Nintendo Wii Balance Board for Rehabilitation in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.62464/ew073c63Keywords:
Cerebral Palsy, Pediatric, Rehabilitation, Neurology, Nintendo, Balance, Pediatric Rehabilitation, Meta-AnalysisAbstract
Background: Cerebral palsy (CP), the leading cause of childhood motor disability, is commonly associated with impaired balance, postural control, and functional mobility. Virtual reality–based interventions, including the Nintendo Wii Balance Board, have been increasingly integrated into pediatric neurorehabilitation. However, the overall effectiveness of Wii-based rehabilitation in children with CP remains uncertain.
Objective: This systematic review and meta-analysis evaluated the effects of Nintendo Wii Balance Board–based therapy on balance, motor, and mobility outcomes in children with CP.
Methods: Randomized controlled trials were identified through a systematic search of major electronic databases, including PubMed, Scopus, Google Scholar, and Web of Science, without publication timeframe restrictions. Eligible studies included pediatric patients with cerebral palsy undergoing Nintendo Wii Balance Board–based rehabilitation, rehabilitation games, or neurological therapy. Outcomes included balance, gross motor function, coordination, motor control, and therapy engagement, measured pre- and post-intervention using standardized clinical scales. Effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs), and heterogeneity was assessed using the I² statistic.
Results: Ten trials involving 257 participants were included. Intervention durations ranged from 8 to 12 weeks and were compared with traditional therapy or no intervention. A meta-analysis of ten studies showed significant improvements in balance favoring Wii-based rehabilitation (SMD = 0.84, 95% CI 0.54–1.15; p = 0.0015), with low heterogeneity (I² = 26%). No significant effects were observed for functional mobility outcomes, including the 1-Minute Walk Test and Timed Up and Go. Individual studies also reported improvements in gross motor function and coordination, as well as increased motivation and engagement.
Conclusion: Nintendo Wii Balance Board–based therapy may improve balance outcomes in ambulatory children with cerebral palsy; however, further high-quality randomized trials with standardized protocols are required.
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Valluri, H., Mohanty, M., Mongil, C. R., Fuentes, G., Sultan, T., & Torres, A. R. (2025). Investigating the burden of cerebral palsy in low- and middle-income countries: Implications and priorities for pediatric neurology. Seminars in Pediatric Neurology, 55, Article 101225. https://doi.org/10.1016/j.spen.2025.101225
Shevell, M., Dagenais, L., & Oskoui, M. (2013). The epidemiology of cerebral palsy: New perspectives from a Canadian registry. Seminars in Pediatric Neurology, 20(2), 60–64. https://doi.org/10.1016/j.spen.2013.06.008
Sadowska, M., Sarecka-Hujar, B., & Kopyta, I. (2020). Cerebral palsy: Current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatric Disease and Treatment, 16, 1505–1518. https://doi.org/10.2147/ndt.s235165
Basoya, S., Kumar, S., & Wanjari, A. (2023). Cerebral palsy: A narrative review on childhood disorder. Cureus, 15(11), Article e49050. https://doi.org/10.7759/cureus.49050
Pavão, S. L., Nunes, G. S., Santos, A. N., & Rocha, N. A. C. F. (2014). Relationship between static postural control and the level of functional abilities in children with cerebral palsy. Brazilian Journal of Physical Therapy, 18(4), 300–307. https://doi.org/10.1590/bjpt-rbf.2014.0056
Bertoncelli, C. M., Bertoncelli, D., Bagui, S. S., Bagui, S. C., Costantini, S., & Solla, F. (2023). Identifying postural instability in children with cerebral palsy using a predictive model: A longitudinal multicenter study. Diagnostics, 13(12), Article 2126. https://doi.org/10.3390/diagnostics13122126
Gonzalez, N. A., Sanivarapu, R. R., Osman, U., et al. (2023). Physical therapy interventions in children with cerebral palsy: A systematic review. Cureus, 15(8), Article e43846. https://doi.org/10.7759/cureus.43846
Sharma, P., Gupta, M., & Kalra, R. (2023). Recent advancements in interventions for cerebral palsy – A review. Journal of Neurorestoratology, 11(3), Article 100071. https://doi.org/10.1016/j.jnrt.2023.100071
Khanna, S., Arunmozhi, R., & Goyal, C. (2023). Neurodevelopmental treatment in children with cerebral palsy: A review of the literature. Cureus, 15(12), Article e50389. https://doi.org/10.7759/cureus.50389
Abd-Elfattah, H. M., Ameen, F. H., Elkalla, R. A., Aly, S. M., & Abd-Elrahman, N. A. F. (2022). Loaded functional strength training versus traditional physical therapy on hip and knee extensors strength and function walking capacity in children with hemiplegic cerebral palsy: Randomized comparative study. Children, 9(7), Article 946. https://doi.org/10.3390/children9070946
Gilbertson, T., Hsu, L. Y., McCoy, S. W., & O’Neil, M. E. (2020). Gaming technologies for children and youth with cerebral palsy. In Springer Nature Switzerland AG (pp. 2917–2945). https://doi.org/10.1007/978-3-319-74558-9_179
Demers, M., Fung, K., Subramanian, S. K., Lemay, M., & Robert, M. T. (2021). Integration of motor learning principles into virtual reality interventions for individuals with cerebral palsy: Systematic review. JMIR Serious Games, 9(2), Article e23822. https://doi.org/10.2196/23822
Tobaiqi, M. A., Albadawi, E. A., Fadlalmola, H. A., & Albadrani, M. S. (2023). Application of virtual reality-assisted exergaming on the rehabilitation of children with cerebral palsy: A systematic review and meta-analysis. Journal of Clinical Medicine, 12(22), Article 7091. https://doi.org/10.3390/jcm12227091
Lampropoulos, G., Anastasiadis, T., & Garzón, J. (2025). Augmented reality and virtual reality in exergaming. Future Internet, 17(8), Article 332. https://doi.org/10.3390/fi17080332
Raipure, A., & Kasatwar, P. (2022). The effects of Nintendo Wii Fit on postural balance control training in the geriatric population: A review. Cureus, 14(11), Article e31420. https://doi.org/10.7759/cureus.31420
Seo, J. W., Kim, J. I., Kim, T., Jang, K. M., Jeong, Y., & Do, J. H. (2022). Sensory interaction and balancing ability evaluation of the elderly using a simplified force plate system. Sensors, 22(22), Article 8883. https://doi.org/10.3390/s22228883
Shakiba, E., Fatoorehchi, S., Pishyareh, E., Vahedi, M., & Hosseini, S. M. (2021). Effect of using WII Balance Board on functional balance of children with ataxic cerebral palsy. Journal of Rehabilitation, 22(3), 394–407. https://doi.org/10.32598/rj.22.3.3289.1
Choi, J. Y. (2024). Motor function measurement in children: Gross Motor Function Measure (GMFM). Annals of Rehabilitation Medicine, 48(5), 301–304. https://doi.org/10.5535/arm.240078
Kachmar, O., Kushnir, A., Fedchyshyn, B., et al. (2021). Personalized balance games for children with cerebral palsy: A pilot study. Journal of Pediatric Rehabilitation Medicine, 14(2), 237–245. https://doi.org/10.3233/prm-190666
Tarakci, D., Huseyinsinoglu, B. E., Tarakci, E., & Ozdincler, A. R. (2016). Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy. Pediatrics International, 58(10), 1042–1050. https://doi.org/10.1111/ped.12942
Gatica-Rojas, V., Méndez-Rebolledo, G., Guzman-Muñoz, E., et al. (2017). Does Nintendo Wii Balance Board improve standing balance? A randomized controlled trial in children with cerebral palsy. European Journal of Physical and Rehabilitation Medicine, 53(4), 535–544. https://doi.org/10.23736/s1973-9087.16.04447-6
Sajan, J. E., John, J. A., Grace, P., Sabu, S. S., & Tharion, G. (2016). Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: A pilot, randomized controlled trial. Developmental Neurorehabilitation, 20(6), 361–367. https://doi.org/10.1080/17518423.2016.1252970
Tarakci, D., Ozdincler, A. R., Tarakci, E., Tutuncuoglu, F., & Ozmen, M. (2013). Wii-based balance therapy to improve balance function of children with cerebral palsy: A pilot study. Journal of Physical Therapy Science, 25(9), 1123–1127. https://doi.org/10.1589/jpts.25.1123
AlSaif, A. A., & Alsenany, S. (2015). Effects of interactive games on motor performance in children with spastic cerebral palsy. Journal of Physical Therapy Science, 27(6), 2001–2003. https://doi.org/10.1589/jpts.27.2001
Cho, C., Hwang, W., Hwang, S., & Chung, Y. (2016). Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy. The Tohoku Journal of Experimental Medicine, 238(3), 213–218. https://doi.org/10.1620/tjem.238.213
Han, J. H., & Ko, J. Y. (2010). Evaluation of balance and activities of daily living in children with spastic cerebral palsy using virtual reality program with electronic games. The Journal of the Korea Contents Association, 10(6), 480–488. https://doi.org/10.5392/jkca.2010.10.6.480
Rgen, M., Akbayrak, T., Gunel, M., Cankaya, O., Guchan, Z., & Turkyilmaz, E. (2016). Investigation of the effects of the Nintendo Wii-Fit training on balance and advanced motor performance in children with spastic hemiplegic cerebral palsy: A randomized controlled trial. International Journal of Therapies and Rehabilitation Research, 5(4), 146. https://doi.org/10.5455/ijtrr.000000157
Sharan, D., Ajeesh, P. S., Rameshkumar, R., Mathankumar, M., Paulina, R. J., & Manjula, M. (2012). Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy. Work, 41(S1), 3612–3615. https://doi.org/10.3233/wor-2012-0667-3612
Irzan, H., Pozzi, M., Chikhladze, N., et al. (2022). Emerging treatments for disorders of consciousness in paediatric age. Brain Sciences, 12(2), Article 198. https://doi.org/10.3390/brainsci12020198
Luna, N. M. S., Bobbio, T. G., De Graaf, M., et al. (2024). The decline in postural balance has a negative impact on the performance of functional tasks in individuals with Parkinson’s disease. Clinics, 79, Article 100382. https://doi.org/10.1016/j.clinsp.2024.100382
Shumway-Cook, A., Hutchinson, S., Kartin, D., Msme, R. P., & Woollacott, M. (2003). Effect of balance training on recovery of stability in children with cerebral palsy. Developmental Medicine & Child Neurology, 45(9), 591–602. https://doi.org/10.1111/j.1469-8749.2003.tb00963.x
Chen, Y., Fanchiang, H. D., & Howard, A. (2017). Effectiveness of virtual reality in children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Physical Therapy, 98(1), 63–77. https://doi.org/10.1093/ptj/pzx107
Leech, K. A., Roemmich, R. T., Gordon, J., Reisman, D. S., & Cherry-Allen, K. M. (2021). Updates in motor learning: Implications for physical therapist practice and education. Physical Therapy, 102(1). https://doi.org/10.1093/ptj/pzab250
Gatica-Rojas, V., Cartes-Velásquez, R., Guzmán-Muñoz, E., et al. (2017). Effectiveness of a Nintendo Wii balance board exercise programme on standing balance of children with cerebral palsy: A randomised clinical trial protocol. Contemporary Clinical Trials Communications, 6, 17–21. https://doi.org/10.1016/j.conctc.2017.02.008
Pacheco, T. B. F., De Medeiros, C. S. P., De Oliveira, V. H. B., Vieira, E. R., & De Cavalcanti, F. a. C. (2020). Effectiveness of exergames for improving mobility and balance in older adults: A systematic review and meta-analysis. Systematic Reviews, 9(1), Article 163. https://doi.org/10.1186/s13643-020-01421-7
AlSoqih, N. S., Al-Harbi, F. A., Alharbi, R. M., et al. (2025). Efficacy of virtual reality interventions for motor function improvement in cerebral palsy patients: Systematic review and meta-analysis. Journal of Clinical Medicine, 14(23), Article 8388. https://doi.org/10.3390/jcm14238388
Liu, C., Wang, X., Chen, R., & Zhang, J. (2022). The effects of virtual reality training on balance, gross motor function, and daily living ability in children with cerebral palsy: Systematic review and meta-analysis. JMIR Serious Games, 10(4), Article e38972. https://doi.org/10.2196/38972
Padala, K. P., Padala, P. R., Lensing, S. Y., et al. (2017). Efficacy of Wii-Fit on static and dynamic balance in community dwelling older veterans: A randomized controlled pilot trial. Journal of Aging Research, 2017, 1–9. https://doi.org/10.1155/2017/4653635
Zardo, F., Bridi, D., Schorn, M., et al. (2025). Effects of a multimodal neurorehabilitation program on gross motor function and activity and participation performance in children with cerebral palsy: A 9-month longitudinal study. Physiotherapy Research International, 31(1), Article e70158. https://doi.org/10.1002/pri.70158
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