1. Introduction
CP is a neuromotor disorder that mainly affects movement, muscle tone, and posture development. This condition arises from an injury to the developing brain during the transition from the prenatal to the neonatal period [1,2,3]. CP refers to a group of permanent movement and postural disorders that result in activity limitations due to non-progressive damage to the immature brain. These motor impairments often coexist with sensory, cognitive, perceptual, communicative, behavioral, and musculoskeletal issues [3].
As Papavasiliou [4] emphasizes, children with CP encounter substantial challenges in developing complex motor skills, often stemming from early deficits in muscle tone. Motor abnormalities interfere with posture and movement, resulting in balance difficulties, muscle weakness, and secondary complications such as contractures and bone deformities. These challenges significantly impair motor skill development and delay the acquisition of new abilities.
Research shows that children with CP face postural control issues in both static (e.g., maintaining posture) and dynamic (e.g., transitioning between positions, navigating environments) activities [5,6,7]. These challenges are linked to sensory deficits, muscle weakness, and poor alignment, which impact daily functions [8,9]. Limitations in daily activities, such as walking, stair climbing, and self-care, are particularly evident due to lower limb dysfunction [10]. These mobility issues emphasize the importance of lower limb function in daily tasks [11]. Physiotherapy aims to enhance postural control and motor performance, with many children undergoing rehabilitation to improve balance and gait [7,9,12,13].
In recent years, technological advancements like VR systems have created new opportunities for rehabilitating individuals with brain injuries, including both pediatric and adult populations [14]. VR is a computational technology that provides artificial sensory feedback, simulating real-life experiences [15,16]. It engages multiple sensory channels, such as sight, hearing, touch, and even smell, with immersion describing how present users feel within the virtual environment [17,18]. The more immersive the VR system, the greater the potential for engaging cognitive processes involved in motor control [18,19].
Virtual reality systems can be categorized into feedback-focused, contact-based, or gesture-based systems, each engaging users differently [18]. Feedback in VR can occur in immersive or non-immersive settings, supporting motor learning principles [20]. VR promotes motor learning through three key elements: (a) repetition, which enhances motor skills and functional abilities [21], (b) sensory feedback, providing multisensory stimulation essential for neural development and brain reorganization [21,22,23], and (c) motivation, as enjoyable VR activities boost engagement and encourage participation in therapy [24].
Monge Pereira et al. [25] highlight that VR systems provide a novel treatment option with various functional goals for children and adolescents with CP. VR therapy is increasingly used to improve balance, walking speed, distance, and overall physical activity [26,27]. This innovative approach enables children with CP to engage in interactive simulations, offering realistic environments and real-time feedback on posture and movement. Furthermore, children often enjoy VR therapy, which increases their motivation to participate [28]. Armoni et al. [29] found that combining VR with conventional therapy improved gross motor function in children with CP classified as GMFCS I–II. They emphasized that VR is a valuable supplement to conventional therapy, offering greater benefits when used together. Similarly, Montoro-Cárdenas et al. [30] concluded that using the Nintendo Wii system alongside conventional physiotherapy for at least 30 min per session over three weeks effectively improves balance, motor symptoms, reduces spasticity, and enhances static balance in children with CP. While these positive results are promising, the heterogeneity of neural disorders raises concerns, limiting the ability to draw definitive conclusions and provide clear clinical guidance [31]. CP is characterized by a wide variety of risk factors, underlying causes, clinical features, and severity of functional impairments, often accompanied by secondary conditions and varying treatment options over time [32,33,34].
Nintendo Wii therapy (NWT) is one of the most widely used non-immersive virtual reality devices in the neurorehabilitation of children with CP that requires active participation and movement. The Nintendo Wii allows participants to interact with a virtual environment projected on a screen using a handled controller or joystick with or without a force platform called the Wii Balance Board [34,35,36]. Findings suggest that the Nintendo Wii, particularly the Wii-Fit Balance Board, can be a valuable tool in rehabilitation programs for improving balance, motor function, and functional mobility in children with cerebral palsy [35,36,37,38,39]. For example, Gatica-Rojas et al. (2017) demonstrated that a Nintendo Wii Balance Board exercise program significantly improved standing balance in children with spastic hemiplegia cerebral palsy, though effects diminished 2–4 weeks post-intervention [37]. Cooper and Williams (2017) found moderate evidence that integrating the Nintendo Wii-Fit Balance Board into exercise programs enhances balance in ambulatory children with cerebral palsy, particularly dynamic balance, with greater improvements requiring frequent sessions over six weeks [38]. Kardes and Serap (2024) demonstrated that combining Wii-Fit exercises with conventional therapy significantly improved static balance, functional mobility, and walking endurance in children with cerebral palsy and their typically developing peers over a 16-week program [39].
Gatica-Rojas et al. (2016) investigated the impact of a Nintendo Wii Balance Board exercise program on functional balance in Latino male outpatients with cerebral palsy, showing significant improvements in dynamic balance but no changes in static balance after 6 weeks [36]. A pilot study conducted in Jamaica explored the potential of using the Nintendo Wii as a rehabilitation tool for children with cerebral palsy, showing improvements in gross motor function and high attendance and engagement, suggesting its feasibility for use in rehabilitation [40]. To our knowledge, gross motor performance measures to evaluate the quality of movement following the use of the Nintendo Wii Balance Board-based intervention for standing activities in children with cerebral palsy have either not been used or have seen limited application.
Building on previous research, this study aims to evaluate whether incorporating a VR-based Nintendo Wii Balance Board exercise program into the standard treatment regimen for children with CP in Greece can improve balance, gross motor function, and performance in standing activities. A single-case experimental design will be used to assess individual-level outcomes. The research questions guiding this study are as follows:
Does the use of the Nintendo Wii Balance Board-based intervention in standing game activities provide an additional therapeutic effect on balance, gross motor function, and quality of movement in children with CP?
Can VR and motion-based systems, such as the Wii Balance Board, be feasibly applied to enhance physical rehabilitation outcomes for children with cerebral palsy, considering the challenges and cultural context in Greece?
This paper is organized into four main sections. Section 1 introduces the purpose and significance of the study, providing the research context and objectives. Section 2 outlines the materials and methods, including the study design, participant criteria, intervention details, and outcome measures. Section 3 presents the results obtained through statistical analysis, focusing on improvements in gross motor function, balance, and motor performance. Section 4 discusses the findings in relation to existing literature, highlights the study’s limitations, and proposes future research directions. Finally, the paper concludes by highlighting the value of integrating the Nintendo Wii Balance Board platform into conventional physiotherapy for children with CP.
2. Materials and Methods
2.1. Study Design, Ethical Approval, and Consent Process
This study utilized a single-case experimental design and was conducted in compliance with the ethical guidelines set by the Research Ethics Committee of the University of West Attica (protocol number 51444/31-05-2022, date of approval 31 May 2022), Athens, Greece. The sample was conveniently selected. Detailed information about the sample is provided in Table 1. Written informed consent was obtained from all participants, with the legal guardians of the children also signing consent forms for their children’s involvement in the study.
2.2. Participants
The study included four children, two males and two females, all diagnosed with cerebral palsy. A feasibility sampling approach was used for participant selection. Following the distribution of informational material, each participant was personally invited to join the study. The participants, aged between 6 and 15 years (mean age 9.75 years, SD = 3.41), were recruited from the Center for Physiotherapy and Rehabilitation of Children (K.E.F.A.P.). An information leaflet with study details was provided to each interested participant. Prior to participation, all guardians and children signed consent forms.
The study’s sample includes an array of clinical presentations of CP, which aligns with the study’s objectives. To qualify for participation, children had to meet the following criteria: (a) aged between 6 and 15 years, (b) classified as GMFCS Level I–II, (c) currently undergoing physiotherapy treatment, (d) capable of demonstrating adequate cognitive understanding, as confirmed by a medical professional, (e) attending school regularly, (f) had a minimum period of 5 years for time participating in their standard physiotherapy program, and (g) had a minimum time of 6 months that their physiotherapist observed a stagnation in their static balance, gross motor function, and gross motor performance.
Exclusion criteria included having received Botox injections or any surgical procedures in the past six months, as well as a history of seizures.
All children were enrolled in a systematic physiotherapy program based on the neurodevelopmental treatment (NDT) approach, attending sessions twice a week.
2.3. Intervention and Setting
Participants followed a structured intervention protocol that integrated conventional physiotherapy with VR-based balance training using the Nintendo Wii Balance Board platform. Each therapy session lasted a total of 45 min, comprising 30 min of conventional physiotherapy and 15 min of VR-based balance training. The intervention was delivered twice weekly over a six-week period, and all sessions were supervised and conducted by the same physiotherapists who had prior experience working with the participating children.
2.3.1. Virtual Reality Integration and the Nintendo Wii Balance Board
The term virtual reality (VR) in this study refers to the non-immersive interaction provided by the Nintendo Wii Balance Board system, which creates a dynamic and interactive virtual environment on a screen. The Wii Balance Board served as the primary interface, allowing participants to control an avatar within a virtual setting by shifting their weight across four integrated force sensors. These sensors captured the participants’ center of pressure and weight distribution in real time, transmitting these data to the virtual environment displayed on a television or computer monitor.
Participants interacted with this virtual environment through a series of structured video games specifically designed to challenge balance, motor control, and coordination. These games required participants to shift their weight in precise directions (forward, backward, or side-to-side) to achieve tasks, complete challenges, or control movements within the virtual environment. Importantly, this weight-shifting mechanism created an immersive experience, engaging the participants in a visually dynamic setting with multisensory feedback.
2.3.2. Video Games Used in the Intervention
Participants selected from the following six games available on the Wii Balance Board platform:
(a). Soccer Heading: Participants moved their center of pressure to position their avatar and “head” the ball into the goal;
(b). Table Tilt: Participants shifted their weight to tilt a virtual table, guiding balls into designated holes;
(c). Ski Slalom: Participants performed lateral weight shifts to navigate a skier through slalom gates;
(d). Ski Jump: Participants leaned forward at the correct time to simulate jumping off a ski ramp;
(e). Tightrope Walk: Participants maintained balance by making small weight adjustments to simulate walking across a tightrope;
(f). Yoga: Participants followed on-screen postures and balance-based movements while maintaining steady weight distribution.
These games were selected because they require precise motor control, dynamic balance, and coordination.
2.3.3. Multisensory Feedback and Immersion
The system provided a multisensory experience through the following components:
Visual feedback: Participants observed their avatar’s movements and game progression on the screen in real time.
Auditory feedback: Encouraging sounds and verbal cues were delivered to motivate and guide participants.
Tactile feedback: The Wii remote controller captured and transmitted movements, finger orientation changes, and speed, providing corresponding visual feedback on the screen during gameplay tasks, which enhanced immersion.
The combination of these feedback mechanisms created an engaging, immersive experience resembling a virtual reality simulation.
Figure 1 demonstrates the intervention. It includes two photos of a participant demonstrating the use of the Nintendo Wii Balance Board during the intervention (rear view for anonymity). On the screen is presented a shot of the video game used (i.e., Soccer Heading, and Table Tilt), illustrating how participants interacted with the virtual environment via weight-shifting movements.
2.4. Measurement Outcomes
Participants were assessed at three time points: before the start of the intervention (baseline), immediately after the six-week intervention period using the balance platform, and two weeks following the completion of the VR intervention. The baseline phase, during which the virtual reality system was not utilized, is referred to as the “virtual reality baseline” phase, representing a plateau where participants continued their previous neurodevelopmental treatment (NDT) interventions.
The following outcome measures were used:
Pediatric Balance Scale (PBS): This is a 56-point scale used to evaluate balance performance in children. The PBS assesses functional balance through 14 tasks, including sitting, standing, and dynamic activities, with higher scores indicating better balance [41,42].
Gross Motor Function Measure (GMFM): This is a widely used tool to evaluate gross motor function in children with cerebral palsy. Specifically, this study used the GMFM Standing Domain (GMFMS) and Walking, Running, and Jumping Domain (GMFMW). The GMFM-88 consists of 88 items divided into five domains: lying/rolling, crawling/kneeling, sitting, standing, and walking/running/jumping. Each item is scored on a 4-point scale, and the scores are expressed as a percentage of the total possible score, with 100% indicating optimal motor function [43,44].
Gross Motor Performance Measure (GMPM): This tool evaluates the quality of movement in children with cerebral palsy. The GMPM consists of 20 selected items from the GMFM, assessing five domains: supine/prone/rolling, crawling/kneeling, sitting, standing, and walking/running/jumping. Three out of the five attributes—alignment, coordination, related movements, stability, and weight shift—are assessed for each item. Scoring is performed on a 5-point Likert scale, ranging from 1 (severely abnormal) to 5 (consistently normal). The final score for each domain is calculated as a percentage of the maximum possible score, reflecting the relative number of activities performed [45].
2.5. Raters
Two experienced pediatric physiotherapists, who were also involved in the therapeutic program, conducted the assessments. Both raters were familiar with the assessment tools and performed independent evaluations for each participant at the end of each phase. The ratings for all four participants were consistent across both raters at each evaluation point.
2.6. Statistical Analysis
To evaluate the effectiveness of the virtual reality balance platform, an intervention protocol was developed for the four participants using a single-case experimental design. To determine significant differences in the mean values of the observed variables across phases, Friedman and Wilcoxon tests were conducted. Statistical analyses were performed using IBM SPSS Statistics v29. Additionally, the Intraclass Correlation Coefficient (ICC) was calculated to evaluate inter-rater reliability between the two evaluators who conducted the assessments. For intra-rater reliability, the ICC was calculated with a 95% confidence interval. Following Cicchetti’s (1994) guidelines [46], ICC values were interpreted as follows: values below 0.40 indicated poor agreement, 0.40–0.59 indicated low agreement, 0.60–0.74 indicated satisfactory agreement, and values of 0.75 or higher were considered excellent agreement.
3. Results
This study involved four participants, including two males and two females, with a mean age of 9.75 years (SD = 3.41), a mean weight of 36.75 kg (SD = 12.26), and a mean height of 139 cm (SD = 11.46). Descriptive details are summarized in Table 1.
The ICC results evaluating the inter-rater reliability between the two evaluators who conducted the assessments are presented in Table 2.
To examine changes across phases, a Friedman test was conducted, suitable for comparing mean ranks in dependent samples that do not follow a normal distribution. The results from the Friedman test indicated statistically significant differences in mean values across the four measured outcomes (GMFMS, GMFMW, PBS, and GMPM) across different phases, with all p-values < 0.05.
The Friedman test revealed significant improvements across the intervention period for GMFMS (p = 0.038), GMFMW (p = 0.032), PBS (p = 0.032), and GMPM (p = 0.039).
To identify changes across phases, two-sided Wilcoxon signed-rank tests were performed between paired phases for each measure (Table 3). While no statistically significant differences at p < 0.05 were observed, all four participants demonstrated consistent improvements across all measures (gross motor function, balance, and gross motor performance) between the baseline and the end of the intervention. These improvements were maintained at the two-week follow-up phase.
These p-values align with those presented in Table 3. However, no significant differences were observed between the end of the intervention and the follow-up phase (two weeks after), as p-values exceeded 0.05 across measures. Μean scores and standard deviations for GMFMS, GMFMW, PBS, and GMPM across the different time phases are presented in Table 4 and in Figure 2.
4. Discussion
Virtual reality- and Wii-based therapies are increasingly being explored as interventions to enhance functional balance and mobility in children with CP [20,30,31,47] as well as performance in daily life activities [48]. Moreover, virtual reality is being recognized as a tool for its use in improving motor skills and facilitating neurorehabilitation [21] as well as for its positive effect on the balance of children with CP compared with traditional rehabilitation methods [31]. Although moderate evidence supports virtual reality rehabilitation as a promising method to improve balance and motor skills in children with cerebral palsy [47], further research and long-term follow-up are needed to define its role in treatment.
This study highlights the potential of incorporating the Nintendo Wii Balance Board into standard physiotherapy programs to enhance functional and dynamic balance, gross motor skills, and overall performance in children with CP in Greece. All four participants, previously plateaued in progress, showed notable improvements in gross motor function (GMFMS), balance (PBS), and movement quality (GMPM) after integrating VR-based balance training into their sessions. Improvements were consistent across baseline, post-intervention, and follow-up assessments, showcasing promising trends in functional outcomes and the feasibility of combining VR with traditional therapy for CP management.
The balance improvements observed in this study can be attributed to integrating the VR Wii Balance Board into the standard physiotherapy program, enhancing rehabilitation by targeting balance, coordination, and movement quality for more effective outcomes. This aligns with the findings of Cooper and Williams [38], who concluded that balance training using the Nintendo Wii improves balance in ambulatory children with CP. It is suggested that VR Nintendo Wii intervention can provide multisensory engagement, fostering neuroplasticity, as highlighted in neuroimaging studies [30,38]. The Nintendo Wii Balance Board’s enhanced motor learning environment, incorporating visual, auditory, vestibular, and proprioceptive stimuli, plays a key role in promoting task-specific motor strategies and potentially enhancing cortical reorganization.
Our findings align with systematic reviews and meta-analyses [20,31] that underscore the benefits of VR-based interventions in improving motor function and balance in children with CP compared to conventional therapy. Although the Wii Balance Board primarily enhances static balance, it also positively influences walking abilities, as reflected in improved GMFM scores. By comparing our results with similar studies [20,36], we provide a nuanced understanding of how VR and balance training can complement conventional rehabilitation methods, offering unique advantages such as increased engagement and task repetition without reporting added fatigue. According to Chen et al. [20], the gaming features of the VR provide children the ability to repeatedly practice the same task with a greater number of repetitions without noticing.
The integration of VR into standard physiotherapy highlights potential opportunities for its use in pediatric rehabilitation. Future studies should focus on assessing the sustained impact of VR interventions and defining guidelines for optimal intervention parameters, including treatment duration, dosage, and task selection, while tailoring these parameters to meet the needs of children with diplegia and hemiplegia caused by CP [47]. For instance, exploring different VR platforms or customizing interventions to target specific motor control aspects could enhance the therapeutic efficacy.
Additionally, the financial and time burdens on families are critical considerations in pediatric rehabilitation. By integrating accessible and engaging methodologies like VR games into conventional therapy, therapists can improve the cost-effectiveness and acceptability of interventions. These findings emphasize the need for further exploration into how VR can be incorporated into daily physiotherapy practices to personalize interventions and optimize motor learning outcomes [47].
While this study is exploratory, larger-scale research involving more diverse populations from various regions of Greece and extended intervention durations is crucial to validate and expand upon the conclusion that this intervention is both feasible and beneficial for children with cerebral palsy in Greece. Additionally, implementing the treatment protocol within the study’s experimental setting shows that a virtual reality balance system can be effectively incorporated into participants’ standard treatment routines. This integration enables children to safely practice their skills while engaging with their regular therapeutic team.
Exploring interventions within diverse cultural contexts [40], such as the home environments [48] of Greek households, could provide critical insights into the adaptability of these therapeutic approaches, particularly given Greece’s numerous hard-to-reach islands, especially during winter. The Nintendo Wii Balance Board offers a potentially sustainable alternative, and its engaging, enjoyable nature, coupled with its capacity to enhance motor learning, highlights its promise as a valuable addition to therapeutic strategies for children with CP.
The concept behind the Nintendo Wii is its ability to create an environment filled with visual, auditory, vestibular, and proprioceptive stimuli, which together support brain reorganization and provide an enjoyable kinesthetic experience for pediatric patients [48]. Wii-based therapy was found to enhance standing balance in children with cerebral palsy, particularly those with spastic hemiplegia; however, its effects diminished within 2–4 weeks post-intervention [37]. We observe that integrating the Nintendo Wii into traditional physiotherapy treatment settings enriches the therapeutic environment, fostering the development of targeted motor behaviors and tasks while supporting the establishment of effective motor control strategies. In addition to the multisensory exposure, Nintendo Wii allows the participant to perform active exercise while standing, which requires constant muscle contraction of both the lower and upper limbs and the erector muscles of the spine, which implies the activation of muscle and joint proprioceptors [39]. Finally, the standing exercises proposed with Nintendo Wii may stimulate the plantar pressure receptors that send the exteroceptive information necessary to maintain balance, together with vestibular and visual information, to the brain [40]. This approach fosters optimal static alignment and the maintenance of both static and dynamic equilibrium.
Various interventions, including functional power-training [49], have demonstrated improvements in walking abilities for children with cerebral palsy as measured by GMFM. Our findings underscore the potential of the Nintendo Wii Balance Board as a simple and effective therapeutic tool for improving motor function in children with cerebral palsy, as evidenced by improved GMFM and GMPM scores. To our knowledge, GMPM scores have not been previously documented following the use of the Nintendo Wii Balance Board in children with cerebral palsy. This study highlights the potential of VR platforms in pediatric rehabilitation, emphasizing the need for further research [47] to develop standardized protocols that optimize treatment parameters—such as duration, dosage, and task selection—while focusing on improving movement quality in children with cerebral palsy, particularly those with diplegia and hemiplegia, as reflected by GMPM scores. It has been recently reported [50] that non-immersive virtual reality can effectively enhance hand function, grip strength, upper extremity function, and manual dexterity in children with cerebral palsy, proving more efficient than traditional therapy when used in combination.
Additionally, pediatric rehabilitation has made significant advances in recent years, and this study aimed to demonstrate that simple technologies, such as the Nintendo Wii Balance Board, could be accessible, convenient, and acceptable for pediatric patients. The preliminary findings suggest that interactive methodologies, like virtual reality games, could be integrated into conventional physical therapy, reducing financial and time burdens on families while increasing accessibility to treatment for Greek families. As virtual reality applications expand, physical therapists have the opportunity to integrate these tools into daily practice, providing feedback for more personalized interventions. The engaging and enjoyable nature of VR appears to enhance motor learning in children without causing additional fatigue. These preliminary findings encourage further exploration of VR’s integration into therapeutic practices, paving the way for its broader application in rehabilitation and home settings.
Summarizing the supplementary use of the Nintendo Wii Balance Board platform in the conventional physiotherapy program for children with CP is considered to be a valuable addition to the existing treatment plan. The utilization of the platform led to notable enhancements in the domains of gross motor skills, balance, and gross motor performance. It is also useful to conduct similar studies with a larger sample of high-functioning GMFCS children with CP, perhaps in a more targeted diagnosis and with a longer study duration. Future studies should focus on optimizing VR Nintendo Wii Balance Board program delivery, developing guidelines, and expanding applications to broader populations, for instance, to enhance cognitive functions [51], and including conditions like ADHD.
Given their intrinsic characteristics, interactive computer games may prove to be an effective intervention, particularly in improving balance and posture in children with CP.
5. Conclusions
This study highlights the potential benefits of integrating VR and the Nintendo Wii Balance Board into standard physiotherapy programs for children with CP. The findings indicate that combining these technologies with traditional therapy can enhance balance, gross motor skills, and overall movement quality. Importantly, the improvements observed in both static and dynamic balance measures underscore the value of this approach in addressing motor challenges in pediatric populations with CP.
The study’s preliminary results suggest that VR-based interventions not only make therapy more engaging but also the multisensory stimulation and task repetition is promising for promoting neuroplasticity and motor control.
Moving forward, standardized protocols for VR integration into pediatric rehabilitation are essential. Future research should focus on studies with larger sample sizes and longer intervention durations to determine the optimal treatment parameters, including duration, intensity, and task selection, for maximizing therapeutic outcomes. Furthermore, expanding research to encompass more diverse and broader populations will help to further validate the effectiveness of VR interventions.
By leveraging the immersive and interactive capabilities of VR, physiotherapists can offer innovative and cost-effective treatment solutions that enhance motor learning, reduce therapy-related burdens on families, and provide a more personalized and enjoyable rehabilitation experience. These findings pave the way for broader adoption of VR technologies in clinical practice, with the potential to significantly improve the quality of life for children with CP and their families.
Conceptualization, A.K.; methodology, V.S. and A.K.; validation, V.S. and A.K.; formal analysis, V.S., P.L. and A.K.; investigation, V.S., A.L. and A.K.; resources, V.S., A.L. and A.K.; writing—original draft preparation, V.S., A.L., A.C., N.C. and A.K.; writing—review and editing, V.S., A.L., A.C., N.C. and A.K.; visualization, V.S., A.L., A.C., N.C. and A.K.; supervision, V.S. and A.L.; project administration, V.S. and A.K. All authors have read and agreed to the published version of the manuscript.
The study was conducted according to the guidelines of the Declaration of Helsinki, and ethics approval was obtained by the Research Ethics Committee of the University of West Attica (protocol number 51444/31-05-2022, date of approval 31 May 2022), Athens, Greece.
Informed consent was obtained from all subjects involved in the study.
The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.
The authors would like to thank all participants for their availability and positiveness to participate in the present study. We would also like to thank the Rehabilitation Centre of K.E.F.A.P., which provided their facilities for undertaking the assessments and the intervention sessions during this research.
The authors declare no conflicts of interest.
Footnotes
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Enlarge this image.Figure 1. Demonstration of the use of the Nintendo Wii Balance Board during the training session.
Enlarge this image.Figure 2. Graph illustrating the mean scores and standard deviations for the four outcome measures Gross Motor Function Measure for Standing Domain (GMFMS), Gross Motor Function Measure for Walking Domain (GMFMW), Pediatric Balance Scale (PBS), and Gross Motor Performance Measure (GMPM) across the three assessment time points (baseline, end of intervention, and re-assessment).
Descriptive characteristics of the sample.
| Participant | Child Ι | Child ΙΙ | Child ΙΙΙ | Child ΙV |
|---|---|---|---|---|
| Gender | Girl | Girl | Boy | Boy |
| Age | 8 | 15 | 6 | 10 |
| Diagnosis | Spastic diplegia | Spastic hemiplegia | Spastic hemiplegia | Spastic diplegia |
| Affected Side | Left | Right | Right | Left |
| GMFMCS | Ι | Ι | Ι | Ι |
Intraclass Correlation Coefficient (ICC) between raters.
| Measurement Tool | ICC | Evaluators’ Agreement |
|---|---|---|
| GMFMS | 0.662 | Satisfactory |
| GMFMW | 0.969 | Excellent |
| PBS | 0.979 | Excellent |
| GMPM | 0.919 | Excellent |
p-values of Wilcoxon tests for assessment time phase comparisons.
| Measure | Baseline–End | End–Two Weeks After | Baseline–Two Weeks After |
|---|---|---|---|
| GMFMS | 0.068 | 0.785 | 0.068 |
| GMFMW | 0.068 | 0.655 | 0.068 |
| PBS | 0.066 | 1.000 | 0.068 |
| GMPM | 0.068 | 0.144 | 0.068 |
Μean scores and standard deviations for GMFMS, GMFMW, PBS, and GMPM across the different time phases (baseline, end, re-assessment).
| Measure and Time Phases | Mean | SD |
|---|---|---|
| GMFMS | ||
| Baseline | 89.75 | 4.75 |
| End | 95.18 | 3.74 |
| Re-assessment | 94.88 | 3.06 |
| GMFMW | ||
| Baseline | 82.08 | 7.07 |
| End | 86.44 | 3.39 |
| Re-assessment | 86.09 | 3.72 |
| PBS | ||
| Baseline | 49.38 | 3.11 |
| End | 54.25 | 0.71 |
| Re-assessment | 54.25 | 0.71 |
| GMPM | ||
| Baseline | 33.60 | 8.70 |
| End | 65.63 | 10.53 |
| Re-assessment | 69.30 | 8.35 |
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; Christakou, Anna 2
; Chrysagis, Nikolaos 1 ; Lalou, Panagiota 1 ; Sakellari, Vasiliki 1
1 Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Agiou Spidonos 28, Egaleo, 12243 Athens, Greece;
2 Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Agiou Spidonos 28, Egaleo, 12243 Athens, Greece;