Wii (game console) May Help Balance in Parkinson's

Wii May Help Balance in Parkinson's
By Ed Susman, Contributing Writer, MedPage Today
Published: June 24, 2013
Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

SYDNEY -- An exercise program that included the use of the Nintendo Wii virtual reality video game appears to have improved balance, reducing the risk of falls among patients with Parkinson's disease, researchers reported here.

On the Tinetti Total Score 18, the patients in the study who used the Wii plus treadmill and cycling exercise routines increased from 22.3 at baseline to 26.6 (P=0.002), according to Antonella Peppe, PhD, research professor at the Fondazione Santa Lucia in Rome.

"The ability of the Wii Balance Board to stimulate the central nervous system makes it potentially useful in the rehabilitation of balance problems in patients with Parkinson's disease," Peppe said in her late-breaker poster presentation at the annual International Congress on Parkinson's Disease and Movement Disorders. "Our results allow us to confirm that the Wii is an excellent tool that can compete with other devices in the rehabilitation of Parkinson's disease."

The researchers also showed that the patients who exercised 60 minutes a day -- 20 minutes playing three different Wii games; 20 minutes on the treadmill, and 20 minutes on the cycle -- appeared to improve balance and gait as measured by both the Tinetti and Unified Parkinson's Disease Rating Scale (UPDRS) Part II and Part III and the Part III balance and gait section scores. At baseline:

Tinetti balance score was 13.83 and that improved to 16 (P=0.002) after patients completed the exercise program. Patients completed 1 to 26 sessions, with the mean of 10.66 hour-long sessions.
Tinetti gait score was 8.5 and that improved to 10.58 (P=0.007) post-treatment.
UPDRS part 2 score was 12.83 and that improved to 6.25 (P=0.002) post-treatment.
UPDRS part 3 score was 31.13 and that improved to 14.08 (P=0.002) post-treatment.
UPDRS part 3 gait and balance score was 6.73 and that improved to 2.0 (P=0.003) post-treatment.
Peppe and colleagues also reported that after treatment patients had improved outcomes on the Global Mobility Task, on the Parkinson's Disease Questionnaire-39 and on the 6-Minute Walk Test.

"Our results with the Wii Balance Board are encouraging," Peppe wrote in her presentation. "In fact, after the rehabilitation trial Tinetti's scale showed a statistically significant decrease in the risk of falling and the Global Mobility Task showed better stability, reflected in decreased time and increased functional ability highlighted by the 6-Minute Walk Test."

The researchers noted, however, that their research was limited by lack of a control group in their pilot study.

Participants mean age was 63.33; their disease onset occurred at a mean age of 51-and-a-half; their disease duration was 11.75 years. Patients' only treatment was levodopa at a mean daily dose of 526.71 mg.

"Peppe et al. demonstrate that therapeutic interventions utilizing the Wii Fit Balance Board show promise in improving symptoms related to Parkinson's disease," said Jennifer Trilk, PhD, clinical assistant professor of biomedical sciences at the University of South Carolina School of Medicine in Greenville.

"The study is interesting and could potentially add to a growing body of evidence for nonpharmacologic therapies related to management of Parkinson's disease," Trilk told MedPage Today.

She said that the use of Wii equipment -- especially the narrow configuration of the Balance Board and the subsequent constraints of foot and leg movement for therapy -- might limit its general use among Parkinson's disease patients.

She also suggested that treadmill walking and cycling were more likely to be associated with gait improvement rather than the Wii-based exercises.

Overall, however, Trilk said she agreed with the researchers "that the Wii Fitness Balance Board could be used, as a component of therapy, for managing symptoms related to Parkinson's disease."





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