Physical and Affective Physical Literacy Domains Improved After a Six-Week Exergame Exercise Program in Older Adults: A Randomized Controlled Clinical Trial.

Introduction: We investigated the effects of an exergames-based exercise program for older adults, and its benefits on their physical literacy (PL) domains, such as physical (mobility skills), affective (motivation and confidence), cognitive (knowledge about physical activity [PA]), and behavioral (daily exertion) when compared with a conventional exercise program and no training (NT) (control). Material and Methods: Forty older adults (mean age 72 years) volunteered and were randomized within three groups-exergame training (ET; n = 15), conventional training (CT; n = 14), and NT (n = 11). ET group performed training sessions based on a commercially available exergame console, while the CT group enrolled in a convention exercise program (aerobic, strength, balance, and flexibility exercises). The training program was conducted three times a week for 6 weeks. The Timed Up and Go Test (TUG), Exercise Confidence Survey (ECS), Motives for Physical Activity Measure-Revised (MPAM-R), Knowledge and Understanding Questionnaire (K&UQ), and total PA tracking (using wearable technology) were used as the study's outcomes. Outcome variables were measured at preintervention (week 0), postintervention (week 6), and at the time of final follow-up (week 9). Results: We observed a reduction in the ET TUG time at postintervention and follow-up. Also, a significant main effect for group and moment of measurement was observed for the Fitness-Health subscore, derived from MPAM-R. The values demonstrated by ET and CT were statistically different (P = 0.01) and a within-group comparison revealed significant differences in the ET from preintervention to both postintervention and follow-up (both, P = 0.01). We did not observe any other significant difference. Conclusion: Our results suggest that a 6-week exergame-based training program may have the potential in improving the physical and affective domains of PL in community-dwelling older adults. The topics related to fitness and health seem to be of interest in this population and programs can make use of them to improve the PL domains.

The Effects of Nintendo Wii Fit on Postural Balance Control Training in the Geriatric Population: A Review.

Elderly populations who engage in consistent, moderate-intensity exercise are more physically active and have better health than elders who have a sedentary lifestyle. Ageing causes the quality and number of muscle fibres to decline, leaving them with less endurance and ability to effectively work in synchronization and less strength and stamina to support weight or keep a sound body system. Medical practitioners often use the word "balance" across many therapeutic disciplines. Balance is commonly used in conjunction with other ideas like stability and postural control. The capacity of the physiological systems to keep the centre of mass within the base of support during static and dynamic postures and to govern physical alignment in an upright position is known as "balance." Impaired balance has a wide range of effects that can harm physical functionality. Falls in the elderly can result in hip fractures and significant morbidity and mortality. Balance dysfunction is one of the primary reasons behind decreased mobility and postural control in the elderly. It mainly affects the ability to walk and to maintain balance control in everyday life. Virtual reality (VR) can be defined as an interaction model between humans and computers that allows conventional computer-based training. It is a novel and expanding technology combining various characteristics like interactivity, independence, and rehabilitation training. These technologies replicate a seemingly natural environment. A fun and engaging aspect of VR technology is the Wii Fit games. These are enjoyable versions of the fundamental exercise and are widely used. A physiotherapy intervention programme can be structured using Wii Fit games to perform balance exercises. These games are widely used for balance training in the geriatric population.

Nintendo® Wii Therapy Improves Upper Extremity Motor Function in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis.

BACKGROUND: Nintendo® Wii-based therapy (NWT) is a non-immersive virtual reality therapy used to recover upper extremity (UE) motor function in children with cerebral palsy (CP). We aimed primarily to elucidate the effectiveness of NWT in improving UE motor and functional impaired abilities in children with CP, compared to conventional therapy or no intervention. The secondary aim was to assess if NWT is more effective when used alone or combined with conventional therapy. METHODS: A systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science, and CINHAL, ending in October 2021, in accordance with PRISMA guidelines. We included randomized controlled trials that compared NWT vs. conventional therapy or no intervention in terms of their impact on different UE impaired abilities (grip strength, tip grip strength, UE dissociated movements, functional capacity in daily living activities, gross and fine motor dexterity, and grasping ability) in children with CP. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). RESULTS: Nine studies (276 participants) were included. NWT is more effective than conventional therapy at improving grip strength (SMD = 0.5, 95% CI 0.08, 0.91), tip grip strength (SMD = 0.95, 95% CI 0.3, 1.61), and grasping ability (SMD = 0.72, 95%CI 0.14, 1.3). NWT is more effective than conventional therapy at improving functional capacity in daily living activities (SMD = 0.83, 95% CI 0.07, 1.56). For fine manual dexterity, NWT was better than no intervention (SMD = 3.12, 95% CI 1.5, 4.7). CONCLUSIONS: Our results indicate that NWT is effective at improving various UE impaired motor skills in children with CP.

Effectiveness of adding virtual reality to physiotherapeutic treatment in patients with total hip arthroplasty. A randomized controlled trial.

OBJECTIVE: To determine the clinical effectiveness of adding virtual reality via the Nintendo Wii console and its Wii Balance Board to physiotherapy treatment in patients with total hip arthroplasty. DESIGN: Randomized controlled trial. SETTING: Clinical Hospital San Borja Arriaran, Santiago, Chile. PARTICIPANTS: A total of 73 patients over 50 years of age with total hip arthroplasty were randomly allocated to two groups. INTERVENTIONS: The control group (n = 37) received 6 weeks of physiotherapy treatment; the intervention group (n = 36) received the same treatment plus virtual reality exercises with the Nintendo Wii console. OUTCOME MEASURES: The two groups were assessed at baseline and after the 6 weeks of treatment. The primary outcome assessed was the function with the WOMAC questionnaire. The secondary outcomes were the Berg Balance Scale, distance covered with the six-minute walk test, and difference in weight load on the lower extremities. RESULTS: A total of 73 patients, 37 patients in the control group (20 women; mean age of 70.9 ± 9.16 years) and 36 patients in the intervention group (18 women; mean age of 70.39 ± 9.02 years) were analyzed. At the end of the treatment, the difference between groups for the total WOMAC score was -10.4 points (p = 0.00), 4.7 points (p = 0.00) for the Berg Balance Scale, and 45.2 mt (p = 0.00) for the six-minute walk test All differences were in favor of the intervention group. CONCLUSIONS: In the short term, the addition of virtual reality via the Nintendo Wii and its Wii Balance Board platform showed statistically significant differences in the function of patients with total hip replacement, but these differences were not minimally clinically important.Trial registration: This research was registered in the Clinical Trials Registry of Australia and New Zealand, with reference ACTRN12618001252202.

The effect of an exergame on physical activity among older adults residing in a long-term care facility: A pilot study.

BACKGROUND: Older adults who engage in arranged residential video games have the potential to gain health benefits such as increase in physical activity beyond purposeful movement with movement-based games. METHODS: A Nintendo Wii video gaming system was implemented for six-weeks as a physical activity intervention with long-term care residents to determine the impact on exercise benefits/barriers, self-efficacy for exercise, and physical activity levels. RESULTS: Paired t-tests revealed improvement in exercise benefits/barriers, self-efficacy for exercise, and physical activity levels, albeit none with statistical significance (all p > .05). CONCLUSIONS: The use of the Nintendo Wii as an intervention to enhance physical activity for older adults in nursing home residents should be considered for use over a longer duration of time with older adults.

Effectiveness of Nintendo Wii on Balance in People with Parkinson's Disease: A Systematic Review.

The use of exergaming exercises is increasingly becoming accepted as an alternative to surgical and medical therapies for Parkinson's disease (PD). Although the area has attracted some results, there is still no conclusive evidence on the benefit of exergaming exercises in improving PD patients' body balance. The current study is a systematic review aiming at examining the effectiveness of the Nintendo Wii Fit ("Wii Fit") game on improving the balance in people with Parkinson's disease. A total of 200 articles were selected online after conducting an extensive search on PubMed, Cochrane, PEDro, CAPES Periodic, ResearchGate, Web of Science, and ProQuest. Upon reviewing the identified sources, ten articles were included, of which four were randomized control trials. The results show that at least five weeks of Wii Fit exercises effectively enhance PD patients' body balance and life outcomes. However, better results occur when patients combine Wii Fit with other conventional exercises.

Effects of Wii Fit exer-gaming on balance and gait in elderly population: A randomized control trial.

OBJECTIVE: To assess the effect of exer-gaming on balance and gait in the elderly. Methods: The randomised controlled trial was conducted at Kulsum International Hospital, Islamabad, Pakistan, from July to October 2018, and comprised physically independent subjects aged 60 years and above who were randomised into experimental and control groups using concealed envelope method. The cases received exer-gaming for 30 minutes twice a week for 8 weeks, while the controls received balance training exercises twice a week for 8 weeks. Assessment was done at baseline and after 8 weeks of intervention. Outcome measures were assessed with Berg balance scale and the gait abnormality rating scale modified. Data was analysed using SPSS 21. RESULTS: Of the 90 subjects, there were 45(50%) in each of the two groups. The intervention group had better outcome in terms of gait (p<0.05) except for foot contact and shoulder extension (p>0.05), while the difference related to balance was not significant (p>0.05). CONCLUSIONS: Exer-gaming was found to be effective in improving various components of gait in the elderly compared to exercises.

Effect of Wii-habilitation on spatiotemporal parameters and upper limb function post-burn in children.

BACKGROUND: Limb burns can cause different functional disorders that greatly impact one's quality of life. AIM: The purpose of the current study was to compare the effect of Nintendo Wii sports intervention, and traditional treatment methods on spatiotemporal parameters and upper limb function post-burn in children. METHODS: Thirty children their age ranging from 7-12 years, with dominant side upper limb burn participated in the study.Vicon3-D motion analysis system and Jebsen hand function test were used to evaluate spatiotemporal parameters (movement duration, peak velocity, and time to peak velocity percentage in three functional tasks) and upper limb function respectively. The children were randomly divided into study and control groups. The study group was rehabilitated with Wii training in addition to traditional therapy, while the control group rehabilitated only with the traditional therapy program. For the study group, the games selected were Wii Bowling, Baseball, and Tennis. Both groups were trained for 60 min daily, three times/week for six weeks. The outcomes were measured pre and post the treatment period. RESULTS: The whole-time duration and peak velocity improved significantly in the study group across the hand to head task (p = 0.001, p < 0.001, respectively), hand to mouth (p = 0.001), and hand to shoulder (p < 0.001, p = 0.0018, respectively) compared with the control group. The time to peak velocity percentage was enhanced significantly in the study group (p < 0.001) than the control group in all three-measured tasks. Moreover, the Jebsen hand function test improved significantly (p < 0.001) in the study group than in the control group. CONCLUSION: Wii-habilitation could be advised as an effective tool in the rehabilitation program of children with post-burn injuries.

The Nintendo® Wii Fit Balance Board can be used as a portable and low-cost posturography system with good agreement compared to established systems.

BACKGROUND: Almost all epidemiological studies over the past 40 years have determined that the incidence of fragility fractures is increasing. Therefore, the assessment of postural stability and monitoring any progress during balance training for geriatric patients to prevent falls are becoming more important. The Nintendo® Wii Fit Balance Board, with its integrated software and scoring system, might be a cheap and easily accessible tool for this purpose. METHODS: This prospective study analyzed the diagnostic value of the Wii Fit Balance Board in 41 healthy subjects using two measurements: the yoga task "tree," which is performed in one-leg stance; and the balance game "table tilt." Our investigation compared these tasks to two established, regularly used systems, the MFT-S3 Check and the Posturomed, by looking for correlation and agreement, using Bland-Altman plots, as well as for differences to demographic data. All measurement tools were also compared to the Sensory Organization Test-the gold standard for detecting impaired balance. RESULTS: We found a moderate correlation between the yoga exercise "tree" and the Sensory Organization Test (correlation coefficient r = 0.514, p = 0.001) as well as the MFT-S3 Check (r = 0.356-0.472, p = 0.002-0.022) and the Posturomed (r = 0.345, p = 0.027). However, results from the balance game "table tilt" did not show a significant correlation with those of the systems to which we compared it (p = 0.301-0.953). CONCLUSIONS: According to the literature, the raw data from the Wii Fit Balance Board are comparable to that obtained by laboratory-grade force platforms. We have found, however, that the yoga pose "tree," as integrated into the Nintendo® Wii Fit Balance Board with its own scoring system, also correlates with the gold-standard Sensory Organization Test. It also correlates with two frequently used diagnostic and therapeutic devices. We, therefore, conclude that the Wii Fit Balance Board is suitable for the evaluation of postural stability and may be useful in preventing falls among the geriatric population. LEVEL OF EVIDENCE: 2b.

Kinetic data simultaneously acquired from dynamometric force plate and Nintendo Wii Balance Board during human static posture trials.

Data provided with this article are relative to kinetic measures from standing posture trials in eye open and eye closed conditions of 15 healthy subjects, acquired from a dynamometric force plate and a Nintendo Wii Balance Board (NBB). Data have been originally collected for a research project aimed at evaluating the reliability of low-cost devices in clinical scenarios. Raw data from the force plate include three ground reaction force components, center of pressure trajectories and torque around the vertical axis. Raw data from the NBB consist of vertical component of the ground reaction force measured by each of the four device sensors. Processed data consist of synchronized center of pressure time-series from both devices, referred to the force plate reference frame. Data were acquired simultaneously from the devices, allowing a direct comparison between the kinetic measures provided by the gold-standard for posture analysis (dynamometric force plate) and a low-cost device (NBB). Utility of present data can be twofold: first they can be used to assess the overall quality of the NBB signals for posturographic analysis by a direct comparison with the same signals acquired from the gold-standard device for kinetic measurement. Secondly, data from the dynamometric force plate can be used per se to evaluate different kind of parameters useful to assess balance capabilities, also by comparing data from different sensorial conditions (eye open versus eye closed).

Efeitos do tratamento com Yoga e Nintendo Wii no medo de cair e mobilidade de idosos caidores / Effects of yoga and Nintendo Wii treatment, without loss of movement and mobility of the elderly / Efectos del tratamiento de yoga y Nintendo Wii, sin pérdida de movimiento y movilidad de los ancianos

Objetivo: observar o efeito da prática do Yoga e do Nintendo Wii no equilíbrio, redução de quedas e medo de cair de idosos caidores. Método: Foram avaliados 20 idosos divididos em 2 grupos e o treinamento foi feito durante um período de 4 meses. A mobilidade foi avaliada pelo teste Time and Up and Go (TUG). O medo de cair foi avaliado pelo FES-I. Foram adotados testes estatísticos apropriados para a comparação inter e intra-grupo antes e após o treinamento, com p ≤0,05. Resultados: não houve diferença significativa no efeito produzido pela Yoga e Nintendo Wii o medo de quedas e mobilidade. Conclusão: as duas técnicas utilizadas, embora tenham levado a uma redução nos escores médios do medo de cair e da mobilidade de idosos caidores, não diferem significativamente no efeito produzido sobre esses desfechos

Objective: to observe or practice the practice of Yoga and the Nintendo Wii unbalanced, reducing the number of falls and the means of falling from the same falls. Method: They were supported by 20 elderly people divided into 2 groups and training was carried out over a period of 4 months. Mobility was assessed by the Time and Up and Go (TUG) test. My hair was rated FES-I. Appropriate statistical tests were presented for inter- and intra-group comparison before and after, with p ≤0.05. Results: there was no significant difference in effect produced by Yoga and Nintendo Wii or by permanence and mobilization. Conclusion: like the techniques used, this led to a reduction in the average scores of the fall and in the mobility of the fallen people, with no significantly different effect produced on these debris.

Objetivo: observar o practicar desequilibrado la práctica de Yoga y Nintendo Wii, reduciendo el número de caídas y los medios para caer de las mismas caídas. Método: fueron apoyados por 20 personas mayores divididas en 2 grupos y la capacitación se llevó a cabo durante un período de 4 meses. La movilidad se evaluó mediante la prueba Time and Up and Go (TUG). Mi cabello fue calificado FES-I. Se presentaron pruebas estadísticas apropiadas para la comparación inter e intragrupo antes y después, con p ≤0.05. Resultados: no hubo diferencias significativas en el efecto producido por Yoga y Nintendo Wii o por permanencia y movilización. Conclusión: al igual que las técnicas utilizadas, esto condujo a una reducción en los puntajes promedio de la caída y en la movilidad de las personas caídas, sin un efecto significativamente diferente producido en estos desechos.

Effects of the Nintendo Wii training on balance rehabilitation and quality of life of patients with Parkinson's disease: A systematic review and meta-analysis.

BACKGROUND: Randomized clinical trials (RCTs) used the Nintendo Wii (NW) in the treatment of Parkinson Disease, however, no meta-analysis was developed to determine the effects in these patients. OBJECTIVE: To analyze RCTs that investigated the effects of NW versus traditional physiotherapy on balance rehabilitation and quality of life of patients with PD. METHODS: Electronic research was conducted between December 2018 and January 2019 in the MEDLINE, PEDro, CENTRAL, LILACS and SciELO databases. The methodological quality was evaluated by the PEDro scale and the completeness of the description of the interventions by the TIDieR checklist. Weighted mean differences (WMD) and 95% confidence interval (CI) were calculated. RESULTS: Five studies were included and presented an average of 5.4 (1.5) on the PEDro scale and 6.7 (1.4) on the TIDieR. Compared to traditional physiotherapy, combined NW and traditional physiotherapy resulted in improvement in balance WMD 1.24 (95% CI: CI: 0.2 to 2.3 N = 72) and quality of life WMD- 8.9 (95% CI: -15.2 to -2.6 N = 56). CONCLUSION: combined NW and traditional physiotherapy was more effective on balance rehabilitation and quality of life of patients with PD, but the values demonstrated a poor methodological quality and a low level of completeness of the intervention descriptions.

Efeito de um plano de exercícios na plataforma wii no equilíbrio da pessoa com paralisia cerebral / Effect of a wii platform exercise plan on balance in people with cerebral palsy

A Paralisia Cerebral resulta de uma anomalia ou lesão não-progressiva das vias motoras ocorrida no cérebro em desenvolvimento. As manifestações clínicas surgem ao longo do tempo e uma das que afeta a sua qualidade de vida é a alteração do equilíbrio. A plataforma Nintendo Wii, por ser de fácil utilização e apresentar uma grande oferta de jogos, foi integrada em programas de reabilitação em pessoas com deficiências físicas e disfunções neuromotoras podendo ser utilizada para melhorar o equilíbrio das pessoas com Paralisia Cerebral, melhorando assim a sua qualidade de vida. Foi realizado um estudo quasi-experimental com o objetivo de avaliar o efeito de um programa de exercícios na plataforma Wii na melhoria do equilíbrio da pessoa com Paralisia Cerebral. Foi utilizado um formulário para caraterização sociodemográfica, a Escala de Equilíbrio de Berg, o Timed Up and Go e feita a avaliação do centro de gravidade na Balance Board da Nintendo Wii. A intervenção foi realizada durante 2 meses na plataforma Wii com 2 sessões por semana com duração de 30 minutos. Participaram no estudo 21 pessoas com Paralisia Cerebral com média de idade de 35 anos das quais 67% são homens. A maioria (12) não sabe ler nem escrever, 38,1% são obesos e 23,8% têm sobrepeso. Os resultados da aplicação da Escala de Equilíbrio de Berg mostra que 2 pessoas mantiveram a pontuação máxima, uma pessoa desceu ligeiramente e 18 pessoas registaram um aumento da pontuação após a intervenção. Quanto ao centro de gravidade 61,9% (13) melhoraram e no Timed Up and Go também houve uma melhoria significativa passando de 9.4 segundos inicialmente para 6.5 segundos no final da intervenção. Conclui-se que houve uma melhoria significativa no equilíbrio das pessoas com Paralisia Cerebral que participaram no estudo.

Cerebral Palsy results from an anomaly or non-progressive motor pathway injury in the developing brain. Clinical manifestations arise over time and one of those that affects their quality of life is the altered balance. The Nintendo Wii platform for being easy to use and presenting a large range of games was integrated into rehabilitation programs for people with physical disabilities and neuromotor dysfunctions and can be used to improve the balance of people with Cerebral Palsy thus improving their quality of life. A quasi-experimental study was carried out to evaluate the effect of an exercise program on the Wii platform in improving the balance of the person with Cerebral Palsy. We used a form for sociodemographic characterization, the balance scale of Berg, the Timed Up and Go and the evaluation of the center of gravity on the Balance Board of Nintendo Wii for balance assessment. The intervention was performed for 2 months on the Wii platform with 2 sessions per week lasting 30 minutes. The study involved 21 people with a mean age of 35 years, 67% of whom were men. Most (12) do not know how to read or write and 38.1% are obese and 23.8% are overweight. The results of the balance scale of Berg application show that 2 people maintained the maximum score, 1 person went down slightly and 18 people registered an increase in the score after the intervention. Regarding the center of gravity, 61.9% (13) improved and in the Timed Up and Go test there was also a significant improvement from 9.4 seconds initially to 6.5 seconds at the end of the intervention. It was concluded that there was a significant improvement in the balance of the people with Cerebral Palsy who participated in the study.

Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke.

BACKGROUND: Stroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group. METHODS: A pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups. RESULTS: At the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group. CONCLUSIONS: The results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.

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.

Reference data on hand grip and lower limb strength using the Nintendo Wii balance board: a cross-sectional study of 354 subjects from 20 to 99 years of age.

BACKGROUND: Accurate assessment of isometric hand grip strength (HGS) and isometric lower limb strength (LS) are often limited to specialized clinics due to high costs and need for specialized equipment and personnel. A mobile and user-friendly device would facilitate a wider use of these measures in the clinical setting. The Nintendo Wii Balance Board (WBB) is a novel and pragmatic tool that has been validated for measuring muscle strength and other clinically relevant physiological variables. However, reference data for HGS and LS are lacking. The purpose of the current study is to establish reference data for HGS and LS in individuals ≥20 years of age using the WBB method, and to characterize the effects of age in these measurements. METHOD: Healthy participants were recruited at various locations and their HGS and LS were tested by six assessors using the WBB. Reference data were analysed and presented in age-groups, while the age-related change in HGS and LS was tested and characterized with linear regression models. RESULTS: Three hundred and fifty-four participants between 20 and 99 years of age were tested. Data are presented separately according to gender and the following age categories: 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80+, and presented in absolute values as well as percentiles. The main findings were; (1) Significantly higher HGS and LS among males compared to females and for the dominant limb compared to the non-dominant limb, (2) a significant decline in strength with increasing age, and (3) the rate of decline increased significantly (i.e. it was non-linear) with age for HGS, but not for LS. CONCLUSION: This study reported reference data with percentiles for a novel method for assessing HGS and LS. Data were consistent with previously known effects of age and gender on HGS and LS. The presented data may supplement future trials using the WBB in research or in the clinical setting.

The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial.

PURPOSE: Virtual reality (VR) training, a virtual environment commonly generated by computer systems, may enhance the therapeutic efficacy of functional rehabilitation programmes. The aim of this study was to investigate the efficacy of a VR assisted intervention (VRAI) versus traditional rehabilitation intervention (TRI) on functional ankle instability (FAI). METHODS: A single-blind randomized controlled study was conducted with 10 subjects for each group. The VRAI was conducted with the Nintendo Wii Fit Plus, whilst the TRI was conducted with a series of exercises with theraband. The muscle strength change of the two groups and the difference between pre and post interventions for each group were compared. RESULTS: The VRAI group had less improvement in the muscle strength of all ankle motions than did the TRI group (p > .05). The VRAI group had a greater improvement in muscle strength of plantar flexion than other motions, whilst the TRI group had an improvement in muscle strength of all ankle motions (p < .05). CONCLUSIONS: The effects of VR training for the condition of FAI were not comparable to conventional training. However, VR training may be added to the conventional training programme as an optional for the condition of FAI. Implications for Rehabilitation Functional ankle instability (FAI) is subjective feelings of ankle instability resulting from proprioceptive and neuromuscular deficits in which individuals may experience "giving way" condition of the ankle. Therapeutic applications of virtual reality (VR) may be comparable to traditional rehabilitation interventions (TRI) in the rehabilitation of individuals with FAI. However, there is no definitive evidence for the issue. Integrating low-cost VR into functional rehabilitation programme can provide insight into an issue of whether it can be replaced with traditional therapeutic approaches. Although, the efficacy of VR application on strengthening muscles is unable to compare to traditional strengthening programmes, it may be considered an optional treatment based on the proprioceptive improvements.

Motor intervention with and without Nintendo® Wii for children with developmental coordination disorder: protocol for a randomized clinical trial.

BACKGROUND: Despite the benefits highlighted by motor interventions based on virtual reality for children with Developmental Coordination Disorder (DCD), there are still doubts as to whether these are greater than those obtained with conventional interventions due to the absence of systematized protocols, and lack of evidence. Here, we present a protocol to systematically compare the effects of two motor-training programs (one Nintendo® Wii-based and the other no-Wii motor activities) on the motor learning in children with DCD. METHODS/DESIGN: Two intervention protocols (one based on Nintendo® Wii and the other no-Wii motor activities) will be carried out, with interventions occurring twice a week in 60-min sessions, with a minimum of 12 and a maximum of 16 sessions per child. The protocols were developed based on the domains of the Movement Assessment Battery for Children - Second Edition (MABC-2) (Manual Dexterity, Aiming and Catching, Balance), with two activities for each of the MABC - two domains. The study will include children aged 7 to 10 years with a total MABC-2 score ≤ 16, and a Developmental Coordination Disorder Questionnaire (DCDQ) score < 46 (age of 7 years), score < 55 (age group of 8 to 9 years and 11 months), or score < 57 (age of 10 years) as scored by the parents. Children will be randomly allocated by draw in one of the two intervention protocols. MABC-2 and DCDQ will be applied before and after intervention to evaluate the effects of the interventions on motor performance and parents' perception, respectively. Motor learning will be assessed by means of the scores obtained in the games. Evaluators and therapists will be trained and evaluators will be blind regarding the data of the children in the study. DISCUSSION: Owing to its motivating aspects, training with Nintendo® Wii may be particularly beneficial for children with DCD. The results of this study protocol should help researchers and therapists to better understand the benefits of Nintendo® Wii-based motor intervention over those obtained with no-Wii interventions in children with DCD. It should also create references about more systematized protocols for replication in clinical practice, seeking the improvement of the motor components of these children. TRIAL REGISTRATION: RBR-89ydgj.

Efficacy of Virtual Reality in Upper Limb Rehabilitation in Patients with Spinal Cord Injury: A Pilot Randomized Controlled Trial.

STUDY DESIGN: Pilot randomized controlled trial. PURPOSE: To compare the efficacy between virtual reality intervention (using Nintendo Wii) along with conventional occupational therapy and conventional occupational therapy alone in improving upper limb function in patients with spinal cord injury (SCI). OVERVIEW OF LITERATURE: The use of virtual reality has gained importance in the rehabilitation sector over the last few years. Nintendo Wii has the potential to encourage upper limb function while engaging in an interesting activity, which is important in long-term interventions, such as the treatment of SCI. METHODS: Overall, 22 patients with SCI participated in the study. They were randomly assigned to two groups. Group I received 30 minutes of virtual reality intervention (using Nintendo Wii) and 30 minutes of conventional therapy, whereas group II received conventional therapy only for 30 minutes. Both groups received therapy 3 days a week for 4 weeks. One hand of each patient was identified as the target hand based on the inclusion criteria. All patients were assessed at baseline, 2 weeks and 4 weeks (post-intervention), and 6 weeks (follow-up). The functional ability of the target hand was assessed using the Capabilities of Upper Extremity (CUE) questionnaire. Gross motor dexterity was assessed using the Box and Block Test (BBT). The level of independence in activities of daily living was assessed by the Spinal Cord Independence Measure-Self Report and quality of life by the World Health Organization Quality of Life-BREF. RESULTS: After 4 weeks of intervention, there was no significant difference in improved hand function between the groups. Mean scores were higher for group I than for group II, with a higher percent change (31.5% in CUE questionnaire and 51.7% in BBT) in group I. CONCLUSIONS: Virtual reality along with conventional therapy produces similar results in upper limb function as does conventional therapy alone.

Home-based balance training using Wii Fit™: a pilot randomised controlled trial with mobile older stroke survivors.

BACKGROUND: Several studies have reported that using the Wii™ Balance Board can provide added value regarding balance (re-)training in neurological diseases. However, for the large group of mobile older stroke survivors, there is no evidence regarding the feasibility of an unsupervised Wii™ Balance Board training in the home setting. The aim of this study was to investigate the feasibility of a home-based Wii™ balance training for these patients and to identify methodological challenges for randomised controlled trials in the future. METHODS: We conducted a pilot randomised controlled trial with two intervention arms in participants' homes. Mobile stroke survivors (aged 60 years or above; 12 weeks after discharge from hospital) received a 6-week (once per week) supervised balance training at the study centre, followed by a 6-week (three times per week) unsupervised balance training at home. We used the Nintendo Wii™ Balance Board for one intervention arm and conventional balance exercises for the other intervention arm. Feasibility was assessed by recruiting rates, appropriateness of assessments regarding sensitivity to changes and acceptance of the intervention by the participants. RESULTS: In two German hospital stroke units, 349 stroke survivors were screened over a period of 6 months, 91 were eligible and 52 were interested. Twelve weeks after discharge, 14 participants agreed and 11 completed the intervention (7 men and 4 women, mean age 74 years). The Berg Balance Scale and Dynamic Gait Index showed ceiling effects already at baseline measure. The participants in both intervention arms evaluated the unsupervised training positively and feasible for self-application. No falls or injuries occurred over the intervention period, while the required scope of the exercises could largely be achieved. CONCLUSIONS: In this pilot study, the recruitment of participants and the chosen assessments were not satisfactory due to selection bias and corresponding ceiling effects. However, the two home-based balance interventions proved feasible for mobile older stroke survivors with low functional limitations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02251470. Registered 29 September 2014.