Balance Board Triggers Favorable Changes in Multiple Sclerosis Patients’ Brains

A balance board designed for a widely used video game console has been shown to help patients suffering from multiple sclerosis (MS) to reduce their risk of accidental falls, according to new findings.

Magnetic resonance imaging (MRI) scans revealed that use of the Nintendo (Redmond, WA, USA) Wii balance board system appears to induce favorable changes in brain connections associated with balance and movement.

The study’s findings were published August 26, 2014, online in the journal Radiology. Balance impairment is one of the most typical and incapacitating symptoms of MS, a disorder of the central nervous system in which the body’s immune system attacks the protective sheath around nerve fibers. Physical rehabilitation is often used to preserve balance, and one of the more promising new tools is the Wii balance board system, a battery-powered device approximately the size and shape of a bathroom scale. Game users stand on the board and shift their weight as they track the action on the television screen during games similar to slalom skiing. Even though Wii balance board rehabilitation has been reported as effective in patients with MS, there is still little understood about the underlying physiologic foundation for any improvements in balance.

Researchers recently used an MRI modality called diffusion tensor imaging (DTI) to assess changes in the brains of 27 MS patients who underwent a 12-week intervention using Wii balance board-based visual feedback training. DTI is a nontraditional MRI technique that allows detailed analysis of the white matter tracts that transmit nervous signals through the brain and body.

MRI scans of the MS patients revealed substantial effects in nerve tracts that are important in balance and movement. The alterations seen on MRI correlated with balance improvements as gauged by an evaluation technique called posturography.

These brain changes in MS patients are likely a manifestation of neural plasticity, or the ability of the brain to adapt and form new connections during a lifetime, according to lead author Luca Prosperini, MD, PhD, from Sapienza University (Rome, Italy). “The most important finding in this study is that a task-oriented and repetitive training aimed at managing a specific symptom is highly effective and induces brain plasticity,” he said. “More specifically, the improvements promoted by the Wii balance board can reduce the risk of accidental falls in patients with MS, thereby reducing the risk of fall-related comorbidities like trauma and fractures.”

Dr. Prosperini noted that similar plasticity has been described in individuals who play video games, but the exact processes behind the phenomenon are still unknown. He theorized that changes can happen at the cellular level within the brain and may be related to myelination, the process of constructing the protective sheath around the nerves.

The rehabilitation-induced enhancements did not continue after the patients discontinued the training protocol, Dr. Prosperini noted, in all probability because specific skills associated with structural changes to the brain after an injury need to be maintained through training. “This finding should have an important impact on the rehabilitation process of patients, suggesting that they need ongoing exercises to maintain good performance in daily living activities,” Dr. Prosperini said.

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Sapienza University