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Although balance training can improve balance across various populations, the underlying mechanisms, such as how balance training may alter sensory integration, remain unclear. This study examined the effects of balance training with visual input manipulations provided by virtual reality versus conventional balance training on measures of postural sway and sensory integration during balance control. Twenty-two healthy young adults were randomly allocated into a balance training group (BT) or a balance training with virtual reality group (BT + VR). The BT received traditional balance training, while the BT + VR additionally received visual manipulations during the 4-week balance training to elicit sensory conflicts. Static balance was measured in the form of center of pressure (COP) sway speed in trained (eyes open) and untrained (eyes closed) balance conditions. A model-based analysis quantified the sensory integration and feedback characteristics of the balance control mechanism. Herein, the visual weight quantifies the contribution of visual orientation information to balance while the proportional and derivative feedback loop-gains correct for deviations from the desired angular position and angular velocity, respectively. Significant main time effects were observed for the visual sensory contribution to balance (p = 0.002, $$\:{\eta\:}_{p}^{2}$$ = 0.41) and for the derivative feedback loop-gain (p = 0.011, $$\:{\eta\:}_{p}^{2}$$ = 0.29). Significant group-by-time interactions were observed for COP sway speed in the untrained task (p = 0.023, $$\:{\eta\:}_{p}^{2}$$ = 0.23) in favor of BT + VR and in the proportional feedback loop-gain, with reductions only in the BT + VR group (p = 0.043, $$\:{\eta\:}_{p}^{2}$$ = 0.2). BT + VR resulted in larger performance improvements compared with traditional BT in untrained tasks, most likely due to reduced reliance on visual information. This suggests that the systematic modulation of sensory inputs leads to enhanced capacity for motor adaptation in balance training.
Although balance training can improve balance across various populations, the underlying mechanisms, such as how balance training may alter sensory integration, remain unclear. This study examined the effects of balance training with visual input manipulations provided by virtual reality versus conventional balance training on measures of postural sway and sensory integration during balance control. Twenty-two healthy young adults were randomly allocated into a balance training group (BT) or a balance training with virtual reality group (BT + VR). The BT received traditional balance training, while the BT + VR additionally received visual manipulations during the 4-week balance training to elicit sensory conflicts. Static balance was measured in the form of center of pressure (COP) sway speed in trained (eyes open) and untrained (eyes closed) balance conditions. A model-based analysis quantified the sensory integration and feedback characteristics of the balance control mechanism. Herein, the visual weight quantifies the contribution of visual orientation information to balance while the proportional and derivative feedback loop-gains correct for deviations from the desired angular position and angular velocity, respectively. Significant main time effects were observed for the visual sensory contribution to balance (p = 0.002, $$\:{\eta\:}_{p}^{2}$$ = 0.41) and for the derivative feedback loop-gain (p = 0.011, $$\:{\eta\:}_{p}^{2}$$ = 0.29). Significant group-by-time interactions were observed for COP sway speed in the untrained task (p = 0.023, $$\:{\eta\:}_{p}^{2}$$ = 0.23) in favor of BT + VR and in the proportional feedback loop-gain, with reductions only in the BT + VR group (p = 0.043, $$\:{\eta\:}_{p}^{2}$$ = 0.2). BT + VR resulted in larger performance improvements compared with traditional BT in untrained tasks, most likely due to reduced reliance on visual information. This suggests that the systematic modulation of sensory inputs leads to enhanced capacity for motor adaptation in balance training.
Introduction. Nintendo® Wii is a non-immersive virtual reality platform that works integrated with the Wii Balance Board as a biofeedback system for balance rehabilitation among post-stroke patients. Objective. Primary objective was to evaluate the feasibility of employing Wii Balance Board training as a standalone treatment approach in clinical practice for sub-acute stroke patients. The secondary objective was to assess the enjoyment status during Wii Balance Board training and to calculate effect size for definitive study. Method. The study design was pilot randomized control trial. We recruited 20 sub-acute stroke patients using a block randomization technique. The participants in the experimental group received Wii Balance Board training for 12 sessions up to 2 weeks. The control group participants received standard physiotherapy treatments for standing balance for 12 sessions until 2 weeks. Outcome measures were clinical-log documentation for feasibility testing, Exergame Enjoyment Questionnaire, mini-BESTest, and FIMs. Results. The study’s enrollment and retention rate was respectively 80% (n = 20) and 70% in each group (n = 7). The incidence rate of adverse events from Wii Fit training was reported to be 40% (n = 4), along with a moderate enjoyment rate (mean±sd=50.10 ± 14.69; n = 10). The experimental intervention did not offer significant benefits over control intervention (p = 0.539, 0.622; Cohen’s d = -0.280, -0.224; 95% CI: -1.158 to 0.605, -1.101 to 0.658). Conclusion. The Wii Balance Board-based exergames training can be considered a feasible and safe balance training approach among sub-acute stroke patients. However, exergames cannot replace standard care balance rehabilitation due to poor efficacy in short term.
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