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.
Highlights
In persons living with multiple sclerosis (MS), the reduction of the physical impairments associated with the disease represents one of the main goals of the rehabilitation process [1, 2]
Individuals who met the following criteria were considered eligible for the study: diagnosis of MS according to the 2005 McDonald criteria [22] and the ability to sustain a stable upright posture for at least 15 minutes, which was the minimum time required for a Wii typical balance training session
The analysis of the activity logs recorded by the Wii console revealed that 5 other participants did not fully comply with the predefined schedule and they were excluded from the analysis
Summary
In persons living with multiple sclerosis (MS), the reduction of the physical impairments associated with the disease represents one of the main goals of the rehabilitation process [1, 2]. Since people with MS often show impaired postural control with consequent increased risk of falls [3], it is important to include specific balance training routines in the rehabilitation plan. It is believed that the positive effects observed are due to biofeedback mechanisms, activated mainly through the visual system, even though the actual modalities of stimulation of the postural control system induced by this device have been scarcely investigated. It is noteworthy that the outcome measures employed to assess the effectiveness of the Wii training program are mixed since balance has been assessed using either clinically rated (e.g., Berg Balance Scale, Equiscale, and the Dynamic Gait Index) or patient-reported outcome measures (such as the Activities-Specific Balance Confidence Scale) or objective
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