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Concept: Wii Remote

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BACKGROUND: Video-games have become an integral part of the new multimedia culture. Several studies assessed video-gaming enhancement of spatial attention and eye-hand coordination. Considering the technical difficulty of laparoscopic procedures, legal issues and time limitations, the validation of appropriate training even outside of the operating rooms is ongoing. We investigated the influence of a four-week structured Nintendo® Wii™ training on laparoscopic skills by analyzing performance metrics with a validated simulator (Lap Mentor™, Simbionix™). METHODOLOGYPRINCIPAL FINDINGS: We performed a prospective randomized study on 42 post-graduate I-II year residents in General, Vascular and Endoscopic Surgery. All participants were tested on a validated laparoscopic simulator and then randomized to group 1 (Controls, no training with the Nintendo® Wii™), and group 2 (training with the Nintendo® Wii™) with 21 subjects in each group, according to a computer-generated list. After four weeks, all residents underwent a testing session on the laparoscopic simulator of the same tasks as in the first session. All 42 subjects in both groups improved significantly from session 1 to session 2. Compared to controls, the Wii group showed a significant improvement in performance (p<0.05) for 13 of the 16 considered performance metrics. CONCLUSIONSSIGNIFICANCE: The Nintendo® Wii™ might be helpful, inexpensive and entertaining part of the training of young laparoscopists, in addition to a standard surgical education based on simulators and the operating room.

Concepts: Surgery, Wii, Nintendo, Wii Play, Nintendo GameCube, Virtual Console, Nintendo DS, Wii Remote

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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

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Reaction time (RT) has been associated with falls in older adults, but is not routinely tested in clinical practice. A simple, portable, inexpensive and reliable method for measuring RT is desirable for clinical settings. We therefore developed a custom software, which utilizes the portable and low-cost standard Nintendo Wii board (NWB) to record RT. The aims in the study were to (1) explore if the test could differentiate old and young adults, and (2) to study learning effects between test-sessions, and (3) to examine reproducibility.

Concepts: Wii, Nintendo, Wii Balance Board, Nintendo GameCube, Virtual Console, Nintendo DS, History of video game consoles, Wii Remote

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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

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The Nintendo Wii Balance Board (WBB) is increasingly used as an inexpensive force plate for assessment of postural control; however, no documentation of force and COP accuracy and reliability is publicly available. Therefore, we performed a standard measurement uncertainty analysis on 3 lightly and 6 heavily used WBBs to provide future users with information about the repeatability and accuracy of the WBB force and COP measurements. Across WBBs, we found the total uncertainty of force measurements to be within ±9.1N, and of COP location within ±4.1mm. However, repeatability of a single measurement within a board was better (4.5N, 1.5mm), suggesting that the WBB is best used for relative measures using the same device, rather than absolute measurement across devices. Internally stored calibration values were comparable to those determined experimentally. Further, heavy wear did not significantly degrade performance. In combination with prior evaluation of WBB performance and published standards for measuring human balance, our study provides necessary information to evaluate the use of the WBB for analysis of human balance control. We suggest the WBB may be useful for low-resolution measurements, but should not be considered as a replacement for laboratory-grade force plates.

Concepts: Measurement, Metrology, Test method, Wii, Wii Balance Board, Wii Fit, History of video game consoles, Wii Remote

2

Persons with visual impairment (VI) are at greater risk for falls due to irreparable damage to visual sensory input contributing to balance. Targeted training may significantly improve postural stability by strengthening the remaining sensory systems. Here, we evaluate the Ashtanga-based Yoga Therapy (AYT) program as a multi-sensory behavioral intervention to develop postural stability in VI.

Concepts: Sensory system, Sense, Visual impairment, Wii, Wii Balance Board, Wii Fit, History of video game consoles, Wii Remote

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The purpose of this study was to investigate the intra-rater reliability of a new method in combination with the Nintendo Wii Balance Board (NWBB) to measure the strength of hallux flexor muscle.

Concepts: Wii, Nintendo, Wii Balance Board, Wii Fit, Nintendo GameCube, Virtual Console, History of video game consoles, Wii Remote

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Impairments in dynamic balance have a detrimental effect in older adults at risk of falls (OARF). Gait initiation (GI) is a challenging transitional movement. Centre of pressure (COP) excursions using force plates have been used to measure GI performance. The Nintendo Wii Balance Board (WBB) offers an alternative to a standard force plate for the measurement of CoP excursion.

Concepts: Wii, Nintendo, Wii Balance Board, Wii Fit, Nintendo GameCube, Virtual Console, History of video game consoles, Wii Remote

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Active video game (AVG) playing, also known as “exergaming,” is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play.

Concepts: Play, Video game, Wii, Wii Balance Board, Wii Fit, Wii Play, Game controller, Wii Remote

0

Testing balance through squatting exercise is a central part of many rehabilitation programs and sports and plays also an important role in clinical evaluation of residual motor ability. The assessment of center of pressure (CoP) displacement and its parametrization is commonly used to describe and analyze squat movement and the laboratory-grade force plates (FP) are the gold standard for measuring balance performances from a dynamic view-point. However, the Nintendo Wii Balance Board (NWBB) has been recently proposed as an inexpensive and easily available device for measuring ground reaction force and CoP displacement in standing balance tasks. Thus, this study aimed to compare the NWBB-CoP data with those obtained from a laboratory FP during a dynamic motor task, such as the squat task. CoP data of forty-eight subjects were acquired simultaneously from a NWBB and a FP and the analyses were performed over the descending squatting phase. Outcomes showed a very high correlation ® and limited root-mean-square differences between CoP trajectories in anterior-posterior (r > 0.99, 1.63 ± 1.27 mm) and medial-lateral (r > 0.98, 1.01 ± 0.75 mm) direction. Spatial parameters computed from CoP displacement and ground reaction force peak presented fixed biases between NWBB and FP. Errors showed a high consistency (standard deviation < 2.4% of the FP outcomes) and a random spread distribution around the mean difference. Mean velocity is the only parameter which exhibited a tendency towards proportional values. Findings of this study suggested the NWBB as a valid device for the assessment and parametrization of CoP displacement during squatting movement.

Concepts: Force, Reaction, Ground reaction force, Wii, Wii Balance Board, Wii Fit, History of video game consoles, Wii Remote