1. Acknowledgements
The UNC Institute on Aging
The Yin & Yang of Wii-hab • Bringing Basic Scientist To Aging
and Older Adults • Gina Ugrinsky, SPT
Are we singing the body electric?
Tiffany Shubert, PhD, MPT
UNC Institute on Aging
Chapel Hill, North Carolina
tshubert@med.unc.edu
Background Background
• The Silver Tsunami
• 35 million Americans > 65 in 2000
• 77 million Americans > 65 in 2050
• The Gamers Are Graying!
• 25% of gamers age 50 and over
• Chronic Disease Epidemic • Aging gamers are the fastest growing demographic
• Average older adult has 3+ diseases • 68% of American households own a gaming console
• Focus on health promotion and prevention
• The Cost • Exercise interventions to improve health
• $468 Billion for Medicare in 2010 • Identify alternative methods for broad dissemination
• $768 Billion for Medicare by 2017 • Maybe gaming is an option for the elderly?
ESA report, 2008
http://www.hhs.gov/news/press.html, http://www.aoa.gov/ accessed 5/20/10
Background Purpose
• Describe therapists use of health games
• Health games and aging with older patients
• Popular press, Wii, and nursing homes
• Identify facilitators and barriers for using
• Health games and rehabilitation health games with older adults
• Eyetoy and Wii for Stroke
(Yavuser, 2008, Flynn 2007, Rand, 2008) • Inventory suggestions for improvements
• Wii for balance (Nichols, 2009) • Describe older adults impressions of
• NIH/RWJF Funded studies health games
• Health games and physical therapy • Describe the potential role of the Wii as a
• ? health promotion intervention
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2. Questionnaire Demographics
• “Commercial Health Games for the • 69 respondents
Rehabilitation of Older Adults” • 43 used health games (100% Wii, 5% Eye Toy)
• 20 interested in using health games
• 35 question online survey (Survey Monkey)
• 10 no interest
• Distribution (November 2009 – January 2010)
• Practice Settings
• APTA Geriatrics Listserv
• 12% Acute care
• APTA Games for Rehab Group • 32% Inpatient Rehab
• Local therapists in North Carolina • 37% Outpatient
• Two large home health companies • 19% Home Health
Demographics Wii-hab Time as Therapy
Patient Considerations Systems Used
• 72% Diagnosis • All respondents (42) use the Wii
• 88% Cognition • 60% use the Wii Fit
• 97% Physical Impairment • 5% use the Eye Toy
• 63% Vital Signs
• 83% Interest
• 75% Motivation
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3. Games Played With Older Patients Games Avoided
• 28% avoid certain games
• Balance board games are too challenging (4)
• Tennis, baseball too fast (3)
• Bowling, too difficult to coordinate release (1)
“ I avoid many since they are too busy/too
fast for many patients not familiar with
video games”
Do You Modify the Wii Fit? How do you assess progress?
50.0%
• 72% Yes 45.0%
40.0%
• HomeBrew 35.0%
• Sitting 30.0%
25.0%
• Set aim for patient 20.0%
• Guard rails 15.0%
10.0%
• Swiss ball 5.0%
• Chairs for balance 0.0%
Wii Fit balance Wii Fit age Time able to Performance I don't use the
• Multiple Miis assessments play playing games Wii to assess
progress
“Modifications based on impairment, not age”
“ I have seen wild fluctuations and there is a steep learning curve”
Home Exercise? PT Goals for the Wii
• 63% recommend patients continue to play • 100% Improve balance
after discharge • 81% Improve endurance, increase
• 20% indicate patients increase compliance activity level, enhance body
with HEP when using the Wii awareness
• 89% stated < 10% of patients have • 50% Increase range of motion, improve
purchased a Wii strength
• 30% Improve adherence to HEP
“I see more compliance in the roughly 45-55 range…Those
over 65 seem to like it in clinic but, report they wouldn't
know how to hook it up or access the games at home”
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4. Safety Concerns Why Do Patients Like the Wii?
• Falls • 90% Fun
• Overexertion • 42% Meaningful activity
• Hitting something with
• 35% Easier to see improvement
Wii-mote
“It's something new to most of them and they really enjoy
it the first couple of times so I use it as a bit of a break
from regular routine. I don't focus my treatment on it”.
Why Don’t They Like It? Why Don’t They Like It?
• Games need more instruction
Frustration (73%)
“The Ski Jump is like Greek”
70.0%
60.0% • Too many distractions – difficult to focus on the
50.0%
task at hand
40.0%
30.0% • Even lower levels of the Fit are often too
20.0%
10.0%
challenging, resulting in frustration
0.0%
Games are Games are Too much Don’t know Don't Don’t like
• Starting over at level 1 after achieving level 5 is
too fast too difficult visual how to set up understand feedback
stimulation the system how to get to from game a problem
the games
they want to
play
• Feedback is too negative
“My patient is mad at her Mii”
What PTs Want Summary – Physical Therapists
• The ability to change the speed of a game • Therapists enjoy using the Wii and are
• A more practical or functional game excited about the potential
• Walking a perceived obstacle course • Disconnect between goals of therapy and
• Less distractions how the Wii is used
• Consistent and correct feedback • The Wii currently may pose challenges for
older adults BUT there is potential for it to
• The ability to start at any level of game
be a viable adjunct to therapy
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5. Older Adult’s Experiences Why we like playing!
• 3 Focus groups of older adults (n = 15) “I see it as a challenge for myself, and to
• 74.5 years average age, range 62 – 92 keep my mind going strong”
• Mix of Wii naïve and Wii users
• Common Themes • Competition
• Why we like playing the Wii • Socialization
• What physical abilities are needed to play
• Be able to play with family
• Fears and frustrations
• Playing but also getting some exercise
• Games for older adults
What do we need to play? Fears and Frustrations
• Wii Naïve Wii naïve
• Vision • Incompetence/embarrassment
• Coordination
• Balance
• Frustration with the game
• Fear of falling
• Wii Users • Mistrust of game progressing too fast
• Balance • Too absorbed in play
• Coordination
• Patience
Fears and Frustrations Interest in a Health Game
Wii Users • 100% of participants indicated interest
• Public humiliation
• Lack of consistency in feedback ‘It would need to be clear that it was not a
• Frustration at progress and then starting over “game” but to improve an aspect of health’
• Disappointment at negative feedback ‘It can keep you awake from the boredom of
10x this, 10x that, that is wonderful!’
“Most every game is too fast and requires more
eye-hand coordination than we have, so we
‘The convenience, the option to exercise at
play bowling” home’
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6. What Older Adults Want What Older Adults Want
• Simplicity – use, graphics, game • Should not be exclusive
• Choice in music
• Games should tell you what aspect of
• Forgiveness of mistakes
health you are trying to improve
• Ways to keep up with the game
• Positive feedback on performance • Interest in games to improve a specific
• Ability to enter own goals and see progress aspect of function
• Interest in cognitive benefits
“Doing something fun and getting results?
“ I want to see a donut when I have burned Yes sure!”
that many calories”
Conclusion The Potential is Endless!
• Older adults are interested in health
games, especially if they were tailored to
their needs
• Physical therapists like Wii-hab, and may
increase use as an adjunct to therapy if
products were tailored to patients needs
• A potential way to create a continuum of
care
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