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Concept: Wii

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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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Observing social interactions between children and adults is a major method in the toolkit of psychologists who examine social development and social relationships. Although this method has revealed many interesting phenomena, it cannot determine the effect of behavior independent of other traits. Research on the role of attractiveness in social development provides an example of this conundrum: Are attractive and unattractive children/adults treated differently because of their attractiveness (independent of their behavior), do they behave differently and thus elicit differential treatment, or both? Virtual world and avatar-based technologies allow researchers to control the social behaviors of targets; however, whether children and adults use the facial attractiveness of avatars as a social cue in the same way as they do with real peers is currently unknown. Using Mii avatars from the popular Nintendo Wii video game console, Study 1 found that the facial attractiveness ratings of real people strongly predicted the attractiveness ratings of avatar faces based on the former group. Study 2 revealed that adults (n=46) and children (n=42) prefer attractive avatars as social partners. The results of this set of methodological studies may help to clarify future research on the relationship between attractiveness and behavior throughout the lifespan. Furthermore, the use of avatars may allow studies to experimentally examine the effects of attractiveness in situations where such research is not ethical (e.g., peer victimization).

Concepts: Scientific method, Sociology, Behavior, Social relation, Wii, Video game console, Mii, Xbox 360

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BACKGROUND: Postural control impairments may persist following anterior cruciate ligament (ACL) reconstruction. The effect of a secondary task on postural control has, however, not been determined. The purpose of this case-control study was to compare postural control in patients following ACL reconstruction with healthy individuals with and without a secondary task. PARTICIPANTS: 45 patients (30 men and 15 women) participated at least 6 months following primary ACL reconstruction surgery. Participants were individually matched by age, gender and sports activity to healthy controls. MATERIALS: Postural control was measured using a Nintendo Wii Balance Board and customised software during static single-leg stance and with the addition of a secondary task. The secondary task required participants to match the movement of an oscillating marker by adducting and abducting their arm. MAIN OUTCOME MEASURES: Centre of pressure (CoP) path length in both medial-lateral and anterior-posterior directions, and CoP total path length. RESULTS: When compared with the control group, the anterior-posterior path length significantly increased in the ACL reconstruction patients' operated (12.3%, p=0.02) and non-operated limbs (12.8%, p=0.02) for the single-task condition, and the non-operated limb (11.5%, p=0.006) for the secondary task condition. The addition of a secondary task significantly increased CoP path lengths in all measures (p<0.001), although the magnitude of the increase was similar in both the ACL reconstruction and control groups. DISCUSSION: ACL reconstruction patients showed a reduced ability in both limbs to control the movement of the body in the anterior-posterior direction. The secondary task affected postural control by comparable amounts in patients after ACL reconstruction and healthy controls. Devices for the objective measurement of postural control, such as the one used in this study, may help clinicians to more accurately identify patients with deficits who may benefit from targeted neuromuscular training programs.

Concepts: Knee, Anterior cruciate ligament, Anterior cruciate ligament reconstruction, Cruciate ligament, Wii, Wii Balance Board, Wii Fit, History of video game consoles

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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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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

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To understand stroke survivors and their caregivers' experience and acceptability of using the Nintendo Wii Sports™ games (Wii™) as a home-based arm rehabilitation tool.

Concepts: Wii, Nintendo, Nintendo Wi-Fi Connection, Shigeru Miyamoto, Nintendo GameCube, Virtual Console, Nintendo DS, Satoru Iwata

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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

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Physical activity is effective in improving glycaemic control in diabetes mellitus. Yet only 40% of people meet the recommended level of physical activity. Nintendo Wii tennis has an energy expenditure of moderate intensity, and may be a viable part of a physical activity programme.

Concepts: Diabetes mellitus type 2, Diabetes mellitus, Obesity, Wii, Shigeru Miyamoto, Video game console, Wii Sports, Super Mario Bros.

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Alterations in the musculoskeletal system, especially in the lower limbs, limit physical activity and affect balance and walking. Postural impairments in haemophilic preteens could increase the risk of bleeding events and deteriorate the physical condition, promoting the progression of haemophilic arthropathy.

Concepts: Wii, Nintendo, Wii Balance Board, Shigeru Miyamoto, Nintendo GameCube, Virtual Console, Nintendo DS, Satoru Iwata

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Purpose To determine if high-intensity, task-oriented, visual feedback training with a video game balance board (Nintendo Wii) induces significant changes in diffusion-tensor imaging (DTI) parameters of cerebellar connections and other supratentorial associative bundles and if these changes are related to clinical improvement in patients with multiple sclerosis. Materials and Methods The protocol was approved by local ethical committee; each participant provided written informed consent. In this 24-week, randomized, two-period crossover pilot study, 27 patients underwent static posturography and brain magnetic resonance (MR) imaging at study entry, after the first 12-week period, and at study termination. Thirteen patients started a 12-week training program followed by a 12-week period without any intervention, while 14 patients received the intervention in reverse order. Fifteen healthy subjects also underwent MR imaging once and underwent static posturography. Virtual dissection of white matter tracts was performed with streamline tractography; values of DTI parameters were then obtained for each dissected tract. Repeated measures analyses of variance were performed to evaluate whether DTI parameters significantly changed after intervention, with false discovery rate correction for multiple hypothesis testing. Results There were relevant differences between patients and healthy control subjects in postural sway and DTI parameters (P < .05). Significant main effects of time by group interaction for fractional anisotropy and radial diffusivity of the left and right superior cerebellar peduncles were found (F2,23 range, 5.555-3.450; P = .036-.088 after false discovery rate correction). These changes correlated with objective measures of balance improvement detected at static posturography (r = -0.381 to 0.401, P < .05). However, both clinical and DTI changes did not persist beyond 12 weeks after training. Conclusion Despite the low statistical power (35%) due to the small sample size, the results showed that training with the balance board system modified the microstructure of superior cerebellar peduncles. The clinical improvement observed after training might be mediated by enhanced myelination-related processes, suggesting that high-intensity, task-oriented exercises could induce favorable microstructural changes in the brains of patients with multiple sclerosis. © RSNA, 2014 Online supplemental material is available for this article.

Concepts: Sample size, Informed consent, Magnetic resonance imaging, Multiple sclerosis, White matter, Cerebellum, Wii, Wii Balance Board