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Elhusein AM, Fadlalmola HA, Awadalkareem EM, Alhusain EYM, Alnassry SM, Alshammari M, Abdulrahman EE, Fadila DES, Ibrahim FM, Saeed AAM, Abdalla A, Moafa HN, El-Amin EI, Mamanao DM. Exercise-based gaming in patients with multiple sclerosis: A systematic review and meta-analysis. BELITUNG NURSING JOURNAL 2024; 10:1-14. [PMID: 38425686 PMCID: PMC10900063 DOI: 10.33546/bnj.3006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/04/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background Multiple sclerosis presents a significant burden, with balance disturbances impacting patients' daily living. Conventional therapies have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options. Objective This study aimed to synthesize evidence on exergaming's role in multiple sclerosis treatment, particularly to evaluate the impact of exergaming on cognitive, motor, and psychological outcomes in patients with multiple sclerosis. Methods A systematic review and subsequent meta-analysis design were employed. An extensive search was conducted up to June 2023 across five electronic databases - Web of Science, Scopus, PubMed, Cochrane, and EMBASE. The data extraction process from the selected studies was conducted independently. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 1 (ROB1) and the National Institutes of Health (NIH) assessment tool. Continuous outcomes were consolidated as mean differences (MD) with 95% confidence intervals (CIs). Meta-analyses were performed using RevMan ver. 5.4. Results Out of 1,029 studies, 27 were included for meta-analysis. There were no significant differences in cognitive outcomes between the exergaming and the no-intervention group or the Conventional Physiotherapy and Rehabilitation interventions (CPRh) subgroups. However, the Symbol Digit Modalities Test (SDMT) showed a statistically significant difference in favor of exergaming in the no-intervention subgroup (MD = 5.40, 95% CI [0.08, 10.72], p = 0.05). In motor outcomes, exergaming only demonstrated better results in the 6-minute walking test compared to the no-intervention group (MD = 25.53, 95% CI [6.87, 44.19], p = 0.007). The Berg Balance Scale score in both studied subgroups and the Timed Up and Go (TUG) test in the no-intervention group favored exergaming. In terms of psychological outcomes, the Beck Depression Inventory did not reveal any significant differences, while the Modified Fatigue Impact Scale (MFIS) score favored exergaming in the CPRh subgroup. Conclusion Exergaming shows promise for enhancing cognitive and motor functions, motivation, adherence, and quality of life in MS patients, which is beneficial for nurses. It can be tailored to individual preferences and easily conducted at home, potentially serving as a viable alternative to traditional rehab programs, especially during relapses. However, further research is necessary to fully understand its optimal and lasting benefits.
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Affiliation(s)
- Amal Mohamed Elhusein
- Nursing Department, College of Applied Medical Sciences, University of Bisha, Bisha, Saudi Arabia
| | - Hammad Ali Fadlalmola
- Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
| | | | | | | | - Mukhlid Alshammari
- College of Applied Medical Science, University of Hafr Al Batin, Saudi Arabia
| | | | - Doaa El Sayed Fadila
- Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
- Gerontological Nursing Department, Faculty of Nursing, Mansoura University, Egypt
| | - Fatma M. Ibrahim
- Community Health Nursing, RAK Medical and Health Sciences University, United Arab Emirates
| | | | - Adel Abdalla
- Prince Sultan Military College of Health Sciences, Nursing Department, Al Dhahran, Saudi Arabia
| | - Hassan N Moafa
- Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- Department of Tropical Medicine, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ehab I. El-Amin
- Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Daniel Mon Mamanao
- Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
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Garg H, Rutherfurd C, Labrum J, Hawley B, Gard E, Davis J. Feasibility, Outcomes, and Perceptions of a Virtual Group Exercise Program in Multiple Sclerosis. J Neurol Phys Ther 2024; 48:54-63. [PMID: 37563754 DOI: 10.1097/npt.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE Individuals with multiple sclerosis (MS) frequently report low physical activity and psychosocial support due to concerns with transportation, time, finances, access to services, and lack of caregiver support. These barriers can be addressed by online group interventions; however, utility of such programs in individuals with MS has not been examined yet. The purpose of this retrospective study was, therefore, to ( a ) investigate the feasibility, safety, and outcomes of a virtual group exercise program in individuals with MS, and ( b ) explore the participant perceptions after the program. METHODS Retrospective data from the medical records of 17 individuals with MS (mean [SD] age = 53.5 [12.3] years, body mass index = 28.2 [7.2]) who completed the virtual 13-week group exercise program, pre- and posttraining functional status questionnaires, and the end-of-program feedback were extracted. The exercise program included aerobic, resistance, balance, and flexibility training components recommended for people with MS. Feasibility, safety, outcomes, and participant perceptions were determined by adherence to the prescribed daily exercise dosage, number of adverse events, within-group differences in self-reported functional status, and thematic analysis of the participant feedback, respectively. RESULTS Participants were adherent (79%), reported minimal adverse effects, and demonstrated significant changes ( P < 0.05) in functional status posttraining. Several themes on the perceived barriers, facilitators, and suggestions for improvement were identified. DISCUSSION AND CONCLUSIONS A virtual 13-week group exercise program can be feasible, safe, effective, and well received by individuals with MS. Future research should investigate the dose-response effectiveness of telehealth and compare various telehealth models of exercise training using large randomized controlled trials.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A434 , which demonstrates an overview of the study).
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Affiliation(s)
- Hina Garg
- Department of Physical Therapy (H.G.), Rocky Mountain University of Health Professions, Provo, Utah; Easterseals Massachusetts (C.R.), Worcester; Rocky Mountain University Foundation Community Rehabilitation Clinic (J.L., B.H.), Provo, Utah; and Rocky Mountain University of Health Professions (E.G., J.D.), Provo, Utah
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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Huynh TLT, Silveira SL, Motl RW. Systematic review of participant characteristics in theory-based behavior change interventions for physical activity in multiple sclerosis: are we missing those with the greatest potential for lifelong benefits? Disabil Rehabil 2022; 44:5784-5803. [PMID: 34334057 DOI: 10.1080/09638288.2021.1954705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. MATERIALS AND METHODS PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. RESULTS Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. CONCLUSIONS There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations.IMPLICATIONS FOR REHABILITATIONTheory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis).Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS.The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS.
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Affiliation(s)
- Trinh L T Huynh
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Malone LA, Mendonca CJ, Kim Y. Active Videogaming Interventions in Adults with Neuromuscular Conditions: A Scoping Review. Games Health J 2022; 11:141-156. [PMID: 35482057 DOI: 10.1089/g4h.2021.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review synthesized active videogaming (AVG) intervention literature over a 10-year period (2010-2020) for people with neuromuscular conditions (18-64 years of age), examining interventions that aimed to improve health and secondary conditions, physical activity, and outcomes quality of life (QOL). Systematic searches yielded 40 eligible studies. The major groups were multiple sclerosis (40%) and stroke (33%), and the study participants had mostly mild-to-moderate disability who were able to play games in a standing position. Research designs primarily involved randomized controlled trials (65%) and pre/post-trial design without a control group (28%). The majority of interventions used commercial off-the-shelf gaming systems, such as Nintendo Wii and Microsoft Kinect. Studies reported significant improvements in health outcomes, specifically in balance (n = 30/36), mobility (n = 24/27), and cardiorespiratory fitness (n = 6/8). Positive changes were also seen in secondary conditions (n = 8/12), physical activity (n = 3/4), and QOL outcomes (n = 8/16). AVG research for people with neuromuscular conditions has grown in both quantity and quality but several gaps remain. Study findings provide a roadmap for future AVG trials on understudied populations, and highlight technology and targeted outcomes as drivers of future intervention research.
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Affiliation(s)
- Laurie A Malone
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
| | - Christen J Mendonca
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
| | - Yumi Kim
- The University of Alabama at Birmingham, UAB/Lakeshore Research Collaborative, Birmingham, Alabama, USA
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Recent Considerations on Gaming Console Based Training for Multiple Sclerosis Rehabilitation. Med Sci (Basel) 2022; 10:medsci10010013. [PMID: 35225946 PMCID: PMC8884021 DOI: 10.3390/medsci10010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Multiple Sclerosis (MS) is a well-known, chronic demyelinating disease of the Central Nervous System (CNS) and one of the most common causes of disability in young adults. In this context, one of the major challenges in patients’ rehabilitation is to maintain the gained motor abilities in terms of functional independence. This could be partially obtained by applying new emerging and cutting-edge virtual/augmented reality and serious game technologies for a playful, noninvasive treatment that was demonstrated to be quite efficient and effective in enhancing the clinical status of patients and their (re)integration into society. Recently, Cloud computing and Internet of Things (IoT) emerged as technologies that can potentially revolutionize patients’ care. To achieve such a goal, a system that on one hand gathers patients’ clinical parameters through a network of medical IoT devices equipped with sensors and that, on the other hand, sends the collected data to a hospital Cloud for processing and analytics is required. In this paper, we assess the effectiveness of a Nintendo Wii Fit® Plus Balance Board (WFBB) used as an IoT medical device adopted in a rehabilitation training program aimed at improving the physical abilities of MS patients (pwMS). In particular, the main scientific contribution of this paper is twofold: (i) to present a preliminary new pilot study investigating whether exercises based on the Nintendo Wii Fit® balance board included in a rehabilitation training program could improve physical abilities and Quality of Life (QoL) of patients compared to that of a conventional four-week rehabilitation training program; (ii) to discuss how such a rehabilitation training program could be adopted in the perspective of near future networks of medical IoT-based rehabilitation devices, interconnected with a hospital Cloud system for big data processing to improve patients’ therapies and support the scientific research about motor rehabilitation. Results demonstrate the advantages of our approach from both health and technological points of view.
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Basha MA, Abdel-Aal NM, Kamel FAH. Effects of Wii Fit Rehabilitation on Lower Extremity Functional Status in Adults With Severe Burns: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:289-296. [PMID: 34571011 DOI: 10.1016/j.apmr.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the effects of the Wii Fit rehabilitation program in addition to a standard physical therapy program (SPTP) on lower extremity functional status and functional mobility in adults with severe burns after hospital discharge. DESIGN A single-blinded, parallel groups, randomized controlled trial. SETTINGS Outpatient rehabilitation center. PARTICIPANTS Thirty-four patients (N=34), aged 31.3±7.3 years old, with lower extremity deep partial-thickness and full-thickness burn and total body surface area of more than 40% were allocated randomly into 2 equal groups. INTERVENTIONS The Wii Fit group received the Wii Fit program for 30 minutes in addition to SPTP for 60 minutes, whereas the SPTP group received SPTP only. The intervention was 3 sessions a week for 12 weeks. MAIN OUTCOME MEASURES The primary outcome measurements were the functional status and functional mobility, which were assessed by the high mobility assessment tool, Lower Limb Functional Index, and timed Up and Go test. The secondary outcomes included exercise capacity, muscle strength, and balance measured by the 6-minute walk test, isokinetic muscle strength assessment, and stability index. All the outcome measures were collected at the baseline and after 12 weeks of intervention. RESULTS After 12 weeks of intervention, there were statistically significant differences between groups in all outcome measures in favor of the Wii Fit group (P<.001). Also, statistically significant differences were found in all the measured outcomes after 12 weeks of intervention in each group (P<.05). CONCLUSIONS Patients with lower extremity burns who received the Wii Fit program in addition to the SPTP had better improvements in lower limb functional status, functional mobility, exercise capacity, muscle strength, and balance than patients who received SPTP alone. The Wii Fit program was a useful adjunctive therapy in rehabilitating adults with lower extremity burn injury.
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Affiliation(s)
- Maged A Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia; Department of Physical Therapy, El-Sahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt.
| | - Nabil M Abdel-Aal
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Fatma Alzahraa H Kamel
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia; Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Fleming KM, Herring MP, Coote SB, Tindall D. Participant experiences of eight weeks of supervised or home-based Pilates among people with multiple sclerosis: a qualitative analysis. Disabil Rehabil 2021; 44:5549-5556. [PMID: 34151667 DOI: 10.1080/09638288.2021.1939446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE An exploratory qualitative study investigating participants' experiences of a feasibility study of supervised and home-based Pilates. METHODS All 10 females who participated in an eight-week supervised (n = 4) or home-based Pilates (n = 6) program were invited and agreed to be interviewed. Data were collected via semi-structured interviews and researcher observations of participant experiences. Data were analysed using codebook thematic analysis framework. RESULTS Two domain summaries emerged: (1) the suitability of home-based Pilates in particular for this population. Participants indicated that supervised and home-based Pilates was a safe, intensity-appropriate, and implementable exercise method to improve mental health outcomes among persons with multiple sclerosis (PwMS), and (2) the benefits experienced by PwMS while participating in Pilates. Home-based Pilates reduced both exercise participation and accessibility barriers commonly experienced by PwMS. Furthermore, PwMS reported improvements in mental health outcomes following Pilates, in both exercise environments. CONCLUSIONS PwMS reported experiencing improved mood following regular Pilates training and indicated that home-based in particular reduced barriers regularly experienced by this population. Results support Pilates as a feasible exercise modality providing potential mood improvements among PwMS. Future appropriately powered home-based randomised controlled trials to further explore the effects of Pilates training on mental health among PwMS with minimal-to-mild mobility disability are warranted.Implications for RehabilitationParticipants in this study described the mental health benefits experienced from engaging in Pilates, a non-traditional exercise modality.Home-based Pilates overcame participatory and accessibility barriers to exercise among people with multiple sclerosis (MS).Participants valued that Pilates was low intensity and did not exacerbate fatigue.Home-based Pilates is a feasible exercise method for people with MS with minimal-to-mild mobility disability.
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Affiliation(s)
- Karl M Fleming
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Matthew P Herring
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Susan B Coote
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,School of Allied Health, University of Limerick, Limerick, Ireland.,Multiple Sclerosis Society of Ireland, Limerick, Ireland
| | - Daniel Tindall
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2021; 51:102928. [PMID: 33845351 PMCID: PMC9764369 DOI: 10.1016/j.msard.2021.102928] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The current coronavirus disease (COVID-19) pandemic makes it difficult to obtain physical therapy in rehabilitation centres, particularly for persons with multiple sclerosis (pwMS), who are a population at high risk, since viral infections may contribute to MS exacerbations and relapses. Active video games could be a way to maintain physical therapy at home as part of the rehabilitation. The aim of this review is to summarise the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for pwMS. METHODS We searched for studies in five databases (PubMed, Scopus, Cochrane, CINAHL and Science direct) up to October 2020. Selection of studies, extraction of data and methodological quality assessment through the PEDro scale were made independently by two authors and discussed with a third author. RESULTS Nine studies were included in this systematic review. We found significant improvements in balance; results were mixed concerning mobility, physical activity and gait. Home-based active video games are feasible and safe, with good compliance and adherence. The methodological quality of the studies was moderate (PEDro scale: 5.3 ± 2). CONCLUSION Overall, home-based active video games were found safe and effective improving static and dynamic balance in pwMS. Compliance was good, probably because it is a motivating and enjoyable training. Active video games can be a relevant alternative for physical rehabilitation at home in pwMS. Future studies should follow more rigorous methodological standards (larger sample sizes, more randomised controlled trials) to improve the quality of evidence and include cost-effectiveness in the analysis.
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Silveira SL, Huynh T, Kidwell A, Sadeghi-Bahmani D, Motl RW. Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102:1788-1800. [PMID: 33549545 DOI: 10.1016/j.apmr.2021.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify and summarize the behavior change techniques (BCTs) included in behavior change interventions for promoting physical activity in persons with multiple sclerosis (MS). DATA SOURCES PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Complete, Scopus, and Embase were initially searched in November 2019, and data extraction began in June 2020. STUDY SELECTION The inclusion criteria for studies were: adults older than 18 years with diagnosed MS, English language, clinical trial designs (ie, pre-post or randomized controlled trials), group or individual interventions, and home or community-based settings wherein physical activity was defined as a primary or secondary outcome. Exclusion criteria for studies included protocol manuscripts pending results, case studies, studies focused on populations with multiple chronic diseases, and interventions targeting multiple behaviors. Two researchers completed screening for study selection, and a third researcher served as a referee. Of the initially identified 8681 studies, 54 studies met selection criteria. DATA EXTRACTION Data extraction was completed by 3 researchers. Each article was coded by 2 of the 3 researchers, and a fourth researcher resolved discrepancies. Data extracted from each paper included study title, authors, country, year, sample size, study design, intervention details, physical activity outcomes, and BCTs. DATA SYNTHESIS Thirty-eight unique behavior change interventions were identified, and 53 of the 93 possible BCTs were included across the studies. The mean number of BCTs per study was 15, and studies and effect sizes across studies ranged from 0.04-1.49. CONCLUSIONS This review provides a comprehensive overview of BCTs as the active ingredients in behavior change interventions targeting physical activity in MS. Results from this study provide a compendium for future intervention development for increasing physical activity and improving overall health in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL.
| | - Trinh Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Ariel Kidwell
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Dena Sadeghi-Bahmani
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
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Objective evaluation of Nintendo Wii Fit Plus balance program training on postural stability in Multiple Sclerosis patients: a pilot study. Int J Rehabil Res 2020; 43:199-205. [DOI: 10.1097/mrr.0000000000000408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ozkul C, Guclu-Gunduz A, Yazici G, Atalay Guzel N, Irkec C. Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial. Mult Scler Relat Disord 2019; 39:101902. [PMID: 31924591 DOI: 10.1016/j.msard.2019.101902] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Balance disorders, fatigue, and walking impairments are the most common symptoms of multiple sclerosis (MS), which lead to a decrease in quality of life. To cope with these disability-increasing symptoms, it is important to select and regularly apply appropriate rehabilitation approaches. In recent years, virtual reality approaches have been suggested as a potentially useful tool in rehabilitation. Exergaming systems are used in the treatment of symptoms associated with MS, but there are few randomized controlled studies investigating the efficacy of these systems. OBJECTIVE To investigate and compare the effects of exercise training with two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis (PwMS). METHODS Forty-seven volunteer PwMS were included in the study and randomized to the group I (Nintendo Wii Fit), group II (Balance Trainer), and group III (control group). The participants in the study groups underwent an exercise program under the supervision of a physiotherapist on 2 days a week for 8 weeks. Outcome measures were the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Six-Minute Walk Test (6MWT), Fatigue Severity Scale (FSS), and Multiple Sclerosis International Quality of Life Questionnaire (MusiQol), which were performed before and after the treatment. RESULTS Forty-two participants completed the study protocol. All parameters evaluated in group I and II showed statistically significant improvement after treatment. Changes in all outcome measures were found to be superior in group I compared with group III. Similarly, all measures except the 6MWT were found to be superior in group II compared with group III. Changes in BBS and MusiQol were found to be superior in group I compared with group II. CONCLUSION In comparison with no intervention, exergaming with Nintendo Wii Fit and Balance Trainer improves balance, increases functionality, reduces fatigue severity, and increases quality of life in PwMS.
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Affiliation(s)
- Andrew M. Byrne
- California Polytechnic State University, San Luis Obispo, USA
| | - Min Kim
- Korea Disabled People’s Development Institute, Seoul, Korea
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Cano Porras D, Siemonsma P, Inzelberg R, Zeilig G, Plotnik M. Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. Neurology 2018; 90:1017-1025. [PMID: 29720544 DOI: 10.1212/wnl.0000000000005603] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Virtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy. METHODS This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed. RESULTS Ninety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended. CONCLUSION Our results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments. REGISTRATION PROSPERO CRD42016042051.
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Affiliation(s)
- Desiderio Cano Porras
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Petra Siemonsma
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Rivka Inzelberg
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Gabriel Zeilig
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands
| | - Meir Plotnik
- From the Center of Advanced Technologies in Rehabilitation (D.C.P., M.P.) and Department of Neurological Rehabilitation (G.Z.), Sheba Medical Center, Tel Hashomer; Departments of Neurology and Neurosurgery (R.I.), Physical and Rehabilitation Medicine (G.Z.), and Physiology and Pharmacology (M.P.), Sackler Faculty of Medicine (D.C.P.), and Sagol School of Neuroscience (R.I., M.P.), Tel Aviv University, Israel; Perception and Action in Complex Environments (D.C.P.), Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium; Division of Health Care (P.S.), University of Applied Science, Leiden; THIM International School for Physiotherapy (P.S.), Nieuwegein; and Predictive Health Technologies (P.S.), Netherlands Organization for Applied Scientific Research, Leiden, the Netherlands.
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Thirumalai M, Kirkland WB, Misko SR, Padalabalanarayanan S, Malone LA. Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation. JMIR Rehabil Assist Technol 2018; 5:e2. [PMID: 29510972 PMCID: PMC5861301 DOI: 10.2196/rehab.8003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/24/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022] Open
Abstract
Background 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. Objective The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments. Methods In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants’ perceived usability. Results The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users’ range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as “good,” while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as “excellent.” We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable. Conclusions This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller’s potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial. Trial Registration ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf)
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States.,UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William B Kirkland
- Engineering and Innovative Technology Department, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samuel R Misko
- Engineering and Innovative Technology Department, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sangeetha Padalabalanarayanan
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laurie A Malone
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Thomas S, Fazakarley L, Thomas PW, Collyer S, Brenton S, Perring S, Scott R, Thomas F, Thomas C, Jones K, Hickson J, Hillier C. Mii-vitaliSe: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis. BMJ Open 2017; 7:e016966. [PMID: 28954791 PMCID: PMC5623500 DOI: 10.1136/bmjopen-2017-016966] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES While the health and well-being benefits of physical activity are recognised, people with multiple sclerosis (MS) often face greater barriers than the general population. The Nintendo Wii potentially offers a fun, convenient way of overcoming some of these. The aim was to test the feasibility of conducting a definitive trial of the effectiveness and cost-effectiveness of Mii-vitaliSe; a home-based, physiotherapist-supported Nintendo Wii intervention. DESIGN A single-centre wait-list randomised controlled study. SETTING MS service in secondary care. PARTICIPANTS Ambulatory, relatively inactive people with clinically confirmed MS. INTERVENTION Thirty participants were randomised to receive Mii-vitaliSe either immediately (for 12 months) or after a 6-month wait (for 6 months). Mii-vitaliSe consisted of two supervised Nintendo Wii familiarisation sessions in the hospital followed by home use (Wii Sports, Sports Resort and Fit Plus software) with physiotherapist support and personalised resources. OUTCOMES Included self-reported physical activity levels, quality of life, mood, self-efficacy, fatigue and assessments of balance, gait, mobility and hand dexterity at baseline, 6 and 12 months. Interviews (n=25) explored participants' experiences and, at study end, the two Mii-vitaliSe facilitators' experiences of intervention delivery (main qualitative findings reported separately). RESULTS Mean (SD) age was 49.3 (8.7) years, 90% female, with 47% diagnosed with MS <6 years ago and 60% new to active gaming. The recruitment rate was 31% (95% CI 20% to 44%). Outcome data were available for 29 (97%) at 6 months and 28 (93%) at 12 months. No serious adverse events were reported during the study. Qualitative data indicated that Mii-vitaliSe was well-received. Mean Wii use across both groups over the initial 6-month intervention period was twice a week for 27 min/day. Mean cost of delivering Mii-vitaliSe was £684 per person. DISCUSSION Mii-vitaliSe appears acceptable and a future trial feasible and warranted. These findings will inform its design. TRIAL REGISTRATION ISRCTN49286846.
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Affiliation(s)
- Sarah Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Louise Fazakarley
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Peter W Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Sarah Collyer
- Poole Hospital NHS Foundation Trust, Dorset Multiple Sclerosis Service, Poole, Dorset, UK
| | - Sarah Brenton
- Poole Hospital NHS Foundation Trust, Dorset Multiple Sclerosis Service, Poole, Dorset, UK
| | - Steve Perring
- Poole Hospital NHS Foundation Trust, Medical Physics, Poole, Dorset, UK
| | - Rebecca Scott
- National Star College, Cheltenham, Gloucestershire, UK
| | - Fern Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Charlotte Thomas
- Bournemouth University, Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | | | | | - Charles Hillier
- Poole Hospital NHS Foundation Trust, Dorset Multiple Sclerosis Service, Poole, Dorset, UK
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18
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Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation. Pediatr Phys Ther 2017; 29 Suppl 3:S23-S36. [PMID: 28654475 PMCID: PMC5488703 DOI: 10.1097/pep.0000000000000387] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Use of virtual reality (VR) and serious games (SGs) interventions within rehabilitation as motivating tools for task specific training for individuals with neurological conditions are fast-developing. Within this perspective paper we use the framework of the IV STEP conference to summarize the literature on VR and SG for children and adults by three topics: Prevention; Outcomes: Body-Function-Structure, Activity and Participation; and Plasticity. Overall the literature in this area offers support for use of VR and SGs to improve body functions and to some extent activity domain outcomes. Critical analysis of clients' goals and selective evaluation of VR and SGs are necessary to appropriately take advantage of these tools within intervention. Further research on prevention, participation, and plasticity is warranted. We offer suggestions for bridging the gap between research and practice integrating VR and SGs into physical therapist education and practice.
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19
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Keune PM, Young WR, Paraskevopoulos IT, Hansen S, Muenssinger J, Oschmann P, Müller R. Measuring standing balance in multiple sclerosis: Further progress towards an automatic and reliable method in clinical practice. J Neurol Sci 2017; 379:157-162. [PMID: 28716231 DOI: 10.1016/j.jns.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/11/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Balance deficits in multiple sclerosis (MS) are often monitored by means of observer-rated tests. These may provide reliable data, but may also be time-consuming, subject to inter-rater variability, and potentially insensitive to mild fluctuations throughout the clinical course. On the other hand, laboratory assessments are often not available. The Nintendo Wii Balance Board (WBB) may represent a low-cost solution. The purpose of the current study was to examine the methodological quality of WBB data in MS (internal consistency, test-retest reliability), convergent validity with observer-rated tests (Berg Balance Scale, BBS; Timed-Up and Go Test, TUG), and discriminative validity concerning clinical status (Expanded Disability Status Scale, EDSS). METHODS Standing balance was assessed with the WBB for 4min in 63 MS patients at two assessment points, four months apart. Additionally, patients were examined with the BBS, TUG and the EDSS. RESULTS A period of 4min on the WBB provided data characterized by excellent internal consistency and test-retest reliability. Significant correlations between WBB data and results of the BBS and TUG were obtained after merely 2min on the board. An EDSS median-split revealed that higher EDSS values (>3) were associated with significantly increased postural sway on the WBB. CONCLUSIONS WBB measures reflecting postural sway are methodologically robust in MS, involving excellent internal consistency and test-retest reliability. They are also characterized by convergent validity with other considerably lengthier observer-rated balance measures (BBS) and sensitive to broader clinical characteristics (EDSS). The WBB may hence represent an effective, easy-to-use monitoring tool for MS patients in clinical practice.
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Affiliation(s)
- Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Germany; Department of Physiological Psychology, Otto-Friedrich-University Bamberg, Germany.
| | - William R Young
- Department of Clinical Sciences, Brunel University London, United Kingdom.
| | | | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Germany.
| | | | | | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Germany; Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, Germany; Department of Sports Science, Friedrich-Schiller-University, Jena, Germany.
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20
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Severini G, Straudi S, Pavarelli C, Da Roit M, Martinuzzi C, Di Marco Pizzongolo L, Basaglia N. Use of Nintendo Wii Balance Board for posturographic analysis of Multiple Sclerosis patients with minimal balance impairment. J Neuroeng Rehabil 2017; 14:19. [PMID: 28284217 PMCID: PMC5346266 DOI: 10.1186/s12984-017-0230-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/07/2017] [Indexed: 12/16/2022] Open
Abstract
Background The Wii Balance Board (WBB) has been proposed as an inexpensive alternative to laboratory-grade Force Plates (FP) for the instrumented assessment of balance. Previous studies have reported a good validity and reliability of the WBB for estimating the path length of the Center of Pressure. Here we extend this analysis to 18 balance related features extracted from healthy subjects (HS) and individuals affected by Multiple Sclerosis (MS) with minimal balance impairment. Methods Eighteen MS patients with minimal balance impairment (Berg Balance Scale 53.3 ± 3.1) and 18 age-matched HS were recruited in this study. All subjects underwent instrumented balance tests on the FP and WBB consisting of quiet standing with the eyes open and closed. Linear correlation analysis and Bland-Altman plots were used to assess relations between path lengths estimated using the WBB and the FP. 18 features were extracted from the instrumented balance tests. Statistical analysis was used to assess significant differences between the features estimated using the WBB and the FP and between HS and MS. The Spearman correlation coefficient was used to evaluate the validity and the Intraclass Correlation Coefficient was used to assess the reliability of WBB measures with respect to the FP. Classifiers based on Support Vector Machines trained on the FP and WBB features were used to assess the ability of both devices to discriminate between HS and MS. Results We found a significant linear relation between the path lengths calculated from the WBB and the FP indicating an overestimation of these parameters in the WBB. We observed significant differences in the path lengths between FP and WBB in most conditions. However, significant differences were not found for the majority of the other features. We observed the same significant differences between the HS and MS populations across the two measurement systems. Validity and reliability were moderate-to-high for all the analyzed features. Both the FP and WBB trained classifier showed similar classification performance (>80%) when discriminating between HS and MS. Conclusions Our results support the observation that the WBB, although not suitable for obtaining absolute measures, could be successfully used in comparative analysis of different populations. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0230-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giacomo Severini
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland. .,Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy.
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Claudia Pavarelli
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Marco Da Roit
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | - Carlotta Martinuzzi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
| | | | - Nino Basaglia
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
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21
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Tariq H. Effect of balance exercises for person with multiple sclerosis using Wii ®game: A systematic review of randomized and non-randomized control trials. ACTA MEDICA INTERNATIONAL 2016. [DOI: 10.5530/ami.2016.1.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Kim KJ, Jun HJ, Heo M. Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability. J Phys Ther Sci 2015; 27:3381-5. [PMID: 26696703 PMCID: PMC4681910 DOI: 10.1589/jpts.27.3381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/05/2015] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost.
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Affiliation(s)
- Ki-Jong Kim
- Department of Physical Therapy, Cheongam College, Republic
of Korea
| | - Hyun-Ju Jun
- Department of Physical Therapy, Cheongam College, Republic
of Korea
| | - Myoung Heo
- Department of Occupational Therapy, Gwangju University: 277
Hyodeok-ro, Nam-gu, Gwangju, Republic of Korea
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23
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Effectiveness and Limitations of Unsupervised Home-Based Balance Rehabilitation with Nintendo Wii in People with Multiple Sclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:916478. [PMID: 26583146 PMCID: PMC4637091 DOI: 10.1155/2015/916478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/15/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
Balance training represents a critical part of the rehabilitation process of individuals living with multiple sclerosis (MS) since impaired postural control is a distinctive symptom of the disease. In recent years, the use of the Nintendo Wii system has become widespread among rehabilitation specialists for this purpose, but few studies have verified the effectiveness of such an approach using quantitative measures of balance. In this study, we analyzed the postural sway features of a cohort of twenty-seven individuals with MS before and after 5 weeks of unsupervised home-based balance training with the Wii system. Center of pressure (COP) time-series were recorded using a pressure platform and processed to calculate sway area, COP path length, displacements, and velocities in mediolateral (ML) and anteroposterior (AP) directions. Although the results show a significant reduction in sway area, COP displacements, and velocity, such improvements are essentially restricted to the ML direction, as the Wii platform appears to properly stimulate the postural control system in the frontal plane but not in the sagittal one. Available Wii games, although somewhat beneficial, appear not fully suitable for rehabilitation in MS owing to scarce flexibility and adaptability to MS needs and thus specific software should be developed.
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24
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Wang TL, Ames TD, Le KM, Wee C, Phieffer LS, Quatman CE. Training Advanced Practice Providers to Collect Functional Outcomes After Fragility Fractures. Geriatr Orthop Surg Rehabil 2015; 6:130-9. [PMID: 26328225 PMCID: PMC4536498 DOI: 10.1177/2151458515577196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The objective of this study was to determine whether advanced practice providers could learn to collect objective functional assessment data accurately and efficiently with commercially available devices that measure kinematics and kinetics (Nintendo Wii Balance Board [WBB] and Level Belt [LB]) to aid in the assessment of fall risk and outcomes after fragility fractures. Methods: Nine advanced practice providers participated in a 1-hour clinical assessment tools (CATs) training session on equipment use, providing standardized instructions, and practice of the testing procedures. Afterward, they participated in a skills demonstration evaluation and completed a postsession survey. Results: Participants successfully achieved a mean of 18.22 (standard deviation 1.56) of 20 performance measures. Of the incomplete or omitted tasks, the majority (10 of 16) occurred within the first of 3 CATs activities. Postsession survey results revealed that 9 of 9 participants reported that the 1 hour provided for training on the CATs was sufficient. All participants reported that after the training, they felt confident they could reliably carry out the tasks to test patients on both the WBB and the LB. The majority of participants reported that they believed that the WBB (7 of 9) and LB (8 out of 9) would be good assets to clinics in assessing patient functionality after fragility fractures. Conclusion: These results indicate that advanced practice providers can confidently learn and effectively test patients with the WBB and LB within 1 hour of training. In the future, adoption of CATs in the clinical setting may allow for objective, easy-to-use, portable, noninvasive, and relatively inexpensive measures to assess functional outcomes in patients with fragility fracture.
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Affiliation(s)
- Tiffany L Wang
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tyler D Ames
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Khoi M Le
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Corinne Wee
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Laura S Phieffer
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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25
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O'Donovan C, Gormley J, Hussey JM. The Potential of "Wii Fit Free Jogging" as an Exercise Test. Games Health J 2015; 3:296-302. [PMID: 26192484 DOI: 10.1089/g4h.2013.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the potential use of "Wii™ Fit Free Jogging" (Nintendo(®), Kyoto, Japan) as a tool to estimate aerobic fitness in healthy young adults. It was hypothesized that virtual distance achieved, an outcome reported by the "Wii Fit Free Jogging" game, may be used to estimate aerobic fitness. MATERIALS AND METHODS Two exercise tests using "Wii Fit Free Jogging" were developed: the Wii Jogging Test and the Wii Step Test. For the Wii Jogging Test participants were required to jog on the spot with the aim of achieving the highest virtual distance possible in a given time. For the Wii Step Test participants had the same aim but were required to step up and down a 30-cm step. The construct and criterion validities of these tests were examined in two separate studies. Results were compared with maximal oxygen consumption (VO2max), which was established using the Bruce treadmill protocol. Oxygen consumption and heart rate were measured using an Oxycon™ Mobile indirect calorimeter (Jaeger™; Viasys Healthcare, Hoechberg, Germany) and a Polar heart rate monitor (Polar Electro Oy, Kempele, Finland). RESULTS There was no difference between the highest oxygen consumption reached during the Wii Step Test and VO2max (P=0.101). In regression analysis virtual distance results from neither the Wii Jogging Test nor the Wii Step Test contributed to the prediction of VO2max (P=0.235 and P=0.396, respectively). CONCLUSIONS In its current form, "Wii Fit Free Jogging" is not suitable for use as an exercise test. Although it elicited near-maximal exertion, there was no valid method of estimating aerobic fitness from virtual distance results.
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Affiliation(s)
- Cuisle O'Donovan
- Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St. James's Hospital , Dublin, Ireland
| | - John Gormley
- Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St. James's Hospital , Dublin, Ireland
| | - Juliette M Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, St. James's Hospital , Dublin, Ireland
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Donzé C. Update on rehabilitation in multiple sclerosis. Presse Med 2015; 44:e169-76. [DOI: 10.1016/j.lpm.2014.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/29/2014] [Indexed: 11/16/2022] Open
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Taylor MJD, Griffin M. The use of gaming technology for rehabilitation in people with multiple sclerosis. Mult Scler 2014; 21:355-71. [PMID: 25533296 DOI: 10.1177/1352458514563593] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gaming technology - exergaming - is a novel tool to facilitate exercise, improve balance, and encourage rehabilitation training. This review will describe some of the key exergame research to promote physical activity and its use in rehabilitation in other diseases or clinical populations. We will then describe the current state of research in exergaming in people with multiple sclerosis and describe the theories for the mechanism behind some of the improvements in outcomes seen after using exergaming. Lastly, we will identify gaps in the literature and provide directions for future work in this growing area. The current work is contradictory and there is no consensus with regards to training duration/intensity and the outcomes used to assess the clinical effectiveness. This in part is due to the off-the-shelf nature of the games used. A more satisfactory approach would be the development of bespoke games which match a clinical need. Exergames are seen as enjoyable and could be effective in enhancing adherence to rehabilitation. However, the definitive RCT has yet to be carried out comparing exergaming to traditional exercise.
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Affiliation(s)
- M J D Taylor
- School of Biological Sciences, University of Essex Colchester, UK
| | - M Griffin
- School of Biological Sciences, University of Essex Colchester, UK
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Forsberg A, Nilsagård Y, Boström K. Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists. Disabil Rehabil 2014; 37:338-44. [PMID: 24833535 PMCID: PMC4364246 DOI: 10.3109/09638288.2014.918196] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Our aim was to describe experiences of using Nintendo Wii Fit™ for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients' physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings. Implications for Rehabilitation Nintendo Wii Fit™ can be used as a fun and challenging way to perform balance exercises. The competitive content embedded in the games triggers continued playing and exercising. The positive effect on balance control can improve standing and walking in everyday activities.
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Affiliation(s)
- Anette Forsberg
- Family Medicine Research Centre, Örebro County Council , Örebro , Sweden
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Thomas S, Fazakarley L, Thomas PW, Brenton S, Collyer S, Perring S, Scott R, Galvin K, Hillier C. Testing the feasibility and acceptability of using the Nintendo Wii in the home to increase activity levels, vitality and well-being in people with multiple sclerosis (Mii-vitaliSe): protocol for a pilot randomised controlled study. BMJ Open 2014; 4:e005172. [PMID: 24812193 PMCID: PMC4028512 DOI: 10.1136/bmjopen-2014-005172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The benefits of physical activity for people with multiple sclerosis (pwMS) have been recognised. However, exercise regimens can be difficult to maintain over the longer term and pwMS may face unique barriers to physical activity engagement. Pilot research suggests the Nintendo Wii can be used safely at home by pwMS with minimal mobility/balance issues and may confer benefits. We have developed a home-based physiotherapist supported Wii intervention ('Mii-vitaliSe') for pwMS that uses commercial software. This is a pilot study to explore the feasibility of conducting a full scale clinical and cost-effectiveness trial of Mii-vitaliSe. METHODS AND ANALYSIS 30 ambulatory, relatively inactive pwMS will be randomised to receive Mii-vitaliSe immediately, or after 6 months. Outcomes, measured at baseline and 6 and 12 months later, will include balance, gait, mobility, hand dexterity and self-reported physical activity levels, fatigue, self-efficacy, mood and quality of life. Interviews conducted on a purposive sample of participants will explore experiences of participation in the study and barriers and facilitators to using the Wii. Mean recruitment, adherence rate and standard deviations (SDs) of potential primary outcomes for the full trial will be estimated and precision summarised using 95% confidence intervals (CIs). Interview transcripts will be thematically analysed using a generic qualitative approach. ETHICS AND DISSEMINATION National Health Service (NHS; ref 12/SC/0420) and university ethical approvals have been obtained as has NHS Research and Development permission from the relevant trust. A home risk assessment will be undertaken for all potential participants. All adverse events will be closely monitored, documented and reported to the study Safety Monitoring Committee. At least one publication in a peer reviewed journal will be produced and research findings presented at a national and international conference. With service users, we will coproduce a summary of the findings for dissemination on our research unit's website and elsewhere. TRIAL REGISTRATION NUMBER ISRCTN 49286846.
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Affiliation(s)
- Sarah Thomas
- Clinical Research Unit, School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Louise Fazakarley
- School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Peter W Thomas
- Clinical Research Unit, School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Sarah Brenton
- Dorset Multiple Sclerosis Service, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - Sarah Collyer
- Dorset Multiple Sclerosis Service, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - Steve Perring
- Medical Physics Department, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - Rebecca Scott
- Physiotherapy Department, National Star College, Cheltenham, Gloucestershire, UK
| | - Kathleen Galvin
- Faculty of Health and Social Care, Hull University, Hull, Yorkshire, UK
| | - Charles Hillier
- Dorset Multiple Sclerosis Service, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
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Pessoa TM, Coutinho DS, Pereira VM, Ribeiro NPDO, Nardi AE, Silva ACDOE. The Nintendo Wii as a tool for neurocognitive rehabilitation, training and health promotion. COMPUTERS IN HUMAN BEHAVIOR 2014. [DOI: 10.1016/j.chb.2013.10.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Qualitative Study Exploring the Usability of Nintendo Wii Fit among Persons with Multiple Sclerosis. Occup Ther Int 2013; 21:21-32. [DOI: 10.1002/oti.1345] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 12/05/2012] [Accepted: 01/28/2013] [Indexed: 11/07/2022] Open
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Prosperini L, Fortuna D, Giannì C, Leonardi L, Marchetti MR, Pozzilli C. Home-Based Balance Training Using the Wii Balance Board. Neurorehabil Neural Repair 2013; 27:516-25. [DOI: 10.1177/1545968313478484] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective. To evaluate the effectiveness of a home-based rehabilitation of balance using the Nintendo Wii Balance Board System (WBBS) in patients affected by multiple sclerosis (MS). Methods. In this 24-week, randomized, 2-period crossover pilot study, 36 patients having an objective balance disorder were randomly assigned in a 1:1 ratio to 2 counterbalanced arms. Group A started a 12-week period of home-based WBBS training followed by a 12-week period without any intervention; group B received the treatment in reverse order. As endpoints, we considered the mean difference (compared with baseline) in force platform measures (ie, the displacement of body center of pressure in 30 seconds), 4-step square test (FSST), 25-foot timed walking test (25-FWT), and 29-item MS Impact Scale (MSIS-29), as evaluated after 12 weeks and at the end of the 24-week study period. Results. The 2 groups did not differ in baseline characteristics. Repeated-measures analyses of variance showed significant time × treatment effects, indicating that WBBS was effective in ameliorating force platform measures ( F = 4.608, P = .016), FSST ( F = 3.745, P = .034), 25-FWT ( F = 3.339, P = .048), and MSIS-29 ( F = 4.282, P = .023). Five adverse events attributable to the WBSS training (knee or low back pain) were recorded, but only 1 patient had to retire from the study. Conclusion. A home-based WBBS training might potentially provide an effective, engaging, balance rehabilitation solution for people with MS. However, the risk of WBBS training-related injuries should be carefully balanced with benefits. Further studies, including cost-effectiveness analyses, are warranted to establish whether WBBS may be useful in the home setting.
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Guidi I, Giovannelli T, Paci M. Effects of Wii exercises on balance in people with multiple sclerosis. Mult Scler 2012; 19:965. [DOI: 10.1177/1352458512461971] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Irene Guidi
- School of Physiotherapy, University of Florence, Italy
| | | | - Matteo Paci
- Unit of Functional Rehabilitation, Prato Hospital, Prato, Italy
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