Balance Systems

What you need to know

Balance boards have been used for a long time in physical therapy to address poor balance. With improvements in the technology of pressure sensors and data compilers, the combination of balance boards with digital feedback has made it very easy for patients to track their movements and objectively observe their own balance.

Assessment of balance may also be converted to treatment with the addition of games that require weight shift in order to complete objectives. It is through this concept that balance systems can utilise virtual reality in order to challenge and assist in the improvement of a person's balance.

Evidence

Intended Patient Population

An extremely popular and well known balance system is the Wii Fit balance board created by Nintendo (Kyoto, Japan). Their balance board consists if 4 pressure sensors located on each corner of the board which when stepped on can measure a person's centre of balance in order to control onscreen avatars to participate in games. Nintendo, an entertainment company, intended to create an outlet by which to break the stereotype of the inactive and lazy gamer, they never intended for their balance system to be used in rehabilitative therapy.

Other companies have realised the therapeutic potential of balance systems and created their own, with notable examples including BioDex, Perry dynamics Proprio, and the bm.a SMART EquiTest®

While these systems were created to assist in balance rehabilitation, their proprietary software and games do not use augmented or virtual reality. As such, any evidence using them will surely be using other technology to create the VR.

Evidence for the use of balance systems with augmented or virtual exists for the follow conditions:

Stroke

Effectiveness of wii-based rehabilitation in stroke: a randomized controlled study

Karasu, Batur, & Karataş., 2018

RCT PEDro: 7/10

Technology: Wii Fit and Wii Balance Board

Deficits targeted: Static and dynamic balance

Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke

Lee, Lee, & Song., 2017

RCT PEDro: 6/10

Technology: Wii Balance Board

Deficits targeted: Postural balance and upper limb function

The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis.

Iruthayarajah et al., 2017

SR + Meta Analysis of 20 articles

Deficits targeted: Static and dynamic balance

Included articles featuring Nintendo Balance Board:

Effects of virtual reality-based training and task-oriented training on balance performance in stroke patients.
- Lee, Kim, & Lee., 2015
- RCT PEDro: 6/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Dynamic balance
Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke
- Hung et al., 2014
- RCT PEDro: 7/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static and dynamic balance
Visual Biofeedback Balance Training Using Wii Fit after Stroke:A Randomized Controlled Trial
- Barcala et al., 2013
- RCT PEDro: 7/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static balance
Active video-gaming effects on balance and mobility in individuals with chronic stroke: A randomized controlled trial
- Fritz et al., 2013
- RCT PEDro: 8/10
- Technology: Wii Fit and Wii Balance Board, PlayStation EyeToy
- Deficits Targeted: Static/dynamic balance and gait parameters/endurance
Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients.
- Cho, Lee, & Song., 2012
- RCT PEDro: 5/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static and dynamic balance

Bang, Son, & Kim., 2016

RCT PEDro 4/10

Technology: Wii Balance Board, treadmill

Deficits targeted: Gait and dynamic balance

Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis

Li, Han, Sheng, & Ma., 2016

SR + Meta Analysis of 16 articles

Deficits targeted: Static and dynamic balance

Included articles featuring Nintendo Balance Board that are not present in other SR on this page:

The efficacy of balance training with video game-based therapy in subacute stroke patients: a randomized controlled trial
- Morone et al., 2014
- RCT PEDro: 7/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static and dynamic balance
Does the Inclusion of Virtual Reality Games within Conventional Rehabilitation Enhance Balance Retraining after a Recent Episode of Stroke?
- Rajaratnam et al., 2013
- RCT PEDro: 4/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static and dynamic balance

Virtual reality for therapeutic purposes in stroke: A systematic review

Viñas-Diz & Sobrido-Prieto., 2016

SR of 25 studies (4 SR + 21 RCT)

Deficits Targeted: Motor function

All studies used in this SR that relate to balance systems are summarised elsewhere on this page

Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke - a systematic review with meta-analysis.

Gibbons, Thomson, de Noronha, & Joseph., 2016

SR + Meta analysis of 22 studies

Deficits Targeted: Low limb outcomes including balance and gait

Included articles featuring Nintendo Balance Board were identical to the previous SR, except for two:

Wii Fit balance training or progressive balance training in patients with chronic stroke: a randomised controlled trial.
- Yatar & Yildirim., 2015
- RCT PEDro: 4/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Dynamic balance
Clinical feasibility of the Nintendo Wii™ for balance training post-stroke: a phase II randomized controlled trial in an inpatient setting.
- Bower et al., 2014
- RCT PEDro: 8/10
- Technology: Wii Fit Plus and Wii Balance Board
- Deficits Targeted: Dynamic balance

The Use of Nintendo Wii in the Rehabilitation of Poststroke Patients: A Systematic Review

Dos Santos et al., 2015

SR of 5 studies

Deficits Targeted: Upper limb function and static/dynamic balance

Included articles featuring Nintendo Balance Board were identical to other summarised SRs, except for one:

Balance analysis in hemiparetics patients after training with Wii Fit program
- Barcala et al., 2011
- RCT PEDro: Unavailable
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static and dynamic balance

Multiple Sclerosis

Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis

Casuso-Holgado et al., 2018

SR + Meta analysis of 11 studies

Deficits Targeted: Balance and gait rehabilitation

Included articles featuring balance systems:

The effects of exergaming on balance, gait, technology acceptance and flow experience in people with multiple sclerosis: a randomized controlled trial.
- Robinson, Dixon, MacSween, van Schaik, & Martin., 2015
- RCT PEDro 5/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static balance and gait parameters
Effect of virtual reality-based balance training in multiple sclerosis.
- Eftekharsadat et al., 2015
- RCT PEDro: 7/10
- Technology: BioDex balance system
- Deficits Targeted: Static and dynamic balance
Exergaming with additional postural demands improves balance and gait in patients with multiple sclerosis as much as conventional balance training and leads to high adherence to homebased balance training.
- Kramer, Dettmers, & Gruber., 2014
- CT PEDro: 5/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static/dynamic balance and gait speed
Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study
- Nilsagård, Forsberg, von Koch., 2013
- RCT PEDro: 7/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Dynamic balance and gait speed
The effect of Nintendo® Wii® on balance in people with multiple sclerosis: a pilot randomized control study.
- Brichetto, Spallarossa, de Carvalho, & Battaglia., 2013
- RCT PEDro: 7/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static and dynamic balance

Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis.
- Prosperini et al., 2013
- RCT Crossover PEDro: 6/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Dynamic balance and gait speed

Mii-vitaliSe: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis

Thomas et al., 2017

RCT PEDro: 7/10

Technology: Wii Fit and Wii Balance Board. Wii Sports Resort

Deficits Targeted: Static/dynamic balance, upper limb function, and fatigue

Parkinson's Disease

Nintendo Wii training on postural balance and mobility rehabilitation of adults with Parkinson's disease: a systematic review

Dominguez Ferraz, Trippo, Dominguez, Santos, Oliviera Filho., 2017

SR of 12 studies

Deficits Targeted: Postural balance and mobility

Included articles featuring balance systems:

Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease
- Liao et al., 2015
- RCT PEDro: 7/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Obstacle crossing and dynamic balance
Effect of Nintendo Wii™-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial.
- Pompeu et al., 2012
- RCT PEDro: 5/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Static/dynamic balance and other measures focussed on by the UPDRS II

Virtual reality for rehabilitation in Parkinson's disease

Dockx et al., 2016

SR of 8 studies

Deficits Targeted: Any facet of Parkinson's rehabilitation

Included articles featuring balance systems that have not appeared on this page are:

Home-based virtual reality balance training and conventional balance training in Parkinson's disease: a randomized controlled trial
- Yang, Wang, Wu, Lo, & Lin., 2016
- RCT PEDro: 7/10
- Technology: Balance board created by Cycling and Health Center of Taichung (Taichung, Taiwan)
- Deficits Targeted: Static and dynamic balance
Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson's Disease: A Randomized Controlled Trial.
- Shen & Mak., 2014
- RCT PEDro: 7/10
- Technology: Computerized dancing system (KSD Technology Co Ltd. Shenzhen, China)
- Deficits Targeted: Balance confidence
Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial.
- van den Heuvel et al., 2014
- RCT PEDro: 8/10
- Technology: Interactive dynamic balance exercises (Motek Medical, Amsterdam, The Netherlands). With movement registration using a force plate (Forcelink, Culemborg, The Netherlands) or inertial sensors (Xsens, Enschede, The Netherlands)
- Deficits Targeted: Static and dynamic balance
Effects of virtual reality-augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial.
- Yen et al., 2011
- RCT PEDro: 7/10
- Technology: Balance board created by Cycling and Health Center of Taichung (Taichung, Taiwan)
- Deficits Targeted: Sensory organisation (via SOT) for single and dual tasks

Virtual Reality-Based Wii Fit Training in Improving Muscle Strength, Sensory Integration Ability, and Walking Abilities in Patients with Parkinson's Disease: a Randomized Control Trial

Liao, Yang, Wu, & Wang., 2015

RCT PEDro: 7/10

Technology: Wii Fit Plus and Wii Balance Board

Deficits Targeted: Gait parameters, muscle strength and sensory integration

Cerebral Palsy

Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Chen, Fanchiang, & Howard., 2018

SR + Meta Analysis of 19 studies

Deficits Targeted: Any facet of Cerebral Palsy

Included articles featuring balance systems:

Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy.
- Tarakci, Ersoz Huseyinsinoglu, Tarakci, & Razak Ozdincler., 2016
- RCT PEDro: 4/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Dynamic balance, gait parameters and independence
Effects of interactive games on motor performance in children with spastic cerebral palsy.
- Alsaif & Alsenany., 2015
- RCT PEDro: 3/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Motor function
Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy.
- Sharan et al., 2012
- RCT PEDro: 4/10
- Technology: Wii Fit and Wii Balance Board
- Deficits Targeted: Post-operative rehabilitation inc balance and motor function

Cerebral Palsy

Parkinson's Disease

Multiple Sclerosis

Stroke

Interested?

Purchasing

Of the balance systems featuring on this page, the Nintendo Wii Fit balance board is by far the cheapest. A price breakdown of each of the systems is as follows:

Nintendo balance board: $40-$100 AUD (preowned + Wii Fit) ebay.com.au
- Requires Nintendo Wii (U) console: $40-$300 AUD depending on model also from ebay.com.au
BioDex balance system: Price unavailable without ordering through website.
PROPRIO balance system: Price unavailable without contacting manufacturer directly.
b.ma SMART EquiTest: Price unavailable without contacting manufacturer directly.