Tuesday, 7 June 2011

‘Wii-habilitation’ and robotic exoskeletons: technology in physiotherapy - 2010

Royal College of Surgeons in Ireland Student Medical Journal 2010; 3: 70-74.

Aideen Henry(1), Aileen Barrett(2)

Author affilitations
1RCSI physiotherapy student
2Practice Education Co-ordinator, School of Physiotherapy, RCSI

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For mobility-impaired patients, gait retraining is an integral part of the rehabilitation programme. Manual assisted body weight support treadmill training (BWSTT) has been a major focus of research and is considered one of the primary methods of gait retraining. In recent years the focus of research has shifted to robotic assisted treadmill training, which is as efficacious as manual assisted BWSTT but is considered more cost-effective with respect to personnel and labour. The Lokomat® is a machine that provides robotic assisted treadmill training by means of a robotic gait orthosis, body weight support system and treadmill. Manufactured by Hocoma in Switzerland, it has been the subject of intense media attention since it was introduced to the US in 2001. Similar attention has been given to the Nintendo WiiTM gaming system for its potential role in rehabilitation. Although not specifically designed for use in the medical arena, the Nintendo WiiTM has been linked with functional rehabilitation benefits in a variety of patient groups. The aim of this paper is to review the clinical applications of the Lokomat® and Nintendo WiiTM, and to provide an analysis of the advantages and disadvantages associated with each as a physiotherapy modality in rehabilitation.

Keywords: Physiotherapy, treadmill training, Lokomat®, virtual reality, Nintendo WiiTM, gait re-education.

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Monday, 6 June 2011

Assisting people with multiple disabilities by actively keeping the head in an upright position with a Nintendo Wii Remote Controller through the control of an environmental stimulation. May 2011

Res Dev Disabil.

2011 May 19.

Shih CH, Shih CJ, Shih CT.

Source: Department of Special Education, National Dong Hwa University, Hualien 970, Taiwan, ROC

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The latest researches have adopted software technology by applying the Nintendo Wii Remote Controller to the correction of hyperactive limb behavior.
This study extended Wii Remote Controller functionality for improper head position (posture) correction (i.e. actively adjusting abnormal head posture) to assess whether two people with multiple disabilities would be able to actively keep the upright head position by controlling their favorite stimulation using a Wii Remote Controller with a newly developed active head position correcting program (AHPCP).
The study was performed according to an ABAB design, in which A represented the baseline and B represented intervention phases.
Results showed that both participants significantly increased their time duration of maintaining upright head position (TDMUHP) to obtain the desired environmental stimulation during the intervention phases.
Practical and developmental implications of the findings were discussed.

Copyright © 2011 Elsevier Ltd. All rights reserved.

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Sunday, 5 June 2011

Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study - April 2011

Physiotherapy : Available online 29 April 2011.

Hamid Bateni

School of Allied Health and Communicative Disorders, Physical Therapy Program, Northern Illinois University, 1425 W. Lincoln Hwy, DeKalb, IL 60115-2828, USA

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To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training.

Quasi-experimental design.

Eight males and nine females aged 53 to 91 years.

Materials and methods
Participants were divided into three groups: one group received both physical therapy training and Wii Fit training (PW group), one group received Wii Fit training alone (WI group), and one group received physical therapy training alone (PT group). Training consisted of three sessions per week for 4 weeks.

Main outcome
Berg Balance Scale (all groups) and Bubble Test (PW and WI groups) scores.

Statistical analysis
Descriptive statistics, medians, interquartile ranges and 95% confidence intervals are reported to identify trends in balance control as a result of different types of training.

All subjects showed improvement in the Berg Balance Scale and Bubble Test scores. The PT and PW groups tended to perform better than the WI group on the Berg Balance Scale following treatment. Although the differences in the Bubble Test score were not substantial between the PW and WI groups, the PW group performed slightly better than the WI group on the Berg Balance Scale.

Wii Fit training appears to improve balance. However, physical therapy training on its own or in addition to Wii Fit training appears to improve balance to a greater extent than Wii Fit training alone.

Keywords: Wii Fit; Postural balance; Berg Balance Scale; Computerised gaming systems

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Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. May 2011

Journal of Neuroengineering Rehabilitation.

2011 May 23;8(1):30

Gil-Gomez JA, Llorens R, Alcaniz M, Colomer C.

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Acquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo Wii Balance Board (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance.

In this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n=9) versus standard rehabilitation (n=8). Effectiveness was evaluated by means of traditional static and dynamic balance scales.

The final sample consisted of 11 men and 6 women. Mean+-SD age was 47.3+-17.8 and mean+-SD chronicity was 570.9+-313.2 days. Patients using eBaViR had a significant improvement in static balance (p=0.011 in Berg Balance Scale and p=0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group.

The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed.

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Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards - May 2011

Gait Posture.

2011 May 11.

Clark RA, McGough R, Paterson K.

Source: Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, 202 Berkeley Street, Parkville, VIC 3010, Australia.

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Weight bearing asymmetry (WBA) during dynamic tasks is prevalent in a variety of clinical populations. However, accurate measurement has previously been out of reach of the clinician due to the costly equipment and technical expertise required.

The aim of this study was to assess the test-retest reliability of WBA data obtained using an inexpensive and simple to use dual force plate system incorporating unmodified Nintendo Wii Balance Boards (NWBB) and customized software. A secondary outcome measure, individual limb COP path velocity, which represents the postural sway under each limb was also examined.

Twenty-three participants performed squats both with and without visual WBA feedback on two separate occasions. Weight-bearing asymmetry as a percentage of body mass and individual limb center of pressure (COP) path velocity were recorded during these trials, with intraclass correlation coefficient (ICC(2,1)) analysis performed to assess test-retest reliability. This system provided reliable values for both outcome measures when performed with and without real-time visual feedback of WBA (ICC(2,1) range=0.75-0.91).

In conclusion, recording WBA and COP path velocity data using NWBB is reliable. Given that tens of millions of NWBB have been sold worldwide, and that reprogramming them for clinical purposes is within the reach of most software developers, similar systems may soon become commonplace in the clinical setting.

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