Step to the Beat

Step to the Beat is a good motivational game that promotes stepping in time with the music that is played through the game. Therapy potential = GOOD

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The game setting and scenario is that of an island - 'Rhythm Island' where the player walks around freely to the beat of the music. 'Step to the Beat' is a simple game that requires the user to jog/shake the Nunchuk in time with the music tempo.

The Nunchuk is normally put into a pocket but can also be held - depending upon the purpose of the therapy. The game is compatible with the Wii Balance Board, the Wii Dance mat or with the Wii Balance Board being used when the user is sitting down (with feet on the board). Walking is sufficient to 'jog' the controller with some songs being a quicker tempo and requiring a brisker pace. None of the songs require the player to run and the game continues even if steps are missed.

As the player walks the on screen character also walks, moving along the paths of the island and allowing the player to explore.

At the same time as the Nunchuk is being 'jogged' the WiiMote can be used to point at 'capsules' that enable the player to open up new music and new areas of the Rhythm Island. The cursor pad on the WiiMote is also used to decide the direction that the character walks in and is often best controlled by the therapist/assistant therefore allowing the patient to focus and concentrate on quality of stepping and rhythm.

The game is good for those wanting to explore lower limb exercise/dynamic balance, either in sitting or standing or for those wanting to work on rhythmical upper limb movements, which could just be the control of movement or t focus on reaction speed, consistency of movement or general co-ordination.

The only down side to this game is its popularity and it can be expensive to buy.  An alternative way to at least trial the game is to rent it - see link below:

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Rayman Raving Rabbids - Go Home and Travel in Time

Both good playable games in their own right but not as easy to integrate within therapy as other games within this series or on the market.  Therapy potential = LIMITED

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Following the successful use of Rayman Ravings Rabbids 2 with some clients, due to its variety of easily accessible mini games, its always worth considering the sequels. Both Rabbids Go Home and Travel In Time do have similar themes of mini games but the navigation is complex making it more difficult to individually pick games out as with Rayman 2.

Both games are stories whereby the player is guided from scene to scene.  The story line within Go Home revolves around collecting as much rubbish as possible to make a tower in order to reach the moon and go home.  The controls require both Wii remote and Nunchuk with a good degree of co-ordination and dexterity.

The Travel in Time storyline takes the player to different stages of the game by transporting them in a time travelling washing machine.  As bizarre as it sounds some of the games within this Rayman plot were quite good but again the use of the Wii remote and Nunchuk quickly makes it less friendly for use in therapy.  Travel in Time consisted of numerous mini games - similar to the successful Rayman 2 but lacked easy navigation and consequently reduced its ease of use.

Both are good games if you have enjoyed the crazy world of Raymans Raving Rabbids previously.  They both require the use of the Nunchuk so need bilateral control, dexterity and co-ordination.  With games similar to Rayman 2 available to use within a therapy session I struggle to identify why I would need or want to use either of these titles.


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Wii Play: Motion

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Wii Play Motion is the sequel to Wii Play.  Wii Play was initially released as an introduction to the controls for the (then) newly released Nintendo Wii.  With the release of the MotionPlus add-on a few years ago its no wonder that Nintendo released another game that demonstrates and teaches the capabilities of the MotionPlus controller.

The game itself is a collection of 12 mini games and is generally sold bundled with a new Wii MotionPlus controller (the game is available individually - see below).  Up to 4 people can play the games at once, although you'll need extra controllers for some.  A couple of titles are familiar from Wii Play - the Pose Mii Plus and the Teeter Targets and more complex versions of

Cone Zone - This game requires the player to hold the controller so that it points in the air, as if it were an ice cream cone.  The game starts when a scoop of ice cream is place into your cone, initially slowly then increasing in speed.  As the scoops get added you have to control the balance of the cone by moving the WiiMote forwards, backwards and to either side.  As the tower of scoops increases so does the sway of the cone and scoops combined.

Veggie Guardin' - Remember 'Whac-a-mole'?  This game works on a similar idea.  The player uses the WiiMote to hit moles as they try to steal fruit from the baskets at the bottom of the screen.  The MotionPlus comes into its own here requiring precision of the 'hit' in order to 'whac' the moles who, initially, try to steal from three baskets but in later stages increase to five baskets.  This game requires reaction speed and the ability to point the WiiMote in the direction of the mole.

Skip Skimmer - A clever and simple game that is made more interesting than it might have been.  The game requires the player to choose a stone to skim across a lake, then perform a 'stone skimming' action to release the stone.  The player has to hold the B button down whilst holding the controller as horizontal through the skimming action.  Speed of the skimming action is also taken into account and affects the final skim.  Once released, the player watches the stone skim across the lake, counting the bounces.  After the skim there is an option to see an analysis of the skim which offers some good feedback and clues as to how to improve.  This element could also be used as an outcome measure if used in therapy.

Trigger Twist - Similar to Shooting Range in Wii Play, this is a slightly more advanced point and shoot target game.  The MotionPlus allows the targets sometimes be 'off screen' requiring the player to point the WiiMote to the left or right to scroll the screen around (indications are given on screen to prompt the player to do this).  This modification of the game takes it from being fairly static, as it was in Wii Play, to being dynamic with a 360 degree stage.
This feature does make it more difficult and a little confusing to start with but the game can be played without  pointing the WiiMote left/right to scroll the screen - you just won't score the higher points.

Pose Wii Plus - A surprising return of the Pose Mii game in Wii Play.  It wasn't hugely successful as a game previously and whilst this upgrade still requires good pronation and supination as the player rotates the WiiMote, it just isn't very interesting and lacks the ability to motivate the player to have another go.

Jump Park - This is a 2-dimensional platform game and doesn't really hold much potential to be used constructively within therapy.

Teeter Targets - This game could be considered to be a combination of 'Breakout' and 'Pinball'.  The WiiMote is held in a horizontal position and tilted from side to side in order to keep the ball in play and hit all the required points.
This game is quite difficult but would be suitable for use either to encourage bilateral hand co-ordination or dexterity and fine control.

Spooky Search - This is one of the better games on Wii Play Motion.  As a ghost hunter you use your WiiMote as a ghost catching device.  The ghosts are all around you and to catch them you must point your WiiMote in their direction.  When you are pointing the WiiMote in a ghosts direction the WiiMote makes a beeping sound.  By pressing the B button you catch the ghost, then guide your caught ghost (holding the B button) to the ghost trap.  The game also requires the player to flick the WiiMote to encourage the ghosts into the trap and they don't always go in first time!  There's a time limit on the game but its long enough for anyone to get the hang of the controls and enjoy trying to track down the ghosts.

Wind Runner - The Mii character in Win Runner is wearing roller skates on a windy day whilst carrying a brolly.  The player controls the direction of the crazed roller skate wearing Mii by the angle at which the brolly is being held with the WiiMote being the umbrellas hand grip.  Its a fast paced game that requires good reaction speed and an understanding of how the wind will fill the umbrella, if given the chance.  Pointing the WiiMote left and right (at whatever angle is needed for the wind to catch the umbrella) will steer the Mii to the respective direction.  Whilst its reasonably good fun there are other games in this collection that require better control of motor function and dexterity.

Treasure Twirl - In this game the WiiMote becomes a line with a diver on the end of it.  Holding the WiiMote horizontally the player has to roll/twist it away or towards you to let the diver and line down or to pull it up.  Tilting the controller to the left or right steers the line down to the treasure at the bottom of the sea, avoiding fish, rocks and other obstacles that may be in the way. The tilting/steering can be done without the twisting of the WiiMote, although the game is against the clock or more specifically against how much oxygen you have to perform the dive.
This is a good game for getting both hands working together and promoting dexterity and grip combined.

Flutter Fly - For this game the WiiMote becomes a leaf that you have to use as a fan to guide the Mii and balloons through the hoops along the course.  As you turn the WiiMote the leaf also turns correspondingly, allowing the player to control the direction of the fanning and therefore direction of the Mii and balloons.
This game is quite difficult, but for someone who is working to improve their grip strength combined with wrist flexion and extension it may have its place within therapy.  A great deal of perception is required to know where and how hard to fan the balloons in order to direct them successfully through the course.

Star Shuttle - Possibly the most difficult game in this collection and potentially the most boring.  The player controls a shuttle as it docks into the mother ship.  The weightlessness of space means that any slight movement will deviate the course of the ship which then needs to be counteracted by additional control movements.  It requires patience and fine motor control coupled with an understanding or appreciation of the quality and direction of the movement created by the player/WiiMote.

The following is a 3d party youtube review that will demonstrate the games. (10mins long)




Summary of potential usefulness of games within therapy:
Good:
Veggie Guardin' - reaction speed, grip, co-ordination, perception of direction, upper limb
Skip Skimmer - upper limb, grip, control
Cone Zone - bilateral hand control, steadiness, perception of required movement

Spooky Search - upper limb, co-ordination using audible and haptic feedback
Treasure Twirl - bilateral hand control and co-ordination, grip, fine control
Pose Wii Plus - pro/supination, reaction to prompts on screen
Trigger Twist - grip, fine motor control, dexterity, reaction speed
Teeter Targets - bilateral hand control, dexterity, reaction speed, planning of movement   


Questionable:
Flutter Fly
Wind Runner
Star Shuttle
Jump Park





The following games could be played using external WiiMote buttons.
Skip Skimmer
Spooky Search
Trigger Twist


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Fit & Fun - Your Virtual Personal Coach - Game Review

Fit and Fun is a fitness orientated game that introduces so couple of games that also aim to contribute to developing fitness skills.  The game combines elements of fitness routines with a handful of accessible and responsive games that can be described as more fun that the routine element.  The game offers the opportunity to use the balance board within two of the games and relies on the holding and positioning of the WiiMote (and Nunchuk at times) to work through the exercises.

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Clear instructions are given both pictorially and written on screen reducing the potential of getting the movements wrong.   The two fun games found on Fit and Fun that can be played in a sitting position are the Bobsled and the Gliding.  The Bobsled is designed to be controlled in a sitting position whilst the gliding is ordinarily played in standing.

The menu screen presents different options which include the following:-
Fitness test
Workout Scheduler
Fast Games

The fitness test initially walks the player through recording heartbeats per minute/pulse followed by how many squats you can do, bike crunch and press ups.  These exercises are explained well with the squats and stomach crunch exercises recording the reps by the movement of the WiiMote held in your hand.  The press up requires the player to enter the reps after the exercise manually,so can easily be skipped if the player is unable to achieve the exercise.

The workout scheduler offers the player to organise a selection of exercises and stretches to perform during one session. The options available include:
Warm up (Beach jogging, Rope Skipping, Wae Bo)
Strength training (general strength exercises e.g. squats - but wide selection covering all areas of the body)
Body shaping (Beach jogging, Rope Skipping, Wae Bo)
Relaxation (Stretches,  Qi Gong, Meditation in sitting or standing)
Fun (Gliding, bobsled, badminton)

Qi Gong and meditation elements of the relaxation option are nice additions and offer good clear written and pictorial advice with regards to how to perform the movements or poses.  Included within the Qi Gong option are 10 movements to practice which are all easy to follow.  The stretching element of the relaxation option demonstrates 14 stretches of which you can choose as many or as few as is appropriate (as with the Qi Gong).

The games included in the programme are as follows:
Gliding - this can be played with or without the balance board.  Without the balance board the player uses the WiiMote on its side and has to employ very subtle and fine control to guide the glider through hoops, scoring points.  When using the balance board the player is intended to stand, but can access the game in a sitting position.  Again, fine control is required to steer the glider through the hoops using forward, back and sideways movements of the body.  It offers enough time to work on balance exercises and is challenging enough for those working on higher levels of control.  Different levels of the game make it easy or harder, depending upon ability and control and also offers plenty of room to improve and demonstrate progression of skills and ability.

Bobsled - this activity is ideally played with the player sitting on the balance board which is placed on the floor.  It requires the ability to lean backwards to increase speed which can be created by sitting the player further back on the board.  To steer the player must lean in a controlled manner to the left and right.  The slow and steady movements that are required by the game offer plenty of time to perform the left and right leaning movements.  The game is based on a time limit whereby the player must reach the next station before the time runs out.  This can limit the use of the game but can also act as a way of measuring a patients progress.
Over or under steering cause the bobsled to via off course and into the barriers, slowing the sled down and causing a loss of time.
The bobsled game is a unique and interesting way of encouraging the control of weight shifting in sitting.

Rope Skipping - The player holds the WiiMote and jumps at the appropriate moment to clear the rope as it is swung on the screen.  This game can either be used to practice jumping and timing or it can be used as a tool to help develop timing and reaction speed in those who are unable to jump.  By shaking the WiiMote at the right moment the character will jump the rope - without the need for the player to be able to actually jump.  Using this method of control would focus on timing, reaction speed, rhythm and upper limb control of fine movement.

Beach Jogging - Uses both the Wiimote and the Nunchuk.  The player is required to jog on the spot whilst performing upper limb jogging movements.  The controllers register the jogging motion and represent forward motion of the on screen character.  Part of the game requires the use of the B and Z buttons to move the runner left and right to avoid other runners and collect water - both of which also gain you points.  The faster you run the more points you collect.
This game could be used as an upper limb fitness test and used as an outcome measure to be tested again at a later date.  The points collected in the given time offering a measure of the quality and pace of the upper limb movements performed.

Wae Bo - Uses the WiiMote and Nunchuk and requires the player to react to the instructions on screen and perform movements of the arms as instructed by the on-screen character.  This game seemed difficult to get the timing right on, with moves being performed but scores not registering.  In principle its a good game to work on reaction speeds and following instructions with regards to movement, but there is a risk of disappointment if the game doesn't register the move.

Badminton - Uses just the Wiimote in the dominant hand.  The game itself takes a little time to get use to as it slows down to allow the player to swing the Wiimote at a certain time to allow for placement of the return shot to the opponent.  Whilst this could be quite distracting for some it could be considered advantageous for some players who have slower reactions speeds with this game offering a small amount of extra time to process the need for the return shot and required upper limb movement.   
For the more able players this game can be quite competitive whereby winning a shot may take considerable effort and sustained periods of concentration and physical effort.

Unlike Wii Fit the game can be played without performing the initial fitness test.  It has potential to be integrated within therapy sessions but in an adapted fashion by using the games and their controls to encourage movement of a varied quality.

The mini games are different to previous fitness or balance games and therefore offer choice for those looking to expand their game collection.

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Marbles! Balance Challenge / Kororinpa : Marble Mania

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Marbles! Balance challenge is the sequel to Kororinpa (also called Marble Sarga in some regions).  The principles of the game are the same - roll a marble around a puzzle platform using controlled and precise movements with either the Wii Remote or (new for the sequel) the Wii Balance Board.

The ability to use the Wii Blanace Board for game play is an excellent feature when considering rehab.  The original Kororinpa game was excellent for fine control, dexterity, perception and reaction speeds.  The sequel, with its choice to use the balance board now offers balance in both standing and sitting with valuable real time visual feedback based on the movements created by the player.  This game play offers balance awareness and motivation to correct movement intuitively in order to play the game, with the levels all being unlocked at the start and progressively getting harder through the numerous levels.

The Wii Remote controlled levels are different to the Balance Board levels - requiring more specific and sensitive skills that would be nearly impossible to control in standing.  There are two main categories - easy and normal to choose from offering plenty of variety and opportunities to progress as co-ordination and dexterity skills improve.

Unlike other games of this nature the visuals are clear and uncomplicated without the risk of confusing orientations and unhelpful points of view.  The simplicity of this game is one of the features that makes it therapy friendly.

The game is easy to navigate but when in the Wii Remote game play the puzzles are based on an unlocking system whereby the more you play the more levels are unlocked meaning play is limited initially.  As a solution to this it is possible to download the Save Data file here.  For more information about how to use save data files click here.

The game can therefore be played in a sitting position or can be made more difficult by using a Real Balance Board adaptation.  More information about working on different levels of balance can be found here.


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Wii Party

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Wii Party is a family orientated game with numerous approaches to game play.  The board games and family activities that the game suggests need upwards of 15 minutes to play are not therapeutically friendly and probably do not have much place in a rehab session.

By navigating through the menus it is possible to play each of the mini games in isolation of any others - meaning that individual games can be chosen and played on their own.

To find the mini games follow:

Menu Screen :  Mini games (bottom right/yellow box) : freeplay : (choose category of the mini game you want to play) : Game (choose the game from the selection)

These games are all unlocked so do not need endless play in order to unlock them.  A full list of the mini games, controls and value during therapy sessions can be found by following this link

Some elements of this game can be played using adaptations, especially the use of a controller with external buttons for those who do not have the control to hold and press the Wii Remote buttons.
Other adaptations could be the use a wrist strap to support the controller on the back of the wrist or ankle to create the movement needed for some of the games. Alternatively the controller could be used with this Fit Board adaptation for the games to work on balance.

This game is similar to Wii Play but with much more too it. There are some basic 'pointing' games that allow for development of upper limb/hand control without the complication of using buttons.

As with most games there are some very useful and therapy friendly elements to Wii Party. The numerous minigames offer a spectrum of short activities that have the potential to help patients regain some co-ordination, reaction speed, dexterity and general upper limb skills.

Never the less Wii Party offers some basic and fun games that can successfully be used and incorporated within a therapy session.

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With a Wii Remote          


or Without Wii Remote    

FisioGames - Games for Health

FisioGames - Games for Health



Here is a weblink for some software that uses the WiiMote but through a PC/Laptop. It could be an answer to providing objective measures of treatments that the Nintendo Wii Console and games do not.

Leave a comment and let others know what you think of this software if you have used it.

Balance Training - PhysioFun

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PhysioFun Balance Training is a WiiWare game using the WiiMote and balance board, available for purchase and download direct from the Wii Shopping Channel for 2000 points. The game concerns itself solely with balance and simple exercises relating to balance, mostly on one leg which immediately creates a criteria for successful use - persons/patients using this game must be able to stand on one leg to get the full benefit of balance training.

The main elements of the software are - the Balance Test, Fun Mode and Physio Mode. The balance test requires the user to stand on the balance board for 30, 60 or 90 seconds. During the test the image of a balance board is displayed with a black dot that moves indicating centre of balance. Once the time is up the results are displayed in the form of a graph showing the area of balance board that the COG was during the time, horizontal shift of weight and vertical shift of weight. These results are then comparable to earlier measurements taken. There is no way of extracting the data through the program for printing or recording purposes - a pen and paper is needed for that.

The Fun Mode is a progressive sequence of 6 balance exercises (all of which are on one leg) that gradually gets harder and harder as you work your way up through the 'student belts' (as in martial arts). The Fun Modes 6 exercises are as follows:
Water: Stand on one leg and maintain balance
Desert: Stand on one leg and raise then lower arms
Forest: Stand on one leg and move arms in a circular motion
Eternal Ice: Stand on one leg and move arms forward and backwards in a running motion
Volcano: Stand on one leg and raise arms above head to block
Temple: Stand on one leg and abduct the opposite leg

Points are awarded for how well the exercise is performed, with a small image of the balance board indicating centre of gravity. Circles on the balance board indicate when balance is excellent, good or not good enough. Time outside of the green 'good' section causes low points and eventual premature end to the activity. Being able to maintain COG over the centre dot on the balance board accelerates the points earned to enable a high score to be achieved.

The progression to the exercises is in the early levels an increase in the length of time these exercises have to be performed with other reviews reporting that the levels extend to 90 seconds each.

The Physio Mode also uses the 6 exercises from the Fun Mode but allows individual training schedules to be created. The exercise can be chosen, the leg to balance on, the length of time the activity is for and the difficulty. There does not seem to be a limit to the number of exercises that can be added to the schedule but only 4 individual schedules can be created at any one time. A calender through this option allows sessions to be recorded by date and retrieved at a later time.

One nice feature of the Physio Mode is the Ongoing Measurement option. This consists of an image of the balance board with the black dot showing where COG is and can be used as a prompt or visual feedback during balance work for as long as is needed. It is just a tool with no time limit, scoring or other distracting element. In my option, it is what Wii Fit has been lacking and I envisage it being a useful aspect of this software.

This software is a good attempt at offering therapeutic use of the Wii and balance board. It is aimed at people who what to improve their existing balance, rather than working to establish fundamental and bilateral balance and therefore aimed at higher level persons/patients.

There is definitely a place for this kind of software and its success may support the development of a broader range of activities.

If you have used this software, please comment below.


More info from Kaasa Health Website

Purchase from WiiWare: Click the image

Just Dance

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Just Dance is an active game that requires the player to follow a sequence of dance moves during well known songs. The game only requires the use of one Wii Remote in dominant hand.

As the player copies the dance moves points are given to the quality and effort of the movements but depends a little upon how the WiiMote is held in the hand and may take some practice to improve.

Each song is listed with indications of difficult and effort - out of 3 stars. The game also offers the choice of a short or long version of the songs. The short version is advantageous for those with limited stamina and the longer version for those who wish to work on cardiovascular fitness.

The game includes a warm up which is approximately 4 minutes long and is not scored or judged. Its main aim is to encourage gentle warm up exercises before using the main game which requires more effort, in a bid to reduce the risk of muscle injury during game play, but can be used as an opportunity to familiarise with the style of game.

Just Dance is a fun exercise orientated game that can be played by up to 4 people at once. Good range of movement is required in one arm in order to play this game successfully, with some songs being playable from a seated position, although sitting may compromise the final score.

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Petz Sports - Dog playground

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Petz Sports - Dog playground is a simple and basic game where by the player has a pet dog that they can teach tricks to, pet, enter into races and play sports with as well as choose what attire the dog is dressed in.

The controls simply and only use the WiiMote along with its A & B buttons, at times both together but much of the game can be played with just the use of the A button.

There are some nice mini games incorporated in the game, including teaching the dog tricks which is a shape trace game and dog races, requiring co-ordinated combinations of movement and button pressing. Other mini games such as 'petting' 'closet' are less likely to hold any interest within therapy sessions, but might be light relief for younger players.

The game on the whole is easy to use and has multi player included.


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Wii Fit

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Wii Fit generally comes with the Fit Board - a controller with 4 pressure sensors that when the user stands or sits on it the board detects changes in weight transference.
Predominantly lower limb and balance exercise.  The 'game' is geared towards users accessing exercises, stretches, balance games and aerobic activities to improve their fitness, lower BMI and weight and records progress. 
The game has some very useful balance games (Soccer Heading, ski slalom, table tilt), some insightful balance tests, the opportunity to 'see' where centre of gravity is through visual feedback plus much more.

Some of the games in Wii Fit can be played in a sitting position.

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Mountain Sports

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Mountain Sports is a collection of Winter sport games that utilises both the WiiMote and or the Balance board. It has good elements to it with regards to the use of the balance board in a sitting posture for tubing, sledging and bobsleigh. Skiing and Snowboarding use the balance board in a standing position with biathalon and curling best controlled with the WiiMote. The control of the games are sluggish at times which can serve as an advantage and disadvantage making the game more accessible to those with limited movements, without making it too hard. The games controlled by the WiiMote alone can be difficult due to the buttons needed for control.

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SSX Blur

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SSX Blur is a snowboarding simulation game that requires the use of both WiiMote and Nunchuk.  Controls are intuitive and rely on fine movements and dexterity.  Turning/steering is achieved by pro and supination of the wrists, buttons are required for movements and the Nunchuk joystick is used as further method of control.

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Rayman Raving Rabbids 2

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Rayman Raving Rabbids is the second Rayman game released for the Wii.  The game is made up of a broad selection of mini games, the majority of which are already unlocked (you don't have to play the game to get access to them).  The games are short, quirky and fun, mostly requiring simple movements.  The mini games require a mixture of WiiMote and Nunchuk therefore offering the potential to develop a variety of hand function skills at differing levels.  This game is excellent as a distraction during sessions due to simplicity of many of the games and movements required.

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Mario & Sonic at the Olympic Games

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Sonic and Mario Olympic Games is a collection of mini games relating to olympic sports.  Most games can be accessed by just using the WiiMote but they can also be played using the Nunchuk as well.  Most of the games require simple movements but can be considered complex with regards to the use of buttons.  Without the use of buttons the character does nor perform as well and therefore it is very difficult to anywhere other than last in the games.  For those with the cognitive ability to remember controls, coupled with dexterity to press buttons then this game offers the opportunity to work on cardiovascular fitness, sequencing and general control of upper limb(s).

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Links Crossbow

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Links Crossbow is a shooting game relying on aim and co-ordination.  The game does use both the WiiMote and Nunchuk, with the Nunchuk joystick being used to control the direction of the player.  It has a progressive level aspect as well as practice modes making it easy to dip into and find an appropriate level to work at.  Games and tasks can easily be repeated to help with learning and familarity, allowing time to be spent on the development up upper limb control.  This game has been used within therapy sessions, although not regularly.

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Blazing Angels

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Blazing Angels is a flight simulator game that requires complex use of both WiiMote and Nunchuk.  The game is based on a storyline making it difficult to access different levels of the game to suit the user.  The games requires high levels of dexterity, quick reaction speeds and control of movements, along with a good ability to remember the button controls in order to play the game.  This game is rarely used in therapy.

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