GAMING SYSTEM VERSUS TRADITIONAL BALANCE TRAINING METHODS POST ANKLE INJURY: A COMPARATIVE STUDY OF EFFECTIVENESS

Betts E.F.¹, Baxter J.A.¹, Bint A.N.¹, Gaffney D.T.¹, Jex N.G.¹, Mason A.C.¹, Sams R.J.¹

¹Central Michigan University, Doctoral Program in Physical Therapy, Mount Pleasant, MI, United States

Background: Ankle injuries are common, with an estimated 2 million persons per year in the United States receiving medical care for sprains, strains, and fractures. Ankle sprains occur at a rate of 25,000 per day; rehabilitation post injury is critical to reduce residual weakness and instability. Given the high incidence rate of ankle injuries, efforts to investigate new, promising rehabilitation techniques for the ankle are warranted.

Purpose: The purpose of this study was to determine whether use of a Nintendo WiiFit ^TM rehabilitation program versus a traditional rehabilitation program resulted in greater balance gains post unilateral ankle injury in young adults.

Methods: Sixteen subjects (7 male, 9 female, with a mean age of 25 ) who had sustained unilateral ankle injury qualified for the study. Tandem Romberg tests (eyes open and eyes closed methods) were used to establish lack of balance control as inclusion criteria. The following tests were administered pre- and post-training: NeuroCom Balance ManagerTM was used to test limits of stability, motor control, adaptation, and unilateral stance; Cybex Norm TM isokinetic dynamometer measured peak and average torque of ankle dorsiflexion (DF) and plantarflexion (PF) at velocities of 60, 120, and 180 degrees per second in a sub-set of subjects; Foot and Ankle Outcome Survey (FAOS) was used pre- and post training as a qualitative measure. Subjects were randomly assigned to either a WiiFit TM (Wii) or a Traditional (T) training group. Wii training consisted of having the subject stand on a balance platform while participating in selected games to challenge balance that were projected on a video screen. T training consisted of training on balance devices such as the BOSU, balance boards, and foam surfaces. All subjects completed 15 - 18 training sessions of 30 minutes´ duration over 6 weeks time in their respective training group and were then re-tested using the pre-test measures.

Results: Both training groups (Wii and T) demonstrated improvement from pre- to post-testing. The Wii group demonstrated greater mean change in the FAOS, movement velocity and limits of stability tests than did the T group; whereas, the T group demonstrated increased ankle DF and PF strength, increased adaptation test scores, and increased motor control as compared to the Wii training group.

Conclusion(s): The findings of the study are consistent with the type of training emphasized in each training group. Wii training placed greater emphasis on reaction time and displacement of the center of gravity, while the T training activities such as lunges in various planes of movement, improved strength. The over-all findings support the use of the Nintendo WiiFit TM as a viable treatment method for patients with ankle injury, although greater improvements than those obtained through traditional balance training may only be realized in select measures of balance control.

Implications: Physical Therapy treatment programs combining aspects of the Nintendo WiiFit TM protocol with those of a traditional training program may lead to further improvement in balance, particularly related to velocity of movement and movement control.

Funding acknowledgements: Graduate Research and Creative Endeavors Grant from Central Michigan University

Topic: Musculoskeletal: lower limb

Ethics approval: This study was approved by the Institutional Review Board for Human Subjects Research at Central Michigan University.

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