A Step in the Right Direction: Evaluating the Effectiveness of Customized Stepping Game Software and Nintendo Wii Balance Boards for Balance Rehabilitation Therapy and Measurement

Abstract

Falling is a serious issue among adults over the age of 65 as the incidence and impact of falls rapidly increases with age. Traditionally, exercise interventions have proven to be effective in improving balance and strength, and in reducing the number and risk of falls. More recently, the use of gaming and virtual reality technologies have been shown to be more engaging and effective than typical exercises alone. Using the Nintendo Wii Balance Board and customized software, a stepping game was developed that has previously been able to identify difference in performance between healthy participants and participants with conditions that affect balance, but the game has not been tested longitudinally. The objectives of this study were to investigate the stepping game system for its efficacy as a supplemental balance therapy by evaluating functional outcomes and participant satisfaction; to further evaluate the stepping game as a measurement tool to quantify longitudinal changes in balance by identifying trends in performance; and to examine the presence of a possible learning effect with the technology. The stepping game was integrated into two older adult exercise classes and functional outcomes were compared between control groups, who participated in the weekly exercise class, and test groups, who received supplemental therapy with the stepping game system. It was then integrated into two additional exercise programs to analyse trends in game performance over an 8 or 10-week period. The results of the pre-post study regarding using the stepping game as a therapy were inconclusive. The game was able to identify statistically significant changes in performance measures (response time, reaction time and step time) for some participants over the span of the exercise program; however, a larger same size and a stricter protocol is necessary to evaluate the clinical significance. One participant's improvement in balance was reflected in both game performance and change in Berg Balance Scale score, highlighting the potential usefulness of the game as an assessment tool. A learning effect with the technology was also identified for some participants. Lastly, there were mixed responses regarding engagement as using the game every week became repetitive and boring.