Tuesday, 28 February 2012

Thoughts on a BJOT article.

The February edition of the BJOT arrived on my doorstep this week and I must admit the contents got me just a little excited - I'm just a little bit of an OT geek.
The article which struck my eye immediately, and unsurprisingly, is the focus for this blog post.

"The use of the Wii Fit in forensic mental health: exercise for people at risk of obesity." Nicola Bacon, Louise Farnworth and Richard Boyd, BJOT, Feb 2012 75(2)

The article looks at how OTs in Australia have utilised virtual reality technology to promote fitness and weight loss in a secure hospital. 
From working in a medium secure unit I have really noticed how at risk and already obese this group of clients are. This is due to many factors such as restrictions on physical activity and a lack of motivation however one large reason is due to the side effects of psychotropic medications. Adverse side effects of the medications used to treat the symptoms of psychoses often include sedation and decreased metabolism, leading to rapid weight gain.
These are definitely side effects which are discussed at work as being very problematic to this client group. It is also important to consider environmental difficulties in addressing weight gain. Within secure environments there are many physical, legal and institutional barriers which prevent clients from accessing exercise opportunities that are available in the general community. Although at my place of work there is some limited gym and sports hall access, due to the majority of the clients being between 20-30yrs old many of the sports which they are interested in, such as extreme and team sports are not accessible to them and that causes a lack of motivation to participate in the opportunities that are available.
This is where the authors of the article feel that virtual reality games such as the Wii fit can provide a stimulating and motivating medium for weight loss within secure settings.

The Wii fit which is a commercially available virtual reality system which utilises motion-sensitive technology to transfer players' movements onto a television screen and a virtual Wii environment. The Wii fit games allow individuals and multiple players to engage in an array of sports and fitness activities ranging from yoga to baseball to kayaking.
One particular benefit to the Wii fit is as follows:
"The 'gaming' factors of virtual reality (VR) technology such as earning points, are believed to help motivate and sustain players engagement in tasks. VR interventions also may be very normalising for forensic patients especially because the average demographic of a video game player is similar to that of the average forensic patient, a 30year old male."
Literature suggests that these Wii Sports games are motivating, enjoyable and realistic forms of physical activity for a variety of client populations although, until recently, little research has been focused on the forensic population.

The method of the study had participants playing the Wii fit up to four times a week in both individual and group sessions which lasted between 7 to 127minutes. The study only had a small population of two clients which were discussed however results showed that when using the Wii fit, participants increased their overall time spent actively moving their bodies in physical activity. Using the Wii fit also changed participants attitudes towards exercise as they realised that it could be 'fun' and 'challenging', especially when staff members also participated.

This article provided an interesting insight into a potential intervention which Occupational Therapists can utilise to both prevent and combat weight gain in secure units. The challenge for forensic occupational therapists is to find a 'better match between the person, environment and occupation in this scenario, in order to assist forensic mental health patients to participate in exercise within a secure setting, to improve their health and well being, and potentially to assist them to lose weight." The Wii Fit and other VR systems could be the perfect way to achieve this. 

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