Sunday, 6 May 2012

Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

BMC Ear, Nose and Throat Disorders Published: 26 March 2012

Dara Meldrum, Susan Herdman, Roisin Moloney, Deirdre Murray, Douglas Duffy, Kareena Malone, Helen French, Stephen Hone, Ronan Conroy and Rory McConn Walsh

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Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus (R) (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy.

In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months.

Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated.

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Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii® Fit Plus, Disability and Rehabilitation

Disability and Rehabilitation: Assistive Technology

May 2012, Vol. 7, No. 3 , Pages 205-210

Dara Meldrum, Aine Glennon1, Susan Herdman, Deirdre Murray, Rory McConn-Walsh

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Purpose: The aim of this study was to investigate the usability of the Nintendo Wii Fit Plus® (NWFP) in the treatment of balance impairment in vestibular and other neurological disease.
Methods: This was a cross-sectional, quasi-experimental study. Participants (n = 26; mean age 43 ± 14, M13:F13) with quantified balance impairment took part in a 30-minute session on the NWFP using exercises and games that challenge balance. Outcomes included the System Usability Scale (SUS), a numerical rating scale of enjoyment and a post treatment questionnaire.
Results: The mean SUS score was high (mean 82 ± 18%) with only two participants rating below 50%. There was a negative correlation of age with SUS scores (r = −0.54; p = 0.004). Mean numerical rating scale score (/10) for enjoyment of the NWFP session was 8.4 ± 3. Of the participants, 88.5% said that they would like to use the NWFP in future treatment. Seventy-three percent reported more enjoyment and motivation than usual physiotherapy. No falls occurred during testing.
Conclusions: This study has quantified the usability of the NWFP as a treatment for balance impairment showing high levels of usability and enjoyment with no serious adverse effects. The results of this study may assist physiotherapists in devising novel balance rehabilitation programmes.

Implications for Rehabilitation
The Nintendo Wii Fit Plus® virtual reality system has the potential to improve balance rehabilitation, but usability of this system requires investigation.

In this study, patients with balance impairment as a result of neurological disease reported very high levels of usability and enjoyment when performing selected Nintendo Wii Fit Plus® balance exercises and games.

The majority of patients preferred the Nintendo Wii Fit Plus to conventional treatment which may have implications for patient compliance with exercise.

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