The assessment of postural control and the influence of a secondary task in people with anterior cruciate ligament reconstructed knees using a Nintendo Wii balance board
Howells BE, Clark RA, Ardern CL, Bryant AL, Feller JA, Whitehead TS, & Webster KE. British Journal of Sports Medicine. Epub ahead of print Dec 25, 2012. DOI:10.1136/bjsports-2012-091525
Postural control may potentially be negatively affected well after anterior cruciate ligament (ACL) reconstruction surgery. The loss of mechanoreceptors within the original ACL may contribute to these deficits, along with many other possible factors (e.g., psychological, neuromuscular). The question remains whether postural control would further be affected while performing a secondary task, which would be more similar to when athletes return to activity post-surgery. Therefore, the purpose of this cross-sectional study was to evaluate postural control with and without a secondary task among patients with ACL reconstructions compared to matched controls. The control group was matched by age, gender, and sport to participants in the ACL reconstruction group (15 women, 30 men per group). The participants performed two stance tasks on the Nintendo Wii Balance Board. One task was a single-leg balance task and the other involved single-leg balance while moving the opposite shoulder based on cues on a screen. The participants were tested on both legs and the order of the tasks and legs were randomly selected. The authors used the Wii Balance Board with a customized program. Participants with ACL reconstructions did significantly worse in the single-leg stance task on both legs (surgical and non-surgical) when compared to their healthy controls. The addition of the secondary task caused both groups to have poorer postural control.
When designing rehabilitation programs, clinicians should realize that the post-ACL patient is likely to have postural control deficits bilaterally. The group differences were found to be greatest in the anterior-posterior directions, likely due to the hamstring and quadriceps involvement. The secondary task did not affect the post-ACL group any more than the control group, which may reinforce the concept that the secondary task challenges the central nervous system’s role in postural deficits rather than the local mechanoreceptors. It would have been interesting if the authors looked at bilateral strength measures and correlated these findings to postural control findings. This is another study that demonstrates the valid and reliable utilization of the Nintendo Wii Balance Board for clinical findings. However, it was a custom written program and the balance board was connected to a laptop. Where it is exciting that a relatively low cost balance board can give clinicians valuable information regarding postural control, there is still a need for more advanced level of programming. This is something that the average clinician is not likely to be able to do. Does anyone have any experience with pairing a Wii balance board to a laptop? Has anyone encountered or utilized any commercially available games or applications in the clinical setting?
Written by: Nicole Cattano
Reviewed by: Jeffrey B. Driban
Effects of Sex on Compensatory Landing Strategies Upon Return to Sport after Anterior Cruciate Ligament ReconstructionHowells BE, Clark RA, Ardern CL, Bryant AL, Feller JA, Whitehead TS, & Webster KE (2012). The assessment of postural control and the influence of a secondary task in people with anterior cruciate ligament reconstructed knees using a Nintendo Wii Balance Board. British Journal of Sports Medicine PMID: 23268373