posted January 12, 2009

Video Games Find Role in Athletes’ Rehabilitation

 Sometimes, something can be both good for you and fun.

Dr. Kirk Brumels of the Hope College athletic training staff had an intuitive sense and a fair bit of anecdotal evidence that popular activity-based video games like "Dance Dance Revolution" and "Wii Fit" Balance Board programs could play a positive role in helping athletes with balance rehabilitation, but he hadn't located any hard data to support the notion.

So, this fall he and a team of student researchers tackled the topic themselves.  They conducted a study, published in the winter 2008 edition of "Clinical Kinesiology," that found that such games offered the best of both worlds:  they were more effective than traditional rehabilitation tools and the athletes enjoyed them more.

Ironically - or, rather, perhaps because the athletes were enjoying using the activities--participants in the study also believed that the games were less difficult than the traditional tools even as they were more effective.

"They perceived it as easier, yet the data suggested that it was as effective as, if not more effective than, the other exercises," Brumels said.

The athletic training program at Hope has been using "Dance Dance Revolution" and "Wii Fit" with athletes who have had ankle sprains, knee injuries and other lower-extremity injuries, to help restore balance, coordination and agility.  "We also use it a lot to help facilitate the transition from crutch use to ambulation," he said.

In "Dance Dance Revolution," the athletes stand on the game's one-square-meter pad and step in a direction indicated by the game's video screen.  Through the "Wii Fit" system they stand on a platform and adjust their posture, leaning and shifting their weight through games such as "Ski Slalom," "Table Tilt" and "Balance Bubble."

Brumels was inspired to start using the games a few years ago, when his daughter showed him her new "Dance Dance Revolution" game.  "I thought, 'Oh, my, this has a ton of applications in the athletic training world and rehabilitation," he said.  The college's athletic training program began using the newly designed Wii system more recently.

He recognizes that the video game balance programs are much more interesting than the traditional balance exercise programs, which involve standing on a variety of stable and unstable surfaces, maybe interacting with a ball or other object, in the training room.

The athletes, he has found, have responded to the greater entertainment value offered by the video games accordingly.  While through the traditional program, he said, they might typically participate for a week and then simply stop showing up, athletes using the games regularly stay for the entire multi-week regimen.

"We've had incredible compliance with the athletes on it," Brumels said.  "As long as it's fun, and they're doing it and it's beneficial to them, that's what we want."

The four-week Hope study involved 25 athletes who were asked to rate their experience with the three systems between one and five according to difficulty, engagement and enjoyability.  While the traditional methods earned a relatively low 2.17 for enjoyability and a 3.33 for engagement, "Dance Dance Revolution" earned 4.14 in both categories and "Wii Fit" earned 4.40 in each.  The traditional methods rated 3.17 out of five for difficulty, while "Dance Dance Revolution" and "Wii Fit" weighed in as easier at 2.71 and 1.60.

Especially significant to Brumels was the finding that the athletes who had used "Dance Dance Revolution" and "Wii Fit" showed greater improvement in balance as measured by force plate testing following their month-long rehabilitation experience.  It was an added bonus that the exercises were perceived as easier and more enjoyable by the participants.

Even as the participants in the study worked on their balance through the various rehabilitation methods, other students learned through the research process itself.  Brumels conducted the study and co-authored the paper during the recent fall semester with four Hope senior athletic training or exercise science majors:  Troy Blasius, Tyler Cortright, Daniel Oumedian and Brent Solberg.  "They were intimately involved in the literature review, the study design, the implementation of it, and the data collection and analysis," he said.

While other studies had considered the clinical potential in games like "Dance Dance Revolution" and the "Wii Fit" system, Brumels said, their emphasis had been on benefits such as the cardiovascular workout they can provide.  Based on his team's review of the literature, he said, the Hope study is the first to consider such games' potential in balance rehabilitation.

In addition to being featured in "Clinical Kinesiology" in the latter part of 2008, the Hope study is slated for additional presentation later this year.  Brumels is scheduled to give talks about it during meetings of the Great Lakes Athletic Trainers' Association and the National Athletic Trainers' Association Annual Educational Symposiums in March and June respectively.