Sports Medicine Research: In the Lab & In the Field: An Electronic Home Balance Program Improves Gait Parameters in Ankle Sprain Patients (Sports Med Res)


Monday, October 30, 2017

An Electronic Home Balance Program Improves Gait Parameters in Ankle Sprain Patients

Effect of Wii Fit™ exercise therapy on gait parameters in ankle sprain patients: A randomized controlled trial

Punt IM, Armand S, Ziltener JL, Allet L. Gait & Posture. 2017; 58:52-58. doi: 10.1016/j.gaitpost.2017.06.284

Take Home Message: Home-based electronic balance training may improve gait parameters in ankle sprain patients, but is not more effective than standard physical therapy or no intervention.

Electronically-based exercise interventions are becoming increasingly popular in patient care as these are relatively low-cost interventions and may increase motivation during rehabilitation. The Nintendo Wii FitTM may improve balance through games that require an individual to complete a virtual task while stabilizing on a balance board. However, it is unknown if similar outcomes would exist with a home-based exergaming protocol.  Hence, the authors compared the effectiveness of a Wii FitTM home balancing protocol to conventional physical therapy and no physical therapy interventions on gait measures (for example, gait speed and joint movement) among participants with sub-acute ankle sprains (see Table below for several key gait measures used in this study). Prior to randomizing a participant, the researchers looked at a participant as they walked across a walkway to obtain baseline gait measures. They then assigned a participant to one of three groups: Wii FitTM home balance training, standard physical therapy, or control group without any interventions. The Wii FitTM balance training group performed preselected balance games at any difficulty level they chose for 30 minutes per session for at least 2 times per week over 6 weeks. Physical therapists applied joint mobilizations, and instructed muscle strengthening and balance exercises for the therapy group for nine 30-minute sessions over 6 weeks. The control group did not receive any therapy or intervention. Following the 6-week period, the researchers evaluated all participants’ gait again. All groups improved with increased gait speed and rate, and decreased step length from baseline to follow-up. The authors found no differences over time between groups.

Spatiotemporal Gait Parameters
Cadence (step rate)
Number of steps per unit of time
Step Length
Distance between corresponding successive points of heel contact of the opposite feet
Single Limb Support Time
The amount of time spent on a leg expressed as a percent of the entire gait cycle
Symmetry of Single Limb Support Time
The amount of time spent on a limb as a percent of the gait cycle compared between right and left legs

These findings indicate that a home-based Wii FitTM protocol may be an additional means to positively impact gait in individuals with ankle sprains; however, neither treatment group differed from the control group. These results are based on strong analyses but they categorized participants that dropped out of the study as “no change”. This could influence the results because there were drop-out rates over 20% in the Wii FitTM and no intervention groups, and about a 10% drop-out rate in the standard therapy group, this may have influenced the outcomes. Additionally, there were differences in intervention exposure as the standard therapy group had nine total sessions while the Wii FitTM group did twelve or more. It would be interesting to see the results based on participants who completed the interventions. It would also be beneficial to see the results with patient-reported outcomes to gauge participant responses. Despite these few limitations, these findings are important to consider clinically as electronically-based therapy may improve patient function efficiently and in an interactive manner. For some patients, the gaming platforms could be used to increase patient motivation for at-home protocols if patients cannot attend clinic-based therapy consistently. However, there are some cautions to be taken from this study. As multiple outcomes improved regardless of the group, certain gait outcomes may naturally improve as ankle sprain patients recover over time. Additionally, it is not standard practice to provide no form of treatment or intervention following injury. Without knowing which patients may embrace home exercise programs with gaming platforms it may be important for clinicians to adopt strategies to promote compliance (for example, calling the patient). The results from this study should not replace current clinical practice for managing ankle injuries, however the implementation of an electronic intervention may be an additional means to improve patient function and movement strategies.

Questions for Discussion: Do you think it would be advantageous to add Wii-based exercise therapy into the clinical setting? Do you think that patients would be more compliant using these or other like forms of interactive therapies? Have you personally used or seen electronically-based rehab, and if so, what are some of the benefits/drawbacks?

Written by: Alexandra DeJong
Reviewed by: Jeffrey Driban

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Anonymous said...

i am use this ankle exercises for foot sprain recovery. Good for foot stability and mobility.

Kevin said...

Hi Alex,

Thanks for sharing this article. I think using electronically-based therapy is an interesting concept that may help with patient enthusiasm and compliance during a rehabilitation progression in the clinic setting. However, I am generally skeptical of the compliance of any HEP, such as in this discussion where you mentioned the drop out rate was greater than 20% for the Wii-based therapy group.
Personally, I have seen this tool used in the clinic setting and with great results/feedback. Its implementation into regular HEPs leaves me skeptical though.

What are your thoughts?

Alex said...

Hi Kevin,

Thank you for your response! I absolutely agree that there is always an issue with potential non-compliance seen with home exercise programs given the lack of patient-clinician supervision. I think that adding in patient buy-in is one of the most important aspects of HEP’s, which can potentially be addressed through patient education, and by making the exercises more interesting and enjoyable as well. I think that especially for younger patients, adding in an electronic component may help address some of these issues, although in the present study you are right there were some drop-outs. Perhaps looking at some form of HEP monitoring could be beneficial to address this problem. It is great to hear that you have had success with this technique in the clinic! This may be another key to compliance through reinforcing techniques in clinic visits on top of home exercise. Thanks again Kevin!

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