Wehab: Wii Homework For Stroke Victims

Nintendo's Wii has been used for a while now by physical therapists, but a revolutionary new platform could transform the game system into an at-home recovery tool, with therapists overseeing progress over 3G.

A revolutionary rehabilitation system has stroke patients ambling onto Wii Balance boards—at home—to play versions of games like Wii Resort and Wii Sports, under the watchful eye of a remotely located therapist. For the first time, therapists can assign "homework therapy," giving patients an opportunity to get continuous monitored therapy services and rehab at home with ease.

"Wehab" is the brainchild of researchers at the University of Notre Dame, and it aims to change the future of stroke therapy. A great deal of balance retraining is needed for stroke patients to perform basic tasks like walking and dressing; rehabilitation requires the patient to put in many hours every day and is often a tedious, time consuming and expensive process. Therapists typically use mirrors and guesswork to assess any progress patients make and it is easy to miss out on little improvements. Given only subjective feedback and constrained by needing to visit a hospital or a therapy center physically, patients can take months or years to regain their motor functions.

"Patients do improve with training, but they do it very slowly," says Dr. Sergi Bermúdez i Badia, an expert in interactive technologies for neuro-rehabilitation at the Madeira Interactive Technologies Institute in Portugal. "What is really needed here is real time feedback on performance that can be given to patients that they can understand and use to correct their pose or movements."

Designed to address these issues, the Wehab suite consists of Nintendo Wii balance boards and web cameras that obtains data on the patient’s movements. Therapists lead the patients through normal rehabilitation exercises on the Wehab and the information is fed into a customized software program that runs on a low-cost Windows-based computer. The software logs, analyzes, and visualizes the data on a large monitor, giving patients the ability to track and see their own progress in real time. Eliminating guesswork and the need to rely solely on therapist’s feedback, patients can experiment with postural changes to see its effects on their performance. "Proper feedback on the small improvements made can boost motivation and therefore can have an additional positive effect on recovery," says Badia.

While therapists have been using regular Wii games in rehabilitation exercises for some time now, the gaming platform alone isn't a plug-and-play solution for rehabilitation.

"For many of the stroke patients, there are significant cognitive deficits that make it difficult for them to keep up with a normal paced game," says Aaron Striegel, the lead researcher on the project. "The typical older age of a stroke patient also complicates matters in that their reaction time is likely a bit slower than what a typical game is targeted at."

Fine-tuning within any game or activity is also impossible since no such controls exist within the original software. With many games, the system is also memory-less and doesn't record data in a way that can be analyzed and assessed later. For game-oriented therapy to be really effective, important aspects such as repetition, intensity, personalization, and goal orientation need to be worked in.

Striegel's Wehab takes all these factors into account and goes a step further. They plan to create a take-home version of Wehab that hospitals can assign to their patients to continue their therapy at home. This is critical because there are many real constraints.

"In the U.S., the payment system is tight on what and how long a stroke client can receive therapy," says Jeanne Harper, a therapist at Skills 4 Living Therapy. "Stroke clients can get return of function months and years after their stroke, and often they do not get uninterrupted continuous therapy services, and often not coordinated services."

Striegel’s solution is to incorporate cloud computing and Internet access into Wehab’s design to allow the patient to perform rehab activities from the comfort of their home.

"You plug in the WeHab system to your TV where it automatically connects to the Internet via a 3G or 4G data connection," says Striegel. "On first starting it up, you are connected to your therapist who video chats with you to answer any questions as you start your rehab in the home setting. Under the watchful eyes of your therapist who can see you and the readings from your screen, you are walked through balance therapy exactly like you experienced in the clinic."

Patients perform tasks monitored remotely by their therapists and work together to achieve targets. They data can be seen by both patient and therapist in real time, allowing the latter to direct the patients to new activities based on improvements. Homework therapy is queued up in the system to be worked on when switched on next. Wehab also phones home each day to share the patient’s progress with the therapist who modifies the program accordingly. Not only does the therapist know exactly how far the home therapy is coming along, but they can also tailor the on-site therapy to be as effective as possible.

Gaming-based rehabilitation technologies such as the Wehab could have more benefits than those readily seen.

"The most interesting part of this technology is how you program it," says Dr James Patton, codirector of the Rehabilitation Institute at Chicago’s Rehab Robotics Lab. "Done correctly, it can give you massive amounts of valuable information, it can diagnose, track progress, prognosticate on the future of recovery, and even decide on the treatment programs a person may need. Treatment can be wildly creative that can monitor, encourage, and even deceive people into doing things they could not before. In fact, at this simple price point, the inevitable mass availability of such systems should bring many creative minds to the table who can develop endless interesting experiences to improve balance and many other motor functions."

How well patients take to the system and how often they will use it are questions that still need to be answered. "One disadvantage may be the intent of having patients perform this at home independently, given the fact that it requires a certain level of balance to get in and off the platform," says Karen Lafferty, a PT field clinician with Bayada Nurses, a national home health care company. "This could be a safety issue." The Notre Dame team is working on resolving these questions and others with the stroke rehab unit at the Memorial hospital in South Bend, Indiana, where prototypes of the system are currently being utilized.

Costing less than $1,500, the system will be available in the market sometime in 2012, making long-term therapy truly affordable—stroke patients can expect to live a better quality of life, instead of being forced into a nursing home.

[Image: Flickr user chronic-shock]

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