Friday, January 31, 2014

Can Wii Fit exergaming help children with migraines? [Study]

Can exergaming help children who have migraines without aura (MoA)? According to a recent study from a group of Italian authors published in Neuropsychiatric Disease and Treatment, playing the exergame Wii Fit over three months can improve measures of balance, coordination, motor tasks in children. Over 12 weeks, children (mean age: 9.13±1.94 years) played games that focused on antero-posterior (snowboarding); medio-lateral (skiing, penguin game, and soccer); and multidirectional weight shifting (bubble game and hula hoop) movements three times per week each for 30 minute sessions. Its good to read that participants were able to choose (autonomy) from 18 different games which likely increased levels of motivation and enjoyment (self-determination theory - SDT). Other games listed include: ski-jump, segway circuit, obstacle course, and skate boarding,ski-slalom, table tilt, snowboard slalom, Tilt City, and Rhythm.
Table 1
Exergaming Points 2 Ponder (ExP2P)
  • In the introduction, the authors stated that since many children with migraines suffer from "...emotional dysfunction, absenteeism from school, and poor academic performance, as well as issues relating to poor cognitive function, and sleep habits"... it would have been nice to see some of these measures tested in the study.
  • It appears that the control group used was a non-active group and many studies are now using active controls to better compare any group effects. 
  • It would be interesting to see what impact other exergames that include more hand-eye coordination (Kinect Brain & Body Connection, EyeToy) as opposed to foot-eye/balance coordination (Wii Fit).
  • I would also wonder what more intense levels of physical activity (with a rhythm game like Dance Central or Just Dance) would do for cognitive function and mood in this population.
Concluding Thoughts
I love and have used a similar version of the following phrase in terms of using games for therapy "video game interventions can increase patient enjoyment and engagement, which may enhance compliance." What remains to be seen in many exergame studies are long term "lasting" effects. Unfortunately most children (and adults too) play games for a short amount of time and then end up switching games so we definitely see a novelty effect (or reactivity). I wonder how we could design experiments that are less dependent on a particular game and more focused on overall health or performance outcomes.  

Esposito M, Ruberto M, Gimigliano F, Marotta R, Gallai B, Parisi L, Lavano SM, Roccella M, & Carotenuto M (2013). Effectiveness and safety of Nintendo Wii Fit Plus™ training in children with migraine without aura: a preliminary study. Neuropsychiatric disease and treatment, 9, 1803-10 PMID: 24453490
Abstract:   Migraine without aura (MoA) is a painful syndrome, particularly in childhood; it is often accompanied by severe impairments, including emotional dysfunction, absenteeism from school, and poor academic performance, as well as issues relating to poor cognitive function, sleep habits, and motor coordination. 
The study population consisted of 71 patients affected by MoA (32 females, 39 males) (mean age: 9.13±1.94 years); the control group consisted of 93 normally developing children (44 females, 49 males) (mean age: 8.97±2.03 years) recruited in the Campania school region. The entire population underwent a clinical evaluation to assess total intelligence quotient level, visual-motor integration (VMI) skills, and motor coordination performance, the later using the Movement Assessment Battery for Children (M-ABC). Children underwent training using the Wii-balance board and Nintendo Wii Fit Plus™ software (Nintendo Co, Ltd, Kyoto, Japan); training lasted for 12 weeks and consisted of three 30-minute sessions per week at their home. 
The two starting populations (MoA and controls) were not significantly different for age  and sex . M-ABC and VMI performances at baseline (T0) were significantly different in dexterity, balance, and total score for M-ABC and visual  and motor tasks for VMI. After 3 months of Wii training (T1), MoA children showed a significant improvement in M-ABC global performance, M-ABC dexterity , M-ABC balance and VMI motor task. 
Our study reported the positive effects of the Nintendo Wii Fit Plus™ system as a rehabilitative device for the visuomotor and balance skills impairments among children affected by MoA, even if further research and longer follow-up are needed.
Esposito M., Ruberto M., Gimigliano F., Marotta R., Gallai B., Parisi L., Lavano S.M., Roccella M. & Carotenuto M. Effectiveness and safety of Nintendo Wii Fit Plus training in children with migraine without aura: a preliminary study, Neuropsychiatric Disease and Treatment, 1803. DOI:

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