Surrounded by a smorgasbord of color in a room filled with games and playthings to suit the fancies of any young person, 17-year-old Michael Dennos is beaming. His hands are planted firmly behind him on a cushioned platform as his physical therapist manipulates his upper body, elongating his spine and broadening the span of his shoulders. His long, thin frame yields to the doctor's maneuvering as if it were instinctive.
The rising college freshman from Durham has been attending physical therapy sessions at Duke's Lenox Baker Children's Hospital for more than 16 years, but starting in the fall he'll have to adapt to a whole new way of living: a life of independence.
Dennos was born with spastic diplegia cerebral palsy, which prevents normal motor control and muscle tone in all four of his limbs, but affects his legs the most. The neurological disorder affects his ability to walk and speak as well as the fine motor skills required to fasten buttons and tie shoe laces. But physical therapy can improve motor control, minimize musculoskeletal problems, and aid in development of gross motor skills such as walking or using a wheelchair. Such therapy can mean physical independence for a person with cerebral palsy.
Though the condition has made life all but easy, Dennos remains enthusiastic about continuing his education. After choosing to pursue a degree in creative writing at St. Andrews Presbyterian College in Laurinburg, the young writer finds that the most difficult decision he has had to face thus far came with deciding which of his many dreams he wished to accomplish first.
"Well, I'm still trying to decide between being a professional movie critic and being a screenwriter," said Dennos.
Activity is abundant in the room, as other pediatric physical therapy patients are escorted in and are coached through their exercises.
"This past year we've been looking at all the ways we can help him transition so that he'll be more independent with his exercise program when he's off to school," said Laura Case, DPT, who teaches courses in Duke's Doctor of Physical Therapy Program. Her clinical interests include pediatric physical therapy, with particular emphasis on children with neuromusculoskeletal diagnoses, such as cerebral palsy.
Case helped Dennos develop ways that he might do his stretches independently on campus, which will help him remain limber and maximize use of muscles over which he maintains control. Case was looking for more ways for him to work independently on balance and coordination as well as strengthening while at college.
One day, one of the students in the DPT program brought in a Wii.
A photo from a 1996 Dialogue showing a five-year-old Michael Demmos with Dr. Rajan Gupta trying out a modified Nintendo joystick.
Dennos' positive response to strength building exercises on the Nintendo game system prompted physical therapy students to rally together and purchase a Wii for Dennos to take to college with him. This physically engaging video game system, with its innovative wireless handheld controller, shows promise of becoming a vital instrument in home-based health care.
The system's growing use in physical therapy has spawned a new clinical term: "Wiihabilitation."
This isn't the first time the teen has been involved in the use of innovative medical technology. Twelve years ago, a five-year-old Dennos made front page news in Duke Dialogue when he assisted engineering students in the modification of both a child-sized toy car and a Nintendo video game system so that they could each be used by physically disabled children.
"Anytime they needed a guinea pig they'd pretty much ask for him," said the teenager's mother and 33-year Duke Hospital employee Patricia Dennos.
The Power Wheels toy had been transformed from a two-speed, foot-pedal operated vehicle to a variable speed car with modifications that allowed its driver to control the speed with a pedal that could be controlled by moving one's head. The Nintendo video game's controllers were converted from a standard two-hand, thumb-operated panel to a joystick for use by those with limited dexterity. When it came time to test the newly altered toys, the five-year-old was more than happy to help.
The Wii Phenomenon
With all of the recent attention surrounding both the Nintendo Wii and the newly released Nintendo Wii Fit and their expected potential in certain areas of physical therapy and muscle training, a few pressing questions arise.
What could one hope to gain from using the Nintendo Wii Fit?
Contrary to popular belief, the Wii Fit video gaming system was not designed as an alternative to regular exercise nor is its purpose to aid in weight loss. In fact, Wii creator Shigeru Miyamoto is often quoted as saying that the Wii Fit console is little more than a complicated scale with the ability to track its users' progress. When used properly, users can expect to improve strength, endurance, balance, and posture. As new levels of endurance are achieved, new and more complex games are unlocked for more vigorous training.
Wii Fit, an add-on to the original Wii video gaming system, comes with a wireless, pressure-sensitive peripheral known as the Wii Balance Board. This scale-like device measures body mass and weight while Wii Fit's software tracks changes and sets goals.
Its use in research as a data collection device is being explored. Duke's Department of Community and Family Medicine will use the Wii as part of a study of postpartum weight loss.
In Dennos' case, however, the Wii module will serve as more than a gaming system or weight-monitoring device. It is a tool that will support his independence from the physical therapy he has participated in his entire life.
"For me, it's just the joy of seeing him go off to college and be independent," said Case with tears welling in the corners of her eyes, "I'm just proud of him."
La-Tasha Davis studies mass communications at N.C. Central University and is a summer intern at Duke Medicine News & Communications.