Could a real hope of improving the lives of people with Parkinson’s disease — here, now, in their own homes — lie in a computer game? With major drug breakthroughs still tantalisingly out of reach, many health professionals and people with Parkinson’s are suddenly excited by the dramatic improvements in function and wellbeing being brought by simply playing the Nintendo Wii — a games system available on every high street that simulates sports and other activities by transferring your movements to the computer screen.

This summer, the Medical College of Georgia in the United States announced the striking results of its research into the effects of “Wii-hab” on people with Parkinson’s disease. In an eight-week study, 18 people were asked to play Wii Sports, including virtual versions of boxing and ten-pin bowling, for an hour a day, three times a week for four weeks. By the end of that time all the participants showed significant improvements in rigidity, movement, fine motor skills and energy levels. Importantly, their depression levels also decreased; depression affects around half of people with Parkinson’s disease.

“I can honestly say I was very surprised by how large the improvements were, particularly on depression,” says Dr Ben Herz, an occupational therapist and assistant professor in the School of Allied Health Sciences at Medical College of Georgia. “The Wii allows patients to work in a virtual environment that’s safe, fun and motivational.” The games require visual perception, hand-eye co-ordination and sequenced movement, so it’s a huge treatment tool from an occupational therapy perspective.

Tina Walker, 50 from Kettering, Northamptonshire, had Parkinson’s disease diagnosed in 2003. She gets waves of uncontrolled movement down her right side, and a tremor that permeates her whole body: she describes it as like being in a car that’s constantly idling. Last year, she played the Wii once or twice with her granddaughter, and because of her symptoms kept being beaten hand over fist.

But, being an occupational therapist by profession, Walker was intrigued at the Wii’s potential to improve hand eye co-ordination, and found out that health professionals around America have started to use it to help the symptoms of neurological conditions such as Parkinson’s. So she got her own Wii this year. After playing for a couple of months, she could give her granddaughter a run for her money.

“It’s brilliant,” says Walker, “Since using it, my fitness and co-ordination have definitely improved. When I started I couldn’t even hit a tennis ball on the Wii Sports game, but I can now control the complex movements that Parkinson’s makes very difficult. The other day my grandson threw me an orange and I actually caught it. I’d never have been able to do that before.”

What she really loves is that this isn’t boring exercises in isolation — the games are motivating, and allow her to have fun with her family. Her “Wii age” — the measure that the device gives you of how well you have mastered the virtual sports on offer — has gone down from 71 to 41.

“I know a lot of people with Parkinson’s who have the game now,” says Walker, who is an active member of the Parkinson’s Disease Society.

It’s only three years since the Wii, the first game system to be controlled by full body movement, rather than buttons and joysticks, was launched. Ever since, health experts have been investigating its uses as a means of increasing aerobic fitness and controlling obesity. But researchers are now beginning to get a measure of its potential for helping those with neurological conditions too.

The Parkinson’s Disease Society in the UK, which funds research and supports patients, is very aware of the current buzz around Wii-habilitation. Though media publicity — and sometimes doctors — tend to focus attention on the potential of drug developments to control or slow the progression of Parkinson’s disease, the similar potential of exercise regimes is often overlooked, according to Dr Kieran Breen, Director of Research and Development at the Parkinson’s Disease Society. The Wii is interesting because of its ability to improve motor skills, not just fitness.

“When someone is first diagnosed with Parkinson’s, the first suggestion they get from physiotherapists is to keep active,” says Breen. “It’s important for people with Parkinson’s as their muscles and joints tend to get stiff and rigid. We know that activities such as dancing can be especially beneficial, because moving to a rhythm seems to help people overcome problems with shuffling, or freezing. But then we’re also beginning to get some evidence that regular exercise can actually help slow down the disease.”

Researchers from the University of Pittsburgh have found that, in rats at least, exercise prevents the degeneration of nerve cells that are normally destroyed by Parkinson’s disease, and is now conducting a large trial to see whether this applies to humans.

It’s the use it or lose it principle. Parkinson’s disease causes degeneration of the nerve cells in the part of brain responsible for movement and co-ordination, and by keeping these cells as active as possible there’s the possibility that they degenerate more slowly.

“Everything at the moment is focused on new drugs slowing the progression of the disease,” says Brean. The Parkinson’s Disease Society, for example, recently announced the discovery of a pathway inside nerve cells that might in the future be stimulated with drugs to protect the dying cells affected by Parkinson’s. “But we mustn’t forget about how beneficial the help from physical therapists and occupational therapists can be in keeping people active. Too often, doctors refer people to physiotherapists too late.”

The benefit of games that promote movement and hand-eye co-ordination is that they provide the sorts of exercises prescribed by therapists in patients’ own homes. The Parkinson’s Disease Society is considering research to investigate their potential. While no one is suggesting

that Wii-hab will provide miracle cures, or reduce the need to develop new drugs, Ben Herz believes it is a “no-brainer” that its potential should be tapped more — and not just for Parkinson’s disease. He first used the Wii with a patient who had been disabled through brain injury.

“It promotes functional movement,” he says. “There are off-the-shelf cooking games and surgery games as well as sports games, so there are all sorts of movements you’re practising. Even people who are in nursing homes can play them lying down.”

Now, in a new study, Herz is investigating the potential of the latest version of the Wii, the Wii Fit, to improve balance and aerobic fitness in people with degenerative diseases. Wii Fit includes a stand-on board, which tracks how well you’re balancing and transfers the pressure from your feet into on-screen activities such as yoga and tightrope-walking. “I had a patient who was walking with a cane for two years, and four months after using Wii Fit, he didn’t need to use it any more.”

Actual research evidence about the benefits of Wii-hab is still thin on the ground. But the anecdotes about its success are beginning to spread. In the UK, the physiotherapist Rebecca Redmond has set up a website (wiihabilitation.co.uk) and online community for those using the Wii as part of rehabilitation programmes. Since its launch last year, it’s had 10,000 new visitors and gets around 80 hits a day.

Redmond has compiled research and accounts of the Wii being used by physiotherapists and occupational therapists to help people with cerebral palsy, behavioural disorders, tennis elbow, head injury, heart attacks and strokes.

Redmond herself works at the National Star College in Cheltenham, where young people with physical and learning disabilities enjoy playing the games as part of their physical therapy programme. “Physiotherapists are coming round to using it in sessions because it’s so motivational — it’s not a treatment as such, but one of a number of tools we have. Because the great thing is, I’m no different from my patients: we all want to have a go.”

Games technology continues to advance. Next year, Microsoft is expected to launch its revolutionary hands-free computer games system, codenamed “Project Natal”, which does away with the need for the hand-held motion sensors of the Wii. It completely reproduces the body’s motion on screen by means of cameras, and will open up new fields for rehabilitating people from movement-inhibiting illness.

But already, for Tina Walker, the benefits are there. It’s not just the physical improvements. The most liberating aspect has been to make her feel more human — providing new ways to laugh and engage with her family: “It’s great to have it around, so if the grandchildren come to see me, I can just say, ‘Come on, let’s have a game.’”

In an illness where depression, isolation, and reliance on carers are so common, that’s arguably the best kind of rehabilitation of all.

What is Parkinson's disease?

Whenever you move, a chemical called dopamine conveys a statement of intent to the part of your brain that is responsible for motor control. The message is further relayed along the network of nerves that connect brain to muscles. If the dopamine supply diminishes dramatically, as happens in Parkinson’s disease (PD), messages cannot be ferried efficiently, and the body cannot respond effectively. Symptoms usually appear when dopamine levels fall by 80 per cent.

The sufferer, who generally experiences his first symptoms when he is over 50, might first notice a tremor in the hand. Later, he will notice that it takes longer to carry out tasks. The speed at which the disease progresses varies greatly between people. A few people develop the disease before 40; this is known as young-onset PD.

There is no definitive biochemical or genetic test for PD: it is diagnosed by observing symptoms and then eliminating other possible causes. Causes are uncertain — genes and environmental factors have both been implicated.

Anjana Ahuja