Health Promotion Journal of Australia 2010: 21(3) 189 Lessons learned: Staff perceptions of the Nintendo Wii as a health promotion tool within an aged-care and disability service Helen Christine Higgins, Julie Kaye Horton, Brent Cameron Hodgkinson and Stephen Brad Muggleton Abstract Issue addressed: Enhancing opportunities for all older people to be physically and mentally active is an imperative in our ageing society. Lessons learned from the use of the Nintendo Wii within Queensland aged- care and disability services were assembled through eliciting staff perceptions regarding the usefulness of Wii technology within their centres. Methods: Telephone interviews were conducted with direct care staff in 53 centres that had been using the Wii technology for at least three months. Content analysis of interview data identified the major response patterns raised by staff. Results: Staff noted that Wii activities were easy to master for more able clients and that there was minimal risk to clients. Staff reported that these activities provided health promoting physical benefits (mobility, range of motion, dexterity, coordination, distraction from pain) and psychosocial gains (social engagement, self-esteem, mastery, ability to pacify challenging behaviours) and were a useful adjunct to other care practices within these aged-care and disabilities services. Conclusions: Staff believed that Wii activities provided purposeful and meaningful opportunities to promote wellbeing for aged and disabled clients within an aged-care and disability service. However, Wii activities were less successful with clients who had significant cognitive and/or physical disabilities. Key words: Age-care, disability, Nintendo Wii, content analysis of provider perceptions. Health Promotion Journal of Australia 2010 21:189-95 So What The notion of successful ageing suggests that engagement in meaningful activity may ameliorate the effects of ageing and promote longer-term independence. Activity-promoting computer technologies such as the Nintendo Wii offer a novel alternative to more traditional ways of stimulating disabled and/or older people���s cognitive processes, physical activity and social engagement, which in turn enhances their quality of life. Reaching Diverse Groups Introduction The present rate of population ageing is unprecedented and without parallel in the history of the human race. Globally, the proportion of people aged 65 years and older was 10% in 2000 and it is estimated to reach 21% by 2050.1 Australia shows similar social trends, with a projected 23% of its population being over 65 years by 2050.2 Rates of disability in Australia and worldwide are increasing principally due to an ageing population and, with the improvements in health care, survival into old age is now a certainty for many people with chronic disease and long-term disability. This affects all facets of human life. In the public sphere, it affects health service provision and aged-care.2 Ageing, per se, is not an illness but rather is a potent risk factor for the development of chronic diseases that impose serious quality of life issues in their own right. This has prompted the notion of successful ageing, which proposes that maximising the opportunities for older adults to engage in regular cognitive, physical and social activity will ameliorate the effects of ageing and promote longer independence.3-6 Across the lifespan, physically active lifestyles improve physical and psychosocial functioning.7 After controlling for age, body mass index and presence of chronic disease, researchers have shown an inverse relationship between functional limitations and physical activity, with moderately active people over 40 years having fewer physically limitations compared with less-active groups.8,9 The benefits of physical activity, such as improved muscle strength, aerobic fitness, flexibility, balance and coordination, may help individuals preserve independent living.4 Physical activity can also improve cognitive function

Health Promotion Journal of Australia 2010: 21(3) 190 in healthy but normally sedentary older people. A study of 59 people aged between 60 and 79 years found that aerobic training had a role in maintaining and enhancing cognitive function in older adults.10 This study found that cardiovascular fitness increased brain volume, supporting the notion that cognitive and neural plasticity occurs across a person���s lifetime. Social and intellectual engagement can also buffer cognitive senescence with researchers suggesting that engagement in problem-solving activities and educative interventions may slow cognitive deterioration in the elderly. A study with 5,000 people aged 55 years and older noted that playing board games reduced the risk of cognitive impairment while watching television was associated with an increased risk of cognitive impairment.11 Evidence suggests that keeping the brain stimulated can enhance memory and concentration, and can help prevent and/or delay dementia.12-14 Consequently, initiatives that facilitate successful ageing where older people are involved in physical, cognitive and social activities are encouraged.4,5 Recent technological solutions that promote or maintain health and wellbeing have become more important as the population of older adults increases. Although some scholars15 caution against the unchecked optimism that computer technology can have a positive impact on the wellbeing of the elderly, others have enthusiastically commented on the benefits resulting from participation by elderly populations in computer-based activities.12,13,16,17 Studies examining the effects of ���first-generation��� computer games as rehabilitation tools showed that experimental groups of elderly people who regularly played games such as Pac Man improved reaction times, manual dexterity, verbal and non-verbal IQ and emotional wellbeing.13,14,18 O���Sullivan19 notes the positive effects on self-confidence and self-esteem that result from mastering a challenging activity such as a computer game. Studies have found that elderly nursing home residents who regularly played video games rated their sense of wellbeing higher than those who had not been given that opportunity.18,20 Computer games also offer complex virtual situations than may encourage personal reflection while providing opportunities to build skills in eye-hand coordination, balance and problem- solving.18 Video games used in cognitive therapy have also been successful in improving concentration and memory for patients following acquired brain injury and for adults with intellectual disability.21-24 A new-generation computer game is the Nintendo Wii home video gaming console, which was launched in September 2006. One of the advantages of the Wii is its wireless controller (Wii remote) which is a hand-held pointing device that can transmit three-dimensional movements and acceleration to the Wii console. All Wii games require physical movements, cognitive perceptual skills, balance and endurance for the participant to be successful. The Wii allows the participant to play simulated sports such as ten-pin bowling, tennis, golf and boxing within virtual courts, fields, courses or alleys, and all use measurable outcomes such as scoring points or completing a task in an allotted time. Published research studies examining the health-promoting effect of Wii sports activities with elderly populations are limited. Drexler25 examined the effects of using the Wii with an 89-year-old male nursing home resident post cerebral vascular accident and found that participation in 30 minutes of Wii bowling three times per week over an eight-week period improved the fine motor dexterity of his affected hand. Another case study of an 89-year-old female nursing home resident with balance problems found that playing Nintendo Wii simulated bowls over six one-hour sessions improved her scores of dynamic balance.26 Most Wii health promotion studies are limited to healthy populations27-29 or include populations such as disabled young people within educational or hospital settings.30-32 These studies found improvements in the participants��� aerobic expenditure, balance and upper body range of motion. Although there are limited published Wii studies with older populations, there are numerous articles within the ���grey��� literature that discuss the anecdotal benefits of Wii activities within rehabilitation and aged-care settings.32-34 This paper describes staff perceptions of the lessons learned regarding the use of the Nintendo Wii within a Queensland not-for-profit aged-care and disability service. Blue Care is one of the largest providers of community health and residential care for aged and disabled people in Australia, providing daily care for more than 12,500 clients across 59 respite centres, 12 therapy centres and more than 60 residential care and retirement living facilities. Direct-care staff include nursing, allied health, diversional therapists and personal care staff. Blue Care purchased Nintendo Wii Sports consoles in July 2008 for distribution to 53 centres, including 29 residential care facilities that provided high dependency (personal care and nursing services) and low dependency (personal care) services, 18 respite centres, five day therapy centres and one independent living centre for retirees. Methods Procedure Interviews were used to gain insights into staff perceptions and experiences of using the Nintendo Wii within their centres. During December 2008, direct-care staff from across 53 Blue Care facilities that had been using the Wii for three to six months were e-mailed an invitation to participate in a Higgins et al. Article