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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Validity of the Nintendo Wii(R) balance board for the assessment of standing balance in Parkinson's disease.

Clinical Rehabilitation 2012 Sept 7 (Epub ahead of print)

 Holmes JD, Jenkins ME, Johnson AM, Hunt MA, Clark RA.

School of Occupational Therapy, The University of Western Ontario, Canada.

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Abstract 
Background:Impaired postural stability places individuals with Parkinson's at an increased risk for falls. Given the high incidence of fall-related injuries within this population, ongoing assessment of postural stability is important.

Objective:To evaluate the validity of the Nintendo Wii(®) balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson's.

Subjects:Twenty individuals with Parkinson's participated.

Intervention:Subjects completed testing on two balance tasks with eyes open and closed on a Wii(®) balance board and biomechanical force platform.Main

Measures:Bland-Altman plots and a two-way, random-effects, single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data.

Results:Concurrent validity was demonstrated to be excellent across balance tasks (intraclass correlation coefficients = 0.96, 0.98, 0.92, 0.94).

Conclusions:This study suggests that the Wii(®) balance board is a valid tool for the quantification of postural stability among individuals with Parkinson's.

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Assessment of the postural control strategies used to play two Wii Fit™ videogames

Gait Posture. 2012 Jul;36(3):449-53.

A. Michalski, C.M. Glazebrook, A.J. Martin, W.W.N. Wong, A.J.W. Kim, K.D. Moody, N.M. Salbach, B. Steinnagel, J. Andrysek, R. Torres-Moreno, K.F. Zabjek


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Abstract
The Nintendo Wii Fit™ may provide an affordable alternative to traditional biofeedback or virtual reality systems for retraining or improving motor function in populations with impaired balance. The purpose of this study was to evaluate postural control strategies healthy individuals use to play Wii Fit™ videogames. Sixteen young adults played 10 trials of Ski Slalom and Soccer Heading respectively. Centre of pressure (COP) excursion and three-dimensional movement data were acquired to determine variability in medial–lateral COP sway and shoulder–pelvic movement. While there was no difference in medial–lateral COP variability between games during trial 1, there was a significant difference after 10 trials. COP sway increased (59–75mm) for Soccer Heading while it decreased (67–33mm) for Ski Slalom from trial 1 to trial 10. During Ski Slalom participants demonstrated decreased shoulder and pelvic movement combined with increased pelvic–shoulder coupling. Conversely, participants demonstrated greater initial shoulder tilt when playing Soccer Heading, with no reduction in pelvic rotation and tilt. Participants decreased pelvic and trunk movements when skiing, suggesting a greater contribution of lower extremity control while they primarily used a trunk strategy to play Soccer Heading.

Highlights 
► We evaluated the balance control strategies adopted when participants played the Wii Fit™.
► Distinct strategies emerged with increased experience playing the Soccer Heading and Ski Slalom games. ► With experience centre of pressure variability increased for Soccer Heading and decreased for Ski Slalom games.
► When playing Soccer Heading participants demonstrated greater shoulder tilt.
► When playing Ski Slalom participants demonstrated increased pelvic–shoulder coupling.

Keywords: Balance control, Balance training, Centre of pressure

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