Calling a video game cutting-edge medicine seems absurd, yet nationwide, physical therapists are becoming avid users of the Wii gaming system. Most commonly, therapists use games like cooking and boxing to help neurological rehab patients. But Josh Lenox, a physical therapist at Encore Rehabilitation at Hartselle Medical Center, saw a new way to incorporate the Wii in his practice. The Wii game system by Nintendo holds the unique and enthralling ability to translate a person's body movements onto the player on the screen. So as you swing the Wii remote as if you're throwing a bowling ball, the bowler on the screen throws and releases the ball using the twists and pressures from your hand and arm. As you move, so does the player on the screen. So when Lenox read that Nintendo had released a balance board as part of their gaming, he envisioned therapy applications for knees, ankles, and regaining balance. In June, Encore began using the new equipment with their patients and applied in therapy on more than fifty patients so far. The Wii balance board resembles a rectangular plastic board often used in step aerobics, but is only about 2 inches high. The patients stand on the board with both feet and shift their weight to play various games. The board can even be used as the patient leans on a walker. One of the favorite games is the tilt board. The patients' weight shifts control the tilt of a board as they try to roll marbles around obstacles and into a hole. "So if they have an ankle problem and are skittish about moving, to complete the game, they have to shift their weight into positions they're not necessarily comfortable with," said Lenox. The need to win overrides the fear or discomfort. For stroke patients, Lenox said, the game helps realign their center of gravity. "We use the game to shift them back to neutral position." Previously, they used a mirror to show stroke patients how much they were leaning. But the Wii balance board "adds additional feedback that requires a response," said Lenox. With Wii, the table or player on the screen reflects how much the patient leans, and also motivates them to correct it or the marbles roll off the board or their player takes a spill. A more complicated game to correct balance involves heading airborne soccer balls that come toward you. "It's very hard to line up the character on the screen in the middle. You have to have perfect balance," said Lenox. For those with coordination problems, like Parkinson's, Lenox uses the rhythm game that requires the player to step on and off the board to music. "If their entire problem is controlling different parts of the body, then that's a timing situation," said Lenox. The best use of the Wii shows in ankle fractures and those having problems with lateral movements, for which the slalom skiing game reigns. "This is excellent for ankles, all the way around, and for knee arthroscopies. But the games are not a miracle thing, but they're real successful," said Lenox. By shifting the balance board lengthwise to imitate snowboarding, the Wii becomes therapy for plantarflexion contracture or tightness. "It motivates them to shift from heels and toes and back and forth to make the snowboarder slide left to right and miss the flags," said Lenox. "For backs, it didn't really work," added Lenox. The games put too much pressure in the lumbar region with the weight shifts. "It tended to make them a little sore, so we backed off of that," he said. The mini-games that came free with the board work perfect for therapy, said Lenox. "They last only a minute or two and keep their attention." Because each game offers about eight levels of difficulty by adding more marbles or obstacles, the patients stay challenged. He added that the games are used in conjunction with the therapies already in place. For Encore's situation, Lenox's Wii adaptation for therapies served an ideal purpose. At Hartselle, a small rural hospital an hour north of Birmingham, Lenox says they face a diversity of therapy needs, but "we don't have the budget that a lot of larger clinics have. Larger facilities can have computer balance equipment that's upwards of $10,000, but the Wii — at $300 to $400 — does a large portion of what that expensive piece does and fits our budget," said Lenox. The success of physical therapy boils down to what a patient is willing to do at home. And that's where Lenox has found the greatest benefit of the Wii. "It's an enjoyable experience, so they do it, " said Lenox. He's found that while patients will neglect to do the other home exercises he prescribes, they will have done the Wii exercises. Not surprisingly, athletes find Wii a highly useful therapy tool. "We've also had a lot of success with younger stroke patients [50 to 60-year-olds] and, interestingly, those with younger grandchildren with Wii systems at home," said Lenox. "They were excited to be able to show the kids they can do it too."