Nintendo Wii Console (Black) with Wii Fit Plus and Balance Board + Motion Plus Controller (Wii)

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Deutsch JE, Brettler A, Smith C, Welsh J, John R, Guarrera-Bowlby P, Kafri M: Nintendo wii sports and wii fit game analysis, validation, and application to stroke rehabilitation. Top Stroke Rehabil 2011, 18: 701-719. 10.1310/tsr1806-701 Bateni H: Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study. Physiotherapy 2012, 98: 211-216. 10.1016/j.physio.2011.02.004 According to Puhl, kids are especially vulnerable when it comes to weight. “We know from research that weight is one of the most prevalent reasons that kids are teased or bullied,” she said. That danger is reflected in testimonies from Osu and others online. “When friends would come round to play, I would tell them that the Wii Fit board was broken because I didn’t want them to see what it said,” Osu told Polygon. Young W, Ferguson S, Brault S, Craig C: Assessing and training standing balance in older adults: a novel approach using the ‘Nintendo Wii’ Balance Board. Gait Posture 2011, 33: 303-305. 10.1016/j.gaitpost.2010.10.089

Dougherty J, Kancel A, Ramar C, Meacham C, Derrington S: The effects of a multi-axis balance board intervention program in an elderly population. Mo Med 2011, 108: 128-132. Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M: Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture 2010, 31: 307-310. 10.1016/j.gaitpost.2009.11.012 Nitz JC, Kuys S, Isles R, Fu S: Is the Wii Fit a new-generation tool for improving balance, health and well-being? A pilot study. Climacteric 2010, 13: 487-491. 10.3109/13697130903395193 Sensory-Motor and Rehabilitative Technology Laboratory (SMaRTlab), San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-7251, USAMiller CA, Hayes DM, Dye K, Johnson C, Meyers J: Using the Nintendo Wii Fit and body weight support to improve aerobic capacity, balance, gait ability, and fear of falling: two case reports. J Geriatr Phys Ther 2012, 35: 95-104. 10.1519/JPT.0b013e318224aa38 The Wii Fit software includes several means of assessing balance ability. Once the Wii Fit software is loaded, participants are first encouraged to perform a “body test” that comprises both “center of balance” and “body control” measures of balance control. In the center of balance assessment, participants stand still on the WBB for 7 s while COP data is collected. From this data, the participant’s average COP deviation from body midline is calculated, indicating a measure of weight bearing asymmetry. Overall, this assessment is thought to provide information about body posture with the assumption that having an equal distribution of weight between left and right legs is ideal. Podsiadlo D, Richardson S: The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39: 142-148. When friends would come round to play, I would tell them that the Wii Fit board was broken because I didn’t want them to see what it said.” Williams BDNL, Bender A, Mattox H, Tibbs JR: The effect of Nintendo Wii on Balance: A Pilot Study Supporting the Use of the Wii in Occupational Therapy for the Well Elderly. Occup Ther Health Care 2011, 25: 131-139. 10.3109/07380577.2011.560627

Lange B, Flynn S, Proffitt R, Chang CY, Rizzo AS: Development of an interactive game-based rehabilitation tool for dynamic balance training. Top Stroke Rehabil 2010, 17: 345-352. 10.1310/tsr1705-345 Berg KO, Wood-Dauphinee SL, Williams JI, Maki B: Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992, 83(Suppl 2):S7-S11. Yamada M, Aoyama T, Nakamura M, Tanaka B, Nagai K, Tatematsu N, Uemura K, Nakamura T, Tsuboyama T, Ichihashi N: The reliability and preliminary validity of game-based fall risk assessment in community-dwelling older adults. Geriatr Nurs 2011, 32: 188-194. 10.1016/j.gerinurse.2011.02.002 Meldrum D, Glennon A, Herdman S, Murray D, McConn-Walsh R: Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii((R)) Fit Plus. Disabil Rehabil Assist Technol 2012, 7: 205-210. 10.3109/17483107.2011.616922Shih CH: A standing location detector enabling people with developmental disabilities to control environmental stimulation through simple physical activities with Nintendo Wii Balance Boards. Res Dev Disabil 2011, 32: 699-704. 10.1016/j.ridd.2010.11.011 Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the first half decade of “Wii-search” Gray P, Hildebrand K: Fall risk factors in Parkinson's disease. J Neurosci Nurs 2000, 32: 222-228. 10.1097/01376517-200008000-00006 Teasell R, McRae M, Foley N, Bhardwaj A: The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. Arch Phys Med Rehabil 2002, 83: 329-333. 10.1053/apmr.2002.29623 Lord SR, Clark RD, Webster IW: Postural stability and associated physiological factors in a population of aged persons. J Gerontol 1991, 46: M69-M76. 10.1093/geronj/46.3.M69

Only a few attempts have been made to utilize Wii Fit software-based balance metrics in research settings, and only limited success has been achieved. First, in a study by Dougherty et al.[ 23], 9 older adults were asked to undergo a 5-week balance training program using a multi-axis balance training board (Indo Board Balance Trainer, EABO Inc.). The participant’s Wii Fit Age was calculated before and after the intervention and results showed that Wii Fit Age was lower (i.e. improved) following training. Despite this mean improvement, however, no statistical differences were found, suggesting that only some of the balance improvement was captured by the Wii Fit Age metric. The only randomized control clinical study at the time of the fifth anniversary was carried out by Nilsagard[ 29] in individuals with multiple sclerosis (MS). MS Patients who played Wii Fit games twice a week for six weeks showed a moderate improvement in the timed up and go test (Cohen’s d = 0.4) and small improvements in the four square step test (Cohen’s d = 0.1) and activities based balance confidence assessment (Cohen’s d = 0.2) compared to a group of individuals with MS that did not play Wii Fit games. These results, while positive, were less impressive than those seen for healthy older adults.Owens SG, Garner JC 3rd, Loftin JM, van Blerk N, Ermin K: Changes in physical activity and fitness after 3 months of home Wii Fit use. J Strength Cond Res 2011, 25: 3191-3197. 10.1519/JSC.0b013e3182132d55 Shih C-H, Shih C-T, Chu C-L: Assisting people with multiple disabilities actively correct abnormal standing posture with a Nintendo Wii Balance Board through controlling environmental stimulation. Res Dev Disabil 2010, 31: 936-942. 10.1016/j.ridd.2010.03.004 Rubenstein LZ, Josephson KR: Falls and their prevention in elderly people: what does the evidence show? Med Clin Noth Am 2006, 90: 807-824. 10.1016/j.mcna.2006.05.013 Reed-Jones RJ, Dorgo S, Hitchings MK, Bader JO: WiiFit Plus balance test scores for the assessment of balance and mobility in older adults. Gait Posture 2012, 36: 430-433. 10.1016/j.gaitpost.2012.03.027 Several attempts have been made to use raw COP data from a customized WBB for balance assessment. Young et al.[ 19], demonstrated that customized WBB COP data could be used to assess changes in older adult balance following a specially designed, game-based intervention over four weeks. Before and after training, six elderly participants undertook a traditional balance test (i.e. Romberg Test) whereby they stood as still as possible on the WBB for two, 30 s trials - one with eyes open and one with eyes closed. The COP data collected showed anterior-posterior COP variability was positively reduced by the intervention, but only in more difficult trials where visual information was not available (i.e. eyes closed conditions). Increases in body sway for individuals with Autism[ 12] and Hearing Loss[ 37] have also been measured with custom WBB COP.

When it comes to talking to people about weight, the words we use matter,” Dr. Puhl said. During research, she found that in both adolescence and adults, words like obese or fat can lead to feelings of shame. Rather than labeling a patient as obese, her team of researchers recommend that doctors default to using neutral words that don’t suggest a moral judgement or failing. Wikstrom EA: Validity and reliability of Nintendo Wii Fit balance scores. J Athl Train 2012, 47: 306-313.

The ubiquitous importance of balance research for neurorehabilitation is unquestioned based on epidemiological reports indicating that older adults and various individuals with neuromuscular disability conditions have an increased likelihood for catastrophic fall-related injuries[ 43– 47]. The cost of such injures is not just to the individual but to the greater health care system at large. To this extent, the goal of the present review was to summarize the first half decade of Wii Fit balance research and provide insight regarding the important results that will shape the next five years. Literature for this review was obtained through a targeted search of PubMED and MEDline databases using keywords such as “Wii” and “Balance”. Papers were included that used the Wii Fit system or WBB for the assessment or training of balance ability. In the first half of this review, approaches are overviewed that utilized the Wii Fit as a neuroengineering tool for balance assessment. Alternatively, the second half of this review discusses detailed evidence supporting use of the Wii Fit as a balance intervention tool for both healthy and diseased populations. Balance assessment using the Wii Fit system Comparing the WBB and a scientific grade force platform