journal of NeuroEngineering and also Rehabilitation volume 11, Article number: 12 (2014) cite this write-up


The Nintendo Wii Fit was released just over five years ago as a way of improving an easy fitness and overall well-being. Regardless of this broad mission, the Wii Fit has actually generated certain interest in the domain that neurorehabilitation together a biobehavioral measurement and training machine for balance ability. Growing interest in Wii Fit technology is likely because of the ubiquitous nature of negative balance and catastrophic falls, i beg your pardon are generally seen in older adults and also various handicap conditions. The current review provides the an initial comprehensive an introduction of Wii to the right balance research, giving particular insight right into the system’s usage for the assessment and training of balance. Overall, at the moment of the 5th anniversary, job-related in the ar showed that practice applications making use of the Wii Balance Board as a proxy for a pressure platform have an excellent promise as a low cost and also portable means to assess balance. Top top the other hand, usage of Wii fit software-based balance metrics has actually been far less efficient in determining balance status. As an intervention tool, hopeful balance outcomes have commonly been acquired using Wii fit balance games, advocating their use for neurorehabilitative training. Regardless of this, restricted sample sizes and few randomized manage designs show that research regarding use the the Wii Fit system for balance intervention remains topic to improvement. Future work aimed in ~ conducting studies with larger scale randomized regulate designs and a higher mechanistic emphasis is recommended to further development the efficacy of this impactful neurorehabilitation tool.

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On December 1st, 2012 the Nintendo Wii right gaming system commemorated its 5th anniversary. This novel system consists of exercise-based video game software, the Wii console, and also a specially developed Wii Balance board (WBB) controller. According to Nintendo, the function for developing the Wii Fit to be to incorporate fun and fitness for every ages, consisting of such aspects of physical wellness as share flexibility, muscle strength, and also upright stand posture. The system is fairly inexpensive (~$200 US), straightforward to access, and also the games are extremely engaging<1–3>. Based on these characteristics, that is not surprising the the Wii fit software is one of the top selling video console gamings of all time.

Beyond its usage in the basic population, the Wii Fit has generated significant interest in the neurorehabilitation research study domain. This is an especially true through respect to the examine of balance control, whereby the Wii Fit software and/or WBB have provided an increasingly attractive method of assessing and also training separation, personal, instance balance ability. The number of balance-related research files using the Wii Fit system (Figure 1) tripled in the two years prior to the 5th anniversary, compared the an initial three year of that existence<1, 2, 4–42>. Undoubtedly, balance research study using the Wii to the right is getting in both popularity and also acceptance in ~ the scientific community.



Growth in Wii fit Research. native 2011 it rotates the 5th anniversary the variety of Wii Fit-balance related papers has shown an exponential increase<1, 2, 4–42>.


The ubiquitous prestige of balance research for neurorehabilitation is unquestioned based on epidemiological reports indicating the older adults and various people with neuromuscular disability conditions have an boosted likelihood because that catastrophic fall-related injuries<43–47>. The price of together injures is not simply to the individual however to the better health treatment system in ~ large. To this extent, the goal of the present review to be to summary the first half te of Wii to the right balance research and provide insight regarding the important results that will shape the next five years. Literature for this evaluation was obtained through a targeted search of PubMED and MEDline databases making use of keywords such as “Wii” and “Balance”. Files were had that provided the Wii Fit device or WBB for the evaluate or cultivate of balance ability. In the very first half of this review, approaches are overviewed that utilized the Wii Fit together a neuroengineering device for balance assessment. Alternatively, the second fifty percent of this evaluation discusses comprehensive evidence sustaining use the the Wii Fit together a balance treatment tool because that both healthy and also diseased populations.

Balance assessment utilizing the Wii right system

Comparing the WBB and also a scientific grade pressure platform

Perhaps the most significant neuroengineering-based invention to arise through the arrival of the Wii right gaming mechanism was the creation of the WBB itself. This device, while restricted to some level in regards to weight volume (~150 Kg) and sampling frequency (~30-50 Hz), have the right to be used as a cost-efficient and transportable variation of a scientific-grade pressure platform. Force platforms are currently the gold traditional for evaluate of balance capability in numerous laboratories and clinics, however cost between $5000-20000 US. These devices carry out accurate procedures of body center of pressure (COP), i beg your pardon is an approximation of the body’s center of fixed (or balance point) projected vertically onto the floor below. COP is critical metric for balance stability assessment given that it closely approximates body sway.

When stand on the WBB, the Wii right system measures body persuade in the next to side (COPx) and also front to earlier (COPy) directions based upon downward pressure sensor data created at each edge of the WBB follow to the complying with equations:


In this equations TR, TL, BR and BL space the force sensor values from the top right, optimal left, bottom right and also bottom left corners the the WBB. This information, in addition to total downward pressure (i.e. Upright ground reaction force), is transmitted with minimal time lag come the Wii console via wireless (i.e. Bluetooth) technology.

In addition to interacting with the Wii console for gaming applications, WBB wireless signals are also readily accessible for use with various other Bluetooth compatible gadgets such as an individual computers and also laptops. To this extent, once synced to a device, the is possible to create customized WBB software applications in a variety of computer programming atmospheres (e.g. LabVIEW, MATlab,) based on COP data and/or the total downward force acquired directly native the WBB in real-time. This straightforward means of unlocking the Wii has opened the door because that the advancement of many custom balance applications.



Representative COPx (A) and COPy (B) data for the force plate and WBB end the food of an instance 20 s static balance trial. Pearson Correlation between the 2 signals is r = 0.99.


Examples of balance evaluate using custom WBB COP data applications

Several attempts have been make to usage raw COP data from a customized WBB for balance assessment. Young et al.<19>, demonstrated that customized WBB COP data might be supplied to assess alters in larger adult balance adhering to a especially designed, game-based intervention over 4 weeks. Before and also after training, 6 elderly participants carried out a timeless balance check (i.e. Romberg Test) by which they stood together still as feasible on the WBB for two, 30 s trials - one with eyes open and also one through eyes closed. The COP data gathered showed anterior-posterior COP variability was positively decreased by the intervention, however only in more daunting trials where visual details was not obtainable (i.e. Eyes closed conditions). Boosts in body guide for individuals with Autism<12> and also Hearing Loss<37> have also been measured with custom WBB COP.

In contrast to the classic balance assessment utilized by Young et al.<19>, Clark et al.<16> defined a slightly an ext novel an approach for assessing vital aspect that balance – weight bearing asymmetry. Load bearing asymmetry is prevalent in plenty of clinical populations, by which greater body load is placed on, typically, the less impaired limb. In this study, 23 healthy and balanced young adults stood through each leg on a different WBB, and performed five squats with and also without intuitive feedback about weight bearing asymmetry. The results proved that participants might reduce asymmetry once visual feedback was provided. In future work, this technique could be used to improve known weight bearing asymmetries in people with hemiplegia early to, for example, punch or cerebral palsy. Further, this findings provide wonderful example that the potential for developing novel balance tools v WBB technology. Because that other instances of non-traditional COP-based applications the the WBB watch Kennedy et al.<22> and Yamamoto et al.<41>.

Balance metrics provided by the Wii Fit video game software

The Wii fit software has several method of assessing balance ability. Once the Wii Fit software is loaded, participants are very first encouraged to do a “body test” the comprises both “center that balance” and also “body control” steps of balance control. In the facility of balance assessment, participants stand still ~ above the WBB because that 7 s when COP data is collected. Indigenous this data, the participant’s median COP deviation from human body midline is calculated, denote a measure of weight bearing asymmetry. Overall, this assessment is thought to provide information about body posture v the presumption that having an equal circulation of weight between left and right foot is ideal.

The second balance metric garnered through the Wii Fit software is based on a body manage test. Unlike the facility of balance test, the body control test is not an assessment of revolution COP but, rather, a complex mix of cognitive and also dynamic COP control. Individuals are offered one assessment “game” at arbitrarily from a group of ten feasible choices. The games range from basic tests of how accurately individuals deserve to move a cursor representing their COP on the television display screen to a target location, to those that are more cognitive in nature (i.e. Entailing counting, ordering and also memorizing the items). As soon as completed, the participant is given a score called the “Wii fit age” for your performance. This metric ranges from 2-99 and also represents age-normalized power such that, because that example, a score that 46 suggests balance capacity equal to the of the typical 46 year old.

Examples of Wii fit software-based balance assessments

Only a couple of attempts have actually been made to use Wii to the right software-based balance metrics in research settings, and only minimal success has been achieved. First, in a research by Dougherty et al.<23>, 9 older adults were asked to undergo a 5-week balance training program using a multi-axis balance training plank (Indo plank Balance Trainer, EABO Inc.). The participant’s Wii Fit age was calculation before and also after the intervention and results verified that Wii Fit age was reduced (i.e. Improved) following training. Despite this median improvement, however, no statistical differences were found, arguing that only some that the balance innovation was caught by the Wii Fit age metric.

To what level two Wii Fit body test metrics correlate through standardized tests of enlarge adult fitness, balance and mobility to be recently figured out by Reed-Jones and also colleagues<13>. This researchers contrasted a battery the clinical examinations with the “Basic Balance Test” and the “Prediction test” of the Wii right software. Overall, there was little correlation in between the clinical tests and also the data noted from the Wii fit software-based tests of balance. This detect mirrored the which was explained by Gras et al.<6>, who also found the the center of balance check was no a precious measure compared to its counterpart determined via a pressure platform. Further, Wikstrom<40> found negative validity and reliability because that 12 the the exer-games linked with the Wii to the right software compared to a traditional balance test. This an outcome may reflect the different requirements of balance for gaming and the balance test made use of by Wikstrom<40>. Taken together, however, these results suggest that Wii right software-based actions of balance ability are no effective.

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Using the Wii Fit because that balance intervention

The most significant scientific use for the Wii Fit has been neurorehabilitation-based balance interventions<1, 2, 4, 7, 10, 14, 15, 17–19, 21, 22, 27–31, 34, 36>. An introduction of researches where the balance ability of healthy and balanced adults have been trained is provided in Table 1. This table reflects a clear bias toward occupational with older individuals. In Table 2, those studies are outlined that have used the Wii Fit mechanism as a way for neurorehabilitating negative balance in miscellaneous clinical conditions. This occupational has focused on a number of clinical populations consisting of Stroke, Parkinson’s condition and Cerebral Palsy. Specific detail regarding the intervention varieties utilized, and also their efficacies are noted herein.