The Validity of Balance Evaluation of Patients with Orthopaedic Knee Problems using Nintendo Wii<sup>®</sup>

Research Article

Phys Med Rehabil Int. 2017; 4(1): 1112.

The Validity of Balance Evaluation of Patients with Orthopaedic Knee Problems using Nintendo Wii®?

Cihan CA¹* , Ummuhan BA², Ferruh T¹ and Sermet I³

¹Department of Physiotherapy and Rehabilitation, School of Health Sciences, Dumlupinar University, Evliya Celebi Campus, 43444, Kutahya, Turkey

²School of Physiotherapy and Rehabilitation, Pamukkale University, Kinikli Campus, 20070, Denizli, Turkey

³Department of Orthopedics and Traumatology, Faculty of Medicine, Dumlupinar University, Evliya Celebi Campus, 43444, Kutahya, Turkey

*Corresponding author: Cihan CA, Department of Physiotherapy and Rehabilitation, School of Health Sciences, Dumlupinar University, 43444, Kutahya, Turkey

Received: March 06, 2017; Accepted: March 29, 2017; Published: April 04, 2017

Abstract

Objectives: In recent years, the Nintendo Wii® (NW) has been widely used in the field of healthcare. There are studies in literature which have used the closed source encoded software of NW in the evaluation of balance. However, the availability of this software is limited in clinical practice. Therefore, in this study it was aimed to examine the relationship between the results of NW balance evaluation made without closed source encoded software with the results of the Kinesthetic Ability Trainer® (KAT) and the Single Leg Stance Test (SLST).

Materials and Methods: The study included 33 volunteers aged 23.85±4.62 years with a chronic orthopaedic knee joint pathology. The balance of the participants was evaluated with NW, KAT and SLST.

Results: A significant correlation at a low level was seen in only 1 parameter between the balance results of NW and KAT (p<0.05). No signficant correlation was observed in the other parameters. A significant relationship was determined between the double foot NW area, the mediolateral (ML) width, affected side ML width and weight-bearing asymmetry (WBA) parameters and the SLST results (p<0.05) at a weak-moderate level (r=-0.38, r=-0.50, r=-0.36, r=-0.38).

Conclusion: In conclusion, NW can be used instead of subjectve tests such as SLST. However, KAT uses a complex evaluation algorithm and provides more sensitive results. Therefore, to be able to increase the sensitivity of the NW balance evaluation system, standardised evaluation procedures should be developed.

Keywords: Virtual reality; Balance; Knee injury; Orthopaedic

Introduction

Balance is defined as the ability to hold the centre of body weight within a support surface [1,2]. There are various methods which can be used in the evaluation of balance. Each of these evaluates balance at a different level [3]. The localisation of the centre of weight varies in different patient groups (lower extremity injuries, osteoarthritis, patients with total knee prosthesis, stroke etc). This leads to weightbearing asymmetry (WBA) [4]. In the evaluation of balance and WBA, force platforms are accepted as the gold standard. The applicability of these in clinics is limited as they are expensive and are difficult to transport from one place to another and then set up. However, as a low-cost alternative, virtual reality systems may provide rapid, easy, valid and reliable data in the evaluation of both balance and WBA [5-10].

The Nintendo Wii® (NW) game console is readily available compared to laboratory-based virtual reality systems. On the Wii Balance Board, which is an accessory of NW, there are 4 sensors. Weight distribution and changes in the pressure centre are determined through these sensors [11-15]. Compared to other evaluation devices, the low cost and portable structure are the greatest advantages [6,16- 19]. Studies which have been conducted on balance evaluation with NW have generally used closed source encoded software. Due to the difficulty of the availability of this software, the utility of NW in clinical practice is limited. Therefore, in this study it was aimed to examine the relationship between the results of NW balance evaluation made without closed source encoded software with the results of the Kinesthetic Ability Trainer® (KAT) and the Single Leg Stance Test (SLST).

Materials and Methods

This study was conducted on volunteer patients in the Physiotherapy and Rehabilitation Department of Dumlupinar University, School of Health Science, between June 2015 and December 2015. Informed consent was obtained from all the participants before starting the study.

The study enrolled a total of 40 cases diagnosed with a chronic knee joint problem by an Orthopaedics and Traumatology specialist (SI). A total of 7 patients were excluded as 5 did not wish to participate and 2 had additional health problems. Thus the study was completed with 33 participants with a mean age of 23.85±4.62 years. Approval for the study was granted by Pamukkale University Non-Interventional Clinical Research Ethics Committee. The inclusion and exclusion criteria are presented below:

Study inclusion criteria:

- Having an orthopaedic knee joint pathology for at least 6 months

- Aged 19-40 years

- Ambulatory without the use of any assistive device (crutches, cane etc)

Study exclusion criteria:

- Having an acute phase knee pathology

- Receiving treatment for the knee problem

- Having undergone knee surgery

- Having another health problem which could affect balance

Evaluation

The evaluations were made a single researcher (CCA). Sociodemographic information and data of the pathologies of the participants were recorded in face-to-face interviews. A Visual Analog Scale (VAS) was used to assess the severity of pain. All the data were gathered under the same environmental conditions (fixed lighting, temperature, etc). The evaluations were repeated 3 times on both feet and on the affected side. For the balance evaluations, the participants were requested to step on to the platform for each repetition with the same foot and measurements were made without shoes and wearing normal daytime clothes. Using the reference points on the KAT and the Wii Balance Board, the same placements of the feet were achieved. The balance evaluation methods researched in the study are explained below.

Balance evaluations

Nintendo Wii® Balance Evaluations: Calibration was made before the evaluations. The oscillations of the pressure centre and the WBA were evaluated with the Wii Fit balance tests. During the test, the participants were requested to maintain balance for as long as possible while looking at a red point 10cm in diameter at a distance of 1.5m. The screen images of the evaluations were recorded by transfer to the computer with the installation of EasyCAP, RCA cable and connectors. These images were standardised with Adobe Photoshop CS6®. The parameters related to the pressure centre oscillations were counted 3 times as pixels using the rapid selection tool and were recorded (Figure 1). The mean of these 3 measurements was used in the analyses.