upper limbs at the same time. Games such as SSX Blur, We Ski and My Horse & Me require reasonably complex controls but tend to be symmetrical – meaning that they demand the same amount of movement and control in both controllers.

By using the Nintendo Wii it is possible to develop the following skills:

Reaction Speed  Any of the games require a reaction to an action occurring on screen. Familiarity with the games can increase reaction time, but so can practice. Simple examples of this are Wii Sports Tennis, Wii Play fishing and many of the mini games found in Carnival Games and Rayman 2.

In addition to the above benefits the Wii also offers:

An opportunity to simulate familiar movements without the need for high level of skill or the danger that may be involved in performing the movement, task or skill in reality. The best examples would be that of the Wii Sports games and Cooking Mama where in reality boxing and frying carry additional risks that rely on effective motor control.

The therapy friendly games are generally fairly generous with regards to the quality and sometimes accuracy of movement. Therefore those with less control can still participate and will not be exposed to failure due to the absence of pure movement required for the task in reality.

Equally those who are able to perform the movements well and effectively can benefit from the same game but are able to work at a different level with the same sense of achievement.

Using adaptations enables those with limited movements and more specifically hand/wrist contractures or deformities to access some games.

By using such adaptations, as found here, it is possible to enable those unable to hold or move the WiiMote in the conventional way. When using the splint and/or adapted WiiMote many of the above skills can also be worked on successfully.

Top Tips……..when working to exercise Arms.

– Warm up before using the Wii always warm up and stretch your muscles and joints so that they are ready for the imminent exercise.

– If you find it difficult to grip the remote whilst performing upper limb movements, use a splint or strapping to attach the remote to your forearm.

– Hold the controllers further from your body. Holding your arm out stretched for any time is work for your shoulders in itself. The further away from your your body that you use the controller(s) the more exercise you will give your arms. Be careful to rest regularly.

– Add weights to your wrists to add extra resistance to your muscles, taking the exercise to a more challenging level.

– Keep the movements as realistic as possible. The Wii can be very forgiving with the accuracy in which movements are interpreted. Erratic and over enthusiastic movements might mean you do better in the game, but you will be at risk of injury to your arms and middle/upper back.

Games: There are a good selection of games available that incorporate upper limb exercise. Information about other games that can be used to exercise arms can be found in the games blog.