Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

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College of Health Care Sciences - Physical Therapy Department

Publication Date / Copyright Date



Nova Southeastern University. College of Health Care Sciences.


Purpose: To assess if a balance retraining program using the NintendoTM Wii Fit: 1) can improve balance, gait, and quality of life in ambulatory individuals with incomplete spinal cord injury (iSCI), 2) can improve standing tolerance in individuals with iSCI, 3) requires individuals to work outside of their limits of stability, 4) can determine if there is a relationship between changes in standing balance measures and the RAND Short Form 36 (RAND SF-36) health measure, 5) can determine if there is a change in postural stability, control, and adaptation to the virtual reality (VR) environment. Problem Statement: There are no studies to date on the effects of an intensive virtual reality balance training program on gait, balance, or quality of life in the iSCI population. Relevance: There is a need for continued research to support effective treatment techniques in individuals with iSCI to maximize each individual's potential. Subjects: Five males with a mean age of 58.6 years who had an iSCI greater than one year post injury. Inclusion: 1) iSCI, 2) ambulate with or without assistive devices, AFOs, and no greater than minimal assistance for a minimum of 10 meters, 3) tolerate static standing for at least 5 minutes at a time with no greater than minimal assistance. Exclusion: 4 Significant orthopedic impairments, pain or a spinal stabilization device that may limit standing or ambulation. Methods: A repeated measures design with three pretests over three weeks, a post-test within one week of the intervention, and a four week follow up. Outcome measures: 10 meter walk test (10MWT), Timed Up and Go (TUG), Forward Functional Reach Test (FFRT) and Lateral Functional Reach Test (LFRT), RAND SF-36. Intervention consisted of one hour sessions with varied games using the Nintendo Wii Fit twice per week for seven weeks. Subjects' subjective reports were collected during the intervention phase. Survey data was also collected at post-test. Results: There were statistically significant changes found in FFRT that were clinically meaningful (Z = -1.84, p = 0.07; average change scores 8.00 centimeters). The changes were also maintained at the four week follow up post-test. Subject reports suggested improvements in balance, endurance, and mobility with daily tasks at home. There was a high correlation between the change scores of the TUG and the RAND SF-36 (r=0.90). Discussion: The training using the NintendoTM Wii Fit improved balance in all five individuals with iSCI. There was an increase in standing during the intervention with decrease in rests. VR training practices task specific training of standing balance. Further research is needed to assess different gaming options to focus on task specific training of gait and mobility.


Physical Therapy


Health and environmental sciences, Balance, Gait, Gaming intervention, Nintendo wii fit, Quality of life, Spinal cord injury

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