Can the Wii aid in physical development? What games should I have for my child to play on the Wii? Why do you use the Wii in physical therapy with my child? Do you ever seen functional gains when children use the Wii on a regular basis?
These are all questions I hear from parents when we discuss incorporating the Wii into a child's physical therapy intervention or for home use.
A recent article reported that 83% of American youth have AT LEAST one video game console in their bedroom. And a typical child, between the ages of 8 and 10 years, spends on average 65 minutaes a day playing a video game!(1) Those statistics are a little mind boggling, but what it tells me as a pediatric physical therapist, is there is a world of interest to be tapped for cardiorespiratory, balance, and coordination training.
The Wii is a unique system in that for many games it encourages movement. Some games; such as Wii Play, Wii Sports, and Wii Party, provide immediate biofeedback by responding to upper extremity movements. Research indicates that when played properly these games can lead to improved upper extremity coordination, fine motor integration and visual perceptual skills(2). Just playing upper extremity games in standing leads to 116% increase in energy expenditure(1).
My favorite component of the Wii system is the Wii balance board. This is available with the Wii Fit and Wii Fit Plus games. The balance board is very responsive to weight shifts and balance reactions. There are many ways to address balance impairments in physical therapy, but the children tend to respond best on the balance board due to the enjoyment and child-friendly biofeedback. The Wii Fit board encourages both upper and lower extremity use and has been shown to improved running speed and agility and balance reactions(2,3). These improvements lead to improved functional abilities! Also using just the lower extremities, as in the obstacle course and penguin games on the Wii Fit, demonstrated 212% increase in energy expenditure(1). Some games on the Wii Fit require utilizing both the upper and lower extremities together. These games focus on integrating bilateral coordination and motor planning, such as tilt city and boxing. Research has found a 275% increase in energy expenditure when playing bilateral games(1).
So.....
Can the Wii aid in physical development? YES if played properly!
Bottom Line - As with anything use in moderation and the Wii cannot make up for playing outside, playing a sport, or getting on a real bicycle, not a virtual bicycle!
Citations
(1)Biddiss, E. Active Video Games to Promote Physical Activity.
(2)Wuang, Y, et.al. Effectiveness of virtual reality using Wii gaming technology in children with Down Syndrome.
(3)Deutsch, J, et.al. Use of a Low-Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent with Cerebral Palsy.
Torticollis, by definition, is a spasm/shortening of the sternocleidomastiod muscle in the neck. This is the muscle that becomes prominent in the front of your neck when you look to one side (rotate) and then drop your front ear towards your chest (side bend). Torticollis is most often diagnosed in infants and children. It may be due to positioning in utero, it may be caused by a flat spot on the head that causes the child to rotate his head to one side when lying on his back, there is theory that children with reflux tend to rotate and side bend their necks to one side to close off the esophagus to prevent refluxing....there are many other possible causes but these are the most pronounced.
Conventionally, torticollis has been treated by stretching the shortened sternocleidomastoid muscle in the neck. While it is the traditional approach and can be effective, most infants and children do not tolerate the substantial stretching required to truly elongate the muscle. Parents often have trouble getting the child into the appropriate position and holding him there to allow for a prolonged stretch. In addition, most children and infants cry during stretching as their pain systems are not fully developed and any pain (whether we would perceive it as good or bad) is pain to a child.
Total Motion Release, TMR, therapy looks more closely at the restrictions and asymmetries found throughout the body that may be impacting the neck. I have found in practice that children with torticollis often also demonstrate asymmetrical movements within the trunk and occasionally within their extremities. During the TMR course, I learned that there are also often restrictions in the hips that cause neck range of motion restrictions as well. The TMR theory suggests that by treating the restrictions in the trunk and the hips, the neck asymmetries will correct as well.
Thinking of it like potting a plant, if the flowers and stems are growing out of the ground at an angle, you don't grab the stems and pull it up right, you dig it up replant the roots upright and refill the soil around it. Similarly here, you fix the root/bulb and the flower corrects itself.
I attended a fabulous course in November of last year, Total Motion Release: TMR Tots. This course is an adaption of the the Total Motion Release therapy that is being successfully implemented with a wide array of patient populations. During the course I got to interact with pediatric physical therapists from various settings and home locations. A few of the therapists attending the course were there for the second time and had been finding frequent success using this innovative manual technique.
Total Motion Release therapy was originally begun with Tom Dalonzo-Baker, MPT. He was about to leave his PT office one afternoon and a lady came in asking for him to help her in any way he could. She had just left the orthopedist and was scheduled to have back surgery, but was currently in severe pain. The only position that brought her comfort was the position that unconventional. Any other movements or manual techniques were bringing her to tears, so he said, "Let's just go where your body wants to go". Tom took the patient into her comfort position and then even farther. After working in that position for awhile her pain was almost alleviated. She ended up not needing back surgery!
So what does that mean for the pediatric population? Well, what research and patient experiences have indicated about TMR is that frequently a limiting factor of mobility is fascia - not just the muscle and/or bone. ascia is like Saran Wrap that covers the tissues of our bodies and allows them to move easily against one another. Oftentimes the fascia restrictions are very impactful on our movement. For example when working with a child with an upper trunk rotational restriction, one side of the trunk is restricted, in this case we'll say it's the right side. So the child can turn far to the right, but is unable to turn his upper body to the left, indicating a discrepancy. Instead of the more conventional idea of stretching the child and turning them far to the left (which they hate) we take them to the position of ease - in this case the right and hold them there. Guess what happens? We gain movement in the opposite direction! Counterintuitive? Maybe at first. But think about the fascia like a piece of yarn with a knot in it, the knot being the restriction... the more you pull on the yarn in each direction, the tighter the knot gets. If instead you relax the yarn, you can remove the knot. Our fascia is very similar to that yarn.
Interested? Check out www.totalmotionrelease.com/pediatricblog.html. Also, continue to check back here and I will update with successful patient cases!
I am starting to hear this phrase more frequently in our clinic...."I think my child will just skip crawling - he's going to be an early walker!"
PARENT BEWARE!
There are developmental reasons that infants and children are expected and encouraged to meet each developmental milestone. Crawling serves as a catalyst for much more than simply mobility for a child!
Crawling assists with the development of:
*bilateral coordination skills
*core strength and stability
*upper extremity coordination
*lower extremity coordination
*proximal upper and lower extremity strength
*development of hand strength finger strength
While it isn't always apparent initially, children that skip crawling often show delays later in development. It isn't uncommon when children come in with poor handwriting or decreased core and upper extremity strength at 4 or 5 years of age to report he/she never crawled.
If you're child is over zealous for walking, make sure you also take time to address crawling! It's more important than you think!
When thinking about a good blog for February, the first thing that comes to mind is LOVE. And while there are many different types of love, I feel blessed to witness a special love everyday I work with the families at Child and Family Development. This love is the love between a child and his/her parent and the love in return from the parent to the child.
This past fall I went to a Mark Schultz concert here in Charlotte. During the concert he sang a song off his new album called "What it Means to Be Loved". The lyrics of the song really put into words the love I see in my office everyday. Of course by the first chorus of the song I was trying to hide the tears in my eyes.
"I wanna give her the world
I wanna hold her hand
I wanna be her mom for as long as I can
And I wanna live every moment until that day comes
I wanna show her what it means to be loved"
Don't worry this song has a very happy ending, and as it reached the end, there was no point in hiding the tears any longer - I just let them stream down my face (along with every other person in the audience). If you haven't heard the song, you should look it up, it is very inspiring!
So this Valentine's Day, I would like to extend my love and devotion to my patients and their families. But even more importantly I would like to personally thank all the parents of children with disabilities for their love and support of their children. It is a love that is indescribable and knows/recognizes no bounds. And most times it is your love and dedication to your children that allows them to make unexpected changes and beat all odds!
I cannot tell you the number of parents and families I meet who tell me, "They said at birth, he would never walk" and now their son with cerebral palsy is running down the hallway. Or, "We always were worried about her reaching her teenage years" and now she plays wheelchair sports and can't wait to go to college. The stories are endless. One of my favorites is a family whose son was diagnosed with Down Syndrome at birth, and they refuse to call it "Downs" in their house they call it "Ups"! I recently heard a child that just turned 4, laugh out loud for the first time.
Often as healthcare professionals; pediatricians, physical therapists, occupational therapists, speech therapists - we get the credit for the changes made in your children. But it is really your love and dedication that push your children to want to make these changes. We are reaping the benefits of what you instill in them!
So THANK YOU and HAPPY VALENTINE'S DAY!
Erin Harkins, DPT
I recently went to see "Adam" on the big screen. It is a cinematic depiction of an adult male, in his late 20s, facing the world while dealing with Asperger's Syndrome. The movie follows the character through various relationships, jobs, and individual thoughts.
Adam, the main character, is abruptly faced with making many decisions on his own, with little guidance. He meets a girl that just moved into his building and their relationship develops. Without giving anything away, I will say that the movie caused me to spend time thinking about many of the children and families that I work with. The movie was a great representation of how successful individuals with the diagnosis of Asperger's can and do become in our society.
The movie was heart warming yet realistic. It is a must see for anyone, but especially for families that may be directly impacted by autism or Asperger's syndrome.
I recently had the opportunity with another local physical therapist to hold a instructional/informational session for 20 local pediatric physical therapists. Our topic was Aquatics and the Pediatric Physical Therapy Patient. Below is a brief synopsis of what we discussed. Are you interested in aquatic therapy for your child? Check out our website, I would be happy to speak with you about our program!
Erin Harkins, DPT
Benefits of Aquatic Therapy v. Land Based Therapy
*Assisted movement via buoyancy of water
*Increased sensory stimulation & proprioceptive input/awareness
*Decreased joint compressive forces
*Inhibition of Spasticity
*Increased circulation
*Decreased heart rate
*Increased resistance in every direction
*Multi-planar movement
*Improved respiratory support
*Safety during gait training
Examples of some Pediatric Patients that Benefit from Aquatic Therapy
*Cerebellar Injury
*Cerebral Palsy
*Complex Regional Pain Syndrome
*Down Syndrome
*Hypotonia
*Juvenile Rheumatoid/Idiopathic Arthritis
*Mitochondrial Disorder
*Orthopedic Concerns
*Prader Willi
*Spina Bifida
*Traumatic Brain Injury
*ANY PATIENT, without contraindication, that possesses impairments that can effectively addressed in an aquatic medium as a supplement to land-based therapy
TOP 10 Impairments Addressed by Aquatic Therapy
*Impaired strength and head/trunk control
*Decreased range of motion
*Abnormal tone and syndergistic patterns
*Decreased balance
*Gait training
*Weightbearing restrictions
*Impaired coordination
*Sensory integration difficulties
*Impaired Endurance
*Pain
Information compiled from:
Cameron MH. Physical Agents in Rehabilitation: From Research to Practice - 2nd edition. 2003.
Aquatic Sensory Integration for the Pediatric Patient - Continuing Education
This summer has provided me with the opportunity to work with more patients in the water. Along with other pediatric physical therapists and pediatric occupational therapists, we have taken to the new facility quite well.
Child and Family Development has worked with the Harris YMCA in Charlotte, North Carolina to develop a schedule in which there are specified areas in the warm indoor pool exclusively for pediatric aquatic therapy. The Harris YMCA has a wonderful set-up that allows me to work with children in various aquatic environments. Most importantly the pool temperature is set at a warm therapeutic level to allow for muscle relaxation and reduce tonal tendencies. The children can enter the pool down a ladder, by zero entry, in a water wheelchair, or down a portable flight of stairs.
The indoor pool goes from zero depth to 6 feet. There is also a whirlpool area that I utilize in ambulation training with the assistance of the water and strength training against the resistance of the water.
We're making waves!
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