Tuesday, 5 February 2013

The effect of Nintendo(R) Wii(R) on balance in people with multiple sclerosis: a pilot randomized control study.

Multiple Sclerosis. 2013 Jan 15. [Epub ahead of print]

Brichetto G, Spallarossa P, de Carvalho ML, Battaglia MA.

Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.

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Improvement of sensory strategies is a relevant part of balance rehabilitation in multiple sclerosis (MS). This study aimed to Assess the effectiveness of visual-feedback exercises in improving balance in MS. We divided 36 patients into Wii and control-treated groups that underwent balance rehabilitation. Outcomes were obtained for Berg Balance Scale (BBS), Modified Fatigue Impact Scale, and sway area under conditions of opened and closed eyes. BBS showed a statistically significant improvement (from 49.6 to 54.6 points, p < 0.05) in the Wii group. Interactive visual-feedback exercises such as Wii could be more effective than the current standard protocol in improving balance disorders in MS.

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Monday, 4 February 2013

Energy cost of common activities in children and adolescents.

Journal of Physical Activity and Health. 2013 Jan;10(1):62-9.

Lyden K, Kozey Keadle S, Staudenmayer J, Freedson P, Alhassan S.
Dept of Kinesiology, University of Massachusetts-Amherst.

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BACKGROUND: The Compendium of Energy Expenditures for Youth assigns MET values to a wide range of activities. However, only 35% of activity MET values were derived from energy cost data measured in youth; the remaining activities were estimated from adult values.

PURPOSE: To determine the energy cost of common activities performed by children and adolescents and compare these data to similar activities reported in the compendium.

METHODS: Thirty-two children (8-11 years old) and 28 adolescents (12-16 years) completed 4 locomotion activities on a treadmill (TRD) and 5 age-specific activities of daily living (ADL). Oxygen consumption was measured using a portable metabolic analyzer.

RESULTS: In children, measured METs were significantly lower than compendium METs for 3 activities [basketball, bike riding, and Wii tennis (1.1-3.5 METs lower)]. In adolescents, measured METs were significantly lower than compendium METs for 4 ADLs [basketball, bike riding, board games, and Wii tennis (0.3-2.5 METs lower)] and 3 TRDs [2.24 m·s-1, 1.56 m·s-1, and 1.34 m·s-1 (0.4-0.8 METs lower)].

CONCLUSION: The Compendium of Energy Expenditures for Youth is an invaluable resource to applied researchers. Inclusion of empirically derived data would improve the validity of the Compendium of Energy Expenditures for Youth.

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Integrating virtual reality video games into practice: Clinicians' experiences.

Posted online on January 30, 2013.

Danielle E. Levac, PT, PhD and Patricia A. Miller, PT, PhD

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The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

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An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: a pilot study.

Child Care Health Dev. 2013 Jan 30. [Epub ahead of print]

Hammond J, Jones V, Hill EL, Green D, Male I.

Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex, UK.

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BACKGROUND: Children with Developmental Co-ordination Disorder (DCD) experience poor motor and psychosocial outcomes. Interventions are often limited within the healthcare system, and little is known about how technology might be used within schools or homes to promote the motor skills and/or psychosocial development of these children. This study aimed to evaluate whether short, regular school-based sessions of movement experience using a commercially available home video game console (Nintendo's Wii Fit) would lead to benefits in both motor and psychosocial domains in children with DCD.

METHODS: A randomized crossover controlled trial of children with movement difficulties/DCD was conducted. Children were randomly assigned to an intervention (n = 10) or comparison (n = 8) group. The intervention group spent 10 min thrice weekly for 1 month using Wii Fit during the lunch break, while the comparison group took part in their regular Jump Ahead programme. Pre- and post-intervention assessments considered motor proficiency, self-perceived ability and satisfaction and parental assessment of emotional and behavioural problems.

RESULTS: Significant gains were seen in motor proficiency, the child's perception of his/her motor ability and reported emotional well-being for many, but not all children.

CONCLUSIONS: This study provides preliminary evidence to support the use of the Wii Fit within therapeutic programmes for children with movement difficulties. This simple, popular intervention represents a plausible method to support children's motor and psychosocial development. It is not possible from our data to say which children are most likely to benefit from such a programme and particularly what the dose and duration should be. Further research is required to inform across these and other questions regarding the implementation of virtual reality technologies in therapeutic services for children with movement difficulties.

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Friday, 4 January 2013

Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation.

Neil A, Ens S, Pelletier R, Jarus T, Rand D.
Source: Abilities Neurological Rehabilitation, Vancouver, Canada
European Journal of Physical Rehabilitation Medicine. 2012 Nov 21.

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BACKGROUND: Virtual reality (VR) is an emerging trend in stroke rehabilitation. VR gaming consoles in stroke intervention have been shown to increase motivation and enjoyment during exercise. The amount and intensity of movements elicited using these consoles are unknown.

AIM: The aims of this study were: 1) to quantify the amount and intensity of movement elicited from both hands of two groups of individuals ([chronic stroke and without a disability [healthy]); 2) to determine the effect of console (Wii/EyeToy) and group (stroke/healthy) on the amount and intensity of upper extremity movement; 3) to determine the effect of console (Wii/EyeToy) and group (stroke/healthy) on the usability and VR experience.

DESIGN: A cross-sectional design was taken.

SETTING: Outpatient rehabilitation setting and healthy participant’s homes.

POPULATION: Participants included ten adults with stroke and ten adults without a disability. Methods. Participants experienced two games from each console. Amount and intensity of movement was measured using accelerometers on both wrists, while the virtual experience and usability was determined with questionnaires.

RESULTS: No significant differences were found between the consoles usability and experience. EyeToy elicited significantly greater activity count than Wii among the healthy participants (P=0.028) and significantly greater movement intensity in both the stroke (P=0.005) and healthy (P=0.005) groups.

CONCLUSION: Both consoles rated high for usability, enjoyment and satisfaction highlighting their suitability for a range of individuals in stroke rehabilitation. EyeToy provides increased movement and movement intensity.

CLINICAL REHABILITATION IMPACT: Both consoles are suitable for use in stroke rehabilitation however this information can be helpful to clinicians while selecting a gaming console according to the type and intensity of movements that he/she aims to encourage during therapy.

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Thursday, 3 January 2013

Can balance in children with cerebral palsy improve through use of an activity promoting computer game?

Technology and Health Care

Volume 20, Number 6 / 2012; Pages -501-510

Authors: Nerrolyn Ramstrand, Frida Lygnegård

Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden

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Introduction: This study aimed to evaluate if use of an activity promoting computer game, used in the home (Nintendo Wii Fit; Nintendo Co Ltd, Japan), could influence balance related outcome measures in children with cerebral palsy.

Method: Eighteen children with hemiplegic or diplegic cerebral palsy were recruited for the study. A randomised cross-over design was used with children tested at baseline, after five weeks of playing Wii Fit games and after five weeks without any intervention. Outcome measures of interest included: performance on the modified sensory organisation test, reactive balance test and rhythmic weight shift test.

Results: No significant difference was observed between testing occasions for any of the balance measures investigated (p > 0.05).

Conclusion: Our results suggest that use of a Nintendo Wii balance board and Wii Fit software for a minimum of thirty minutes per day in the patient's own home, over a five week period, is not effective as a balance training tool in children with cerebral palsy.

Keywords:  Balance, postural stability, interactive games, Nintendo Wii, cerebral palsy, children

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Wednesday, 2 January 2013

Wii-habilitation as balance therapy for children with acquired brain injury.

Authors: Tatla SK, Radomski A, Cheung J, Maron M, Jarus T.

Developmental Neurorehabilation. 2012 Dec 11. [Epub ahead of print]

Acute Rehabilitation Team, Sunny Hill Health Centre for Children, 3644 Slocan Avenue , Vancouver, BC V5M 3E8 , Canada.

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Purpose: To evaluate the effectiveness of the Nintendo Wii compared to traditional balance therapy in improving balance, motivation, and functional ability in children undergoing acute rehabilitation after brain injury.
Methods: A non-concurrent, randomized multiple baseline single-subject research design was used with three participants. Data were analyzed by visual inspection of trend lines.
Results: Daily Wii balance training was equally motivating to traditional balance therapy for two participants and more motivating for one participant. While improvements in dynamic balance were observed, the results for static balance remain inconclusive. All participants demonstrated improvements in functional ability.
Conclusion: Wii balance therapy is a safe, feasible, and motivating intervention for children undergoing acute rehabilitation after an acquired brain injury. Further research to examine the effectiveness of Wii balance therapy in this population is warranted.

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Tuesday, 1 January 2013

The assessment of postural control and the influence of a secondary task in people with anterior cruciate ligament reconstructed knees using a Nintendo Wii Balance Board.

British Journal of Sports Medicine. 2012 Dec 25. [Epub ahead of print]

Howells BE, Clark RA, Ardern CL, Bryant AL, Feller JA, Whitehead TS, Webster KE.

Source Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia.

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Postural control impairments may persist following anterior cruciate ligament (ACL) reconstruction. The effect of a secondary task on postural control has, however, not been determined. The purpose of this case-control study was to compare postural control in patients following ACL reconstruction with healthy individuals with and without a secondary task. 
45 patients (30 men and 15 women) participated at least 6 months following primary ACL reconstruction surgery. Participants were individually matched by age, gender and sports activity to healthy controls. 
Postural control was measured using a Nintendo Wii Balance Board and customised software during static single-leg stance and with the addition of a secondary task. The secondary task required participants to match the movement of an oscillating marker by adducting and abducting their arm. 
Centre of pressure (CoP) path length in both medial-lateral and anterior-posterior directions, and CoP total path length.


When compared with the control group, the anterior-posterior path length significantly increased in the ACL reconstruction patients' operated (12.3%, p=0.02) and non-operated limbs (12.8%, p=0.02) for the single-task condition, and the non-operated limb (11.5%, p=0.006) for the secondary task condition. The addition of a secondary task significantly increased CoP path lengths in all measures (p<0.001), although the magnitude of the increase was similar in both the ACL reconstruction and control groups.


ACL reconstruction patients showed a reduced ability in both limbs to control the movement of the body in the anterior-posterior direction. The secondary task affected postural control by comparable amounts in patients after ACL reconstruction and healthy controls. Devices for the objective measurement of postural control, such as the one used in this study, may help clinicians to more accurately identify patients with deficits who may benefit from targeted neuromuscular training programs.

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