Games are fun Games that help to improve our cognitive skills, manual dexterity, physical abilities, problem-solving skills, creativity, and overall brain health work to keep us flexible in many more ways than one. In our recent discussion of mobile device applications, I didn’t include many games; but there are some great offerings.
Did you know that crossword puzzles help word finding skills, but not memory? Aerobic exercise helps to improve physical fitness and keeps the brain healthier through increased blood flow, which does help to improve memory. Studies have shown that aerobic fitness is associated with healthier gray and white brain matter which helps to reduce long-term disability in MS (Prakash, 2010).
Physical therapy (PT), often combining strength training and flexibility, cardiovascular and endurance exercise, as well as balance and gait training, is a mainstay of treatment for people with multiple sclerosis and other neurological disorders. I can attest that the benefits of PT can be significant and long lasting, but sometimes continuing physical therapy exercise on your own can be less than exciting. As a result, compliance to exercise programs can be difficult even when the benefits are tangible (Mostert, 2002).
Physical therapy can also improve neurological function through neuroplasticity, or brain plasticity, that works as an adaptive mechanism to compensate for lost functions in the event of brain injury or trauma. Neuroplasticity, however, is not a static phenomenon; it changes as different types of plasticity are more active or less prevalent during a person’s lifetime.
At the time I was finally diagnosed with MS, I had lost use of my left hand, arm, and several fingers. During four months of intense physical/occupational therapy, my therapist guided me through very specific and targeted activities and exercises aimed at creating new neural pathways between my hand and my brain in order to regain lost function. She described it as creating a detour and making the detour the permanent road for the electrical messages. That is one form of neuroplasticity.
Researchers in Italy, led by Dr. Luca Prosperini from Sapienza University in Rome, have demonstrated that training with a popular video game that incorporates a battery-operated balance board (Nintendo Wii Fit) can induce favorable changes in a portion of the brain involved in balance, posture, voluntary motor function, motor learning, and cognition; the specific area being the superior cerebellar peduncles in the cerebellum which were measured by diffusion tensor imaging (a special MRI technique). The changes in the brain of 27 MS patients who underwent a 12-week intervention using the balance board correlated with improved balance control as measured by static posturography during the 24-week study. However, both clinical and imaging changes did not persist beyond 12 weeks after training (Properini, 2014).
“The most important finding in this study is that a task-oriented and repetitive training aimed at managing a specific symptom is highly effective and induces brain plasticity,” Dr. Prosperini stated in a press release. “More specifically, the improvements promoted by the Wii balance board can reduce the risk of accidental falls in patients with MS, thereby reducing the risk of fall-related comorbidities like trauma and fractures.”
Previous research conducted by Prosperini’s team found that home-based training with the Wii balance board may provide an effective, engaging, balance rehabilitation solution for people with MS; however, the risk of training-related injuries should be carefully balanced with the benefits (Prosperini, 2013).
These were not the first studies to use the Wii Fit balance board with MS patients. Researchers in Chicago have examined the potential of using the Wii Fit to increase physical activity (PA) behavior and health among people with MS. In 26 MS patients who were prescribed a Wii Fit exercise program lasting 14 weeks, 3 day a week, results of patient questionnaires revealed that PA, strength and balance significantly improved at week 7, but at week 14, PA levels declined and the difference was no longer significant (Plow, Finlayson, 2011).
A follow-up study found that MS patients reported that the Wii Fit helped build confidence in abilities, achieve goals related to engagement in leisure activities, and remove barriers associated with going to a gym to exercise. However, Wii Fit induced initial reactions of intimidation and worries about falling, and feedback during game play reminded participants of their impairments (Plow, Finlayson, 2014). I must admit that I enjoy playing games using the Wii Fit balance board, but there are some activities which I find to be much more challenging than others.
Additional studies involving the Wii Fit balance board and people with MS have occurred in Italy (Brichetto, 2013; Guidi, 2013) and in Sweden (NilsagÃ¥rd, Forsberg, von Koch, 2013) where researchers also documented the views of both patients and physical therapists in one study (Forsberg, NilsagÃ¥rd, BostrÃ¶m, 2014). Researchers in England, supported by the National Health Services (NHS), have recently published the protocol for a pilot study designed to explore the feasibility of conducting a full scale clinical trial of Mii-vitaliSe, a home-based physiotherapist-supported intervention for people with MS using the Wii Fit balance board and computer game (Thomas, 2014). A study to test the idea of conducting a study; sometimes science makes me grin.
So what are some of your favorite video games that require physical activity, or mobile apps that either encourage being active or working your brain?
Brichetto G, Spallarossa P, de Carvalho ML, Battaglia MA. The effect of Nintendo ® Wii ® on balance in people with multiple sclerosis: a pilot randomized control study. Mult Scler. 2013 Aug;19(9):1219-21. doi: 10.1177/1352458512472747. Epub 2013 Jan 15.
Forsberg A, NilsagÃ¥rd Y, BostrÃ¶m K. Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists. Disabil Rehabil. 2014 May 16:1-7. [Epub ahead of print]
Guidi I, Giovannelli T, Paci M. Effects of Wii exercises on balance in people with multiple sclerosis. Mult Scler. 2013 Jun;19(7):965. doi: 10.1177/1352458512461971. Epub 2012 Oct 4.
Mostert S, Kesselring J. Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler. 2002 Apr;8(2):161-8.
NilsagÃ¥rd YE, Forsberg AS, von Koch L. Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Mult Scler. 2013 Feb;19(2):209-16. doi: 10.1177/1352458512450088. Epub 2012 Jun 6.
Plow M, Finlayson M. A qualitative study exploring the usability of Nintendo Wii Fit among persons with multiple sclerosis. Occup Ther Int. 2014 Mar;21(1):21-32. doi: 10.1002/oti.1345. Epub 2013 Apr 24.
Plow M, Finlayson M. Potential benefits of nintento wii fit among people with multiple sclerosis: a longitudinal pilot study. Int J MS Care. 2011 Spring;13(1):21-30. doi: 10.7224/1537-2073-13.1.21.
Prakash RS, Snook EM, Motl RW, Kramer AF. Aerobic fitness is associated with gray matter volume and white matter integrity in multiple sclerosis. Brain Res. 2010 Jun 23;1341:41-51. doi: 10.1016/j.brainres.2009.06.063. Epub 2009 Jun 25.
Prosperini L, Fanelli F, Petsas N, et al. Multiple Sclerosis: Changes in Microarchitecture of White Matter Tracts after Training with a Video Game Balance Board. Radiology. 2014 Aug 18:140168. [Epub ahead of print]
Prosperini L, Fortuna D, GiannÃ¬ C, et al. Home-based balance training using the Wii balance board: a randomized crossover pilot study in multiple sclerosis. Neurorehabil Neural Repair. 2013 Jul-Aug;27(6):516-25. doi: 10.1177/1545968313478484. Epub 2013 Mar 11.
Wii Balance Board Induces Change in the Brains of MS Patients. Press Release, August 25, 2014. Radiological Society of North America. Accessed at http://www2.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=754
Thomas S, Fazakarley L, Thomas PW, et al. Testing the feasibility and acceptability of using the Nintento Wii in the home to increase activity levels, vitality and well-being in people with multiple sclerosis (Mii-vitaliSe): protocol for a pilot randomized controlled study. BMJ Open. 2014 May 7;4(5):e005172. doi: 10.1136/bmjopen-2014-005172.