title: Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series.
abstract: BACKGROUND
  Early rehabilitation in the intensive care unit (ICU) improves patients' physical function. Despite reports of using commercially available interactive video game systems for rehabilitation, there are few data evaluating feasibility and safety as part of routine in-patient rehabilitation, particularly in the ICU.
  
  
  METHODS
  We conducted an observational study from September 1, 2009, to August 31, 2010, of adults admitted to a 16-bed medical ICU receiving video games as part of routine physical therapy (PT), evaluating use and indications and occurrence of 14 prospectively monitored safety events.
  
  
  RESULTS
  Of 410 patients receiving PT in the medical ICU, 22 (5% of all patients; male, 64%; median age, 52 years) had 42 PT treatments with video games (median [interquartile range] per patient, 1.0 [1.0-2.0]). Main indications for video game therapy included balance (52%) and endurance (45%), and the most common activities included boxing (38%), bowling (24%), and balance board (21%). Of 42 treatments, 69% occurred while standing and 45% while mechanically ventilated. During 35 hours of PT treatment, 0 safety events occurred (95% upper confidence limit for safety event rate, 8.4%).
  
  
  CONCLUSIONS
  Novel use of interactive video games as part of routine PT in critically ill patients is feasible and appears safe in our case series. Video game therapy may complement existing rehabilitation techniques for ICU patients.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Critical Care Physical Medicine and Rehabilitation Program, Johns Hopkins University, Baltimore, MD 21287, USA. michelle.kho@jhmi.edu
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Kho
authors.forename: Abdulla
authors.initials: A
authors.lastname: Damluji
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Zanni
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011446:Prospective Studies; D012046:Rehabilitation / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface; D018910:Video Games / Q000009:adverse effects