Eli's Rehab Report

Published on Sun Apr 27, 2008 PDF

But be sure to tread carefully in billing territory

Are you up on the latest rehab trend hitting skilled nursing facilities and other rehab settings? In many areas, Nintendo's Wii is complementing traditional therapeutic exercises for therapy patients, particularly seniors in long-term care. And patients' motivation to participate in rehab is, not surprisingly, increasing, according to first-hand users.

Read on to see what your peers have to say about the Wii's rehab benefits and some important pointers to consider if you want to purchase one for your facility.

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 bodily movements.

How it works: In one hand, the patient holds a remote, which senses movement and mimics it through a character on the video screen. Sometimes a patient even uses two remotes (one in each hand) depending on the game. Most therapists consider the game Wii Sports a staple since 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," says 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 tears 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, says 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."

Good idea: For more advanced patients, you could even add more challenge to the patient's center of gravity by having him stand on an unstable surface, Blondheim says. In addition, OTs might even work on hand-eye coordination.

Keep It Safe ...

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.

No flying remotes: Remember those reports of bizarre injuries and smashed televisions when the Wii first came out last year? You can avoid a dangerous flying remote by using the remote's safety wrist strap, White adds.

You'll also want to make sure the patient isn't overdoing it. "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.

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.

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 obviously, the patient shouldn't be left alone. "An injury could occur, or the specific facilitation we are going for will not be achieved," he says.

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," says Dave Milano, PT, director of rehab services for Laurel Health System in Wellsboro, Pa. "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 says.

Remember the "fundamental reimbursement rule that therapists are paid for what they do, not for what their patients do," Milano says. As long as the therapist is working directly with the patient, using his 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 re-education code for balance work, he says.