The Effect of Balance Therapy on Postural Stability in a Group of Seniors Using Active Video Games (Nintendo Wii)

IntroductionIn the US, two and a half million older people are treated in emergency departments for fall-related injuries, and over 700,000 seniors are hospitalized each year. Not only is quality of life lower after these incidents, but these falls can also lead to the death (Centers for disease control and prevention, 2015). Each year, one out of five falls causes a serious injury. Most injuries are to the head (47%), upper limbs (28%) and lower limbs (26%), (Majkusova & Jarosova, 2014). Impaired coordination, balance, and gait are associated with a higher risk of falling in the elderly (Bainbridge, Bevans, Keeley, & Oriel, 2011; Melzer, Benjuya, & Kaplanski, 2004). Furthermore, risk of falling is higher in those with worsened health or psychological conditions such as sensory deficits (mainly impaired vision), the use of supportive equipment or drugs (antihypertensive, psychotropic medications), fear of falls, fainting, and sleep disorders. Floor material can also negatively influence balance.With increased age, muscles lose both quality and quantity, and bone mineral density changes (Pereira, Vogelaere, & Baptista, 2008). Physiological aspects of ageing include decreased total muscle capacity, higher adiposity in women, lower muscle density, less muscle strength, lower muscle power, and decreased muscle volume (Brady, & Straight, 2014; Degens, Erskine, & Morse, 2009). In turn, decreased muscle capacity negatively influences physical functions (Brady, & Straight, 2014). For example, 37% of seniors between the ages of 65 and 74 and 42% of seniors older than 75 were injured due to impaired physical function (Kolař, 2013). Good balance requires upright posture, which involves three body systems: the sensory (proprioception, vision, and the vestibular system), control (the brain and spinal cord) and executive function systems (the musculoskeletal system and soft tissues surrounding the impacted bone) (Bainbridge, et al., 2011; Pereira, et al., 2008). The capacity of all three areas can be increased by physical activity.Physical activity has been shown to decrease the risk of falling due to its positive impact on balance and strength (Daly, et al., 2008; Keogh, Justin, W., Power, Wooller, Lucas, & Whatman, 2014; Lee, Biggan, Taylor, & Ray, 2014; Lehnert, M., Chmelik, F., Cuberek, R., & Svobodova, V., 2014). Currently, there are various possibilities for conducting physical activities in elderly populations, such as strength training with machines, functional strength training (Lohne-Seiler, Torstveit, & Anderssen, 2013), joint-mobility training, muscle coordination training (Santana-Sosa, Barriopedro, Lopez-Mojares, Perez, & Lucia, 2008) or various combinations of different approaches. It is believed, though not completely understood, that high-intensity training and high-velocity strength training in elderly populations lead to an increase in the number and diameter of motor neurons. Additionally, both directions of nerve impulse transmission are faster after this type of training. Physiological adaptations, such as an increase in the cross-sectional area of muscles after strength training, are better documented than neuromuscular adaptation (Lohne-Seiler, et al., 2013). Due to technological advances, physical activity via the Nintendo Wii gaming system (USA) can be executed. The Nintendo Wii is safe and has no side effects. Moreover, it has the benefit of producing higher motivation in clients because they are playing a game and receive immediate feedback from the screen (Bower, Clark, Mcginley, Martin, & Miller, 2014; Keogh, Justin, W., et al., 2014). Keog et al. (2014) described the positive effect of the Wii on functional ability and improvements in upper limb strength in elderly subjects after eight weeks of intervention. Additionally, a study on patients recovering from stroke (Bower, et al., 2014) showed a positive effect on upper limb strength development after only two to four weeks of intervention. …