Abstract
BackgroundWeight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. The aim of this research is to determine whether commercially-available Wii Balance Boards with customized software providing real-time feedback could be used in a clinical setting to evaluate and improve weight-bearing asymmetry in people with various neurological conditions.MethodsTwenty participants (age = 43.25 ± 19.37 years) receiving physiotherapy as a result of a neurological condition performed three trials each of two tasks (static standing and sit-to-stand) with and without visual feedback. Vertical forces were measured using available Wii Balance Boards coupled with customized software that displayed visual feedback in real-time. Primary outcome measures included weight-bearing asymmetry as a percentage of body mass, peak force symmetry index, and a visual analogue scale score rating self-perceived level of asymmetry.ResultsWeight-bearing asymmetry during the static balance task was significantly reduced (Z = −2.912, p = 0.004, ES = 0.65) with visual feedback. There was no significant difference (Z = −0.336, p = 0.737) with visual feedback for the dynamic task, however subgroup analysis indicated that those with higher weight-bearing asymmetry responded the most to feedback. Correlation analysis revealed little or no relationship between participant perception of weight-bearing asymmetry and the results for the static or dynamic balance task (Spearman’s rho: ρ = 0.138, p = 0.561 and ρ = 0.018, ρ =0.940 respectively).ConclusionsThese findings suggest that weight-bearing asymmetry can be reduced during static tasks in patients with neurological conditions using inexpensive commercially-available Wii Balance Boards coupled with customized visual feedback software. Further research is needed to determine whether real-time visual feedback is appropriate for reducing dynamic weight-bearing asymmetry, whether improvements result in improved physical function, and how cognitive and physical impairments influence the patient’s ability to respond to treatment.
Highlights
Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting
Controversy exists regarding whether weight bearing asymmetry (WBA) is due to the constraints of the neurological pathology or is a central nervous system adaptation [1], improving symmetry remains a goal for patients with an acquired brain injury or other neurological condition due to these adverse consequences [9]
The linear regression analysis of the initial level of WBA recorded in the no feedback trials and the response to visual feedback revealed a significant and strong positive relationship (F = 323, p < 0.001, R2 = 0.947) during the static balance task, with higher initial levels of WBA associated with a greater response to feedback (Figure 2)
Summary
Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. High levels of WBA are commonly reported [2] and some measures of dynamic asymmetry have been associated with an increased falls risk in older adults [3,4,5]. This in turn leads to an increased risk of further injury [6], institutionalisation [7] and/or death [8]. Some previous studies have used digital scales to evaluate standing balance in stroke patients [16], these instruments are not suitable for assessing balance during dynamic activities
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