Nintendo Wii Game in Balance Stroke Rehabilitation: A Narrative Review

Document Type : Review Articles


1 Associate Professor, Musculoskeletal Research Center AD Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Musculoskeletal Research Center AD Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

3 MSc Student, Musculoskeletal Research Center AD Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran



Introduction: Stroke is known as the second cause of disability in adults, which finally leads to disabilities such as movement impairments, cognitive disorders, and speech disorders. Balance disturbance and neuromuscular incoordination are the most common adverse effects of stroke. Using virtual reality systems are considering as a standard treatment method in neurologic disorders especially in stroke. Nintendo Wii games let patients do different tasks in miscellaneous environment.Materials and Methods: Medline, PEDro, and Cochrane library databases were searched until 2018. Articles that used Nintendo Wii in treatment of balance disturbance in any phase of stroke were selected.Results: Among 21 studies, 8 were selected. In these studies, balance test was used as main outcome measure. Improvement of static balance was shown in 2 studies. In 3 of them, balance improved significantly in intervention group rather than control group. Moreover, in 3 other studies, improvement process was reported in patients with stroke, but the results were not significant.Conclusion: The result of all included studies showed positive effect of Nintendo Wii game on balance in patients with stroke.


  1. Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, et al. The burden of stroke in Africa: A glance at the present and a glimpse into the future. Cardiovasc J Afr 2015; 26(2 Suppl 1): S27-S38.
  2. Katan M, Luft A. Global burden of stroke. Semin Neurol 2018; 38(2): 208-11.
  3. World Health Organization. Global Health Estimates 2016: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2016. Geneva, Switzerland: WHO; 2018.
  4. Sawner KA, LaVigne JM, Brunnstrom S. Brunnstrom's movement therapy in hemiplegia: A neurophysiological approach. Philadelphia. PA: Lippincott; 1992.
  5. Minet LR, Peterson E, von Koch L, Ytterberg C. Occurrence and predictors of falls in people with stroke: Six-year prospective study. Stroke 2015; 46(9): 2688-90.
  6. Kong KH, Lee J. Temporal recovery of activities of daily living in the first year after ischemic stroke: a prospective study of patients admitted to a rehabilitation unit. NeuroRehabilitation 2014; 35(2): 221-6.
  7. Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke 2016; 11(4): 459-84.
  8. Omiyale O, Crowell CR, Madhavan S. Effect of Wii-based balance training on corticomotor excitability post stroke. J Mot Behav 2015; 47(3): 190-200.
  9. Cheok G, Tan D, Low A, Hewitt J. Is nintendo wii an effective intervention for individuals with stroke? A systematic review and meta-analysis. J Am Med Dir Assoc 2015; 16(11): 923-32.
  10. Taylor MJ, McCormick D, Shawis T, Impson R, Griffin M. Activity-promoting gaming systems in exercise and rehabilitation. J Rehabil Res Dev 2011; 48(10): 1171-86.
  11. Kim EK, Kang JH, Park JS, Jung BH. Clinical feasibility of interactive commercial nintendo gaming for chronic stroke rehabilitation. J Phys Ther Sci 2012; 24(9): 901-3.
  12. Ponce FJM, Flores JAV, Torreblanca JMM. Aplicaciones del controlador wiimote para personas com discapacidad. Jornadas de Automatica. 2009.
  13. Anderson F, Annett M, Bischof WF. Lean on Wii: Physical rehabilitation with virtual reality Wii peripherals. Stud Health Technol Inform 2010; 154: 229-34.
  14. Deutsch JE, Brettler A, Smith C, Welsh J, John R, Guarrera-Bowlby P, et al. Nintendo wii sports and wii fit game analysis, validation, and application to stroke rehabilitation. Top Stroke Rehabil 2011; 18(6): 701-19.
  15. Braz NFT, Dutra LR, Medeiros PES, Scianni AA, de Morais Faria CDC. Effectiveness of Nintendo Wii in functional and health outcomes of individuals with Parkinson’s disease: A systematic review. Fisioter Pesqui 2018; 25(1): 100-6.
  16. Hung JW, Chou CX, Hsieh YW, Wu WC, Yu MY, Chen PC, et al. Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke. Arch Phys Med Rehabil 2014; 95(9): 1629-37.
  17. Morone G, Tramontano M, Iosa M, Shofany J, Iemma A, Musicco M, et al. The efficacy of balance training with video game-based therapy in subacute stroke patients: A randomized controlled trial. Biomed Res Int 2014; 2014: 580861.
  18. Bower KJ, Clark RA, McGinley JL, Martin CL, Miller KJ. Clinical feasibility of the Nintendo Wii for balance training post-stroke: A phase II randomized controlled trial in an inpatient setting. Clin Rehabil 2014; 28(9): 912-23.
  19. Yatar GI, Yildirim SA. Wii Fit balance training or progressive balance training in patients with chronic stroke: A randomised controlled trial. J Phys Ther Sci 2015; 27(4): 1145-51.
  20. Bang YS, Son KH, Kim HJ. Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients. J Phys Ther Sci 2016; 28(11): 3112-5.
  21. Trinh T, Shiner CT, Thompson-Butel AG, McNulty PA. Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke. Disabil Rehabil 2017; 39(19): 1939-49.
  22. Golla A, Muller T, Wohlfarth K, Jahn P, Mattukat K, Mau W. Home-based balance training using Wii Fit: A pilot randomised controlled trial with mobile older stroke survivors. Pilot Feasibility Stud 2018; 4: 143.
  23. Ahmed S, Mayo NE, Higgins J, Salbach NM, Finch L, Wood-Dauphinee SL. The Stroke Rehabilitation Assessment of Movement (STREAM): A comparison with other measures used to evaluate effects of stroke and rehabilitation. Phys Ther 2003; 83(7): 617-30.
  24. Hu X, Suresh NL, Chardon MK, Rymer WZ. Contributions of motoneuron hyperexcitability to clinical spasticity in hemispheric stroke survivors. Clin Neurophysiol 2015; 126(8): 1599-606.
  25. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: A systematic review. Lancet Neurol 2009; 8(8): 741-54.
  26. Gatica-Rojas V, Cartes-Velasquez R, Mendez-Rebolledo G, Guzman-Munoz E, Lizama LEC. Effects of a Nintendo Wii exercise program on spasticity and static standing balance in spastic cerebral palsy. Dev Neurorehabil 2017; 20(6): 388-91.
  27. Prosperini L, Leonardi L, De Carli P, Mannocchi ML, Pozzilli C. Visuo-proprioceptive training reduces risk of falls in patients with multiple sclerosis. Mult Scler 2010; 16(4): 491-9.
  28. Rougier P. Optimising the visual feedback technique for improving upright stance maintenance by delaying its display: Behavioural effects on healthy adults. Gait Posture 2004; 19(2): 154-63.
  29. Barcala L, Grecco LA, Colella F, Lucareli PR, Salgado AS, Oliveira CS. Visual biofeedback balance training using wii fit after stroke: A randomized controlled trial. J Phys Ther Sci 2013; 25(8): 1027-32.