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Wii game and balance training

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  • 1. Wii Games and Balance Training in Stroke & Parkinson Disorder. Prepared by Sweta Christian PT, DPT. DoctorofPhysiotherapy@Gmail.com www.DoctorofPhysiotherapy.Wordpress.com www.ArdentPT.com
  • 2. Parkinson's Gait Abnormalilties A person Parkinson's shows various gait abnormalities and have increased risk to fall related injuries. The following are the gait abnormalities noted in Parkinson's Disorder . The person represents a propulsive posture with the neck bending forward. Scissor like gait patterns are noted with toe-heel gait. Waddling gait or duck like gait is noted. Increase in the muscle tone/spasticity is present leading to toe dragging. Due to forward bending posture the center of gravity is shifted forward increasing the risk of fall related injuries. Picture credit:Wikipedia.
  • 3. Purpose • The main purpose of this presentation is to analyse the effectiveness ofWii games in improving the balance and co-ordination in individuals with balance and gait problems. • Through this presentation we are going to follow up with some basic ideas on how to improve balance in older adults with gait related disorders.We picked balance disorder seen in Parkinson's, stroke, muscular dystrophies ,neuropathies, replacement surgeries and vestibular disorders.
  • 4. BalanceTests • Before proceeding one should make sure to check the balance and co-ordination of the older adults using the following tests. • 1) Berg Balance Scale. • 2)Timed up and Go test • 3)Test forVertigo • 4) Physical Activity Employment scale • 5) Optional: RockportTest
  • 5. Research Study Case-study 1-Wii game for Balance improvement Participants • A total of 7 older adults with a Berg scale of <52 and aged 84 were selected from the continuing care retirement committee for this study (Agmon, Perry, Phelan, Demiris and Nguyen, 2011).The participants were tested based on the physical activities, balance and co-ordination before initiating the study. Results and Conclusion • During the study the participants played varied Wii games such as Basic step, soccer heading, ski slalom and table tilt. The participants were instructed and trained how to play (sessions: 31 minutes) (Agmon et al., 2011). • Results of the study showed increased in the Berg Balance scale from 49 (2.1) to 53 (1.8) and increased in the walking speed from 1.04 to 1.33 miles/second. • Conclusion: Using theWii Fit games with supervised balance training at home is safe and feasible for older adults having balance and co-ordination problems (Agmon et al., 2011).
  • 6. Research Study Case-study 2--Wii Nintendo for Balance & Gait improvements. Participants • Franco, Jacobs, Inzerillo and Kluzik (2012) performed a pilot study to evaluate the effectiveness of NintendoWii games for balance programs. • 32 residents from the senior living facility between the age of 63-90 participated in this program. • Participants were separated in three groups • 1)Wii Fit--(N=11) only for balance games with home exercises supplements. • 2) Matter of Balance group--Complete exercise of Matter of balance program (n=11) • 3) control group--- group with no intervention at all (n=10). (Franco et al., 2012). Results and Conclusion • One-wayAnova test was performed. • Results did not show significant increase in the Berg andTinetti Gait scale. (Franco et al., 2012). • AlthoughWii Nintendo did not produce effective results, it was noted that the older population enjoyed playing theWii game which MIGHT further help in balance and co-ordination improvement.
  • 7. Research Study Case-Study 3--Use of Wii-Fit Nintendo to improve gait fear, risk of fall, aerobic capacity and balance in individuals with lower limb amputation Participants • Two participants were selected: 1) 62 year old male 32 months post traumatic transfemoral amputation reported fear of fall and restrictions in theActivities of daily living (ADL). • 2) 58 year old male 9 years post transfemoral amputation reported limited energy and balance during walking and gait activities (Miller, Hayes, Dye, Johnson and Meyers, 2012). Results and Conclusion • Intervention program included: 6 weeks of 2 supervised session per week for 20 mins on Nintendo and 20 mins of gait training using body weight support( Miller et al., 2012) • Conclusion: Participants demonstrated increase in dynamic balance, balance confidence, economy of movement and spatio-temporal parameters of gait (Miller et al., 2012).
  • 8. Research Study Case-study 3--- Use ofWii-Nintendo in total-knee replacement outpatient rehabilitation. Participants • 17 males and 33 females with the mean age of 68 years were selected for the study (Fung, Shaffer, Chung and Gomez, 2012). Results and Conclusion • The game of 15 minutes session encouraged multidirectional weight shifting and lateral shifting and provided positive reinforcement and visual bio-feedback (Fung et al., 2012). • However, further research is needed to evaluate its effectiveness in outpatient rehabilitatin (Fung et al., 2012).
  • 9. Conclusion • In each case-study we tried to evaluate the effectiveness ofWii game based on balance, amputation, gait disorder and outpatient therapy. • Depending upon the patient's symptoms and balance Wii-game can be proved beneficial for the individual in improving the balance and gait co-ordination. • It is necessary to imply that Wii games should be practiced and prescribed based upon the person's abnormality. • Key-points that should be kept in mind is to evaluate the balance/co-ordination and other tests before allowing the participant to indulge inWii-Fit games. • All the Wii-fit games for older adults should be supervised and proper guidance should be provided.
  • 10. References • Agnom, M., Perry, C.K., Phelan, E., Demiris, G., & Nguyen, H.Q. (2011). A pilot study ofWii Fit exergames to improve balance in older adults. J Geriatr Phys Ther.2011 Oct-Dec;34(4):161-7. • Franco, J.R., Jacobs, K., Inzerillo, C., & Kluzik, J. (2012).The effect of Nintendo Wii- Fit and exercise in improving balance and quality of life in community dwelling elders.Technol Healthcare. 2012;20(2):95-115. • Miller, C.A., Hayes, D.M., Dye, K., Johnson, C., & Meyers, J. (2012).Using the Nintendo Wii-Fit and BodyWeight Support to improve aerobic capacity, balance, gait ability and fear of falling: two case reports. J Geriatr PhysTher.2012 April- June;35(2):95-104. • Fung,V., Ho, A., Shaffer, J., Chung, E., & Gomez, M. (2012). Use of Nintendo Wii-Fit in the rehabilitation of outpatients following total knee replacements. Physiotherapy. 2012 Sep;98(3):183-8.
  • 11. Copyrights • This presentation is strictly for educational use only. • Content of this presentation should not be reproduced or altered without the permission of the author. • You are free to use it and share it with proper attributions. • All rights reserved (R): Sweta Christian PT, DPT. • http://www.ardentpt.com • http://www.doctorofphysiotherapy.wordpress.com • If you need to contact: Email: Doctorofphysiotherapy@Gmail.com • ThankYou.