Read Full Text: A qualitative study exploring the usability of Nintendo Wii Fit among persons with multiple sclerosis
Journal: Occupational Therapy International
Year Published: 2014
Ranked 41st on our 2014-2019 list of the 50 most influential articles
The use of advanced technologies in rehab currently feels like a space race.
I think most people foresee a future where technology is an integral part of rehab, and there seems to be a lot of movement and competition in the tech industry as companies scramble to position themselves as frontrunners.
In the Club, we’ve been tracking the evidence behind different types of technologies, and we’ve already looked at virtual reality several times. We’ve also looked at robot-assisted therapy.
Today, we are looking at a different category of rehab tech: exergaming.
I believe that exergaming is one of the most obvious and straightforward applications of technology in rehab. And, I also believe that the habit formations underlying exercise routines present an untapped opportunity for OT—so I’m excited to dive into this research with you!
The article was a qualitative study of exergaming for people with mild to moderate Multiple Sclerosis (MS) symptoms. Notably, patients who participated in a home-based program using the Wii Fit reported that it helped build confidence in abilities, achieve goals related to engagement in leisure activities. However, the program was met with initial reactions of intimidation and worry about falling.
A reminder about the importance or exercise as part of a rehab program for persons with MS.
Exercise is important for everyone.
But, it is especially important for those with chronic conditions. Early this year, we discussed how exercise has a neuroprotective effect, which may actually slow the progression of Parkinson’s Disease.
For patients with MS, exercise does not appear to directly combat the disease in this specific way, but its use is being explored to manage specific symptoms, such as restless legs syndrome and balance and gait deficits. Some studies have also shown that exercise produces positive effects on cognition.
Unfortunately, as is common among adults with disabling conditions, many patients with MS decrease physical activity because they’re afraid of worsening their symptoms—and this can result in deconditioning. To combat this tendency, there is actually a movement to prescribe exercise for MS patients.
What type of exergaming program was utilized in this study?
The exergaming program in this particular study was a 14-week Wii Fit program, in which patients were prescribed Wii Fit exercises 3x/week. (The duration of the sessions was customized to each patient.)
Patients were encouraged to engage in all four types of Wii Fit exercises: yoga, balance, strength, and aerobic training.
How was OT utilized in this study?
One of the authors of the study was from the OT department at the University of Chicago, so you can definitely see an OT influence in the article.
But, as to OT’s involvement in the actual exergaming program, it was set up as an independent home exercise program. So, instruction was given for set-up, and then there were check-ins every other week via phone.
How was information gathered?
Thirty patients participated in the study. An initial safety assessment was completed with the Wii Fit. Then, a 30-minute semi-structured interview was completed prior to the sessions starting, followed by another interview after the program had ended.
Questions were structured based on the occupational well-being model.
What were the results?
The article has many instructive quotes that were pulled from the interviews. I highly recommend you read them if you are interested in this topic.
Overall, five trends from the interviews were highlighted:
- The Wii Fit provided feedback that encouraged patients to reflect on their abilities. (This experience is positive for some, and negative for others.)
- Participating in an exercise program was important to some participants, because it fit into their personal narrative/identity of being an “exerciser.”
- Several participants described this type of exercise as being convenient and fun.
- Others found that, even though the technology was novel, they still faced the same barriers as when they participated in typical exercise programs.
- And finally, there were usability issues. Some participants had difficulty learning the program, and others wanted more ability to customize the program to meet their specific needs.
Takeaways for OT practitioners
(These are my personal takeaways, and were not mentioned in the article.)
1. Habit formation is key to exercise—and I think this is an area where OT needs to start shining.
I love that the conclusion of the article asserted that future exergaming interventions should incorporate “effective behavior change strategies.”
In the past, I’ve rarely thought of my therapy as functioning to simply help patients create new habits. I’m usually focused on short-term goals. But, is habit formation how we should be framing much of our therapy?
After all, our goal is not for our patients to succeed only in therapy, creating a dependence on us.
Our goal is to help them create new habits and routines that will translate to their daily lives and have lasting benefits.
2. New habits lead to a transformed identity—and we don’t focus on that often enough.
Again, I’m looking at myself here, in that I am guilty of not thinking enough about the long-term goals of my patients.
But, I’ve personally experienced an identity shift from a therapeutic exercise program. I felt a shift from being someone who was debilitated by a health condition to someone who considers myself an (overall) healthy exerciser—and I can’t gush enough about how personally meaningful this has been.
Ultimately, this identity shift has been the most important part of the therapy for me, even though it took about a year to actually own the shift. But, even a year later, I can say that I don’t think I would have arrived here with a structured program and the medical support I received as I started it.
3. We can’t get lost in the weeds of new technologies. Instead, we need to focus on the foundational goals of habit formation and identity transformation—and think of technologies as tools that will come and go.
I imagine I’m not the only one who read this article and felt like the Wii Fit was “so five years ago.” 
I know it is still a very popular platform, but there are now so many commercially available exergaming platforms out there, and I’m sure the next five years will bring even more.
With the rapid change in technology, I think it is really important that as therapists, we focus on the foundational skills I mentioned above—because technologies will come and go, and certain platforms will work better for different people. But all of them bring the same challenge: it is hard work to form a healthy habit, and if you have a health condition, there are even more barriers.
This is exactly why the support of the occupational therapy profession is needed.
Listen to my takeaways in podcast form:
(Possibly) Earn CEUs/PDUs for reading this article
Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.
And, here’s the full APA citation you many need:
Plow, M., & Finlayson, M. (2013). A Qualitative Study Exploring the Usability of Nintendo Wii Fit among Persons with Multiple Sclerosis. Occupational Therapy International, 21(1), 21–32. doi: 10.1002/oti.1345