Motion Detection and Monitoring Tools: how the Wii and Kinect are influencing the field of health and wellness

By Alexis Fotiu & Bronwyn Spira PT 

The developers of motion detection devices such as Nintendo’s Wii and Microsoft’s Kinect are focusing more and more on the health and fitness capabilities of these devices.  These game consoles are popular for playing games such as soccer, tennis, and baseball and doing exercise videos that focus on strength training, aerobics, yoga, and balance. The fitness and health care industry is now starting to see motion detection and monitoring tools emerge as a way of providing virtual therapy to patients. The Wii is already being used to help treat Veteran patients and people with Alzheimers. The release of Microsoft’s Kinect Software Development Kit for Windows is increasing health professionals’ interests in these motion detection devices as well.  Motion detection and monitoring tools seem to be the next trend in physical therapy and rehabilitation.  How do these devices work and what benefits will they bring to physical therapy patients and clinicians?

The Wii comes with a Wiimote, which is the primary controller for the Wii console.  A main feature of the Wii remote is its motion sensing capability, which allows the user to interact with and manipulate items on screen via gesture recognition (1).  This allows someone playing a video game to actually participate physically in the game they are playing.  Players enact the kicking of a soccer ball, throwing of a baseball, or swing of a tennis racquet and the motion detector picks up these movements and displays them on the screen.  Healthcare professionals could easily leverage the potential in both motion detection and monitoring tools to rehabilitate patients with injuries or disabilities.

"The Wii is a great tool to promote exercise, strengthen cognitive ability and aid visual spatial problems," said Michaele Sheehan, physical therapist at the VA Medical Center in Denver, Colorado (2).  In fact, physical therapists at many VA centers are seizing the opportunity to use the motion detection device in the rehabilitation of Veterans and older patients. Robert Engelbrecht, an army Veteran treated at the Houston VA, has used the Wii as part of his physical therapy regime for the past two years. "It's more difficult than I expected. It gives me a challenge and is more interesting than other therapy exercises" (2).  Engelbrecht lost his leg in combat and has been using the Wii gaming system to aid in his recovery of balance and strength in his left side. "The Wii is motivational and gives Veterans great feedback," said Flynn, a VA physical therapist in Houston. "The visual feedback from the screen is better than me telling them they are off balance" (2).  The Wii engages patients because it enables them to be competitive, have fun, and stay fit all while completing their physical therapy exercises.

Following on the heels of Nintendo’s Wii platform, Microsoft released the Kinect device in 20XX. Kinect has a movement recognition camera (a webcam-style add-on) and does not require a controller, which makes it easier for older generations to use. The webcam sensor can read all of your movements and determine how well you're using your muscles, how many calories you're burning and more (4). Fishing Cactus, a company in Belgium, developed the first serious medical game for Kinect in 2010.  The game is called R.O.G.E.R. (Realistic (in) Observation Game and Experiences (in) Rehabilitation).  The game was made for patients who suffer from a lack of logic and organizational skills (typically post-stroke patients, Alzheimer, hemi-negligent patients, and patients with similar symptoms) (4).

The developers of R.O.G.E.R. created a photo-realist environment running directly on the Xbox 360 composed of a bedroom, bathroom and a dressing room in which representations of objects are placed.  The therapist can assign tasks to the patient to observe how they react.  An example the company gave was assigning the task of packing for a trip to a specific location (such as the beach).  Therapists could then observe what items the patient would pack and if they remembered where objects were located.  It helps the health professionals to analyze and observe if patients are disorganized and see where they have lost their common sense (3).

Fishing Cactus presented R.O.G.E.R. during Microsoft TechDays in 2011 and hopes to have the program completed by 2012 (5).  The development of R.O.G.E.R. shows that the use of virtual therapy is not only being used for physical rehabilitation but for cognitive rehabilitation as well.  The possibilities provided by virtual therapy seem endless as technology continues to advance.

On February 1 2012, Microsoft Research released Kinect for Windows Software Development Kit

This commercial software development tool will allow software engineers to develop programs that serve as an interface between windows and the Kinect. The possibilities for this tool in physiotherapy are greatly enhanced by the ability to use Kinect with a PC. For instance, therapists could use this tool to create individualized home exercise programs that the patient could follow at home. Data about the quality and quantity of each exercise performed would be recorded so that the therapist could review the patient's progress. (6)

There are numerous benefits to using a system like this.  A virtual therapy program would provide instant feedback to both patients and therapists.  Patients would be more motivated to complete their physical therapy exercises, since they know they are being monitored. It encourages patients to complete their therapy with as much accuracy as possible since it is difficult for them to “cheat” when performing activities due to the camera’s ability to detect and sense whole body position (6). The “gaming” component can also positively affect outcomes since the patients are now in a more competitive environment.

While these devices are great at providing an easy, engaging, and fun way for patients to recuperate, there are some disadvantages.  The accuracy of these devices is questionable. Kinect is able to identify joints regardless of body position with 98.4% accuracy but is not able to detect fine motor activity (6).  While this level of accuracy seems high, when it comes to peoples’ health, 100% accuracy is really required in order to provide efficient treatment. Also, therapists and patients will need training to learn how to use Kinect, especially when it comes to developing a patient’s home exercise program.  In order for this form of physical therapy to be applied, both patients and clinics will need to own the device, which may not be practical or affordable.. (6).  Even for patients who have the device, Kinect is not very portable, restricting patients to their home in order to complete  their HEP.

Even though these disadvantages may prevent virtual therapy from being implemented right away, it is clear that these developments in technology are generating the interests of health professionals around the world.  There is a great opportunity to modernize the way patients receive care.  Motion sensor and monitoring tools are becoming increasingly popular and, according to a pilot program at the VA, patients who have used these devices as a form of physical therapy love the interactive tools and are more enthusiastic about completing their exercises than they were with traditional physical therapy. As technology continues to iterate and the demand for virtual therapy increases among patients, we can expect motion detection and monitoring tools to play a significant role in the future of remote physical therapy treatment.

Raphael Cariou, a 3D App Designer, along with his company Reality Frontier, is creating motion capture capabilities for iPhone, Windows Phone 7 and Android with a long-term goal of specializing in augmented reality for mobile applications (7).  Raphael and his team are building mobile applications that can analyze the content of photos and videos otherwise known as motion capture (MoCap).  MoCap is the process by which a device can capture patterns of live movement of a person or object. The data is then transmitted to a computer, where simulation software displays it applied to a virtual actor.

Motion detection is grabbing the attention of developers everywhere and inevitably will play a major role in future care delivery models.

1) "Wii Remote." Wikapedia. Wikapedia, 08 02 2012. Web. 2 Mar 2012. <http://en.wikipedia.org/wiki/Wii_Remote>.

2) "Wii-hab: Veterans Get More Than Fun With Wii Rehab." United States Department of Veterans Affairs. U.S. Department of Veterans Affairs, 10 03 2010. Web. 5 Mar 2012. <http://www.va.gov/health/NewsFeatures/20100308a.asp>.

3) "Fishing Cactus presents R.O.G.E.R, the first Medical Kinect Serious game." Fishing Cactus. Fishing Cactus, 2010. Web. 2 Mar 2012.

4) Dray, Sarah. "Kinect Vs. Move Exercise | LIVESTRONG." LIVESTRONG. Demand Media, Inc, 06 11 2011. Web. 10 Mar 2012. <http://www.livestrong.com/article/550854-kinect-vs-move-exercise/>.

5) "Microsoft supports “ROGER”, 1st Medical Serious Game on Kinect." CAPE CALM. Capecalm, Inc, 2011. Web. 10 Mar 2012. <http://capecalm.tv/2011/03/01/microsoft-supports-roger-1st-medical-serious-game-on-kinect-enmicrosoft-techdays-2011/>.

6) "X-Box and Kinect in Physiotherapy." Physiopedia. Physiopedia, 06 02 2012. Web. 2 Mar 2012. <http://www.physio-pedia.com/index.php/X-Box_and_Kinect_in_Physiotherapy>.

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