Elsevier

Burns

Volume 38, Issue 4, June 2012, Pages 493-500
Burns

Commercially available interactive video games in burn rehabilitation: therapeutic potential

https://doi.org/10.1016/j.burns.2012.02.010Get rights and content

Abstract

Commercially available interactive video games (IVG) like the Nintendo Wii™ (NW) and PlayStation™II Eye Toy (PE) are increasingly used in the rehabilitation of patients with burn. Such games have gained popularity in burn rehabilitation because they encourage range of motion (ROM) while distracting from pain. However, IVGs were not originally designed for rehabilitation purposes but rather for entertainment and may lack specificity for achieving rehabilitative goals. Objectively evaluating the specific demands of IVGs in relation to common burn therapy goals will determine their true therapeutic benefit and guide their use in burn rehabilitation. Upper extremity (UE) motion of 24 normal children was measured using 3D motion analysis during play with the two types of IVGs most commonly described for use after burn: NW and PE. Data was analyzed using t-tests and One-way Analysis of Variance. Active range of motion for shoulder flexion and abduction during play with both PE and NW was within functional range, thus supporting the idea that IVGs offer activities with therapeutic potential to improve ROM. PE resulted in higher demands and longer duration of UE motion than NW, and therefore may be the preferred tool when UE ROM or muscular endurance are the goals of rehabilitation. When choosing a suitable IVG for application in rehabilitation, the user's impairment together with the therapeutic attributes of the IVG should be considered to optimize outcome.

Introduction

Commercially available interactive video games (IVG) are increasingly being used in rehabilitation to augment occupational and physical therapy (OT/PT) regimens [1], [2], [3], [4]. IVGs have been found to offer patients with injuries or disabilities an experiential, active and enjoyable option that can be incorporated into many rehabilitative plans of care [2], [5], [6]. Such video games combine features of virtual reality technology that have been shown to be effective in rehabilitation with popular video game imaging to provide a motivating framework with visual and audio feedback [7], [8], [9]. Rehabilitation delivered using a virtual environment can enhance the user's effort, facilitate physical recovery, and improve adherence with therapy. IVGs have gained popularity in burn rehabilitation because they are perceived by therapists to encourage range of motion (ROM) while also distracting the patient from pain [2], [6], [10], [11].

Two IVGs commonly described for use in rehabilitation are PlayStation Eye Toy™ (Sony Computer Entertainment America, Los Angeles, CA) and Nintendo Wii™ (Nintendo of American Inc., Redmond, WA) [2], [4], [12], [13], [14], [15]. These systems are off-the-shelf, low cost gaming consoles originally designed for the general population for gaming/entertainment purposes. They use an inexpensive interface device (web camera or accelerometer) which allows the user to interact with virtual objects in a competitive game environment displayed on a standard television screen. The games are designed to be fun and interactive, provide activities for a variety of age groups and have built-in motivational features such as score keeping and video playbacks. IVG consoles are portable and usually compatible with common household electronics (television, home computer), so they can be set up in most home environments to encourage follow-through.

Both NW and PE have been described for use with the burn population [2], [6], [11]. However, thus far, most studies are descriptive and objective comparative studies are very limited on the topic. IVGs were not originally designed for rehabilitation purposes but rather for entertainment/gaming and may lack specificity for achieving rehabilitative goals. Objectively evaluating the specific demands of IVGs in relation to common burn therapy goals will help determine their true therapeutic benefit and guide their use in burn rehabilitation. In addition, comparison between gaming systems will help identify game characteristics that may influence therapeutic outcomes and can help rehabilitation specialists in selecting the most suitable IVG for the specified therapeutic goal. Such investigations will contribute to the evidence base related to IVGs as a therapeutic tool in rehabilitation.

The objective of this study was to use three-dimensional (3D) motion analysis to measure shoulder range of motion (ROM) achieved in normal children while playing two different types of IVGs. Objectively measuring, in real time, motion characteristics of the shoulder during IVG play can help determine the therapeutic potential of IVGs and guide clinical decision making regarding their use in rehabilitation. The specific aims of our study were to determine: (1) Do children achieve shoulder ROM within functional and/or normal limits during play with IVGs? And (2) Does one IVG facilitate greater shoulder ROM during play than another?

Section snippets

Methods

Upper extremity (UE) motion of 24 normal children between the ages of 5–18 years of age was measured using 3D motion analysis during video game play. All subjects were volunteers from the community with no history of musculoskeletal or neurologic injury/disease and demonstrated normal UE motion according to published standards [16]. An 8 camera 3D motion analysis system was used to capture kinematic data (Motion Analysis Corporation, Santa Rosa, CA) while the subjects played two different types

Results

Twenty-four normal children with a mean age of 10.0 ± 3.3 years were tested. All but one subject was right hand dominant and males represented 50% (Table 2). None of the subjects had previous gaming experience with PE and all subjects had at least minimal experience with NW (Table 3).

Subjects exhibited greater maximal motion for shoulder flexion and shoulder abduction during IVG play with PE as compared to NW (Fig. 3). The amount of time subjects had their UEs elevated during play was also

Discussion

Simply describing innovative treatment modalities in burn rehabilitation is no longer sufficient evidence for adopting their use in clinical practice [18]. Systematic analysis and comparison is the necessary first step for determining the efficacy of treatment tools and procedures. Burn rehabilitation interventions should be founded in clinical research similar to medical interventions.

Studies show that the shoulder represents one of the most frequent sites of contracture after burn with

Study limitations

This study had some limitations. First, ROM was only measured in non-injured subjects. The ROM attained by burn patients with restricting scars may be different than normal subjects. Often functional ROM is the goal of post-burn therapy and understanding what effect an intervention has in a normal population will help us determine if it appropriate for an impaired population. If normal children playing IVGs do not achieve functional ROM, yet that is the defined goal of burn rehabilitation, the

Conclusion

As video gaming technology becomes increasingly popular in burn rehabilitation, therapists are readily using IVGs as a therapeutic tool for intervention. However, it is important that IVGs, like other interventions, be critically evaluated for the specific therapeutic potential(s) they offer and not applied generically. When choosing a suitable IVG for application in burn rehabilitation, one must consider the user's impairment together with attributes of the IVG to promote best outcome.

Conflict of interest statement

None of the authors have any conflict of interest to disclose related to this study.

Disclaimers

None.

Financial support

None.

Acknowledgment

We thank Lynda Painting for her technical assistance with recruiting and testing.

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    Previously presented at: American Burn Association Western States Burn Conference (oral presentation) San Francisco, CA; October 2010. American Burn Association Annual Meeting (poster presentation) Chicago, IL; March 2011.

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