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Concept: Wii Menu


OBJECTIVE: The purpose of this study is to assess the effect of exercise training using the Nintendo Wii Fit videogame and balance board system on balance and gait in adults with Parkinson Disease (PD). DESIGN: Prospective Interventional Cohort Study. SETTING: Outpatient group exercise class. PARTICIPANTS: 10 subjects with PD, Hoehn and Yahr Stages 2.5 or 3, with a mean age of 67.1 years; 4 men, 6 women. INTERVENTIONS: Subjects participated in supervised group exercise sessions 3 times per week for 8 weeks, practicing three different Wii balance board games (marble tracking, skiing and bubble rafting) adjusted for their individualized function level. Subjects trained for 10 minutes per game, a total of 30 minutes training per session. MAIN OUTCOME MEASURES: Pre-and post-exercise training, a physical therapist evaluated subjects' function using the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Sharpened Romberg with eyes open and closed. Postural Sway was assessed at rest and with tracking tasks using the Wii balance board. Subjects rated their confidence in balance using the Activities-specific Balance Confidence (ABC) scale and depression on the Geriatric Depression Scale (GDS). RESULTS: Balance as measured by the BBS improved significantly, with an increase of 3.3 points (p = .016). The DGI improved as well (mean increase 2.8, p = .004), as did postural sway measured with the balance board (decreased variance in stance with eyes open by 31%, p = .049). Though the Sharpened Romberg with eyes closed increased by 6.85 points and with eyes opened by 3.3 points, improvements neared significance only for eyes closed (p = .07 versus p = .188). There were no significant changes on patient ratings for the ABC (mean decrease -1%, p = .922) or the GDS (mean increase 2.2, p = .188). CONCLUSIONS: An 8-week exercise training class using the Wii Fit balance board improved selective measures of balance and gait in adults with PD. However, no significant changes were seen in mood or confidence regarding balance.

Concepts: Wii, Nintendo, Wii Balance Board, Wii Fit, Wii Menu, Wii Play, History of video game consoles, Wii Remote


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.

Concepts: Wii, Nintendo, Wii Balance Board, Wii Menu, Shigeru Miyamoto, Wii Play, Nintendo GameCube, Video game console


The aim of this study was to examine differences in the performance of children with probable Developmental Coordination Disorder (p-DCD) and balance problems (BP) and typical developing children (TD) on a Wii Fit task and to measure the effect on balance skills after a Wii Fit intervention. Twenty-eight children with BP and 20 TD-children participated in the study. Motor performance was assessed with the Movement Assessment Battery for Children (MABC2), three subtests of the Bruininks Oseretsky Test (BOT2): Bilateral Coordination, Balance and Running Speed & Agility, and a Wii Fit ski slalom test. The TD children and half of the children in the BP group were tested before and after a 6weeks non-intervention period. All children with BP received 6weeks of Wii Fit intervention (with games other than the ski game) and were tested before and afterwards. Children with BP were less proficient than TD children in playing the Wii Fit ski slalom game. Training with the Wii Fit improved their motor performance. The improvement was significantly larger after intervention than after a period of non-intervention. Therefore the change cannot solely be attributed to spontaneous development or test-retest effect. Nearly all children enjoyed participation during the 6weeks of intervention. Our study shows that Wii Fit intervention is effective and is potentially a method to support treatment of (dynamic) balance control problems in children.

Concepts: Assessment, Wii, Wii Balance Board, Wii Fit, Wii Menu, Shigeru Miyamoto, Wii Play, Slalom skiing


The Nintendo Wii Fit was released just over five years ago as a means of improving basic fitness and overall well-being. Despite this broad mission, the Wii Fit has generated specific interest in the domain of neurorehabilitation as a biobehavioral measurement and training device for balance ability. Growing interest in Wii Fit technology is likely due to the ubiquitous nature of poor balance and catastrophic falls, which are commonly seen in older adults and various disability conditions. The present review provides the first comprehensive summary of Wii Fit balance research, giving specific insight into the system’s use for the assessment and training of balance. Overall, at the time of the fifth anniversary, work in the field showed that custom applications using the Wii Balance Board as a proxy for a force platform have great promise as a low cost and portable way to assess balance. On the other hand, use of Wii Fit software-based balance metrics has been far less effective in determining balance status. As an intervention tool, positive balance outcomes have typically been obtained using Wii Fit balance games, advocating their use for neurorehabilitative training. Despite this, limited sample sizes and few randomized control designs indicate that research regarding use of the Wii Fit system for balance intervention remains subject to improvement. Future work aimed at conducting studies with larger scale randomized control designs and a greater mechanistic focus is recommended to further advance the efficacy of this impactful neurorehabilitation tool.

Concepts: Wii, Nintendo, Wii Balance Board, Wii Fit, Wii Menu, Shigeru Miyamoto, History of video game consoles, Wii Remote


BACKGROUND:: Two prevalent unmet supportive care needs reported by the non-small cell lung cancer (NSCLC) population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Yet, there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy. OBJECTIVE:: The objective of this study was to evaluate the feasibility, acceptability, safety, and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue (CRF) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home. INTERVENTIONS/METHODS:: Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management, a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus. Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks. RESULTS:: The intervention positively impacted end points such as CRF severity; perceived self-efficacy for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercises); and functional performance (number of steps taken per day). CONCLUSIONS:: A home-based, light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. IMPLICATIONS FOR PRACTICE:: Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention. Next steps include testing of this health-promoting self-management intervention in a larger-scale randomized controlled trial.

Concepts: Cancer, Lung cancer, Non-small cell lung carcinoma, Randomized controlled trial, Wii, Wii Balance Board, Wii Fit, Wii Menu


To determine the effectiveness of vestibular rehabilitation using the Wii Fit balance platform, in adults with dizziness.

Concepts: Wii, Wii Balance Board, Wii Fit, Wii Menu, Shigeru Miyamoto, Wii Play, Game controller, Super Mario Bros.


Children with Developmental Coordination Disorder (DCD) are physically less active, preferring more sedentary behavior and are at risk of developing health problems or becoming overweight. 18 children (age 6-10years) with lower levels of motor coordination attending a primary school in a low-income community in South Africa (score on Movement Assessment Battery for Children Second edition equal to or below the 5th percentile) were selected to participate in the study and were age-matched with typically developing peers (TD). Both groups of children engaged in 20min of active Nintendo Wii Fit gaming on the balance board, twice a week for a period of five weeks. All children were tested before and after the intervention using the lower limb items of the Functional Strength Measurement, the 5×10 meter sprint test, the 5×10 meter slalom sprint test, and the Balance, Running speed and Agility subtest of the Bruininks Oseretsky Test of Motor Proficiency 2nd edition (BOT-2). After intervention, both groups of children improved in functional strength and anaerobic fitness. The magnitude of these changes was not related to participant’s motor coordination level. However, differences in change between the TD and DCD group were apparent on the motor performance tests; children with DCD seemed to benefit more in balance skills of the BOT-2, while the TD children improved more in the Running speed and Agility component of the BOT-2. Compliance to the study protocol over 5weeks was high and the effect on physical functioning was shown on standardized measures of physical performance validated for children with and without DCD.

Concepts: Motor control, Test method, Running, Sprint, Wii, Wii Balance Board, Wii Fit, Wii Menu


The use of exergame for balance competencies was recently explored in women affected by balance ability reduction with non-conclusive results. The aim of the study was to evaluate the efficacy of a supervised exergame performed with the Wii Fit(®) compared to conventional exercises on balance function, quality of life, fear of fall and well-being in women with bone loss. Thirty-eight female participants aged over 65 years, with a bone loss condition, were enrolled and random allocated in the Wii group or control group. Subject enrolled in Wii group performed a balance training with a Wii Fit supervised by a physiotherapist (1 h, 2 days per week, during 8 weeks) while in control subjects performed the same amount of conventional balance exercises. Subject enrolled in experimental group showed significantly higher scores in terms of Berg Balance Scale (p = 0.027). In SF-36 scores, a significant difference was reported for physical activity score after treatment (p = 0.031). Fear of falling and the psychological scales were not significantly different between the two groups. In women with bone loss condition, a supervised Wii Fit training has shown better efficacy in improving balance performance with respect to conventional balance exercises.

Concepts: Randomized controlled trial, Efficacy, Wii, Balance, Wii Balance Board, Wii Menu, Shigeru Miyamoto, Wii Play


Objective Adherence to rehabilitation exercise is much lower in patients with hematologic malignancies (22.5-45.8%) than in patients with solid tumors (60-85%) due to the administration of more intensive chemotherapeutic regimens in the former. Virtual reality exercise can be performed even in a biological clean room and it may improve the adherence rates in elderly patients with hematologic malignancies. Thus, in this pilot study, we aimed to investigate the feasibility and safety of virtual reality exercise intervention using Nintendo Wii Fit in patients with hematologic malignancies receiving chemotherapy. Methods In this feasibility study, 16 hospitalized patients with hematologic malignancies aged ≥60 years performed virtual reality exercise for 20 minutes using the Nintendo Wii Fit once a day, five times a week, from the start of chemotherapy until hospital discharge. The adherence rate, safety, and physical and psychological performances were assessed. Results The adherence rate for all 16 patients was 66.5%. Nine patients completed the virtual reality exercise intervention with 88 sessions, and the adherence rate was 62.0%. No intervention-related adverse effects >Grade 2, according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, were observed. We noted maintenance of the physical performance (e.g., Barthel index, handgrip strength, knee extension strength, one-leg standing time, and the scores of timed up and go test and Instrumental Activities of Daily Living) and psychosocial performance (e.g., score of hospital anxiety and depression scale). Conclusion Virtual reality exercise using the Wii Fit may be feasible, safe and efficacious, as demonstrated in our preliminary results, for patients with hematologic malignancies receiving chemotherapy.

Concepts: Cancer, Oncology, Wii, Nintendo, Wii Fit, Wii Menu, Shigeru Miyamoto, Nintendo GameCube