PRELIMINARY EVIDENCE FOR VIRTUAL REALITY EXERGAMING (NINTENDO® WII FIT PLUS™) IN BALANCE AND GAIT REHABILITATION OF CHILDREN WITH CEREBRAL PALSY — A Single-Arm Pre-Post Pilot Study

ABSTRACT Introduction: Children with cerebral palsy (CP) present significant challenges in balance and gait that adversely affect their quality of life. Exergaming platforms offer a potentially engaging and accessible complement to conventional physiotherapy. Objective: This pilot study aimed to evaluate preliminary evidence for the effects of a Nintendo® Wii Fit Plus™ virtual reality (VR) program on balance and walking performance in children with CP. Methods: A single-arm pre-post pilot study was conducted at the Association for the Protection of Motor Disabled Persons in Sfax, Tunisia. Eight children with CP (mean age 10.875 ± 3.56 years; GMFCS levels I–III) participated in a seven-week VR rehabilitation program (minimum 30 min/session, three sessions/week). Balance was assessed using the Pediatric Balance Scale (PBS), Trunk Control Measurement Scale (TCMS), and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2). Walking ability was assessed using the 6-Minute Walk Test (6MWT) and the 10-Meter Walk Test (10MWT). Paired t-tests were used to compare pre- and post-intervention scores, with effect sizes reported (Cohen’s dz ). Results: All participants demonstrated improvements across all outcome measures following the intervention. Balance scores improved significantly for PBS (pre: 34.25 ± 12.06 vs. post: 38.50 ± 11.24; p = 0.001; dz = 0.37), TCMS (pre: 37.50 ± 6.59 vs. post: 41.38 ± 6.68; p = 0.007; dz = 0.59), and BOT-2 (pre: 3.38 ± 3.82 vs. post: 6.75 ± 4.53; p = 0.001; dz = 0.81). Walking ability also improved on both the 6MWT (pre: 254.88 ± 79.59 m vs. post: 275.63 ± 79.31 m; p < 0.001; dz = 4.69) and 10MWT (pre: 0.82 ± 0.24 m/s vs. post: 0.93 ± 0.25 m/s; p = 0.001; dz = 1.84). Conclusion: This pilot study provides preliminary evidence suggesting that a short-term Nintendo® Wii Fit Plus™ exergaming program may improve balance and walking ability in children with CP. These findings should be interpreted with caution given the small sample and absence of a control group. Adequately powered randomized controlled trials are warranted to confirm these encouraging preliminary results. Keywords: cerebral palsy; virtual reality; exergaming; Nintendo Wii Fit Plus; balance; gait; rehabilitation; pilot study Abbreviations: CP: cerebral palsy; VR: virtual reality; GMFCS: Gross Motor Function Classification System; MACS: Manual Ability Classification System; PBS: Pediatric Balance Scale; TCMS: Trunk Control Measurement Scale; BOT-2: Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition; 6MWT: 6-Minute Walk Test; 10MWT: 10-Meter Walk Test; COP: center of pressure; WBB: Wii Balance Board; ICC: intraclass correlation coefficient; SD: standard deviation; CI: confidence interval