Effectiveness of Nintendo Wii in functional and health outcomes of individuals with Parkinson’s disease: a systematic review

Braz, Nayara Felicidade Tomaz; Dutra, Letícia Rocha; Medeiros, Paulo Eduardo Souza; Scianni, Aline Alvim; Faria, Christina Danielli Coelho de Morais

doi:10.1590/1809-2950/17131825012018

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 25 (1) • Jan-Mar 2018 • https://doi.org/10.1590/1809-2950/17131825012018 copy

Effectiveness of Nintendo Wii in functional and health outcomes of individuals with Parkinson’s disease: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The objective of this study was to conduct a systematic review of the literature on the effectiveness of Nintendo Wii in the improvement of functional and health outcomes of individuals with Parkinson’s disease. A systematic review of the literature was developed following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), with research in MEDLINE, SciELO, LILACS, PEDro through a search strategy that combined the terms Wii, Parkinson’s Disease, rehabilitation, and physical therapy, followed by manual search. Inclusion criteria were: experimental studies or quasi-experiments related to interventions involving the use of Nintendo Wii to improve functional outcomes in individuals with Parkinson’s disease, published until February 2016, without language restriction. The methodological quality of the studies was assessed with the PEDro scale. Of the 701 studies found, we included seven that met the inclusion criteria - most of the articles (57.14%) had bad methodological quality and were quasi-experiments. The results suggest that the use of Wii seems effective to improve functional outcomes (balance, mobility, motor performance and independence) and health (reducing the risk of falls), being more consistent the results for the improvement of balance. Studies with better methodological quality are needed for the establishment of evidence. Standardization on the types of games, intensity and frequency suitable for each type of patient with PD are still required.

Keywords |
Parkinson’s Disease; Virtual Reality; Neurology; Rehabilitation; Physical Therapy

Study (PEDro score)	Study design	N	Sex (M/F)	Age (mean±SD or age group) (years)	Outcomes assessed (numbers present the relation to assessment tool)	Assessment tools (numbers present the relation to the outcome assessed)
Esculier et al. ¹²12. Esculier JF, Vaudrin J, Beriault P, Gagnon K, Tremblay LE. Home-based balance training programme using Wii Fit with balance board for Parkinson's disease: a pilot study. J Rehabil Med. 2012;44(2):144-50. doi: 10.2340/16501977-0922 https://doi.org/10.2340/16501977-0922... (4)	Experimental					Activities-specific Balance Confidence Scale(1);
					Subjective perception of balance and fear of falling(1);	Sit-to-Stand Test (2,3);
		11 PDWiit	6/5 PD	PDWiit: 61.9±11.0	Functional balance(2);	Timed Up-and-Go(2,3);
		9 CGWiit	5/4 CG	CGWiit: 63.5±12.0	Mobility in ADL(3);	Tinetti performance-oriented mobility assessment(2);
					Static balance(4).	10 meter walk test(3);
						Community Balance and Mobility Assessment(2,3);
						Unipodal support test(4).
Loureiro et al. ¹⁵15. Loureiro APC, Ribas CG, Zotz TGG, Chen R, Ribas F. Feasibility of virtual therapy in rehabilitation of Parkinson's disease patients: pilot study. Fisioter Mov. 2012;25(3):659-66. doi: 10.1590/S0103-51502012000300021 https://doi.org/10.1590/S0103-5150201200... (3)	Quasi-experimental	6 PDWiit	NR	65±13.0	Subjective perception of effort(1);	Borg Scale(1);
					Static and dynamic balance(2);	Berg Balance Scale(2);
					Quality of life(3);	Notthingham Health Profile(3);
					Functional range(4).	Timed-Up-and-Go(2);
						Functional Reach Test(4).
Pompeu et al. ¹⁶16. Pompeu JE, Mendes FAS, Silva KG, Lobo AM, Oliveira TP, Zomignari AP, et al. Effect of Nintendo Wii-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. Physiotherapy. 2012;98(3):196-204. doi: 10.1016/j.physio.2012.06.004 https://doi.org/10.1016/j.physio.2012.06... (6)	Experimental	16 PDct	NR	60 to 85	Independence for ADL(1)	Unified Parkinson’s Disease Rating Scale(1);
		16 PDWiit			Static and dynamic balance(2)	Unipodal Support Test(2);
						Berg Balance Scale(2)
Mhatre et al. ¹⁷17. Mhatre PV, Vilares I, Stibb SM, Albert MV, Pickering L, Marciniak CM, et al. Wii fit balance board playing improves balance and gait in Parkinson disease. PM R. 2013;5(9):769-77. doi: 10.1016/j.pmrj.2013.05.019 https://doi.org/10.1016/j.pmrj.2013.05.0... (3)	Quasi-experimental	10 PDWiit	6/4	61.7 (44 to 91 years)		Dynamic Gait Index(1);
					Dynamic balance(1)	Sharpened Romberg Test(2);
					Static balance(2)	Berg Balance Scale(1);
					Depression(3)	Wii-Fit balance board(2);
					Subjective perception of balance and fear of falling(4)	Geriatric Depression Scale(3);
						Activities-specific Balance Confidence Scale(4).
Zalecki et al. ¹⁸18. Zalecki T, Gorecka-Mazur A, Pietraszko W, Surowka AD, Novak P, Moskala M. Visual feedback training using Wii Fit improves balance in Parkinson's disease. Folia Med Cracov. 2013;53(1):65-78. (3)	Quasi-experimental	24 PDWiit	17/7	61.8 (43 to 80)		Berg Balance Scale(1);
					Functional balance(1)	Tinetti performance-oriented mobility assessment(1);
					Mobility in ADL(2)	Timed-Up-and-Go(2);
					Subjective perception of balance and fear of falling (3)	Sit-to-Stand Test (1,2);
					Functional capacity(4)	ABC scale(3).
						10 meter walk test(4).
Gonçalves et al. ¹⁹19. Gonçalves BG, Leite MA, Orsini M, Pereira JS. Effects of using the Nintendo Wii Fit Plus platform in the sensorimotor training of gait disorders in Parkinson's disease. Neurol Int. 2014;6(1):5048. doi:10.4081/ni.2014.5048 https://doi.org/10.4081/ni.2014.5048... ⁾ (3)	Quasi-experimental	15 PDWiit	7/8	68.70±10.2	Motor function(1) Functional capacity(2)	Unified Parkinson’s Disease Rating Scale(2);
					Functional capacity(2)	Schwab & England Scale(1);
						Functional Independence Measure(2).
Liao et al. ²⁰20. Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual reality-based training to improve obstacle-crossing performance and dynamic balance in patients with Parkinson's disease. Neurorehabil Neural Repair. 2015;29(7):658-67. doi: 10.1177/1545968314562111 https://doi.org/10.1177/1545968314562111... (9)	Experimental	12 PDWiit	NR	PDWiit: 67.3;	Sensory Integration(1)	Sensory organization test(1);
		12 PDct		PDct: 65.1;	Quality of life(2)	Parkinson’s Disease questionnaire(2);
		12 PDwithout intervention		PDwithout intervention: 64.6.	Fear of falls(3)	Falls Efficacy Scale-International(3);
					Dynamic balance(4)	Timed-Up-and-Go(4);

Study	Intervention Protocol	Results	Conclusion
Esculier et al. ¹²12. Esculier JF, Vaudrin J, Beriault P, Gagnon K, Tremblay LE. Home-based balance training programme using Wii Fit with balance board for Parkinson's disease: a pilot study. J Rehabil Med. 2012;44(2):144-50. doi: 10.2340/16501977-0922 https://doi.org/10.2340/16501977-0922...	Training with the Nintendo Wii 40 min, 3x a week for 6 weeks for both groups.	The PDWiit showed significant improvement in the tests: unipodal support, COP, RMS, CBM, STST, TUG, 10MWT, POMA.	Home training program using visual feedback with the Wii Fit can improve the static and dynamic balance, global mobility and functional abilities of individuals with PD.
		The CGWiit showed significant improvement in the unipodal support test, CBM, STST, TUG.
Loureiro et al. ¹⁵15. Loureiro APC, Ribas CG, Zotz TGG, Chen R, Ribas F. Feasibility of virtual therapy in rehabilitation of Parkinson's disease patients: pilot study. Fisioter Mov. 2012;25(3):659-66. doi: 10.1590/S0103-51502012000300021 https://doi.org/10.1590/S0103-5150201200...	Use of the Wii 20 min, 2x a week for 5 weeks.	The PDWiit showed significant improvement in the tests: Borg scale, Berg Balance Scale, Functional Range Conditioning to the right and to the left side.	Virtual reality therapy using the Wii Fit can improve the balance of individuals with PD.
Pompeu et al. ¹⁶16. Pompeu JE, Mendes FAS, Silva KG, Lobo AM, Oliveira TP, Zomignari AP, et al. Effect of Nintendo Wii-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. Physiotherapy. 2012;98(3):196-204. doi: 10.1016/j.physio.2012.06.004 https://doi.org/10.1016/j.physio.2012.06...	PDct: conventional balance training, 60 min, 2x a week for 7 weeks;	Both groups showed improvements in UPDRS-II. No difference between the PDct and PDWiit was found before, immediately, after or 60 days after the intervention.	Both groups improved their respective interventions without the intervention with the Wii showing a distinct result.
	PDWiit: balancing training with Wii, 60 min, 2x a week for 7 weeks.
Mhatre et al. ¹⁷17. Mhatre PV, Vilares I, Stibb SM, Albert MV, Pickering L, Marciniak CM, et al. Wii fit balance board playing improves balance and gait in Parkinson disease. PM R. 2013;5(9):769-77. doi: 10.1016/j.pmrj.2013.05.019 https://doi.org/10.1016/j.pmrj.2013.05.0...	Training with the Wii 30 min, 2x a week for 8 weeks.	Significant improvement was found in the Berg balance scale, dynamic gait index and Sharpened Romberg test with eyes closed.	There was significant improvement in specific measures of balance and gait of individuals with PD.
Zalecki et al. ¹⁸18. Zalecki T, Gorecka-Mazur A, Pietraszko W, Surowka AD, Novak P, Moskala M. Visual feedback training using Wii Fit improves balance in Parkinson's disease. Folia Med Cracov. 2013;53(1):65-78.	Training with the Wii 20 minutes, twice daily, 7x a week for 6 weeks.	Significant differences in all tests were found after the intervention, except in the ABC scale.	Training with the Wii Fit has significantly improved the balance of individuals with PD.
Gonçalves et al. ¹⁹19. Gonçalves BG, Leite MA, Orsini M, Pereira JS. Effects of using the Nintendo Wii Fit Plus platform in the sensorimotor training of gait disorders in Parkinson's disease. Neurol Int. 2014;6(1):5048. doi:10.4081/ni.2014.5048 https://doi.org/10.4081/ni.2014.5048...	Training with use of the Wii 40 min, 2x week for 7 weeks.	Significant improvement was found in the scales Schwab & England; FIM and UPDRS III after training.	The training improved the motor function and functional capacity of individuals with PD.
Liao et al. ²⁰20. Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual reality-based training to improve obstacle-crossing performance and dynamic balance in patients with Parkinson's disease. Neurorehabil Neural Repair. 2015;29(7):658-67. doi: 10.1177/1545968314562111 https://doi.org/10.1177/1545968314562111...	PDWiit: 45 min of training with the Wii followed by 15 min of training on the treadmill, 2x a week for 6 weeks;	The PDWiit showed better results in performance testing when crossing obstacles, in dynamic balance, SOT, TUG, FES-I and PDQ-39 than the control group.	The PDWiit significantly improved the performance at the intersection of obstacle and balance.
	PDct: 45 minutes of exercises of stretching, strength and balance followed by 15 min of training on the treadmill, 2x a week for 6 weeks.

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[1] Corresponding address: Professor Christina Danielli Coelho de Morais Faria - Universidade Federal de Minas Gerais, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Departamento de Fisioterapia - Av. Antônio Carlos, 6627, Campus Pampulha - Belo Horizonte (MG), Brazil - Zip Code: 31270-901 - Phone: (31) 3409-4783 - E-mail: cdcmf@ufmg.br