Wii balance training in stroke patients

INTERVENTION: Randomization was performed by using ‘random permutated blocks’ using blocks of 2 patients for each of the 2 treatments (Pocock, 1994). Using this method and a randomization table, the 2 treatments were put in random order and placed in dense , numbered envelopes. One person who was not involved in any of the other study procedures conducted the randomization. Blinding was applied to the researcher who performed the measurements and who analyzed the data. It was not possible to blind the patient or the therapist, because both knew which balance therapy was given. According to group allocation, patients were provided twice a week 30 minutes of conventional balance therapy or Wii Fit balance training under supervision of a physical therapist. For the residual days of the week, the patients were instructed to exercise, in conformity with the allocated group, for at least 30 minutes a day at home (more was allowed). The intervention lasted for eight weeks. Nintendo Wii Fit With Wii Fit balance training, the Wii Balance board was used, which consists of 4 transducers to assess force distribution and the resulting movements in the Center of Pressure (CoP). Eleven games to exercise balance (Table Tilt (plus), Ski Slalom, Balance Bubble (plus), Penguin Slide, Heading, Tilt City, Segway Circuit, Perfect 10, Snowball Fight, Muscle Workouts and Step Basics) were selected in accordance with the physical therapist. At the sessions under supervision, the physical therapist selected, in consultation with the patients, one or more games for the patients to exercise in that session. This selection was based on two conditions: whether the patients enjoyed the game and if the game was feasible for the patients. At home the patients were allowed to select one or more games for their balance exercises. For safety reasons, the patients were allowed to use a walker during the exercise when he/ she needed it. Conventional balance therapy The conventional balance therapy consisted of d CONDITION: Subacute stroke patients in an outpatient setting ; Circulatory System ; Stroke, not specified as haemorrhage or infarction PRIMARY OUTCOME: 1. Balance measured using the Berg Balance Scale (BBS) prior to and directly after the eight‐week intervention; 2. Gait instability measured using the Dynamic Gait Index (DGI) prior to and directly after the eight‐week intervention INCLUSION CRITERIA: 1. Patients with subacute stroke (>6 weeks and <6 months) 2. Discharged from the rehabilitation center 3. Ischemic, hemorrhagic or recurrent stroke (diagnosed by a neurologist) 4. Aged >18 years 5. Continued outpatient physical therapy 6. Functional Ambulation Category (FAC) independence level of =4 7. Berg Balance Scale (BBS) score <56 or a BBS score of 56 and a score of 0 or 1 at item 5 of the Dynamic Gait Index (DGI) 8. Understanding of simple exercises 9. None of the included patients used the Wii for at least the last four weeks before the trial started 10. All participants provided written informed consent before the start of the study SECONDARY OUTCOME: 1. Walking speed measured using the 5 Meter Walk Test (5MWT) prior to and directly after the eight‐week intervention; 2. Fatigue measured using the Fatigue Severity Scale (FSS) prior to and directly after the eight‐week intervention; 3. Fatigue measured using the VAS‐Fatigue Severity Scale (VAS‐f) prior to and directly after the eight‐week intervention; 4. Independence of Activities of Daily Living measured using the Barthel Index (BI) prior to and directly after the eight‐week intervention; 5. Physical activity measured using the actigraph (GT1M‐1 and GT1M‐2) prior to and directly after the eight‐week intervention; 6. Physical activity measured using the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) prior to and directly after the eight‐week intervention; 7. Individuals perceived functioning in daily activities and social participation measured using the Life Habits prior to and directly after the eight‐week intervention; 8. Individual perceived general health (quality of life) measured using the Short‐Form 36 (SF‐36) prior to and directly after the eight‐week intervention