title: Low-cost evaluation and real-time feedback of static and dynamic weight bearing asymmetry in patients undergoing in-patient physiotherapy rehabilitation for neurological conditions.
abstract: BACKGROUND
  Weight bearing asymmetry is common in patients with neurological conditions, and recent advances in gaming technology have produced force platforms that are suitable for use in a clinical setting. The aim of this research is to determine whether commercially-available Wii Balance Boards with customized software providing real-time feedback could be used in a clinical setting to evaluate and improve weight-bearing asymmetry in people with various neurological conditions.
  
  
  METHODS
  Twenty participants (age = 43.25 ± 19.37 years) receiving physiotherapy as a result of a neurological condition performed three trials each of two tasks (static standing and sit-to-stand) with and without visual feedback. Vertical forces were measured using available Wii Balance Boards coupled with customized software that displayed visual feedback in real-time. Primary outcome measures included weight-bearing asymmetry as a percentage of body mass, peak force symmetry index, and a visual analogue scale score rating self-perceived level of asymmetry.
  
  
  RESULTS
  Weight-bearing asymmetry during the static balance task was significantly reduced (Z = -2.912, p = 0.004, ES = 0.65) with visual feedback. There was no significant difference (Z = -0.336, p = 0.737) with visual feedback for the dynamic task, however subgroup analysis indicated that those with higher weight-bearing asymmetry responded the most to feedback. Correlation analysis revealed little or no relationship between participant perception of weight-bearing asymmetry and the results for the static or dynamic balance task (Spearman's rho: ρ = 0.138, p = 0.561 and ρ = 0.018, ρ =0.940 respectively).
  
  
  CONCLUSIONS
  These findings suggest that weight-bearing asymmetry can be reduced during static tasks in patients with neurological conditions using inexpensive commercially-available Wii Balance Boards coupled with customized visual feedback software. Further research is needed to determine whether real-time visual feedback is appropriate for reducing dynamic weight-bearing asymmetry, whether improvements result in improved physical function, and how cognitive and physical impairments influence the patient's ability to respond to treatment.
authors.forename: Joanna
authors.initials: J
authors.lastname: Foo
authors.forename: Kade
authors.initials: K
authors.lastname: Paterson
authors.forename: Gavin
authors.initials: G
authors.lastname: Williams
authors.forename: Ross
authors.initials: R
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D056228:Feedback, Sensory; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology; D055070:Resistance Training / Q000379:methods*; D012984:Software; D016474:Weight-Bearing; D055815:Young Adult