Effects of a Nintendo Wii exercise program versus Tai Chi Chuan on standing balance in older adults: a preliminary study.

[Purpose] This study compared the effect of the Nintendo Wii balance board (NWBB) and Tai Chi Chuan (TCC) on the standing balance (SB) of older adults. [Participants and Methods] Twelve older adults (NWBB=7 and TCC=5) completed the intervention and two testing sessions (pre-post). SB was assessed using posturographic measures with the center of pressure (CoP) in five modes: quiet eyes open (QSB-EO) and eyes closed (QSB-EC), on sponge (SBS-EO and SBS-EC), and with optokinetic field (SB-OF). [Results] Both interventions significantly decrease the area of CoP sway (CoPSway) in QSB-EO and SB-OF. The NWBB-group decreased CoPSway in SBS-EC and CoP velocity (Vmean) in QSB-EO, QSB-EC, and SBS-EC. The TCC-group decreased the Vmean in SBS-EO and conversely the Vmean in QSB-EC increased. [Conclusion] Sponge and optokinetic field were the most unstable assessments. These findings reveal the potential benefits for SB of both interventions, however the NWBB improved more variables in the postural control of older adults.

Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial.

OBJECTIVE: To establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy-spastic hemiplegia. It also aims to compare the effectiveness of this programme under two delivery modalities, telerehabilitation (TR) and face-to-face (FtF). METHODS: This is a registered randomized controlled clinical trial protocol (ACTRN12621000117819). Eighteen sessions of low-cost virtual reality therapy will be provided through both, FtF and TR modalities using a Nintendo Wii balance board. Each programme will last for 6 weeks and will consist of 3 sessions per week of 25 minutes each. Twenty patients diagnosed with cerebral palsy-spastic hemiplegia will be recruited for each group: FtF or TR (n = 40). Participants will be assessed at baseline, by the end of weeks 2, 4, and 6, and at weeks 8 and 10 (post-intervention follow-ups). The primary outcome will be the Center of Pressure sway area (CoParea); secondary outcomes will be standard deviation and velocity of the CoP in the mediolateral and anterior-posterior directions; tertiary outcomes will include the Modified-Modified Ashworth Scale for lower limbs, Modified Ashworth Scale for upper limbs, timed up-and-go tests, the timed one-leg standing and 6-minute walk test. RESULTS: This study provides an assessment of the feasibility and effectiveness of an affordable rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy. CONCLUSION: The designed rehabilitation programme using low-cost virtual reality may improve postural control in children with cerebral palsy-spastic hemiplegia. The TR modality is likely to be as effective as the FtF modality. The TR programme has been designed to overcome access barriers to physiotherapy services for children with cerebral palsy in low-resource settings, remote areas, and in restricted mobility contexts.

Does Nintendo Wii Balance Board improve standing balance? A randomized controlled trial in children with cerebral palsy.

BACKGROUND: Evidence on the effect of systemic exercise programs to improve the standing balance with the Nintendo Wii system is very limited and its post-treatment effectiveness is unknown in cerebral palsy (CP) patients. AIM: Primary aim was to compare the effect of Nintendo Wii balance board (Wii-therapy) and standard physiotherapy (SPT), on the performance of standing balance in children and adolescents with CP. Secondary aim was to determine the post-treatment effectiveness of Wii-therapy and SPT. DESIGN: Two-arm, matched-pairs, parallel-groups, randomized, controlled clinical trial. SETTING: Outpatient Rehabilitation Centre in the city of Talca. POPULATION: Patients with CP type spastic hemiplegia (SHE) and spastic diplegia (SDI), aged 7 to 14 years, and level I or II of GMFCS or GMFCS-ER. Were excluded patients with FSIQ<80, epilepsy, previous surgeries and application of Botulinum Toxin-A in the lower limb, uncorrected vision and hearing disorders. METHODS: Thirty-two CP patients (10.7±3.2 years old) were randomly assigned to either Wii-therapy (SDI=7; SHE=9) or SPT intervention (SDI=7; SHE=9). In each group, patients received three sessions per week over a period of 6 weeks. Standing balance was assessed at baseline and every 2 weeks. Additionally, two follow-up assessments (4 additional weeks) were performed to determine post-treatment effectiveness. Standing balance was quantified on force platform obtaining the outcomes area of center-of-pressure (CoP) sway (CoPSway), standard deviation in the medial-lateral (SDML) and the anterior-posterior (SDAP) directions, and velocity in both directions (VML and VAP). RESULTS: Compared to SPT, Wii-therapy significantly reduced the CoPSway (P=0.02) and SDAP in the eyes-open condition (P=0.01). However, the effects wane after 2-4 weeks. Post-hoc analysis revealed that only SHE children benefited from Wii-therapy. CONCLUSIONS: Wii-therapy was better than SPT in improving standing balance in patients with CP, but improves the balance only in SHE patients. Also, Wii-therapy effectiveness waned 2-4 weeks after the end the intervention. CLINICAL REHABILITATION IMPACT: A systematic exercise program like Wii-therapy using the Nintendo Wii Balance Board device can be considered to improves the standing balance in patients with CP, specifically in the SHE type. This program is easy to transfer to physiotherapists and rehabilitation centers.

Effectiveness of a Nintendo Wii balance board exercise programme on standing balance of children with cerebral palsy: A randomised clinical trial protocol.

BACKGROUND: Patients with cerebral palsy (CP) typically receive limited physical therapy services. However, the Nintendo Wii system offers a simple and affordable mode of virtual reality therapy. There are no clinical trials assessing the Nintendo Wii balance board for improving standing balance in CP. METHODS: This randomised clinical trial will evaluate the effectiveness of an 18-session/six-week protocol using Wii therapy (W-t) compared with conventional therapy (C-t) in Chilean CP patients. The C-t group will perform the typical exercises prescribed by physical therapists for 40 min each session. W-t will consist of a virtual reality training session using the Nintendo Wii balance board console for 30 min each session. The primary outcome variable is the area of centre-of-pressure (CoP) sway (CoPSway). The secondary outcomes are the standard deviation (SDML; SDAP) and velocity (VML; VAP) of CoP in the ML and AP directions. For a mean difference of 21.5 cm2 (CoPSway) between the groups, we required a minimum of 16 participants in each group. Data will be collected at baseline (week 0), during the study (weeks 2 and 4), at the end of the study (week 6), and during the follow-up (weeks 8 and 10). Measurements of postural control during quiet standing for both groups will be assessed on a force platform AMTI OR67. DISCUSSION: This is the first trial that measures and compares the effects of a Nintendo Wii Balance Board exercise programme on standing balance in children with cerebral palsy compared to conventional therapy.

Cuantificación del balance en la posición de pie en una población de adultos mayores y niños chilenos / Quantification of standing balance in an elderly population and in children in Chile

Objetivo: cuantificar las diferencias en la excursión del centro de presión (COP) en una población de adultos mayores y una de niños. Materiales y métodos: el diseño del estudio fue un corte transversal. Se obtuvo una muestra por conveniencia de 38 adultos mayores y 20 niños. Los parámetros obtenidos desde la plataforma de fuerza fueron: área y velocidad promedio del COP, y las bandas de frecuencia (0,0625; 0,125; 0,25; 0,5; 1; 2 y 4 Hz). Resultados: la evaluación del balance de pie en ausencia del sistema visual evidenció diferencias significativas en las variables área y velocidad promedio de desplazamiento del COP. El grupo de niños genera una mayor área del COP durante la prueba que el de adultos mayores (p = 0,009). Sin embargo, los ajustes posturales en los niños son mucho más rápidos que en el grupo de edad más viejo (p = 0,002). Conclusiones: en ausencia del sistema visual, el grupo de adultos mayores presentó una menor área y velocidad de ajuste postural que el grupo más joven. Este último grupo utilizó los sistemas somatosensorial y vestibular para mantener el balance de pie.

Objective: To quantify the differences in the trajectory of the center of pressure (COP) in an elderly population and a group of children. Methods: This was a cross-section study for which a convenience sample of 38 elderly adults and 20 children was obtained. The parameters studied were: area and average speed of excursion of the COP, and the frequency bands (0.0625; 0.125; 0.25; 0.5; 1, 2 y 4 Hz). Results: During the standing balance evaluation in the absence of the visual system, there are significant differences in the area and average velocity of the COP. The group of children generates much more area of COP during the test than the elder group (p = 0.009). However, postural adjustments in children are faster than those of the older group (p = 0.002). Conclusions: In the absence of the visual system, the elderly group had lower area and speed of postural adjustment than the younger group. The latter group used the vestibular and somatosensory systems to maintain standing balance.