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Kinect vs Nintendo Wii: A physical therapy perspective

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Recently the Heart and Stroke Foundation of Canada published an article on how “Video games show promise in stroke rehab”. While I already knew of the information in the article, I thought it was very well written and will go a long way in increasing awareness of virtual reality rehabilitation.

The article interviews Dr. Saposnik, who has explored the use of the Nintendo Wii as a tool for stroke rehabilitation. This is not new to us. We have spoken to dozens of clinicians who use the Nintendo Wii for the same reasons, often because it is low cost, easy to use, and fun. What is surprising to me is that the Nintendo Wii was released back in 2006, and it is still one of the most widely used virtual rehabilitation devices in the market. It was not even designed for physical therapy! When we ask therapists what they like about the system, they often reply that it is fun for the patients, and there are some good games that serve as therapy exercises. When we ask them how many games, it is about two or three, out of dozens.

This is to be expected. The Nintendo Wii and its games were not designed with physical therapy in mind. Only certain activities are going to be appropriate, and even then there are limitation to its effectiveness as a physical therapy tool.

I never had to stand up from the couch to perform this running activity.

First, its scoring system is not particularly telling of a patient’s progress, so it does not serve as an effective assessment device. Second, while the controllers are wireless, you are still required to hold a physical controller. For stroke survivors, for example, this might require the controller to be placed within their affected hand, and then tied into place, since they may not be able to hold the controller properly on their own. Finally, you can cheat at the games. For instance, for one running activity, you are supposed to run in place, with the controller held against your hip. A way to achieve a higher score would be to simply take the Nintendo Wii remote and shake it quickly up and down. The system has now way of detecting if you are ‘cheating’ or not, and therefore requires constant supervision by a clinician to ensure you are performing the proper movements.

Don’t get me wrong, I love the Nintendo Wii, and I am excited to try the new Nintendo Wii U, but it is not designed for physical therapy. Now some of you might be asking why we are using the Microsoft Kinect. Wasn’t it designed as a gaming peripheral for the Xbox 360 gaming console? You are right and it was, but now it is more.

This is an example of how the Kinect generates a “skeleton” of your body.

Microsoft first released the Kinect as a motion capture device for their Xbox 360. It essentially allowed you to control the games with your own body, not using any physical controller. You are the controller essentially. Shortly after, people began developing other really interesting application, such as using the Kinect as a 3D scanner, or attaching them to robots so they could navigate around a room. Microsoft dubbed this movement the “Kinect Effect“. It was shortly after this movement began, Microsoft released the software development kits for the Kinect, for free, as well as developed the Kinect for Windows’ PC. They essentially provided everyone with the tools necessary to develop Kinect applications, sparking creativity and inovation. For Jintronix, we began to use the Kinect for physical rehabilitation, because we felt it addressed many of the issues of the Wii.

First, we are developing our own software, so we are able to analyze and provide meaningful clinical feedback. We are not relying on ‘stars’ to let you know if you are getting better. Second, the Kinect is a depth sensing camera, which means it tracks your movements in 3D space without you having to hold any hardware, so just about anyone can use it. Third, it is able to track the movements of all the major joints in your body at the same time, so if your therapists wants you to work out your shoulder, and you are moving you back, it will know, which means so will they. This is an extremely important feature of the Kinect, because often during a person’s therapy, they will try to accomplish the goal of the exercises, however possible, even if that means they are not performing the activity correctly. These are known as compensation movements.

Ultimately we are trying to increase the access and quality of virtual rehab services. The Nintendo Wii is not able to provide sufficient clinical content, and who can blame it, it is being used for a purpose it was never intended for. That being said, the Wii has greatly advanced the acceptance of video games as a means of delivering physical therapy, as demonstrated by the Heart and Stroke Foundation, and researchers like Dr. Saposnik. Now that the idea of games for rehab is more accepted, it is time to take that notion to the next level, and deliver more clinically meaningful experiences. The Kinect, by nature of its design, is simply a more versatile tool, with the potential for a greater number of applications.

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