Sports Medicine Research: In the Lab & In the Field: Wii Balance Boards for Testing Postural Control During Single-Leg Stance Tests (Sports Med Res)
Friday, May 10, 2013

Wii Balance Boards for Testing Postural Control During Single-Leg Stance Tests

Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks.

Huurnink A, Fransz DP, Kingma I, and van Dieen JH. J Biomech. 2013; 46:1392-1395.
           
Take Home Message: The Wii Balance Board is an acceptable substitute for measuring the center of pressure during single leg stance balance tests.

While a laboratory grade force plate is the gold standard for both testing and training balance, these force plates are limited to research laboratories. Due to the importance of balance testing and training during the rehabilitation process, a cost effective, widely available and portable force plate is desirable. Therefore, Huurnink and colleagues compared a laboratory grade, in-floor force plate to the Wii Balance Board (WBB). Fourteen (6 male, 8 female) healthy participants were recruited and took part in this study. All participants performed 10 sets of 3 exercises (single leg stance with eyes open, single leg stance with eyes closed, and single leg stance after a short hop). All trials were completed on the WBB which was positioned on a force plate to allow for simultaneous measurement and control within subject variability. All participants were told to hold the stance as long as possible, keeping their hands on their hips, and focus on a point 2 meters in front of the force plates. If during a trial, the participant moved their stance leg or touched the ground with their contralateral leg, the trial was thrown out. Both the mean center of pressure sway (the average distance the center of pressure moved during the balance trial) and center of pressure path velocity (the velocity at which the center of pressure moved) were measured and analyzed as these parameters are considered the gold standard for balance performance. Overall, mean center of pressure sway and center of pressure path velocity for all trials on the force plate and WBB were similar. This data suggests that although not exact, the WBB is a sufficient alternative to a force plate when measuring the center of pressure during single leg stance balance tests.

Overall, the data presented in this study suggests that the WBB is comparable to the force plate and can be implemented in clinical practice. While there was a slight overestimation with the WBB compared to the force plate, it was very consistent and the utilization of the WBB offers clinicians an inexpensive and widely available option to implement measurable, balance exercises into their treatment regiment. While this will surely be attractive to clinicians, caution should be exercised when interpreting this data. The WBB is limited to measuring center of pressure; therefore, it should conceivably be used for rehabilitation exercises and not for research purposes. Further, little detail was given as to the availability of the data collection program used. Ultimately, this data gives clinicians an accurate and widely available tool to use in balance training. Further, using a gaming system in a rehabilitation setting may be seen as a more enjoyable experience to those patients receiving the treatment. The WBB can also give clinicians the power to easily implement a home exercise program due to the popularity and ease of access to the WBB. 

Tell us what you think. Would you consider implementing the WBB into your rehabilitation regime if widely available? If not, do you see any other potential uses for this technology in your clinical practice?

Written by: Kyle Harris
Reviewed by:  Stephen Thomas

Huurnink A, Fransz DP, Kingma I, & van Die├źn JH (2013). Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks. Journal of Biomechanics, 46 (7), 1392-5 PMID: 23528845

9 comments:

Catherine LeBlanc said...

The Wii balance board could be a great tool to incorporate within a rehabilitation program. As the article stated, patients may adhere better to the exercises performed on the WBB and therefore may have better outcomes. The WBB could better assess center of pressure and movement then the objectivity of a clinicians eyes alone. However, I believe there is still more information needed on the WBB to determine if it really can be an inexpensive alternative to the force plate. Personally, I would utilize at home programs for patients, simply because there is always the risk of improper adherence to the exercise program. However, with a better ability to record all measurements, clinicians in all settings could greatly benefit from utilizing a WBB to keep patients engaged and enthusiastic about rehabilitation.

Kyle Harris said...

Catherine,

Great comment, I couldn't agree more. I don't think that the WBB will replace the force plate in the research setting or from the final return to play measures, but I do believe, as you do, that the HEP is where the WBB will greatly improve and expedite return to play. I would be very interested to see if clinicians could identify a program or game to use as well. Adding a competitive element such as a game might also include patient adherence. I think this goes back to you point of keeping our, "patients engaged and enthusiastic about their rehabilitation."

Caitlyn Richbourg said...

I think that the WBB is an advantageous, yet simple tool to incorporate in future rehabilitation programs. In my undergraduate lower rehabilitation class, as a project I had come up with a rehab protocol for a common lateral ankle sprain using the WBB. From there, I was actually able to implement my program in the local DIII college where I was positioned clinically at the time.

Form my personal experience, the WBB is a relatively inexpensive, and easy tool to use, with very positive results in clinical situations. The gaming aspect of the WBB can be used to enhance competitive spirits among injured athletes, as well as keep them interested in their rehabilitation protocol.

However, the WBB definitely has some limitations in the long run. Obviously it doesn't really compete with an actual force plate when looking at accuracy and data collection. Also, there are only so many options, functionally, and when used in the rehab sense, the WBB is a limiting factor past a certain point in a progression sense.

Kyle said...

Caitlyn,

Thanks for the post. Its great to hear from someone with some clinical experience with the WBB. I agree that there would logically be limitations to the WBB. So perhaps at this point it is not something to consider for detailed data collection. But there seems to be some good evidence that not only can the WBB be effective in it usefulness as a rehab tool, but the gaming aspect of it is something a true force plate cannot offer. Does that sounds like an honest assessment? How did your athletes at the local DIII college take to the program?

ChelseaJacoby said...

I think utilizing the Wii Balance Board (WBB) is an excellent idea especially in regards to the rehabilitation process. Everyday new technology is being announced and I think keeping up to date with that is just as important as keeping up with advances in our field of work and finding ways to combine the two. I think rehabilitation with the WBB will definitely hit hard in the younger population of patients/athletes because they will most likely already be comfortable with the equipment and associate Wii with fun activities which will already motivate them before the rehab even starts. I also think it’s a great idea to utilize the WBB in rehab because of all of the games/activities they offer it will be easy to find at least one game’s activity that will specifically cater to what the patient needs, for example Wii Baseball for upper extremity rehab and Wii soccer for lower extremity. The competitive nature of the games itself could also ignite that competitiveness in the patient/athlete that they may have lost during injury as well. The final selling factor for me is the cost effectiveness, due to the inexpensive nature the system could be applied in rehabilitation programs all over and allow more patients/athletes to experience the improvements, even in their own home.

Kyle Harris said...

ChelseaJacoby,

Thanks for the comment. I agree with all of your points but especially with your comment on the WBB being used to generate competition and motivate the patient. For many clinicians, it makes a lot of sense to motivate athletes in the rehab process via the same thing that motivates them to play their chosen sport (competition). Have you tried to use this in any other way in your daily practice and/or how do you think you could promote healthy competition to motivate your athletes?

Jason Shermer said...

There is such an open end with this technology. I think it would be nice if the WBB had a software on it's own that could maybe have a concussion testing and rehab protocol or so much more it can do, and this technology can open up so much in the rehab setting... It can happen, haha

Alex Ruxton said...

I find it intriguing that a Wii game console can serve as a resource in a rehabilitation setting. I think that it could serve as a tool in the high school and collegiate setting. I think using the Wii would improve the patients adherence to the program. The Wii may also give the patient a sense of familiarity with the tool and make the rehab easier.

Brandon Green said...

The WBB would be a great tool because it's a new and interactive way to rehab an athlete. Like much of technology today, it can only get better with the consistent updates that can help yield better results clinically. The WBB can also help the athlete adhere to the program. Another positive about the WBB is the results can be recorded in a profile easily and it can have a degree of competition.

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