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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Abstract
BACKGROUND:
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. 
PARTICIPANTS:
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. 
MATERIALS:
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. 
MAIN OUTCOME MEASURES:

Centre of pressure (CoP) path length in both medial-lateral and anterior-posterior directions, and CoP total path length.

RESULTS:

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.

DISCUSSION:

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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Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction

KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY 2012
Gul Baltaci, Gulcan Harput, Bunyamin Haksever, Burak Ulusoy andHamza Ozer

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Abstract

Purpose
The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction.
Methods Thirty volunteer subjects were enrolled in either Wii Fit (n = 15; mean age, 29 ± 7 years) or conventional rehabilitation (n = 15; mean age, 29 ± 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine.
Results There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation.
Conclusion Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual–perceptual processing, coordination, proprioception and functional mobility.

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