The effect of virtual reality exercises with Nintendo Wii system on balance in hemiplegia patients: Randomized controlled trial

Decreased postural stability and balance disorders are a common problem in hemiplegic patients secondary to stroke. Disturbed equilibrium reactions in stroke have critical importance because of increasing risk of falling and injuries. An efficient rehabilitation program begining immediately after stroke minimizes functional losses. In recent years, the virtual reality exercise program has begun to gain a widespread application as a supportive therapy in stroke rehabilitation. The aim of this study was to examine the efficiency of virtual reality exercises with Nintendo Wii system on balance and independence in motor functions.This randomized controlled assesor-blinded study included 23 stroke inpatients with hemiparesis all within 12 months poststroke. Patients were randomly assigned to one of the two groups via block randomization method. Both groups participated in a conventional balance rehabilitation programme. Twelve patients in the study group received a four week balance training programme five times per week with a session duration of 20 minutes using the Nintendo Wii system in addition to the conventional balance rehabilitation programme. Balance was assessed by the Berg balance scale, the functional reach test, the timed up and go test, the postural assesment scale for stroke, the static balance index. Also displacement of centre of pressure sway and centre of pressure displacement during weight shifting was calculated by Emed-SX system. Independence in motor functions was assessed by FIM ambulation and FIM transfer subscales. The outcome measures were evaluated at baseline, 4th week (posttreatment), 8th week (follow-up).Repeated measures analysis of variance was performed for each of the outcome measure. Significant group time interaction was detected in the scores of the Berg balance scale, the functional reach test, eyes open anteropoterior and mediolateral center of pressure sway distance, eyes closed anteroposterior center of pressure sway distance, center of pressure displacement during weight shifting to effected side, uneffected side and total centre of pressure displacement during weight shifting (p<0.05). Time effect was statistically significant in the scores of the Berg balance scale, the functional reach test, the timed up and go test, the postural assesment scale for stroke, the static balance index ,eyes open anteropoterior and mediolateral center of pressure sway distance, eyes closed mediolateral center of pressure sway distance, the center of pressure displacement during weight shifting to effected side, the functional independence measure ambulation and transfer scores (p<0.05).Virtual reality exercises with Nintendo Wii system combined with a conventional balance rehabilitation programme enhances balance performance and independence in motor functions in stroke patients.Key words: Hemiplegia, balance, virtual reality