Therapist uses Nintendo Wii in rehab therapy

Cpl. Blair Phillips stands slightly crouched, shoulders hunched forward, finger firmly nestled against the trigger, his gaze intently fixed on his targets as they come into view.

TORONTO — Cpl. Blair Phillips stands slightly crouched, shoulders hunched forward, finger firmly nestled against the trigger, his gaze intently fixed on his targets as they come into view.

First come the balloons, their long strings dangling against the backdrop of a cloudy sky. Then the bulls-eyes. A series of frantically swirling grey discs follow close behind.

The scene isn’t playing out against enemy combatants in a war zone but on a large TV at St. John’s Rehab Hospital, where the injured reservist is taking aim at animated images darting onto and off of the screen.

But there’s an added dimension to the device he’s using to take out his pixelated targets: the remote is housed inside a replica of the gun he carries on the front lines.

Phillips is testing out an innovative, customized therapy incorporating the Nintendo Wii video gaming system in an effort to simulate his real-life combat experience.

Occupational therapist Terrence Yuen said it was a conversation with his son that sparked the idea of creating a toy model of a gun to house the Wii control Phillips could use in a rehab training exercise.

Yuen teamed the high-tech remote that accompanies the gaming console with some old-fashioned craftsmanship, building a wooden replica of the rifle Phillips uses on the job in a bid to help bolster his strength and endurance.

“The game itself has the components of challenging his endurance because you’re shooting, you’re engaged into it, you concentrate — it’s an expected target which we cannot simulate in any therapy sessions,” he said.

“What I do is provide a device (which) can actually simulate the amount of weight that he has to use,” he added. “Then we combine the weight requirement and the endurance requirement of what he has to do in his real job.”

Phillips, 22, has been paying twice-weekly, three-hour visits to the rehab facility as he recovers from injuries from his first tour of duty in Afghanistan.

On Sept. 27, Phillips was exercising at a combat outpost clad only in gym shorts and boots when a rocket-propelled grenade exploded nearby.

A piece of it “came raining down” on him, the shrapnel piercing his bare flesh and shattered his left shoulder blade.

“Initially it just felt wet on my back, so I knew that’s where I was hit,” recalled Phillips, who also suffered a broken collar-bone, broken ribs and a bruised lung.

“I was close enough to my buddies that I tried yelling out, but I just couldn’t. It felt like I got kicked in the chest.”

It would take several surgeries to treat the wound, including two separate procedures just to clean it out, and many weeks before “it started feeling like solid bone again.”

Yuen said his goal in incorporating Wii therapy is to help Phillips achieve what he wants — namely, to have the endurance and strength to cope with the on-the-job task of firing his weapon.

Yuen and his son surfed the web in search of an illustration of the rifle, the Canadian version of the M-16. They downloaded it, taking measurements from the diagram and making from them a life-sized replica.

Since the Wii remote uses a laser to control the game, Yuen knew he needed something to hold onto the gun handle without blocking the beam.

He scoured the hospital and found Plexiglas which he cut and modified allowing him to place the controller inside, with a rubber band to lock it.

A plastic syringe and spring became the makeshift trigger.

Yuen devoted a few days after hours in the workshop to craft the handles and assess what did and didn’t work, finishing work on the replica in a total of seven hours during that period.

The replica weighs about 1.4 kilos.

By adding weights on top of the device, Yuen gradually wants to ramp that up to about 5.9 kilos — equivalent to the weight of the combat rifle.

Following the first session testing out the handcrafted replica and the Wii game, Phillips seemed pleased with the initial results.

“It was somehow familiar, which was very nice. (Yuen) obviously spent a lot of time and put a lot of thought into it,” he said.

As Yuen began gradually adding more weight during the exercise to test his capacity, Phillips said it felt “a bit more real.”

“Even when my arm was perfectly functional, keeping the weight suspended out there was a bit difficult and tiring and adding the weight definitely did get closer to the feel of the real weapon.”

There are numerous studies on the use of virtual reality in patients to help them work through their rehab by concentrating less on pain and more on moving their arms and legs.

But the systems used tend to be extremely expensive, said Jennifer Shaffer, professional practice leader for physiotherapy at St. John’s Rehab.

“They’re tens and twenties of thousands of dollars to implement, so that clearly wasn’t an option for us,” she said.

“When the Wii came out, it’s $300, and we thought that was a more a cost-effective and more fun way to get patients to do more and make it fun for them, and engaging and stimulating.”

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