Utilizing Physically Interactive Videogames for the Balance Training of Adolescents with Deafness within a Physical Education Course

IntroductionTriathlon A person is considered as having deafness in case hearing loss exceeds 70 decibels and it is so severe that the individual is not in position to process linguistic information through hearing, with or without amplification and use of hearing aids (Panteliadou, 2014). Hearing loss affects a person's communication, behavior, and also motor development (Wiegersma & Van der Velde, 1983; Kaltsatou, Fotiadou, Tsimaras, Kokaridas & Sidiropoulou, 2013) with limited physical activity, which, in turn, affects their general health condition and psychological state, causing individuals to experience depression and stress (Woodcock & Pole, 2007). Children or adolescents with deafness often have reduced orientation, kinesthetic and rhythm perception ability, the latter impacting the development of various motor abilities that are related to the fundamental physical ability of balance (Gheysen, Loots & van Waelvelde, 2008; Kaltsatou et al., 2013). Numerous research studies have shown that children or adolescents with deafness exhibit lower levels of performance in balance ability compared to their hearing peers (e.g. Horak, Shumway-Cook, Crowe & Owen Black, 1988; Siegel, Marchetti & Tecklin, 1991; Zwierzchowska, Gawlik & Grabara, 2004; Azevedo & Samelli, 2008; Gheysen et al., 2008). Children and adolescents with deafness need and can benefit from adapted Physical Education (PE) programs for the development of their motor abilities and skills, and should be offered equal exercise opportunities as their hearing peers (Gheysen et al., 2008; Kaltsatou et al., 2013). As for balance ability, adapted exercise programs are particularly important including exercises targeting the improvement of proprioception, namely the individual's ability to recognize the position of body in space and to control movements (Valovich McLeon, 2008; Di Stefano, Clark & Padua, 2009; Winnick, 2011). Balance exercises usually involve specialized equipment such as balance boards and inflated balance disks (Malliou, Gioftsidou, Pafis, Beneka, & Godolias, 2004). However, traditional therapeutic exercise programs are often boring and usually require specialized equipment that is more difficult or expensive to acquire than the widely available commercial gaming platforms that users can also have in their homes (Shih, Shih & Chu, 2010). As for balance, treating balance disorders is often a costly and time-consuming procedure. Thus, motivational, low-cost and easy-to-apply balance rehabilitation methods are needed (Gil-Gomez, Lozano, Alcaniz & Perez, 2009). Physically interactive videogames -or 'exergames'- are a relatively new generation of videogames, believed to have the potential to positively influence youngsters' physical activity, given that they combine exercise and gaming (Yang, Smith, & Graham, 2008; Vernadakis, Gioftsidou, Antoniou, Ioannidis, & Giannousi, 2012). In such 'exertainment' games, the user's body movements control the virtual activity within the game environment (Epstein, Beecher, Graf & Roemmich, 2007). Exergames have attracted the interest of many researchers, who maintain that those games can spur motivation towards exercise (Yang et al., 2008; Papastergiou, 2009; Whitehead, Johnston, Nixon & Welch, 2010; Staiano, Abraham & Calvert, 2013; Vernadakis, Kouli, Tsitskari, Gioftsidou, & Antoniou, 2014). Furthermore, they may offer to individuals with disabilities opportunities to improve their motor performance within a non-threatening environment (e.g. Hilton, Attal, Best, Reistetter, Trapani & Collins, 2015). In fact, Nintendo Wii Fit exergames and the Nintendo Wii Balance Board have been used for balance training in children with disabilities with positive results. Abdel Rahman (2010) compared the effectiveness of a 6-week program involving three Wii Fit balance exergames ('Soccer Heading', 'Tightrope Walk', 'Penguin Slide') to that of a 6-week traditional balance training program, in children with Down's syndrome aged 10 to 13 years, reporting that the Wii Fit group significantly improved their balance ability compared to the traditional group. …