On July 20, we announced our collaborative effort with Texas Health Plano to bring one of only three SpineAssist® surgical robots in the United States to Texas. For patients with cases such as scoliosis that require especially complicated surgeries, this is good news. The device enables us to operate on the spine with accuracy to less than one half a millimeter.

The SpineAssist® technology has two key components: A workstation that enables surgeons to pre-plan procedures in 3D based on the patient’s individual anatomy, creating a “surgical blueprint,” and a robotic arm that guides the surgeon during the procedure using the preoperative plan.

Like a pilot in a flight simulator, I can map out the patient’s spinal anatomy and perform the entire procedure before the patient even arrives for surgery. For highly complicated surgical procedures, it allows me to be more efficient and more precise, and to anticipate potential complications before they occur.

Texas Back Institute is the exclusive training center for physicians learning how to use the SpineAssist® device that will make a significant impact in spinal surgery practices all over the country and for their patients who will greatly benefit from this technology.

Dr. Isador Lieberman

Over the past couple of years, people have turned to the Wii console for exercise programs. These programs offer more flexibility than traditional workout videos, in that they can be customized and offer a variety of routines. A limitation of some of these programs however, is that they cannot accommodate for individuals with medical conditions such as back or other joint pains. As with any workout program, it is important that individuals are able to modify their routine in order to avoid injury of underlying degenerative changes such as arthritic joints or the spine. Even classes such as yoga or Pilates are not universally good. Extension exercises such as “cobra position”, for example may aggravate some degenerative spine conditions. Flexibility may be limited, thus preventing an individual from performing the exercise properly.Following are some of the current Wii console programs, and my thoughts on their ability to accommodate individuals with spinal degenerative conditions: 

Wii Fit Plus- this game is the standard software provided with the current edition of the Wii Fit board. It includes several fairly good, but basic, exercises that focus on different body parts as well as some aerobic exercises and is highly customizable. It does not get “hung up” if the individual is not “properly” performing an exercise.  The biggest drawback with this software, however, is that there is a lag between individual exercises, which significantly disrupts the flow of a good workout program.  (2 stars) 

EA Active- this game is highly customizable and allows individuals to select which exercises they want to perform or they may select from preset workout programs. It can be very frustrating, however, in that the software expects the individual to perform exercises perfectly such as lunges and will get hung up until the individual completes the exercise to its expectation. This causes the game to often disrupt the flow of exercises. Thankfully individual exercises can be skipped, but again the overall experience can be frustrating. There are also several “fun” activities such as practicing volleyball, basketball or baseball maneuvers. (1 star) 

Your Shape with Jenny McCarthy- this game, instead of using the motion detecting controllers, utilizes a camera that detects the participant’s motion and provides feedback as to how the individual is performing. The benefit of this software is that exercises may be performed in any fashion without disrupting the flow of the workout. A poorer score is provided if exercises are not performed as the software is expecting, however, it is unclear how this impacts the intensity or flow of future workouts. The software indicates that the program “learns” the participant’s capabilities, but it is unclear how accurate this claim is. The software also has options to include hand weights, a step bench and a Swiss ball, however, with my testing I have yet to see an exercise with the Swiss ball or hand weights despite always selecting that I have them.  Most of the exercises are straight out of “step class” regardless of what body part you say you want to work on. Another drawback of this software is that individual exercise programs cannot be customized and the user is unable to skip particular exercises so if an exercise is being done that the participant is unable to perform, then he/she must wait until the end of the exercise before moving on. (3 stars)  

Fitness Ultimatum 2010 with Jillian Michaels- so far, this is my favorite exercise program with the Wii console. It is highly customizable, you are able to skip exercises when needed, and there is no penalty for not performing an exercise as the software expects. It utilizes the regular hand controller as well as the Wii Fit board. There is a pause screen between exercises, but one is able to go to the next exercise as quickly as desired or is free to take a break. The only drawback is the limited number of individual exercises available, however, the overall exercise intensity is quite good.  (4 stars)  

Obviously there are many other titles available for the Wii console, including recent software based upon The Biggest Loser which has apparently received good ratings as well. My recommendation when looking at which software to purchase for the Wii is to ensure that the flow of exercises is not disrupted if the participant is not found to be performing exercises “properly” as with the EA Active software. Similarly, the user should be free to skip an exercise if desired and obviously being able to develop customized workout programs is beneficial as well.  

Good luck, and stay safe.  

Dr. Jason Marchetti

Physical Medicine and Rehabilitation

Texas Back Institute

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