Eli's Rehab Report

Published on Fri Jan 14, 2011 PDF

But be sure to tread carefully in billing territory.

If you aren't offering -- and promoting -- a Nintendo Wiibased therapy option for your clients, you're missing out on a huge potential audience.

Though it's been around for a few years now, the Nintendo Wii remains a superstar when it comes to motivating patients to participate in rehab. For instance, therapists at Shore Memorial Hospital in New Jersey use the gaming system to "distract patients from how much work they're actually doing," says Jennifer Brooks, PT, a therapist with the hospital.

Best bet: You can incorporate Wii-hab into what you're already doing, Brooks says. "We use the Wii as just another tool a physical therapist can choose to use for almost any of our basic patient population," she explains. And offering a Wii option will not only energize your current clients, it will attract new ones who might see your use of new technology as the differentiating factor between you and your competitors.

But before you invest in the game platform and its many therapy-friendly games, consider these important pointers:

Take A Natural Approach to Full-Body Therapy

Wii's unique blend of traditional video gaming and natural physical movement offers rehab opportunities for many different conditions and patient populations. Most video games require only thumb movement, but the Wii encourages light activity. Play requires residents to sit down and stand up and make natural body movements.

Get started: There are a slew of games on the market, but Wii Sports is the starting point for most practices because it includes many well-known sports patients can "play" that mimic many natural movements. "Boxing and tennis seem to be the most versatile of the game package," comments Lane Blondheim, PT, MT, with Active Health and Rehab, a private practice in Montgomery, Ala. "We also use baseball and bowling."

Naturally, maneuvering a remote for these sports requires movements that can rehabilitate upper body injuries, such as rotator cuff repairs and shoulder impingements, but patients who need work on their lower body or balance can also benefit.

For one, most of the games are designed to play standing, so you can work on CVA patients, for example, who are using a walker and need to work on balance, points out Jodi White, PT, director of rehab for Hoyt Nursing & Rehab Centre in Saginaw, Mich. "We rarely have someone sitting in a wheelchair playing, and if that's the case, the patient's endurance is likely very poor, and we're probably working on upper extremity ROM and endurance."

Next step: After your patients have mastered Wii Sports, you can move onto the next favorite: Wii Fit. This game makes users stand on a board that tracks their balance and center of gravity, and requires users to coordinate their upper and lower extremities.

Address Safety Each Time To Keep Injuries At Bay

No doubt the Wii is sitting well with therapists, but as with any new rehab tool, therapists must remember safety. For example, always consider the patient's balance and the likelihood of falls. "We always have a gait belt and someone assisting the patient," White says.

Of course, the Wii is much safer now than when it first hit stores four years ago. Each remote is equipped with a safety wrist strap to keep them in patients' hands and not sailing  across the room.

However, one term that was coined then and still applies now is "wii-njury," which is an injury resulting from intense or extended play. "The game is so popular with residents that some of them would play to that point, so we keep an eye on their vitals and stop them if necessary," White says. In fact, Hoyt Nursing & Rehab Centre doesn't use the Wii anywhere in the facility except for rehab in case residents go unattended or overdo it.

Bonus: Most Wii games are offered in three-five minute chunks of time with some only taking about a minute. That means you can ask patients between game play how they're feeling. This would remind patients to assess their bodies for any soreness or difficulty -- before they've gone too far.

And for those patients in other rehab settings who may want to go home and play on a Wii if they decide they like it, it wouldn't hurt to offer them some solid home exercise advice to avoid injury, Blondheim says.

Follow Traditional Rules For Skilled Services

As the well-known rehab mantra goes, you can't bill for it if it isn't skilled therapy. So you should always have a clear intent for why the patient is playing the Wii.

"Each of the treatments we perform with the Wii has a particular functional goal in mind and is performed under the direct supervision of a licensed therapist," Blondheim says. "That therapist monitors ROM, trunk stability, balance, etc. during each intervention." And it goes without saying that the patient shouldn't be left alone. "An injury could occur, or the specific facilitation we are going for will not be achieved," he explains.

Important: Be careful not to get sucked into the "virtual patient" on the screen, either. Understand that "users can achieve the same video effects with very different movements," cautions Dave Milano, PT, director of rehab services for Laurel Health System in Wellsboro, Penn. "Like any therapeutic program, patient movements must be properly directed and controlled, and this should be carefully monitored with the Wii since the goal, of course, is to achieve a physiologic result, not a video one."

Getting reimbursed: As far as coding and billing goes, "make the call based on what you're doing with the patient," Blondheim suggests.

Remember the "fundamental reimbursement rule that therapists are paid for what they do, not for what their patients do," Milano says. So as long as the therapist is working directly with the patient, using his or her professional skills to achieve a functional goal, then "the coding should be obvious."

For example, you would bill the code for therapeutic exercises for strength work or the neuromuscular reeducation code for balance work, he explains.