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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Tuesday 5 February 2013
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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Abstract
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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Lyden K, Kozey Keadle S, Staudenmayer J, Freedson P, Alhassan S.
Dept of Kinesiology, University of Massachusetts-Amherst.
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Abstract
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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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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Abstract
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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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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Abstract
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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Abstract:
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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Source: Abilities Neurological Rehabilitation, Vancouver, Canada
European Journal of Physical Rehabilitation Medicine. 2012 Nov 21.
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Abstract:
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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Abstract
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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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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Abstract
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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Abstract
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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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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Abstract
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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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:
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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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Thursday 25 October 2012
Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study.
Physiotherapy. 2012 Sep;98(3):211-6. Epub 2011 Apr 29.
Bateni H.
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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Abstract
OBJECTIVES: To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training.
DESIGN: Quasi-experimental design.
PARTICIPANTS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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Bateni H.
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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Abstract
OBJECTIVES: To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training.
DESIGN: Quasi-experimental design.
PARTICIPANTS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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Wednesday 24 October 2012
Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study.
Physiotherapy. 2012 Sep;98(3):217-23.
Epub 2012 Jul 9.
dos Santos Mendes FA, Pompeu JE, Modenesi Lobo A, Guedes da Silva K, Oliveira Tde P, Peterson Zomignani A, Pimentel Piemonte ME.
Department of Neuroscience and Behaviour, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
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Abstract
OBJECTIVES: To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit™ training in patients with Parkinson's disease and healthy elderly people.
DESIGN: Longitudinal, controlled clinical study.
PARTICIPANTS: Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people.
INTERVENTIONS: Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer.
MAIN OUTCOME MEASURES: Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test.
RESULTS: Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task.
CONCLUSIONS: The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.
Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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dos Santos Mendes FA, Pompeu JE, Modenesi Lobo A, Guedes da Silva K, Oliveira Tde P, Peterson Zomignani A, Pimentel Piemonte ME.
Department of Neuroscience and Behaviour, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
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Abstract
OBJECTIVES: To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit™ training in patients with Parkinson's disease and healthy elderly people.
DESIGN: Longitudinal, controlled clinical study.
PARTICIPANTS: Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people.
INTERVENTIONS: Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer.
MAIN OUTCOME MEASURES: Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test.
RESULTS: Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task.
CONCLUSIONS: The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.
Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
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Tuesday 23 October 2012
The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy.
Dev Neurorehabil. 2012 Oct 3.
Jelsma J, Pronk M, Ferguson G, Jelsma-Smit D.
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town , South Africa.
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Abstract
Objective: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy.
Methods: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given for 3 weeks. Outcome measures included modified balance and running speed and agility (RSA) scales of the Bruininks-Oserestky test of Motor Performance 2 and the timed up and down stairs (TUDS).
Results: Balances score improved significantly (F(2, 26) = 9.8286, p = 0.001). Changes over time in the RSA (F(2, 26) = 0.86198, p = 0.434) and the TUDS (F(2, 26) = 1.3862, p = 0.268) were not significant. Ten children preferred the intervention to conventional physiotherapy.
Conclusion: Most children preferred the IVG but as the effect did not carry over into function, IVG should not be used in place of conventional therapy and further research is needed into its use as an adjunct to therapy.
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Jelsma J, Pronk M, Ferguson G, Jelsma-Smit D.
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town , South Africa.
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Abstract
Objective: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy.
Methods: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given for 3 weeks. Outcome measures included modified balance and running speed and agility (RSA) scales of the Bruininks-Oserestky test of Motor Performance 2 and the timed up and down stairs (TUDS).
Results: Balances score improved significantly (F(2, 26) = 9.8286, p = 0.001). Changes over time in the RSA (F(2, 26) = 0.86198, p = 0.434) and the TUDS (F(2, 26) = 1.3862, p = 0.268) were not significant. Ten children preferred the intervention to conventional physiotherapy.
Conclusion: Most children preferred the IVG but as the effect did not carry over into function, IVG should not be used in place of conventional therapy and further research is needed into its use as an adjunct to therapy.
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Monday 22 October 2012
A Wii virtual activity severe thumb metacarpal injury.
BMJ Case Rep. 2012 Oct 10;2012
Galanopoulos I, Garlapati AK, Ashwood N, Kitsis C.
Department of Trauma and Orthopaedics, Queen's Hospital, Burton-on-Trent, UK.
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Abstract
In this paper we present a case of a severe thumb bone injury sustained during simulated sporting activity using a Wii games console. Although several types of injury related to this form of physical activity have been encountered during the last few years with increasing frequency, this particular basal thumb fracture has not been reported in the literature yet. This was a complex Rolando type of fracture similar to those obtained doing the actual activity mimicked by the game. Ensuring a safe environment and adequate preparation before undertaking sport is key to prevent injury and the same principles are needed when undertaking virtual sport.
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Galanopoulos I, Garlapati AK, Ashwood N, Kitsis C.
Department of Trauma and Orthopaedics, Queen's Hospital, Burton-on-Trent, UK.
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Abstract
In this paper we present a case of a severe thumb bone injury sustained during simulated sporting activity using a Wii games console. Although several types of injury related to this form of physical activity have been encountered during the last few years with increasing frequency, this particular basal thumb fracture has not been reported in the literature yet. This was a complex Rolando type of fracture similar to those obtained doing the actual activity mimicked by the game. Ensuring a safe environment and adequate preparation before undertaking sport is key to prevent injury and the same principles are needed when undertaking virtual sport.
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Thursday 20 September 2012
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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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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Wednesday 19 September 2012
Energy expended playing Xbox Kinect™ and Wii™ games: a preliminary study comparing single and multiplayer modes.
Physiotherapy. 2012 Sep;98(3):224-9. Epub 2012 Jul 25.
O'Donovan C, Hirsch E, Holohan E, McBride I, McManus R, Hussey J.
Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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O'Donovan C, Hirsch E, Holohan E, McBride I, McManus R, Hussey J.
Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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Abstract
OBJECTIVES: It has been reported that a higher galvanic skin response is seen when playing video games against another human player than when playing alone, which suggests increased effort. The objectives of this study were to compare energy expenditure when playing two popular active video game consoles, and to compare energy expenditure when playing in single and multiplayer modes.
DESIGN: Crossover trial with randomised playing order.
PARTICIPANTS: Fourteen healthy adults with a mean age of 21 [standard deviation (SD) 3] years.
METHODS AND INTERVENTIONS: Energy expenditure was measured using an indirect calorimeter at rest, during 10minutes of play on Xbox Kinect™ Reflex Ridge in both single and multiplayer modes, and during 10minutes of play on Wii™ Sports Boxing in both single and multiplayer modes.
MAIN OUTCOME MEASURES: Metabolic equivalents (METs), heart rate, oxygen consumption and kilocalories expended.
RESULTS: The energy expenditure during all gaming conditions was of a light intensity. Playing on the Xbox Kinect elicited greater energy expenditure than playing on the Wii [mean difference=0.9 METs, 95% confidence interval (CI) 0.2 to 1.5]. Playing games in multiplayer mode led to greater energy expenditure (mean difference=0.5 METs, 95% CI 0.1 to 0.9) and heart rate (mean difference=7.9 beats/minute, 95% CI 2.0 to 13.8) than playing in single player mode.
CONCLUSIONS: No gaming condition required moderate-intensity activity in this group of young healthy adults. Potential explanations for the difference in energy expenditure seen between consoles and modes are discussed.
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Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
OBJECTIVES: It has been reported that a higher galvanic skin response is seen when playing video games against another human player than when playing alone, which suggests increased effort. The objectives of this study were to compare energy expenditure when playing two popular active video game consoles, and to compare energy expenditure when playing in single and multiplayer modes.
DESIGN: Crossover trial with randomised playing order.
PARTICIPANTS: Fourteen healthy adults with a mean age of 21 [standard deviation (SD) 3] years.
METHODS AND INTERVENTIONS: Energy expenditure was measured using an indirect calorimeter at rest, during 10minutes of play on Xbox Kinect™ Reflex Ridge in both single and multiplayer modes, and during 10minutes of play on Wii™ Sports Boxing in both single and multiplayer modes.
MAIN OUTCOME MEASURES: Metabolic equivalents (METs), heart rate, oxygen consumption and kilocalories expended.
RESULTS: The energy expenditure during all gaming conditions was of a light intensity. Playing on the Xbox Kinect elicited greater energy expenditure than playing on the Wii [mean difference=0.9 METs, 95% confidence interval (CI) 0.2 to 1.5]. Playing games in multiplayer mode led to greater energy expenditure (mean difference=0.5 METs, 95% CI 0.1 to 0.9) and heart rate (mean difference=7.9 beats/minute, 95% CI 2.0 to 13.8) than playing in single player mode.
CONCLUSIONS: No gaming condition required moderate-intensity activity in this group of young healthy adults. Potential explanations for the difference in energy expenditure seen between consoles and modes are discussed.
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Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Tuesday 18 September 2012
Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study.
Physiotherapy. 2012 Sep;98(3):238-42. Epub 2012 Jul 23.
Gordon C, Roopchand-Martin S, Gregg A.
Source:Section of Physical Therapy, University of the West Indies, Kingston, Jamaica.
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Abstract
OBJECTIVES:
To explore the possibility of using the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy (CP) in a developing country, and determine whether there is potential for an impact on their gross motor function.
DESIGN:
Pilot study with a pre-post-test design.
SETTING:
Sir John Golding Rehabilitation Center, Jamaica, West Indies.
PARTICIPANTS:
Seven children, aged 6 to 12years, with dyskinetic CP were recruited for the study. One child dropped out at week 4.
INTERVENTION:
Training with the Nintendo Wii was conducted twice weekly for 6weeks. The games used were Wii Sports Boxing, Baseball and Tennis.
MAIN OUTCOME MEASURES:
Percentage attendance over the 6-week period, percentage of sessions for which the full duration of training was completed, and changes in gross motor function using the Gross Motor Function Measure (GMFM).
RESULTS:
All six participants who completed the study had 100% attendance, and all were able to complete the full 45minutes of training at every session. Those who were wheelchair bound participated in two games, whilst those who were ambulant played three games. The mean GMFM score increased from 62.83 [standard deviation (SD) 24.86] to 70.17 (SD 23.67).
CONCLUSION:
The Nintendo Wii has the potential for use as a rehabilitation tool in the management of children with CP. Clinical trials should be conducted in this area to determine whether this could be an effective tool for improving gross motor function.
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Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Gordon C, Roopchand-Martin S, Gregg A.
Source:Section of Physical Therapy, University of the West Indies, Kingston, Jamaica.
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Abstract
OBJECTIVES:
To explore the possibility of using the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy (CP) in a developing country, and determine whether there is potential for an impact on their gross motor function.
DESIGN:
Pilot study with a pre-post-test design.
SETTING:
Sir John Golding Rehabilitation Center, Jamaica, West Indies.
PARTICIPANTS:
Seven children, aged 6 to 12years, with dyskinetic CP were recruited for the study. One child dropped out at week 4.
INTERVENTION:
Training with the Nintendo Wii was conducted twice weekly for 6weeks. The games used were Wii Sports Boxing, Baseball and Tennis.
MAIN OUTCOME MEASURES:
Percentage attendance over the 6-week period, percentage of sessions for which the full duration of training was completed, and changes in gross motor function using the Gross Motor Function Measure (GMFM).
RESULTS:
All six participants who completed the study had 100% attendance, and all were able to complete the full 45minutes of training at every session. Those who were wheelchair bound participated in two games, whilst those who were ambulant played three games. The mean GMFM score increased from 62.83 [standard deviation (SD) 24.86] to 70.17 (SD 23.67).
CONCLUSION:
The Nintendo Wii has the potential for use as a rehabilitation tool in the management of children with CP. Clinical trials should be conducted in this area to determine whether this could be an effective tool for improving gross motor function.
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Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Saturday 4 August 2012
Can exergames increase physical activity?
Posted by John Ferrara on June 7, 2012
Earlier this year, a study published in the journal Pediatrics found that five games that are marketed with the promise of increasing players' physical fitness produced no actual difference in activity. 78 kids between 9 and 12 were given Wii consoles, and then one group was given a couple of exergames while a control group was given "inactive" games like Madden and Mario Kart. The kids wore devices to measure their physical activity, and they kept logs of when they played.
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To be certain, the study was performed by a very accomplished group of researchers. The lead author, Tom Baranowski of Baylor College, is one of the most widely published researchers of health games. And this was a very well-designed study, printed in the foremost journal on children's health. Nevertheless, the study should not be read to mean that games can't affect physical activity and can't have a positive impact on public health. That's because it didn't account for the most influential factor in a health game's impact -- its design.
More info
Earlier this year, a study published in the journal Pediatrics found that five games that are marketed with the promise of increasing players' physical fitness produced no actual difference in activity. 78 kids between 9 and 12 were given Wii consoles, and then one group was given a couple of exergames while a control group was given "inactive" games like Madden and Mario Kart. The kids wore devices to measure their physical activity, and they kept logs of when they played.
+/- Click for more/less
To be certain, the study was performed by a very accomplished group of researchers. The lead author, Tom Baranowski of Baylor College, is one of the most widely published researchers of health games. And this was a very well-designed study, printed in the foremost journal on children's health. Nevertheless, the study should not be read to mean that games can't affect physical activity and can't have a positive impact on public health. That's because it didn't account for the most influential factor in a health game's impact -- its design.
More info
Friday 3 August 2012
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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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
Click here for more information
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
Click here for more information
Thursday 2 August 2012
The heart rate response to nintendo wii boxing in young adults.
Cardiopulmonary Physical Therapy Journal 2012 Jun;23(2):13-29.
Department of Physical Therapy, A.T. Still University, Mesa, Arizona
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Abstract
PURPOSE: To determine if 30 minutes of Nintendo Wii Sports boxing provides cardiorespiratory benefits and contributes to the daily exercise recommendations for healthy young adults.
METHODS: Twenty healthy 23- to 27-year-olds participated in two sessions to measure maximum heart rate (HR(max)) via a treadmill test and heart rate (HR) response to 30 minutes of Wii Sports boxing. Heart rate in beats per minute (bpm) was measured continuously, and exercise intensity during each minute of play was stratified as a percentage of HR(max). Mixed designs analysis of variance (ANOVA) and Pearson product moment correlations were used to analyze the data.
RESULTS: Mean (SD) HR response to boxing was 143 (15) bpm or 77.5% (10.0%) of HR(max). The mean HR response for experienced participants was significantly lower than inexperienced participants, P = .007. The ANOVA revealed a significant interaction between experience and time spent at various intensities, P = .009. Experienced participants spent more time in light to vigorous intensities, inexperienced participants in moderate to very hard intensities. Fitness was not correlated with mean HR response to boxing, P = .49.
CONCLUSION: Thirty minutes of Nintendo Wii Sports boxing provides a moderate to vigorous aerobic response in healthy young adults and can contribute to daily recommendations for physical activity.
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Monday 23 July 2012
A game-console to improve balance in Parkinson Disease: preliminary results using the Nintendo Wii
Italian Journal of Physiotherapy 2012 June;2(2):45-9
Pelosin E., Avanzino L., Trompetto C., Marinelli L., Marchese R., Abbruzzese G.
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Pelosin E., Avanzino L., Trompetto C., Marinelli L., Marchese R., Abbruzzese G.
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Abstract:
AIM: Balance impairment is a common problem in idiopathic Parkinson’s disease (PD) often responsible for increased risk of falls, mobility restriction and loss of independence. Conventional exercises are often repetitive and may induce patients to lose their interest and to interrupt physical therapy at home. This study was aimed at evaluating theeffect of 5 days training with a low-cost, commercially available playing system, the Nintendo Wii® (NW), in improving balance in PD.
METHODS: Ten patients with PD and ten aged-match normal subjects (NS) were recruited and performed 30 minutes exercises playing with NW every day for one week. Subjects were evaluated by means of static posturography and Berg Balance Scale (BBS) before and after training.
RESULTS: The 5-day training, based on video-game system, induced a significant decrease in all the posturographic parameters in both groups improving postural stability of PD to a level comparable to baseline condition in NS. BBS score improved after training in PD patients.
CONCLUSION: These preliminary results suggest that a video game-based approach can exert a positive effect improving postural stability in PD patients. Because the NW device promotes better compliance, has wide applicability and is enjoyable to use, this treatment concept holds promise for PD rehabilitation
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AIM: Balance impairment is a common problem in idiopathic Parkinson’s disease (PD) often responsible for increased risk of falls, mobility restriction and loss of independence. Conventional exercises are often repetitive and may induce patients to lose their interest and to interrupt physical therapy at home. This study was aimed at evaluating theeffect of 5 days training with a low-cost, commercially available playing system, the Nintendo Wii® (NW), in improving balance in PD.
METHODS: Ten patients with PD and ten aged-match normal subjects (NS) were recruited and performed 30 minutes exercises playing with NW every day for one week. Subjects were evaluated by means of static posturography and Berg Balance Scale (BBS) before and after training.
RESULTS: The 5-day training, based on video-game system, induced a significant decrease in all the posturographic parameters in both groups improving postural stability of PD to a level comparable to baseline condition in NS. BBS score improved after training in PD patients.
CONCLUSION: These preliminary results suggest that a video game-based approach can exert a positive effect improving postural stability in PD patients. Because the NW device promotes better compliance, has wide applicability and is enjoyable to use, this treatment concept holds promise for PD rehabilitation
Click here for more information
Thursday 5 July 2012
WiiFit™ Plus balance test scores for the assessment of balance and mobility in older adults
Gait and Posture
Rebecca J. Reed-Jones, Sandor Dorgo , Maija K. Hitchings , Julia O. Bader
Rebecca J. Reed-Jones, Sandor Dorgo , Maija K. Hitchings , Julia O. Bader
Highlights
► WiiFit™ balance tests do not correlate with standardized functional balance, mobility and fitness tests. ► Wii balance score does correlate with visual processing speed as measured by Useful Field of View. ► WiiFit™ may provide advantageous information supplementary to standard functional mobility and balance tests. ► Caution should be used when using the WiiFit™ balance tests in isolation to test balance ability.
Abstract
The Nintendo Wii™ is becoming an increasingly popular technology for the training and assessment of balance in older adults. Recent studies have shown promising results for its use in fall prevention. However, it is not clear how scores on the WiiFit™ balance games relate to current standardized tests of balance and mobility. The purpose of this study was to evaluate the relationship between WiiFit™ Plus balance tests, and standardized tests of older adult fitness, balance, mobility, self-reported balance confidence, and visual attention and processing. Results from 34 older adult participants indicate that WiiFit™ balance tests do not correlate well with standardized functional balance, mobility and fitness tests. However, the Wii balance score, as measured by the Basic Balance Test of the WiiFit™, does correlate with visual processing speed as measured by the Useful Field of View (UFOV®) test. These results indicate that WiiFit™ balance tests may provide advantageous information supplementary to information obtained through standard functional mobility and balance tests; however, caution should be used when using the WiiFit™ balance tests in isolation. Further research is necessary as these technologies become widely used in clinical and home settings for balance training and assessment.
Monday 25 June 2012
Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study.
Ylva E Nilsagård, Anette S Forsber and Lena von Koch
Multiple Sclerosis Journal, 2012 June 6
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Abstract
Background: The use of interactive video games is expanding within rehabilitation. The evidence base is, however, limited.
Objective: Our aim was to evaluate the effects of a Nintendo Wii Fit® balance exercise programme on balance function and walking ability in people with multiple sclerosis (MS).
Methods: A multi-centre, randomised, controlled single-blinded trial with random allocation to exercise or no exercise. The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games, twice a week for 6–7 weeks. Primary outcome was the Timed Up and Go test (TUG). In total, 84 participants were enrolled; four were lost to follow-up.
Results: After the intervention, there were no statistically significant differences between groups but effect sizes for the TUG, TUGcognitive and, the Dynamic Gait Index (DGI) were moderate and small for all other measures. Statistically significant improvements within the exercise group were present for all measures (large to moderate effect sizes) except in walking speed and balance confidence. The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI.
Conclusion: In comparison with no intervention, a programme of supervised balance exercise using Nintendo Wii Fit® did not render statistically significant differences, but presented moderate effect sizes for several measures of balance performance.
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Multiple Sclerosis Journal, 2012 June 6
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Abstract
Background: The use of interactive video games is expanding within rehabilitation. The evidence base is, however, limited.
Objective: Our aim was to evaluate the effects of a Nintendo Wii Fit® balance exercise programme on balance function and walking ability in people with multiple sclerosis (MS).
Methods: A multi-centre, randomised, controlled single-blinded trial with random allocation to exercise or no exercise. The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games, twice a week for 6–7 weeks. Primary outcome was the Timed Up and Go test (TUG). In total, 84 participants were enrolled; four were lost to follow-up.
Results: After the intervention, there were no statistically significant differences between groups but effect sizes for the TUG, TUGcognitive and, the Dynamic Gait Index (DGI) were moderate and small for all other measures. Statistically significant improvements within the exercise group were present for all measures (large to moderate effect sizes) except in walking speed and balance confidence. The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI.
Conclusion: In comparison with no intervention, a programme of supervised balance exercise using Nintendo Wii Fit® did not render statistically significant differences, but presented moderate effect sizes for several measures of balance performance.
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Sunday 17 June 2012
Impact of an Active Video Game on Healthy Children's Physical Activity
Tom Baranowski, Dina Abdelsamad, Janice Baranowski, Teresia Margareta O'Connor, Debbe Thompson, Anthony Barnett, Ester Cerin and Tzu-An Chen
Pediatrics;
Originally published online February 27, 2012;
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Abstract
OBJECTIVE: This naturalistic study tests whether children receiving a new (to them) active video game spontaneously engage in more physical activity than those receiving an inactive video game, and whether
the effect would be greater among children in unsafe neighbourhoods, who might not be allowed to play outside.
METHODS: Participants were children 9 to 12 years of age, with a BMI .50th percentile, but ,99th percentile; none of these children a medical condition that would preclude physical activity or playing video
games. A randomized clinical trial assigned children to receiving 2 active or 2 inactive video games, the peripherals necessary to run the games, and a Wii console. Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment. Neighbourhood safety was assessed with a 12 item validated questionnaire.
RESULTS: There was no evidence that children receiving the active video games were more active in general, or at any time, than children receiving the inactive video games. The outcomes were not moderated
by parent perceived neighborhood safety, child BMI z score, or other demographic characteristics.
CONCLUSIONS: These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children.
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Pediatrics;
Originally published online February 27, 2012;
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Abstract
OBJECTIVE: This naturalistic study tests whether children receiving a new (to them) active video game spontaneously engage in more physical activity than those receiving an inactive video game, and whether
the effect would be greater among children in unsafe neighbourhoods, who might not be allowed to play outside.
METHODS: Participants were children 9 to 12 years of age, with a BMI .50th percentile, but ,99th percentile; none of these children a medical condition that would preclude physical activity or playing video
games. A randomized clinical trial assigned children to receiving 2 active or 2 inactive video games, the peripherals necessary to run the games, and a Wii console. Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment. Neighbourhood safety was assessed with a 12 item validated questionnaire.
RESULTS: There was no evidence that children receiving the active video games were more active in general, or at any time, than children receiving the inactive video games. The outcomes were not moderated
by parent perceived neighborhood safety, child BMI z score, or other demographic characteristics.
CONCLUSIONS: These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children.
Click here for more information
Wednesday 6 June 2012
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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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.
Click here for more
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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Background
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.
Methods
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.
Discussion
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.
Provisional PDF of article here Click here for more information
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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Background
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.
Methods
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.
Discussion
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.
Provisional PDF of article here Click here for more information
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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May 2012, Vol. 7, No. 3 , Pages 205-210
Dara Meldrum, Aine Glennon1, Susan Herdman, Deirdre Murray, Rory McConn-Walsh
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Abstract:
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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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.
Click here for more
Saturday 28 April 2012
Postural activity and motion sickness during video game play in children and adults
EXPERIMENTAL BRAIN RESEARCH
Volume 217, Number 2 (2012), 299-309,
Chih-Hui Chang, Wu-Wen Pan, Li-Ya Tseng and Thomas A. Stoffregen
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Abstract Research has confirmed that console video games give rise to motion sickness in many adults. During exposure to console video games, there are differences in postural activity (movement of the head and torso) between participants who later experience motion sickness and those who do not, confirming a prediction of the postural instability theory of motion sickness. Previous research has not addressed relations between video games, movement and motion sickness in children. We evaluated the nauseogenic properties of a commercially available console video game in both adults and 10-year-old children. Individuals played the game for up to 50 min and were instructed to discontinue immediately if they experienced any symptoms of motion sickness, however mild. During game play, we monitored movement of the head and torso. Motion sickness was reported by 67% of adults and by 56% of children; these rates did not differ. As a group, children moved more than adults. Across age groups, the positional variability of the head and torso increased over time during game play. In addition, we found differences in movement between participants who later reported motion sickness and those who did not. Some of these differences were general across age groups but we also found significant differences between the movement of adults and children who later reported motion sickness. The results confirm that console video games can induce motion sickness in children and demonstrate that changes in postural activity precede the onset of subjective symptoms of motion sickness in children.
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Volume 217, Number 2 (2012), 299-309,
Chih-Hui Chang, Wu-Wen Pan, Li-Ya Tseng and Thomas A. Stoffregen
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Abstract Research has confirmed that console video games give rise to motion sickness in many adults. During exposure to console video games, there are differences in postural activity (movement of the head and torso) between participants who later experience motion sickness and those who do not, confirming a prediction of the postural instability theory of motion sickness. Previous research has not addressed relations between video games, movement and motion sickness in children. We evaluated the nauseogenic properties of a commercially available console video game in both adults and 10-year-old children. Individuals played the game for up to 50 min and were instructed to discontinue immediately if they experienced any symptoms of motion sickness, however mild. During game play, we monitored movement of the head and torso. Motion sickness was reported by 67% of adults and by 56% of children; these rates did not differ. As a group, children moved more than adults. Across age groups, the positional variability of the head and torso increased over time during game play. In addition, we found differences in movement between participants who later reported motion sickness and those who did not. Some of these differences were general across age groups but we also found significant differences between the movement of adults and children who later reported motion sickness. The results confirm that console video games can induce motion sickness in children and demonstrate that changes in postural activity precede the onset of subjective symptoms of motion sickness in children.
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Friday 27 April 2012
Determining intensity levels for selected Wii Fit activities in college aged individuals.
By Joshua D. Grieser
Master of Science in Exercise and Sports Studies thesis
May 2010
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ABSTRACT
Introduction: Physical activity is important to the proper growth, development, and overall health of an individual. Current physical activity trends show declines in activity level throughout aging. To counteract inactivity many physical activity interventions have been implemented in different age groups and yet very little change in activity level has been seen. The Nintendo Wii® offers a popular technological intervention tool with its movement oriented game play. The physiological costs and intensity of the Nintendo Wii Fit® game have not been thoroughly researched, yet the Wii is being used as a physical activity tool in many arenas.
Purpose: The purpose of this study was to determine the intensity level of playing selected Nintendo Wii Fit® games using indirect calorimetry. Using the intensity information, it was determined if playing Wii Fit® (an exercise themed game) on the Nintendo Wii® video game console is an adequate activity for meeting the ACSM moderate physical activity guidelines threshold. Participants: Twenty-five participants, 5 males and 20 females, aged 22 ± 2 years (M ± SD) with little previous Wii experience were recruited for this study.
Method: Participants randomly completed two different Wii Fit activity sessions with two difficulty levels within the strength, endurance, and yoga categories. A resting metabolic rate and exercise VO2were measured on each participant with a TrueMax 2400 metabolic cart. Oxygen consumption was then converted into metabolic equivalents to estimate activity intensity level. SPSS18.0 (Chicago, IL, USA) was use for statistical analysis.
Results: Results indicated that VO2 of the selected Wii Fit activities was significantly higher than resting 2 VO levels. For example, the least intense activity was the Yoga Warrior activity, which had a mean intensity of 2.30 ± 0.42 METs and was still significantly higher than resting 2 VO levels, t (24) = 15.5, p < .001. The calculated MET values ranged from 3.28 ± 0.71 METs to 3.43 ± 0.60 METs for the strength activities, and ranged from 4.98 ± 1.22 METs to 5.73 ± 1.36 METs for the aerobic Basic Run exercises, indicating that the intensity levels of these activities met or exceeded the ACSM moderate intensity threshold of 3 METs. In contrast, the yoga exercises were significantly lower (from 2.30 ± 0.42 METs to 2.6749 ± .48 METs) than the recommended 3 METs, t (24) = -3.347, p= .003 for moderate intensity physical activity. Finally, the results showed that the medium difficulty level aerobic exercises (5.73 ± 1.36 METs) had significantly higher MET values than the easy aerobic exercises (4.98 ± 1.22 METs), t (24) = 5.00, p < .001.
Discussion: The findings of this study illustrate the potential of the Nintendo Wii Fit® game to be an adequate physical activity tool. Furthermore, these findings will allow for the further advancement of exercise themed video games to become satisfactory replacements for traditional physical activities in future interventions.
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Wednesday 25 April 2012
Interactive virtual reality Wii in geriatric day hospital: A study to assess its feasibility, acceptability and efficacy.
Geriatrics & Gerontology International
2012 Apr 2
Chan TC, Chan F, Shea YF, Lin OY, Luk JK, Chan FH. Source Department of Medicine, Division of Geriatrics, Queen Mary Hospital, The University of Hong Kong, Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong, China
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Abstract
Aim: Rehabilitation using interactive virtual reality Wii (Wii-IVR) was shown to be feasible in patients with different medical problems, but there was no study examining its use in a geriatric day hospital (GDH). The aim of the present study was to test the feasibility, acceptability and efficacy of Wii-IVR in GDH.
Methods: It was a clinical trial with matched historic controls. Patients of a GDH were recruited to participate in Wii-IVR by playing "Wii Fit". Participants used a Wii controller to carry out movements involved in an arm ergometer. Each participant received eight sessions of Wii-IVR in addition to conventional GDH rehabilitation. Feasibility was assessed by the total time receiving Wii-IVR, the percentage of maximal heart rate reserve (%MHR) and Borg perceived exertion scale (BS) after participating in Wii-IVR. %MHR and BS were compared with those after carrying out an arm ergometer for the same duration. Acceptability was assessed by an interviewer-administered questionnaire. Efficacy was assessed by comparing improvements in Functional Independence Measure (FIM) between participants and matched historic controls, who received conventional GDH rehabilitations only.
Results: A total of 30 patients completed the study. Participants completed a total of 1941 min of event-free Wii-IVR. The mean %MHR was 15.9% ± 9.9% and the mean BS was 7.9 ± 2.3. There was no significant difference in %MHR and BS between participating in Wii-IVR and arm ergometer. Most participants found Wii-IVR similar to the arm ergometer, and would like to continue Wii-IVR if they had Wii at home. Improvements in FIM of participants were significantly more than that of historic controls.
Conclusions: Wii-IVR in GDH was feasible and most participants accepted it. Participants had more improvements in FIM.
2012 Apr 2
Chan TC, Chan F, Shea YF, Lin OY, Luk JK, Chan FH. Source Department of Medicine, Division of Geriatrics, Queen Mary Hospital, The University of Hong Kong, Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong, China
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Abstract
Aim: Rehabilitation using interactive virtual reality Wii (Wii-IVR) was shown to be feasible in patients with different medical problems, but there was no study examining its use in a geriatric day hospital (GDH). The aim of the present study was to test the feasibility, acceptability and efficacy of Wii-IVR in GDH.
Methods: It was a clinical trial with matched historic controls. Patients of a GDH were recruited to participate in Wii-IVR by playing "Wii Fit". Participants used a Wii controller to carry out movements involved in an arm ergometer. Each participant received eight sessions of Wii-IVR in addition to conventional GDH rehabilitation. Feasibility was assessed by the total time receiving Wii-IVR, the percentage of maximal heart rate reserve (%MHR) and Borg perceived exertion scale (BS) after participating in Wii-IVR. %MHR and BS were compared with those after carrying out an arm ergometer for the same duration. Acceptability was assessed by an interviewer-administered questionnaire. Efficacy was assessed by comparing improvements in Functional Independence Measure (FIM) between participants and matched historic controls, who received conventional GDH rehabilitations only.
Results: A total of 30 patients completed the study. Participants completed a total of 1941 min of event-free Wii-IVR. The mean %MHR was 15.9% ± 9.9% and the mean BS was 7.9 ± 2.3. There was no significant difference in %MHR and BS between participating in Wii-IVR and arm ergometer. Most participants found Wii-IVR similar to the arm ergometer, and would like to continue Wii-IVR if they had Wii at home. Improvements in FIM of participants were significantly more than that of historic controls.
Conclusions: Wii-IVR in GDH was feasible and most participants accepted it. Participants had more improvements in FIM.
Thursday 5 April 2012
Comparison Between Nintendo Wii Fit Aerobics and Traditional Aerobic Exercise in Sedentary Young Adults
Douris, PC, McDonald, B, Vespi, F, Kelley, NC, and Herman, L.
Journal of Strength and Conditioning Research
26(4): 1052–1057, 2012
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Journal of Strength and Conditioning Research
26(4): 1052–1057, 2012
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Abstract:
Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit, an active video game console, vs. an equal duration of moderate-intensity brisk walking. Twenty-one healthy sedentary college-age students (mean age 23.2 ± 1.8 years) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit “Free Run” program. Physiologic parameters measured included heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants' positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii Fit (142.4 ± 20.5 b·min−1) was significantly greater (p = 0.001) compared with exercising on the treadmill (123.2 ± 13.7 b·min−1). Rate pressure product was also significantly greater (p = 0.001) during exercise on the Wii Fit. Participants' rating of perceived exertion when playing Wii Fit (12.7 ± 3.0) was significantly greater (p = 0.014) when compared with brisk walking on the treadmill (10.1 ± 3.3). However, psychologically when playing Wii Fit, participants' positive well-being decreased significantly (p = 0.018) from preexercise to postexercise when compared with exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate-intensity exercise when playing Nintendo Wii Fit “Free Run” with a self-selected intensity. We concluded that Nintendo Wii Fit “Free Run” may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.
© 2012 National Strength and Conditioning Association
More info click here
Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit, an active video game console, vs. an equal duration of moderate-intensity brisk walking. Twenty-one healthy sedentary college-age students (mean age 23.2 ± 1.8 years) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill vs. 30 minutes playing Nintendo Wii Fit “Free Run” program. Physiologic parameters measured included heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants' positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified using the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii Fit (142.4 ± 20.5 b·min−1) was significantly greater (p = 0.001) compared with exercising on the treadmill (123.2 ± 13.7 b·min−1). Rate pressure product was also significantly greater (p = 0.001) during exercise on the Wii Fit. Participants' rating of perceived exertion when playing Wii Fit (12.7 ± 3.0) was significantly greater (p = 0.014) when compared with brisk walking on the treadmill (10.1 ± 3.3). However, psychologically when playing Wii Fit, participants' positive well-being decreased significantly (p = 0.018) from preexercise to postexercise when compared with exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate-intensity exercise when playing Nintendo Wii Fit “Free Run” with a self-selected intensity. We concluded that Nintendo Wii Fit “Free Run” may act as an alternative to traditional moderate-intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.
© 2012 National Strength and Conditioning Association
More info click here
Wednesday 4 April 2012
Clinical Use of Nintendo Wii(TM) Bowling Simulation to Decrease Fall Risk in an Elderly Resident of a Nursing Home: A Case Report
Journal of Geriatric Physical Therapy:
2009 - Volume 32 - Issue 4 - p 174–180
Case Report
Authors: Clark, Robert PT, ; Kraemer, Theresa PT, PhD,
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Abstract
Purpose:: Of the estimated 1.7 million residents of nursing homes in the United States, approximately half fall annually; and 11% of these sustain injury. This is twice the rate for persons dwelling in the community. By addressing fall risk, physical therapists have an opportunity to reduce falls which are the leading cause of injury deaths, as well as the most common cause of nonfatal injuries for older adults in the United States. This case report examines the effect of a novel interactive video game intervention to address balance dysfunction in an elderly resident of a nursing home who was at risk for falls.
Case Description:: The patient is an 89‐year‐old resident diagnosed with an unspecified balance disorder and a history of multiple falls. Self reports of gait abnormalities, scores on several clinical measures, and her fall history classified her as having substantial risk for future falls.
Intervention:: A nontraditional approach to balance training, employing the Nintendo Wii bowling simulation, was used as intervention for this patient's balance disorder.
Outcomes:: After 6 one‐hour treatment sessions, the patient's Berg Balance Score improved from 48 to 53. On the Dynamic Gait Index, the patient improved her score from 19 to 21. The patient's Timed Up and Go Test improved from 14.9 to 10.5 seconds, all suggesting a reduced risk of falling. The patient's ABC Score improved from 88 to 90%.
Conclusion:: Physical therapy intervention, using the Nintendo Wii bowling simulation, may have decreased fall risk for this individual.
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Authors: Clark, Robert PT, ; Kraemer, Theresa PT, PhD,
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Abstract
Purpose:: Of the estimated 1.7 million residents of nursing homes in the United States, approximately half fall annually; and 11% of these sustain injury. This is twice the rate for persons dwelling in the community. By addressing fall risk, physical therapists have an opportunity to reduce falls which are the leading cause of injury deaths, as well as the most common cause of nonfatal injuries for older adults in the United States. This case report examines the effect of a novel interactive video game intervention to address balance dysfunction in an elderly resident of a nursing home who was at risk for falls.
Case Description:: The patient is an 89‐year‐old resident diagnosed with an unspecified balance disorder and a history of multiple falls. Self reports of gait abnormalities, scores on several clinical measures, and her fall history classified her as having substantial risk for future falls.
Intervention:: A nontraditional approach to balance training, employing the Nintendo Wii bowling simulation, was used as intervention for this patient's balance disorder.
Outcomes:: After 6 one‐hour treatment sessions, the patient's Berg Balance Score improved from 48 to 53. On the Dynamic Gait Index, the patient improved her score from 19 to 21. The patient's Timed Up and Go Test improved from 14.9 to 10.5 seconds, all suggesting a reduced risk of falling. The patient's ABC Score improved from 88 to 90%.
Conclusion:: Physical therapy intervention, using the Nintendo Wii bowling simulation, may have decreased fall risk for this individual.
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Saturday 17 March 2012
Activity-promoting gaming systems in exercise and rehabilitation
Matthew J. D. Taylor, PhD; Darren McCormick, BSc; Teshk Shawis, MBChB, FRCP; Rebecca Impson,
MSc; Murray Griffin, PhD
Journal of Rehabilitation Research & Development
Volume 48, Number 10, 2011 Pages 1171–1186
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Abstract—
Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation.
Key words: activity-promoting, Dance Dance Revolution,
exercise, falls, games, gaming systems, injury, Nintendo Wii,
rehabilitation, Sony EyeToy, Xbox Kinect.
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MSc; Murray Griffin, PhD
Journal of Rehabilitation Research & Development
Volume 48, Number 10, 2011 Pages 1171–1186
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Abstract—
Commercial activity-promoting gaming systems provide a potentially attractive means to facilitate exercise and rehabilitation. The Nintendo Wii, Sony EyeToy, Dance Dance Revolution, and Xbox Kinect are examples of gaming systems that use the movement of the player to control gameplay. Activity-promoting gaming systems can be used as a tool to increase activity levels in otherwise sedentary gamers and also be an effective tool to aid rehabilitation in clinical settings. Therefore, the aim of this current work is to review the growing area of activity-promoting gaming in the context of exercise, injury, and rehabilitation.
Key words: activity-promoting, Dance Dance Revolution,
exercise, falls, games, gaming systems, injury, Nintendo Wii,
rehabilitation, Sony EyeToy, Xbox Kinect.
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Friday 2 March 2012
Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii Balance Boards
Research in Developmental Disabilities, Volume 33, Issue 4, July–August 2012, Pages 983-989
Ching-Hsiang Shih, Man-Ling Chang
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Abstract
The latest researches have adopted software technology to modify the Nintendo Wii Balance Board functionality and used it to enable two people with developmental disabilities to actively perform physical activities. This study extended the latest research of the Wii Balance Board application to assess whether four people (two groups) with developmental disabilities would be able to actively improve their physical activities collaboration – walking to the designated location following simple instructions, by controlling their favorite environmental stimulation through using three Nintendo Wii Balance Boards. We employed an A–B–A–B design, with A represented the baseline and B represented intervention phases. Data showed that both groups of participants significantly increased their collaborative target response (collaboratively performing designated physical activities) by activating the control system to produce their preferred environmental stimulation during the intervention phases. Practical and developmental implications of the findings are discussed.
Highlights
-Commercial high-technology products can be used as high performance assistive devices.
-The Nintendo Wii Balance Board can be used as a high performance standing location detector.
-Four people (two groups) with developmental disabilities can control environmental stimulation through the Wii Balance Board by performing collaborative physical activities.
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Ching-Hsiang Shih, Man-Ling Chang
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Abstract
The latest researches have adopted software technology to modify the Nintendo Wii Balance Board functionality and used it to enable two people with developmental disabilities to actively perform physical activities. This study extended the latest research of the Wii Balance Board application to assess whether four people (two groups) with developmental disabilities would be able to actively improve their physical activities collaboration – walking to the designated location following simple instructions, by controlling their favorite environmental stimulation through using three Nintendo Wii Balance Boards. We employed an A–B–A–B design, with A represented the baseline and B represented intervention phases. Data showed that both groups of participants significantly increased their collaborative target response (collaboratively performing designated physical activities) by activating the control system to produce their preferred environmental stimulation during the intervention phases. Practical and developmental implications of the findings are discussed.
Highlights
-Commercial high-technology products can be used as high performance assistive devices.
-The Nintendo Wii Balance Board can be used as a high performance standing location detector.
-Four people (two groups) with developmental disabilities can control environmental stimulation through the Wii Balance Board by performing collaborative physical activities.
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Wednesday 29 February 2012
ReWiiRe: Research for Wii Rehabilitation
Text taken from the ReWiire website
ReWiiRe stands for Research for Wii technology in Rehabilitation. The project aim is twofold. Firstly to investigate therapist use and the patient experience of using the Nintendo Wii console technology in physical rehabilitation programmes in four NHS Trusts across hospital and community settings.
Please click on the link below for comprehensive and detailed information about the project.
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ReWiiRe stands for Research for Wii technology in Rehabilitation. The project aim is twofold. Firstly to investigate therapist use and the patient experience of using the Nintendo Wii console technology in physical rehabilitation programmes in four NHS Trusts across hospital and community settings.
Please click on the link below for comprehensive and detailed information about the project.
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Motor Control Outcomes Following Nintendo Wii Use by a Child With Down Syndrome
Case Study
Pediatric Physical Therapy: Spring 2012 - Volume 24 - Issue 1 - p 78–84
Berg, Patti PT, MA, MPT, NCS; Becker, Tiffany PT, DPT; Martian, Andrew PT, DPT; Danielle, Primrose Kimberly PT, DPT; Wingen, Julie PT, DPT
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Abstract
Purpose: The purpose of this work was to examine motor outcomes following an 8-week intervention period of family-supported Nintendo Wii use by a child with a diagnosis of Down syndrome (DS).
Summary of Key Points: A 12-year-old child with a diagnosis of DS and with limited Wii exposure was asked to play Wii games in the home 4 times each week for 20 minutes each session for 8 weeks. Family members were encouraged to participate. The participant chose what games to play and selected 4 different games. Repeatedly practicing the skills involved in these games resulted in improvements in the child's postural stability, limits of stability, and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition balance, upper-limb coordination, manual dexterity, and running speed and agility standard scores.
Conclusions: Wii game use by a child with DS may elicit improvements in highly practiced motor skills and postural control.
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Pediatric Physical Therapy: Spring 2012 - Volume 24 - Issue 1 - p 78–84
Berg, Patti PT, MA, MPT, NCS; Becker, Tiffany PT, DPT; Martian, Andrew PT, DPT; Danielle, Primrose Kimberly PT, DPT; Wingen, Julie PT, DPT
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Abstract
Purpose: The purpose of this work was to examine motor outcomes following an 8-week intervention period of family-supported Nintendo Wii use by a child with a diagnosis of Down syndrome (DS).
Summary of Key Points: A 12-year-old child with a diagnosis of DS and with limited Wii exposure was asked to play Wii games in the home 4 times each week for 20 minutes each session for 8 weeks. Family members were encouraged to participate. The participant chose what games to play and selected 4 different games. Repeatedly practicing the skills involved in these games resulted in improvements in the child's postural stability, limits of stability, and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition balance, upper-limb coordination, manual dexterity, and running speed and agility standard scores.
Conclusions: Wii game use by a child with DS may elicit improvements in highly practiced motor skills and postural control.
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Tuesday 28 February 2012
Home-based balance training programme using Wii Fit with balance board for Parkinsons’s disease: A pilot study
Journal of Rehabilation Medicine 2012 Feb;44(2):144-50.
Esculier JF, Vaudrin J, Bériault P, Gagnon K, Tremblay LE.
Faculty of Health Sciences, School of Rehabilitation, University of Ottawa, Québec, Canada.
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Esculier JF, Vaudrin J, Bériault P, Gagnon K, Tremblay LE.
Faculty of Health Sciences, School of Rehabilitation, University of Ottawa, Québec, Canada.
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Abstract
Objectives: To evaluate the effects of a home-based balance training programme using visual feedback (Nintendo Wii Fit game with balance board) on balance and functional abilities in subjects with Parkinson’s disease, and to compare the effects with a group of paired healthy subjects.
Subjects: Ten subjects with moderate Parkinson’s disease and 8 healthy elderly subjects.
Methods: Subjects participated in a 6-week home-based balance training programme using Nintendo Wii Fit and balance board. Baseline measures were taken before training for the Sit-to-Stand test (STST), Timed-Up-and-Go (TUG), Tinetti Performance Oriented Mobility Assessment (POMA), 10-m walk test, Community Balance and Mobility assessment (CBM), Activities-specific Balance and Confidence scale (ABC), unipodal stance duration, and a force platform. All measurements were taken again after 3 and 6 weeks of training.
Results: The Parkinson’s disease group significantly improved their results in TUG, STST, unipodal stance, 10-m walk test, CBM, POMA and force platform at the end of the 6-week training programme. The healthy subjects group significantly improved in TUG, STST, unipodal stance and CBM.
Conclusion: This pilot study suggests that a home-based balance programme using Wii Fit with balance board could improve static and dynamic balance, mobility and functional abilities of people affected by Parkinson’s disease.
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Objectives: To evaluate the effects of a home-based balance training programme using visual feedback (Nintendo Wii Fit game with balance board) on balance and functional abilities in subjects with Parkinson’s disease, and to compare the effects with a group of paired healthy subjects.
Subjects: Ten subjects with moderate Parkinson’s disease and 8 healthy elderly subjects.
Methods: Subjects participated in a 6-week home-based balance training programme using Nintendo Wii Fit and balance board. Baseline measures were taken before training for the Sit-to-Stand test (STST), Timed-Up-and-Go (TUG), Tinetti Performance Oriented Mobility Assessment (POMA), 10-m walk test, Community Balance and Mobility assessment (CBM), Activities-specific Balance and Confidence scale (ABC), unipodal stance duration, and a force platform. All measurements were taken again after 3 and 6 weeks of training.
Results: The Parkinson’s disease group significantly improved their results in TUG, STST, unipodal stance, 10-m walk test, CBM, POMA and force platform at the end of the 6-week training programme. The healthy subjects group significantly improved in TUG, STST, unipodal stance and CBM.
Conclusion: This pilot study suggests that a home-based balance programme using Wii Fit with balance board could improve static and dynamic balance, mobility and functional abilities of people affected by Parkinson’s disease.
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Monday 27 February 2012
Wii Fit® training vs. Adapted Physical Activities: which one is the most appropriate to improve the balance of independent senior subjects? A randomized controlled study
Clinical Rehabilation 2012 Feb 9. [Epub ahead of print]
Toulotte C, Toursel C, Olivier N.
Universite Lille Nord de France, Faculte des sciences du sport et de l'education physique, France.
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Abstract
Objective: To compare the effectiveness of three protocols (Adapted Physical Activities, Wii Fit(®), Adapted Physical Activities + Wii Fit(®)) on the balance of independent senior subjects. Design: Case comparison study.Settings: Healthy elderly subjects living in independent community dwellings. Subjects: Thirty-six subjects, average age 75.09 ± 10.26 years, took part in this study, and were randomly assigned to one of the four experimental groups: G1 followed an Adapted Physical Activities training programme, while the second group (G2) participated in Wii Fit(®) training and the third one (G3) combined both methods. There was no training for the fourth group (G4). All subjects trained once a week (1 hour) for 20 weeks and were assessed before and after treatment. Main measures: The Tinetti test, unipedal tests and the Wii Fit(®) tests. Results: After training, the scores in the Tinetti test decreased significantly (P < 0.05) for G1, G2 and G3 respectively in static conditions and for G1 and G3 in dynamic conditions. After training, the performance in the unipedal tests decreased significantly (P < 0.05) for G1 and G3. The position of the centre of gravity was modified significantly (P < 0.05) for G2 and G3. Conclusion: After 20 training sessions, G1 (Adapted Physical Activities), G2 (Wii Fit(®)) and G3 (Adapted Physical Activities and Wii Fit(®)) improved their balance. In addition, G1 and G3 increased their dynamic balance. The findings suggest that Adapted Physical Activities training limits the decline in sensorial functions in the elderly.
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Toulotte C, Toursel C, Olivier N.
Universite Lille Nord de France, Faculte des sciences du sport et de l'education physique, France.
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Abstract
Objective: To compare the effectiveness of three protocols (Adapted Physical Activities, Wii Fit(®), Adapted Physical Activities + Wii Fit(®)) on the balance of independent senior subjects. Design: Case comparison study.Settings: Healthy elderly subjects living in independent community dwellings. Subjects: Thirty-six subjects, average age 75.09 ± 10.26 years, took part in this study, and were randomly assigned to one of the four experimental groups: G1 followed an Adapted Physical Activities training programme, while the second group (G2) participated in Wii Fit(®) training and the third one (G3) combined both methods. There was no training for the fourth group (G4). All subjects trained once a week (1 hour) for 20 weeks and were assessed before and after treatment. Main measures: The Tinetti test, unipedal tests and the Wii Fit(®) tests. Results: After training, the scores in the Tinetti test decreased significantly (P < 0.05) for G1, G2 and G3 respectively in static conditions and for G1 and G3 in dynamic conditions. After training, the performance in the unipedal tests decreased significantly (P < 0.05) for G1 and G3. The position of the centre of gravity was modified significantly (P < 0.05) for G2 and G3. Conclusion: After 20 training sessions, G1 (Adapted Physical Activities), G2 (Wii Fit(®)) and G3 (Adapted Physical Activities and Wii Fit(®)) improved their balance. In addition, G1 and G3 increased their dynamic balance. The findings suggest that Adapted Physical Activities training limits the decline in sensorial functions in the elderly.
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Sunday 26 February 2012
Using the Nintendo Wii as an Intervention in a Falls Prevention Group
Journal of American Geriatrics Society. 2012 Feb;60(2):385-7
Griffin M, Shawis T, Impson R, McCormick D, Taylor MJ.
Department of Biological Sciences, University of Essex.
No abstract is available for this article.
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Griffin M, Shawis T, Impson R, McCormick D, Taylor MJ.
Department of Biological Sciences, University of Essex.
No abstract is available for this article.
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Saturday 25 February 2012
The Use of Nintendo Wii with Long-Term Care Residents
Journal of the American Geriatrics Society
Volume 59, Issue 12, pages 2393–2395, December 2011
Kirsten Brandt AB, Miguel A. Paniagua MD, FACP
No abstract available
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Volume 59, Issue 12, pages 2393–2395, December 2011
Kirsten Brandt AB, Miguel A. Paniagua MD, FACP
No abstract available
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Stroke patients' experiences with Wii Sports® during inpatient rehabilitation
Scandinavian Journal of Occupational Therapy
Posted online on February 20, 2012
Authors: Dora Celinder & Hanne Peoples
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Abstract
Posted online on February 20, 2012
Authors: Dora Celinder & Hanne Peoples
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Abstract
Introduction: Commercial virtual reality games have been used as adjunct therapy for stroke rehabilitation, mainly after patients have been discharged. The aim of this study was to explore stroke patients' experiences with Wii Sports® as a supplement to conventional occupational therapy in a controlled hospital setting.
Materials and methods: The study had a qualitative triangulation design that included semi-structured interviews and field notes. Nine Danish stroke patients participated, receiving between one and nine interventions with Wii Sports® during a three-week period. Responses were coded by qualitative content analysis.
Results: Analysis revealed one overarching category, “Connecting to past, present, and future occupations”, and three categories that encompassed patients' experiences with Wii: (i) variety, (ii) engagement, and (iii) obstacles and challenges. Interview findings were confirmed by field notes that included observations of engagement and challenges.
Discussion: Stroke patients in hospital settings may experience Wii Sports® as a beneficial and challenging occupation for both rehabilitation and leisure. Incorporation of Wii Sports® into conventional occupational therapy services may benefit patient rehabilitation directly or provide motivation for alternative leisure activities.
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Thursday 2 February 2012
Video Games in Health Care: Closing the Gap
Review of General Psychology
2010, Vol. 14, No. 2, 113–121
2010, Vol. 14, No. 2, 113–121
Pamela M. Kato
University Medical Center Utrech
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Abstract
Although a great deal of media attention has been given to the negative effects of playing video games,
relatively less attention has been paid to the positive effects of engaging in this activity. Video games in
health care provide ample examples of innovative ways to use existing commercial games for health
improvement or surgical training. Tailor-made games help patients be more adherent to treatment
regimens and train doctors how to manage patients in different clinical situations. In this review,
examples in the scientific literature of commercially available and tailor-made games used for education
and training with patients and medical students and doctors are summarized. There is a history of using
video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus
on making tailor-made games for different disease groups, which have been evaluated in scientific trials
more recently. Commercial video games have been of interest regarding their impact on surgical skill.
More recently, some basic computer games have been developed and evaluated that train doctors in
clinical skills. The studies presented in this article represent a body of work outlining positive effects of
playing video games in the area of health care.
University Medical Center Utrech
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Abstract
Although a great deal of media attention has been given to the negative effects of playing video games,
relatively less attention has been paid to the positive effects of engaging in this activity. Video games in
health care provide ample examples of innovative ways to use existing commercial games for health
improvement or surgical training. Tailor-made games help patients be more adherent to treatment
regimens and train doctors how to manage patients in different clinical situations. In this review,
examples in the scientific literature of commercially available and tailor-made games used for education
and training with patients and medical students and doctors are summarized. There is a history of using
video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus
on making tailor-made games for different disease groups, which have been evaluated in scientific trials
more recently. Commercial video games have been of interest regarding their impact on surgical skill.
More recently, some basic computer games have been developed and evaluated that train doctors in
clinical skills. The studies presented in this article represent a body of work outlining positive effects of
playing video games in the area of health care.
Tuesday 20 December 2011
A Pilot Study of Wii Fit Exergames to Improve Balance in Older Adults
Journal of Geriatric Physical Therapy:
October/December 2011 - Volume 34 - Issue 4 - p 161–167
Agmon, Maayan PT, PhD, MA, BA; Perry, Cynthia K. PhD, ARNP; Phelan, Elizabeth MD, MS; Demiris, George PhD; Nguyen, Huong Q. PhD
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Abstract
Purpose: To determine the safety and feasibility of using Nintendo Wii Fit exergames to improve balance in older adults.
Methods: Seven older adults aged 84 (5) years with impaired balance (Berg Balance Scale [BBS] score < 52 points) were recruited from 4 continuing care retirement communities to participate in a single group pre- and postevaluation of Wii Fit exergames. Participants received individualized instructions (at least 5 home visits) on playing 4 exergames (basic step, soccer heading, ski slalom, and table tilt) and were asked to play these games in their homes at least 30 minutes 3 times per week for 3 months and received weekly telephone follow-up. They also completed a paper log of their exergame play and rated their enjoyment immediately after each session. Participants completed the BBS, 4-Meter Timed Walk test, and the Physical Activity Enjoyment Scale at baseline and 3 months. Semistructured interviews were conducted at the 3-month evaluation.
Results: Participants safely and independently played a mean of 50 sessions, median session duration of 31 minutes. Two of the games were modified to ensure participants' safety. Participants rated high enjoyment immediately after exergame play and expressed experiencing improved balance with daily activities and desire to play exergames with their grandchildren. Berg Balance Scores increased from 49 (2.1) to 53 (1.8) points (P = .017). Walking speed increased from 1.04 (0.2) to 1.33 (0.84) m/s (P = .018).
Conclusions: Use of Wii Fit for limited supervised balance training in the home was safe and feasible for a selected sample of older adults. Further research is needed to determine clinical efficacy in a larger, diverse sample and ascertain whether Wii Fit exergames can be integrated into physical therapy practice to promote health in older adults.
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October/December 2011 - Volume 34 - Issue 4 - p 161–167
Agmon, Maayan PT, PhD, MA, BA; Perry, Cynthia K. PhD, ARNP; Phelan, Elizabeth MD, MS; Demiris, George PhD; Nguyen, Huong Q. PhD
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Abstract
Purpose: To determine the safety and feasibility of using Nintendo Wii Fit exergames to improve balance in older adults.
Methods: Seven older adults aged 84 (5) years with impaired balance (Berg Balance Scale [BBS] score < 52 points) were recruited from 4 continuing care retirement communities to participate in a single group pre- and postevaluation of Wii Fit exergames. Participants received individualized instructions (at least 5 home visits) on playing 4 exergames (basic step, soccer heading, ski slalom, and table tilt) and were asked to play these games in their homes at least 30 minutes 3 times per week for 3 months and received weekly telephone follow-up. They also completed a paper log of their exergame play and rated their enjoyment immediately after each session. Participants completed the BBS, 4-Meter Timed Walk test, and the Physical Activity Enjoyment Scale at baseline and 3 months. Semistructured interviews were conducted at the 3-month evaluation.
Results: Participants safely and independently played a mean of 50 sessions, median session duration of 31 minutes. Two of the games were modified to ensure participants' safety. Participants rated high enjoyment immediately after exergame play and expressed experiencing improved balance with daily activities and desire to play exergames with their grandchildren. Berg Balance Scores increased from 49 (2.1) to 53 (1.8) points (P = .017). Walking speed increased from 1.04 (0.2) to 1.33 (0.84) m/s (P = .018).
Conclusions: Use of Wii Fit for limited supervised balance training in the home was safe and feasible for a selected sample of older adults. Further research is needed to determine clinical efficacy in a larger, diverse sample and ascertain whether Wii Fit exergames can be integrated into physical therapy practice to promote health in older adults.
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Monday 19 December 2011
Assisting people with disabilities to actively improve their collaborative physical activities with Nintendo Wii Balance Boards by controlling environmental stimulation.
Research in Developmental Disabilities, Volume 33, Issue 1, January-February 2012, Pages 39-44
Ching-Hsiang Shih, Chia-Ju Shih and Ching-Tien Shih
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Ching-Hsiang Shih, Chia-Ju Shih and Ching-Tien Shih
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Highlights
► Commercial high-technology products can be used as high performance assistive devices. ► The Nintendo Wii Balance Board can be used as a high performance standing location detector. ► Four people (two groups) with developmental disabilities can control environmental stimulation through the Wii Balance Board by performing collaborative physical activities.
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Sunday 18 December 2011
The energy expenditure of an activity-promoting video game compared to sedentary video games and TV watching
Journal of Pediatric Endocrinology and Metabolism. Volume 24, Issue 9-10, Pages 689–695
Naim Mitre, Randal C. Foster, Lorraine Lanningham-Foster & James A. Levine
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Abstract
Background: In the present study we investigated the effect of television watching and the use of activity-promoting video games on energy expenditure in obese and lean children.
Methods: Energy expenditure and physical activity were measured while participants were watching television, playing a video game on a traditional sedentary video game console, and while playing the same video game on an activity-promoting video game console.
Results: Energy expenditure was significantly greater than television watching and playing video games on a sedentary video game console when children played the video game on the activity-promoting console. When examining movement with accelerometry, children moved significantly more when playing the video game on the Nintendo Wii console.
Conclusion: Activity-promoting video games have shown to increase movement, and be an important tool to raise energy expenditure by 50% when compared to sedentary activities of daily living.
Keywords children, energy expenditure, obesity, physical activity, television, video-games
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Naim Mitre, Randal C. Foster, Lorraine Lanningham-Foster & James A. Levine
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Abstract
Background: In the present study we investigated the effect of television watching and the use of activity-promoting video games on energy expenditure in obese and lean children.
Methods: Energy expenditure and physical activity were measured while participants were watching television, playing a video game on a traditional sedentary video game console, and while playing the same video game on an activity-promoting video game console.
Results: Energy expenditure was significantly greater than television watching and playing video games on a sedentary video game console when children played the video game on the activity-promoting console. When examining movement with accelerometry, children moved significantly more when playing the video game on the Nintendo Wii console.
Conclusion: Activity-promoting video games have shown to increase movement, and be an important tool to raise energy expenditure by 50% when compared to sedentary activities of daily living.
Keywords children, energy expenditure, obesity, physical activity, television, video-games
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Saturday 17 December 2011
Wii Your Health: A Low-Cost Wireless System for Home Rehabilitation after Stroke using Wii Remotes with its Expansions and Blender
Emmanuel Tsekleves, Dionysios Skordoulis, Ioannis Paraskevopoulos, and Cherry Kilbride
Biomedical Engineering 2011, February 16-18 2010 Innsbruck, Austria. ACTA Press
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Biomedical Engineering 2011, February 16-18 2010 Innsbruck, Austria. ACTA Press
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Abstract
Full body motion capture via the Wiimote and the new Wii MotionPlus sensor has yet to be investigated or developed. In addition, the mapping of the Wiimote-captured motion data to a computer generated 3D model inside an open source professional 3D animation tool has yet to be attempted. Within this paper the authors initiate a new study into full markerless human body motion tracking for physical rehabilitation. In particular, it includes the investigation and development of the first phase of a system that is able to capture full human body motion data by a set-up of several Wiimotes placed on different human body segments. This will allow the development of an affordable store and forward treatment option that would enable and motivate physical rehabilitation patients and in particular stroke patients, to conduct physical therapy from home. Finally, by extending a professional 3D animation software tool (Blender), motion data captured through the new system can be mapped onto a virtual 3-D human model in real time, thereby making it possible to have a strong correlation between the physical human and a virtual character to enhance the clinical utility of this innovative technology.
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Full body motion capture via the Wiimote and the new Wii MotionPlus sensor has yet to be investigated or developed. In addition, the mapping of the Wiimote-captured motion data to a computer generated 3D model inside an open source professional 3D animation tool has yet to be attempted. Within this paper the authors initiate a new study into full markerless human body motion tracking for physical rehabilitation. In particular, it includes the investigation and development of the first phase of a system that is able to capture full human body motion data by a set-up of several Wiimotes placed on different human body segments. This will allow the development of an affordable store and forward treatment option that would enable and motivate physical rehabilitation patients and in particular stroke patients, to conduct physical therapy from home. Finally, by extending a professional 3D animation software tool (Blender), motion data captured through the new system can be mapped onto a virtual 3-D human model in real time, thereby making it possible to have a strong correlation between the physical human and a virtual character to enhance the clinical utility of this innovative technology.
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Friday 16 December 2011
Improving Lower Limb Weight Distribution Asymmetry During the Squat Using Nintendo Wii Balance Boards and Real-Time Feedback.
McGough, R, Paterson, K, Bradshaw, EJ, Bryant, AL, and Clark, RA.
Improving lower limb weight distribution asymmetry during the squat using Nintendo WII balance boards and real-time feedback. J Strength Cond Res 26(1): 47-52, 2012-
McGough R, Paterson K, Bradshaw EJ, Bryant AL, Clark RA.
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Abstract
Weight-bearing asymmetry (WBA) may be detrimental to performance and could increase the risk of injury; however, detecting and reducing it is difficult in a field setting. This study assessed whether a portable and simple-to-use system designed with multiple Nintendo Wii Balance Boards (NWBBs) and customized software can be used to evaluate and improve WBA. Fifteen elite Australian Rules Footballers and 32 age-matched, untrained participants were tested for measures of WBA while squatting. The NWBB and customized software provided real-time visual feedback of WBA during half of the trials. Outcome measures included the mean mass difference (MMD) between limbs, interlimb symmetry index (SI), and percentage of time spent favoring a single limb (TFSL). Significant reductions in MMD (p = 0.028) and SI (p = 0.007) with visual feedback were observed for the entire group data. Subgroup analysis revealed significant reductions in MMD (p = 0.047) and SI (p = 0.026) with visual feedback in the untrained sample; however, the reductions in the trained sample were nonsignificant. The trained group showed significantly less WBA for TFSL under both visual conditions (no feedback: p = 0.015, feedback: p = 0.017). Correlation analysis revealed that participants with high levels of WBA had the greatest response to feedback (p < 0.001, ρ = 0.557). In conclusion, WBA exists in healthy untrained adults, and these asymmetries can be reduced using real-time visual feedback provided by an NWBB-based system. Healthy, well-trained professional athletes do not possess the same magnitude of WBA. Inexpensive, portable, and widely available gaming technology may be used to evaluate and improve WBA in clinical and sporting settings.
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Improving lower limb weight distribution asymmetry during the squat using Nintendo WII balance boards and real-time feedback. J Strength Cond Res 26(1): 47-52, 2012-
McGough R, Paterson K, Bradshaw EJ, Bryant AL, Clark RA.
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Abstract
Weight-bearing asymmetry (WBA) may be detrimental to performance and could increase the risk of injury; however, detecting and reducing it is difficult in a field setting. This study assessed whether a portable and simple-to-use system designed with multiple Nintendo Wii Balance Boards (NWBBs) and customized software can be used to evaluate and improve WBA. Fifteen elite Australian Rules Footballers and 32 age-matched, untrained participants were tested for measures of WBA while squatting. The NWBB and customized software provided real-time visual feedback of WBA during half of the trials. Outcome measures included the mean mass difference (MMD) between limbs, interlimb symmetry index (SI), and percentage of time spent favoring a single limb (TFSL). Significant reductions in MMD (p = 0.028) and SI (p = 0.007) with visual feedback were observed for the entire group data. Subgroup analysis revealed significant reductions in MMD (p = 0.047) and SI (p = 0.026) with visual feedback in the untrained sample; however, the reductions in the trained sample were nonsignificant. The trained group showed significantly less WBA for TFSL under both visual conditions (no feedback: p = 0.015, feedback: p = 0.017). Correlation analysis revealed that participants with high levels of WBA had the greatest response to feedback (p < 0.001, ρ = 0.557). In conclusion, WBA exists in healthy untrained adults, and these asymmetries can be reduced using real-time visual feedback provided by an NWBB-based system. Healthy, well-trained professional athletes do not possess the same magnitude of WBA. Inexpensive, portable, and widely available gaming technology may be used to evaluate and improve WBA in clinical and sporting settings.
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Saturday 12 November 2011
Effects of an Interactive Computer Game Exercise Regimen on Balance Impairment in Frail Community-Dwelling Older Adults: A Randomized Controlled Trial
Published online before print - 28 July 2011
Physical Therapy October 2011 vol. 91 no. 10 1449-1462
Tony Szturm, Aimee L. Betker, Zahra Moussavi, Ankur Desai andValerie Goodman
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Physical Therapy October 2011 vol. 91 no. 10 1449-1462
Tony Szturm, Aimee L. Betker, Zahra Moussavi, Ankur Desai andValerie Goodman
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Abstract
Background Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills.
Objectives The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction.
Design This study was a randomized controlled trial.
Setting The study was conducted in a geriatric day hospital.
Participants Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study.
Interventions Participants were randomly assigned to either a control group or an experimental group. The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital. The experimental group received a program of dynamic balance exercises coupled with video game play, using a center-of-pressure position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface, with progression to a compliant sponge pad. Each group received 16 sessions, scheduled 2 per week, with each session lasting 45 minutes. Measurements Data for the following measures were obtained before and after treatment: Berg Balance Scale, Timed “Up & Go” Test, Activities-specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction and Balance, and spatiotemporal gait variables assessed in an instrumented carpet system test.
Results Findings demonstrated significant improvements in posttreatment balance performance scores for both groups, and change scores were significantly greater in the experimental group compared with the control group. No significant treatment effect was observed in either group for the Timed “Up & Go” Test or spatiotemporal gait variables.
Limitations The sample size was small, and there were group differences at baseline in some performance measures. Conclusion Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise. This coupling, in turn, resulted in a greater improvement in dynamic standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.
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Background Due to the many problems associated with reduced balance and mobility, providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills.
Objectives The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging, interactive video game paradigm. The intervention focused on performing targeted dynamic tasks, which included reactive balance controls and environmental interaction.
Design This study was a randomized controlled trial.
Setting The study was conducted in a geriatric day hospital.
Participants Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study.
Interventions Participants were randomly assigned to either a control group or an experimental group. The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital. The experimental group received a program of dynamic balance exercises coupled with video game play, using a center-of-pressure position signal as the computer mouse. The tasks were performed while standing on a fixed floor surface, with progression to a compliant sponge pad. Each group received 16 sessions, scheduled 2 per week, with each session lasting 45 minutes. Measurements Data for the following measures were obtained before and after treatment: Berg Balance Scale, Timed “Up & Go” Test, Activities-specific Balance Confidence Scale, modified Clinical Test of Sensory Interaction and Balance, and spatiotemporal gait variables assessed in an instrumented carpet system test.
Results Findings demonstrated significant improvements in posttreatment balance performance scores for both groups, and change scores were significantly greater in the experimental group compared with the control group. No significant treatment effect was observed in either group for the Timed “Up & Go” Test or spatiotemporal gait variables.
Limitations The sample size was small, and there were group differences at baseline in some performance measures. Conclusion Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise. This coupling, in turn, resulted in a greater improvement in dynamic standing balance control compared with the typical exercise program. However, there was no transfer of effect to gait function.
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Wednesday 2 November 2011
Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series
Journal of Critical Care
Available online 25 September 2011.
Michelle E. Kho PT, PhD, Abdulla Damluji MBChB, MPH , Jennifer M. Zanni PT, MSPT, ScD, Dale M. Needham MD, PhDa
Available online 25 September 2011.
Michelle E. Kho PT, PhD, Abdulla Damluji MBChB, MPH , Jennifer M. Zanni PT, MSPT, ScD, Dale M. Needham MD, PhDa
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Abstract
Background
Early rehabilitation in the intensive care unit (ICU) improves patients' physical function. Despite reports of using commercially available interactive video game systems for rehabilitation, there are few data evaluating feasibility and safety as part of routine in-patient rehabilitation, particularly in the ICU.
Methods
We conducted an observational study from September 1, 2009, to August 31, 2010, of adults admitted to a 16-bed medical ICU receiving video games as part of routine physical therapy (PT), evaluating use and indications and occurrence of 14 prospectively monitored safety events.
Results
Of 410 patients receiving PT in the medical ICU, 22 (5% of all patients; male, 64%; median age, 52 years) had 42 PT treatments with video games (median [interquartile range] per patient, 1.0 [1.0-2.0]). Main indications for video game therapy included balance (52%) and endurance (45%), and the most common activities included boxing (38%), bowling (24%), and balance board (21%). Of 42 treatments, 69% occurred while standing and 45% while mechanically ventilated. During 35 hours of PT treatment, 0 safety events occurred (95% upper confidence limit for safety event rate, 8.4%).
Conclusions
Novel use of interactive video games as part of routine PT in critically ill patients is feasible and appears safe in our case series. Video game therapy may complement existing rehabilitation techniques for ICU patients.
Keywords: Rehabilitation; Critical care; Adults; Mechanical ventilation; Interactive video games Click here for more
Abstract
Background
Early rehabilitation in the intensive care unit (ICU) improves patients' physical function. Despite reports of using commercially available interactive video game systems for rehabilitation, there are few data evaluating feasibility and safety as part of routine in-patient rehabilitation, particularly in the ICU.
Methods
We conducted an observational study from September 1, 2009, to August 31, 2010, of adults admitted to a 16-bed medical ICU receiving video games as part of routine physical therapy (PT), evaluating use and indications and occurrence of 14 prospectively monitored safety events.
Results
Of 410 patients receiving PT in the medical ICU, 22 (5% of all patients; male, 64%; median age, 52 years) had 42 PT treatments with video games (median [interquartile range] per patient, 1.0 [1.0-2.0]). Main indications for video game therapy included balance (52%) and endurance (45%), and the most common activities included boxing (38%), bowling (24%), and balance board (21%). Of 42 treatments, 69% occurred while standing and 45% while mechanically ventilated. During 35 hours of PT treatment, 0 safety events occurred (95% upper confidence limit for safety event rate, 8.4%).
Conclusions
Novel use of interactive video games as part of routine PT in critically ill patients is feasible and appears safe in our case series. Video game therapy may complement existing rehabilitation techniques for ICU patients.
Keywords: Rehabilitation; Critical care; Adults; Mechanical ventilation; Interactive video games Click here for more
Tuesday 1 November 2011
Energy Expenditure and Enjoyment during Video Game Play: Differences by Game Type
Medicine & Science in Sports & Exercise:
October 2011 - Volume 43 - Issue 10 - pp 1987-1993
LYONS, ELIZABETH J.; TATE, DEBORAH F., WARD, DIANNE S.; BOWLING, J. MICHAEL; RIBISL, KURT M.; KALYARARAMAN, SRIRAM
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Abstract
Purpose: Play of physically active video games may be a way to increase physical activity and/or decrease sedentary behavior, but games are not universally active or enjoyable. Active games may differ from traditional games on important attributes, which may affect frequency and intensity of play. The purpose of this study was to investigate differences in energy expenditure and enjoyment across four game types: shooter (played with traditional controllers), band simulation (guitar or drum controller), dance simulation (dance mat controller), and fitness (balance board controller).
Methods: Energy expenditure (METs) and enjoyment were measured across 10 games in 100 young adults age 18-35 yr (50 women).
Results: All games except shooter games significantly increased energy expenditure over rest (P < 0.001). Fitness and dance games increased energy expenditure by 322% (mean ± SD = 3.10 ± 0.89 METs) and 298% (2.91 ± 0.87 METs), which was greater than that produced by band simulation (73%, 1.28 ± 0.28 METs) and shooter games (23%, 0.91 ± 0.16 METs). However, enjoyment was higher in band simulation games than in other types (P < 0.001). Body mass-corrected energy expenditure was greater in normal weight than in overweight participants in the two most active game types (P < 0.001).
Conclusions: Active video games can significantly increase energy expended during screen time, but these games are less enjoyable than other more sedentary games, suggesting that they may be less likely to be played over time. Less active but more enjoyable video games may be a promising method for decreasing sedentary behavior.
©2011The American College of Sports Medicine
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October 2011 - Volume 43 - Issue 10 - pp 1987-1993
LYONS, ELIZABETH J.; TATE, DEBORAH F., WARD, DIANNE S.; BOWLING, J. MICHAEL; RIBISL, KURT M.; KALYARARAMAN, SRIRAM
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Abstract
Purpose: Play of physically active video games may be a way to increase physical activity and/or decrease sedentary behavior, but games are not universally active or enjoyable. Active games may differ from traditional games on important attributes, which may affect frequency and intensity of play. The purpose of this study was to investigate differences in energy expenditure and enjoyment across four game types: shooter (played with traditional controllers), band simulation (guitar or drum controller), dance simulation (dance mat controller), and fitness (balance board controller).
Methods: Energy expenditure (METs) and enjoyment were measured across 10 games in 100 young adults age 18-35 yr (50 women).
Results: All games except shooter games significantly increased energy expenditure over rest (P < 0.001). Fitness and dance games increased energy expenditure by 322% (mean ± SD = 3.10 ± 0.89 METs) and 298% (2.91 ± 0.87 METs), which was greater than that produced by band simulation (73%, 1.28 ± 0.28 METs) and shooter games (23%, 0.91 ± 0.16 METs). However, enjoyment was higher in band simulation games than in other types (P < 0.001). Body mass-corrected energy expenditure was greater in normal weight than in overweight participants in the two most active game types (P < 0.001).
Conclusions: Active video games can significantly increase energy expended during screen time, but these games are less enjoyable than other more sedentary games, suggesting that they may be less likely to be played over time. Less active but more enjoyable video games may be a promising method for decreasing sedentary behavior.
©2011The American College of Sports Medicine
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Abstract
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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