Cited by 150Cerebral Palsy and Movement DisordersStroke Rehabilitation and RecoveryChildren's Physical and Motor Development

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The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy

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Jelsma, Jennifer, Pronk, Marieke, Ferguson, Gillian, Jelsma-Smit, Dorothee·2013·Developmental Neurorehabilitation

DOI 10.3109/17518423.2012.711781

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Abstract

OBJECTIVE: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy. METHODS: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given for 3 weeks. Outcome measures included modified balance and running speed and agility (RSA) scales of the Bruininks-Oserestky test of Motor Performance 2 and the timed up and down stairs (TUDS). RESULTS: Balances score improved significantly (F(2, 26) = 9.8286, p = 0.001). Changes over time in the RSA (F(2, 26) = 0.86198, p = 0.434) and the TUDS (F(2, 26) = 1.3862, p = 0.268) were not significant. Ten children preferred the intervention to conventional physiotherapy. CONCLUSION: Most children preferred the IVG but as the effect did not carry over into function, IVG should not be used in place of conventional therapy and further research is needed into its use as an adjunct to therapy.

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Background
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Method
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Method
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Result
Rationale and design of active play @ home: a parent-led physical activity program for children with and without disability
Rubin, D. A., WILSON, K. S., Wiersma, L. D., Weiss, J. W., & Rose, D. J. (2014) · BMC Pediatrics · doi:10.1186/1471-2431-14-41 · Cited by 20
“In those with disability, the use of interactive console-based games seems a promising area of study as positive results in gross motor function have been shown for programs in children with cerebral palsy [40,41] as well as Down syndrome [42].”
Background
Effectiveness of interactive computer play on balance and postural control for children with cerebral palsy: A systematic review
Pin, T. W. (2019) · Gait & Posture · doi:10.1016/j.gaitpost.2019.07.122 · Cited by 20
An exploratory study of gait and functional outcomes after neuroprosthesis use in children with hemiplegic cerebral palsy
Bailes, A. F., Caldwell, C., Clay, M., Tremper, M., Dunning, K. K., & Long, J. T. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1225827 · Cited by 17
“Also, results from this study are similar to previous studies,[56–58] that did not find a significant improvement in the TUDS after Wiibased [56] or virtual reality [57,58] intervention.”
Result
EFFECT OF VIRTUAL REALITY VERSUS TRADITIONAL PHYSICAL THERAPY ON FUNCTIONAL BALANCE IN CHILDREN WITH DOWN SYNDROME: A RANDOMIZED COMPARATIVE STUDY
Ghafar, M. A. A., & Abdel‐Raouf, O. (2017) · International Journal of Physiotherapy and Research · doi:10.16965/ijpr.2017.146 · Cited by 19
The Effects of a 5-Day Virtual-Reality Based Exercise Program on Kinematics and Postural Muscle Activity in Youth with Cerebral Palsy
Mills, R., Levac, D. E., & Sveistrup, H. (2018) · Physical & Occupational Therapy In Pediatrics · doi:10.1080/01942638.2018.1505801 · Cited by 17
“For example, replacing regular physiotherapy sessions with training using the Nintendo Wii for 3weeks (four 25-minute sessions per week) resulted in improved balance scores as well as clinical motor function/performance testing in children with CP (Jelsma et al., 2013) and those with poor motor performance as identifi…”
Method
Effects of Augmented Reality Interventions on the Function of Upper Extremity and Balance in Children With Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial
Malick, W. H., Butt, R., Awan, W. A., Ashfaq, M., & Mahmood, Q. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.895055 · Cited by 16
“Due to asymmetric alignment, children with SHCP commonly bear weight through the unaffected lower extremity (LE) which, when combined with inherent spasticity, may cause muscle weakness and atrophy on the paretic side, growth retardation, and reduced balance (6).”
Background
Exergaming improves balance in children with spastic cerebral palsy with low balance performance: results from a multicenter controlled trial
Meyns, P., Blanckaert, I., Bras, C. E. C., Jacobs, N., Harlaar, J., van de Pol, L. A., Plasschaert, F. S., Waelvelde, H. V., & Buizer, A. I. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1954704 · Cited by 15
Applications of VR Technologies for Childhood Disability
Green, D., & Wilson, P. H. (2014) · Virtual reality technologies for health and clinical applications · doi:10.1007/978-1-4939-0968-1_10 · Cited by 14
Does an exercise programme integrating the Nintendo Wii-Fit Balance Board improve balance in ambulatory children with cerebral palsy?
Cooper, T., & Williams, J. M. (2017) · Physical Therapy Reviews · doi:10.1080/10833196.2017.1389810 · Cited by 14
Visual Feedback in Augmented Reality to Walk at Predefined Speed Cross-Sectional Study Including Children With Cerebral Palsy
Guinet, A.-L., Bouyer, G., Otmane, S., & Desailly, É. (2022) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2022.3198243 · Cited by 13
“The results of this study confirmed that people with CP can adapt their walking speed and that they can positively respond to the real-time AR feedback [25].”
Result
The Use of Serious Gaming to Improve Sensorimotor Function and Motivation in People with Cerebral Palsy: A Systematic Review
Crebbin, K., Grisbrook, T. L., Elliott, C. M., & Thornton, A. (2022) · Games for Health Journal · doi:10.1089/g4h.2022.0112 · Cited by 14
“56–58 On the other hand, results of the comparative studies were more mixed.”
Running in people with cerebral palsy: A systematic review
Chappell, A., Gibson, N., Morris, S. L., Williams, G. P., & Allison, G. T. (2018) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1434846 · Cited by 13
Effects of exercise intervention on balance function in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials
Xiao, J., Liu, L., Tang, N., & Yi, C. (2024) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-024-00922-5 · Cited by 12
“The research was conducted in multiple countries worldwide: Egypt [32, 35, 38, 39], New Zealand [33], Turkey [34, 46, 47, 52, 55], Greece [36], Denmark [37], Chile [40], Spain [41], Brazil [42, 43], India [44, 50], South Africa [45], Thailand [48], USA [49, 51], and France [53, 54].”
Background
Therapeutic technology
Selzer, M. E., Clarke, S., Cohen, L. G., Kwakkel, G., & Miller, R. H. (2014) · Cambridge University Press eBooks · doi:10.1017/cbo9780511995590.012 · Cited by 12
Change in functional balance after an exercise program with Nintendo Wii in Latino patients with cerebral palsy: a case series
Gatica-Rojas, V., Cartes‐Velásquez, R., Méndez-Rebolledo, G., Olave-Godoy, F., & Villalobos-Rebolledo, D. (2016) · Journal of Physical Therapy Science · doi:10.1589/jpts.28.2414 · Cited by 12
Development of stratified normative data and reference equations for the timed up and down stairs test for healthy children 6–14 years of age
del Corral, T., Vivas-Mateos, J., Castillo-Pelaz, M., Aguilar‐Zafra, S., & López‐de‐Uralde‐Villanueva, I. (2021) · Physiotherapy · doi:10.1016/j.physio.2021.03.002 · Cited by 12
The non-fitness-related benefits of exergames for young individuals diagnosed with autism spectrum disorder: A systematic review
Morris, P. O., Hope, E., & Mills, J. P. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.101953 · Cited by 17
Efficacy of videogames and exergames in pediatric neurorehabilitation: a systematic review
Polizzi, A., Rinella, S., Ruggieri, M., Gentile, A. E., Verrelli, C. M., & Iosa, M. (2023) · Minerva Pediatrics · doi:10.23736/s2724-5276.23.07146-x · Cited by 10
Performance Variability During Motor Learning of a New Balance Task in a Non-immersive Virtual Environment in Children With Hemiplegic Cerebral Palsy and Typically Developing Peers
Cheng, M., Anderson, M., & Levac, D. E. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.623200 · Cited by 11
“Some of this variability may be explained by personal and predisposing factors, such as gender, experience with video game play, and upper extremity impairment level (52).”
Background
Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial
Gatica-Rojas, V., Cartes‐Velásquez, R., Soto-Poblete, A., & Lizama, L. E. C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0268163 · Cited by 10
A Clinical Decision-Making Framework for the Use of Video Gaming as a Therapeutic Modality
Espy, D., Reinthal, A. K., & Bello-Haas, V. P. M. D. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.610095 · Cited by 10
A systematic review on the usage of games for healthcare
Costa, T. H., Soares, N. M., Reis, W. A., & Bublitz, F. M. (2015) · IEEE International Conference on Consumer Electronics - Berlin (ICCE-Berlin) · doi:10.1109/icce-berlin.2015.7391316 · Cited by 10
“We noticed a tendency for researches on Brain Injury, Elderly, Cerebral Palsy and Overweight.”
Method
Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review
Beckers, L., Stal, R., Smeets, R., Onghena, P., & Bastiaenen, C. (2020) · Developmental Neurorehabilitation · doi:10.1080/17518423.2019.1645226 · Cited by 10
“(1990) Withdrawal/reversal (A-B-A) design Celeration line approach Statistical significance was determined through the use of Bloom’s probability table Autocorrelation coefficient to determine serial dependency Jelsma et al.(48) (2013) Multiple-baseline design Non-overlap of All Pairs (NAP) Repeated measures ANOVA Tuk…”
Method
Efficacy of Virtual Reality-Based Rehabilitation Interventions to Improve Balance Function in Patients with Cerebral Palsy: A Systematic Review and Meta-analysis of RCTs
Ziab, H. M., Mazbouh, R., Saleh, S., Talebian, S., Sarraj, A. R., & Hadian, M. R. (2022) · Archives of Neuroscience · doi:10.5812/ans-122865 · Cited by 10
“To conclude, three main features should be considered when selecting VRI exercises or games: (1) games should be selected as per the patients’ preferences to increase motivation and induce better clinical improvements (27) and elaborate an adequate applied clinical intervention (40), (2) To avoid any adverse effects (…”
Los videojuegos en el tratamiento fisioterápico de la parálisis cerebral
Sebastián, M. P. Y., Sebastián, M. M. Y., Amiano, A. L., & Rubio, M. C. S. (2016) · Fisioterapia · doi:10.1016/j.ft.2015.11.005 · Cited by 9
An exergame to improve balance in children who are blind.
Morelli, T., Lieberman, L. J., Foley, J. T., & Folmer, E. (2014) · Cited by 9
The strength of balance: Strength and dynamic balance in children with and without hypermobility
Ituen, O. A., Duysens, J., Ferguson, G. D., & Smits-Engelsman, B. C. M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0302218 · Cited by 11
Self-citation
Inclusivity is child’s play: pilot study on usability, acceptability and user experience of a sensory-motor PC game for children with cerebral palsy (GiocAbile)
Consales, A., Biffi, E., Nossa, R., Pittaccio, S., Lazzari, F., Malosio, M., Nicora, M. L., Tauro, G., Redaelli, D. F., Chaudhary, A., et al. (2024) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-024-01830-7 · Cited by 7
Physical Exercise Interventions Using Virtual Reality in Children and Adolescents with Cerebral Palsy: Systematic Review
Aguado, J. V., Espada, M. C., Muñoz-Jiménez, J., Ferreira, C. C., & Gámez-Calvo, L. (2025) · Healthcare · doi:10.3390/healthcare13020189 · Cited by 8
“Others only mention that spastic CP is studied [32,33,41,45], with hemiplegic CP being the most mentioned type [34,35,38,40,47,49,50,53].”
Influential
Can Virtual Reality games improve scores on clinical balance scales in children with cerebral palsy: preliminary results of a randomized controlled clinical trial
Meyns, P., Harlaar, J., van de Pol, L. A., Barkhof, F., & Buizer, A. I. (2017) · Gait & Posture · doi:10.1016/j.gaitpost.2017.06.390 · Cited by 7
Mejora del control postural y equilibrio en la parálisis cerebral infantil: revisión sistemática
Gómez-Regueira, N., & Viñas‐Diz, S. (2016) · Fisioterapia · doi:10.1016/j.ft.2015.11.006 · Cited by 7
Therapeutic potential and ownership of commercially available consoles in children with cerebral palsy
Farr, W. J., Green, D., Male, I., Morris, C., Bailey, S. E. R., Gage, H., Speller, S., Colville, V., Jackson, M., Bremner, S. A., et al. (2017) · British Journal of Occupational Therapy · doi:10.1177/0308022616678635 · Cited by 7
“The therapeutic potential of VRT has been explored using commercial systems like the Nintendo Wii, Wii Fit and Xbox Kinect, or through the use of more personalised and bespoke systems such as MiTii (see, for example, Boyd et al., 2013; Deutsch et al., 2008; James et al., 2015; Jelsma et al., 2012; Mitchell et al., 201…”
MethodInfluential
Balance training using specially developed serious games for cerebral palsy children, a feasibility study
Bonnechère, B., Omelina, L., Jansen, B., Rooze, M. A., & Jan, S. V. S. (2014) · International Conference on Pervasive Computing Technologies for Healthcare · doi:10.4108/icst.pervasivehealth.2014.255332 · Cited by 7
“Nintendo Wii FitTM) have been recently tested as a supplementary treatment for CP children with encouraging results on balance and on motivation [6].”
EFFECT OF VIRTUAL REALITY TRAINING ON BALANCE AND FUNCTIONALITY IN CHILDREN WITH CEREBRAL PALSY: A RANDOMIZED CONTROLLED TRIAL
Fidan, Ö., & Genç, A. (2023) · Türk fizyoterapi ve rehabilitasyon dergisi · doi:10.21653/tjpr.1017679 · Cited by 6
Intensive Training with Virtual Reality on Mobility in Adolescents with Cerebral Palsy—Single Subject Design
Valenzuela, E. D. J., Rosa, R. M., Monteiro, C. B. D. M., Keniston, L., Ayupe, K. M. A., Frônio, J. D. S., & Chagas, P. S. D. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910455 · Cited by 6
Reliability, minimum detectable change, and minimum clinically important difference of the balance subtest of the Bruininks-Oseretsky test of motor proficiency-second edition in children with cerebral palsy
Kim, S. G., & Kim, D. H. (2022) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-190639 · Cited by 6
“Although previous studies have used the BOT-2 to assess the balance ability of children with CP [10, 11], reliability of the balance subtest of the BOT-2 in children with CP has not been studied.”
Equilíbrio dos deficientes visuais antes e após Gameterapia
Frade, M. C. M., Cardeña, J. P., Shimano, S. G. N., Oliveira, C. C. E. S., & de Oliveira, N. M. L. (2014) · Revista Educação Especial · doi:10.5902/1984686x13720 · Cited by 6
Innovation in metaverse virtual reality technology and gamification physical education learning styles on students' motor skills
Utamayasa, I. G. D., Kusuma, A. I., & Ariani, L. P. T. (2025) · Journal of Human Sport and Exercise · doi:10.55860/pd3pdm39 · Cited by 5
“…show that VR and exergames can significantly improve children's motor skills compared to the control group, consistent with previous studies (Jelsma et al., 2013), which conducted VR training (Nintendo Wii Fit) for 25 minutes, 4 times a week for 3 weeks and found that children's motor…”
Effectiveness of virtual reality training compared to balance-specific training and conventional training on balance and gross motor functions of children with cerebral palsy: A double blinded randomized controlled trial
Ziab, H. M., Saleh, S., Talebian, S., Olyaei, G., Mazbouh, R., Sarraj, A. R., & Hadian, M. R. (2024) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-220120 · Cited by 5
“Jelsma et al. also reported that a three-week Nintendo Wii Fit training program improved the balance of children with spastic hemiplegia with results lasting up to two months post-treatment [62].”
The Landscape of Virtual Reality Use in Mobility Rehabilitation from 2010–2023: A Scoping Review
Felsberg, D. T., Pousti, R., Howard, C. K., Ross, S. E., Raisbeck, L. D., McGuirt, J. T., & Rhea, C. K. (2025) · Technologies · doi:10.3390/technologies13050167 · Cited by 5
Reliability and Validity of the Turkish Version of the Early Clinical Assessment of Balance (ECAB) for Young Children with Cerebral Palsy
Aras, B., Seyyar, G. K., Kayan, D., & Aras, Ö. (2018) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-018-9644-7 · Cited by 5
Jogos sérios em saúde: conceitos e aplicações
de Lima, T. F. M., de Assis, G. A., Corrêa, A. G. D., & Brandão, A. F. (2021) · doi:10.29327/558730.1-11 · Cited by 5
The Effects of Visual Biofeedback Balance Training on Functional Ability in Children with Cerebral Palsy : A Pilot Study
Yun, C.-K., & Yoo, J.-N. (2016) · Journal of the Korean Society of Physical Medicine · doi:10.13066/kspm.2016.11.3.133 · Cited by 5
“This is consistent with the study results that reported that intervention methods that induce active movement of COG within BOS through motivation induction, such as training devices using games, are effective in improving balance ability (Jelsma et al., 2013).”
Result

Authors: Jelsma, J., Pronk, M., Ferguson, G., & Jelsma-Smit, D.
Affiliations: University of Cape Town (ZA)
Corresponding author: Jelsma, Jennifer
ORCID: Jelsma, Jennifer
Pronk, Marieke
Ferguson, Gillian
Venue: Developmental Neurorehabilitation
Publisher: Informa UK Limited
Published: 2012-10-03
Volume: 16
Issue: 1
Pages: 27-37
ISSN: 1363-8491 (ISSN-L)
1751-8423
1751-8431
DOI: 10.3109/17518423.2012.711781
OpenAlex: W2023488182
Cited by: 150
References: 39
Citations by year: 2026: 2 · 2025: 9 · 2024: 9 · 2023: 5 · 2022: 9 · 2021: 10 · 2020: 4 · 2019: 12 · 2018: 15 · 2017: 21 · 2016: 20 · 2015: 9 · 2014: 18 · 2013: 7
FWCI: 7.75
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
Locations: Developmental Neurorehabilitation (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders: EuroQol Research Foundation
University of Cape Town
Topics: Health Sciences › Medicine › Rehabilitation › Cerebral Palsy and Movement Disorders
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
Keywords: Wii Fit, spastic hemiplegic cerebral palsy, balance control, gross motor function, children, physiotherapy, Timed Up and Go test, treatment preferences, adjunctive therapy
MeSH terms: Adolescent, Cerebral Palsy, Child, Postural Balance, Female, Hemiplegia, Humans, Male, Motor Skills, User-Computer Interface, Exercise, Video Games, Physical Therapy Modalities

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The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy

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