For this cycle’s critique I’m examining the paper: Balance exercise for persons with multiple sclerosis using Wii games: a randomized, controlled multi-center study. This article was written by Ylva E Nilsagard, Annette S Forsberg and Lena von Koch and was published in the Multiple Sclerosis Journal, 2012.
I chose this article for two reasons. First, I am directly affected by Multiple Sclerosis (MS), so this strikes near and dear to my heart, second the paper examines a different kind of learning that we have not covered in my Games and Learning course yet: motor or body learning. We have covered cognitive learning, that is learning through your brain, but we have not covered any kind of body learning, or motor skills.
In order to qualify for the study, participants had to meet certain criteria, such as the MacDonald criteria for a diagnosis of MS. In the end they had 84 participants, more females than males (this is expected as MS affects more women than men), people with different subtypes of MS, and those with a variety of mobility assistive device needs.
The study takes two groups of participants, an exercise group and a non-exercise group and theorizes that the group following the exercise plan will have better results on some standard MS balance and coordination tests. All participants (from both groups) are given baseline tests before the start of the study. Then, the exercise group were then paired up with a physiotherapist to start on the program.
Participants in the exercise group were assigned a schedule of exercising the the Wii Fit game twice a week. They did this in the presence of their physiotherapist. First participants were allowed to familiarize themselves with the Wii Fit balance board. Then, when they were comfortable, they would increase the level of difficulty or chose a more difficult exercise routine. Participants played single player, and were encouraged to voice how they were feeling during the game. The physiotherapist was there to record observations and make sure the exercises were being done correctly.
Their study concluded that statistically there were no significant differences between both groups (exercise and non-exercise). However, they did notice a marked difference overall in some of the tests for both groups. This could have been due to the fact that those that were not picked for the exercise group expressed motivation to start exercising on their own.
There were of course limitations and constraints to the study. A significant amount of younger people contacted for the study declined because they could not fit in an exercise program with work. I question: If the mean age was younger, would the results have changed? The average age of MS diagnosis is 34 years old, and the mean age in this study was 50 years old. Also, most new diagnoses are of the relapsing-remitting sub-type, which has a slower decline in balance and motor function. There was of course the small sample size. With only 84 participants in all, their sample size was not large enough to detect any difference between the two groups.
What I especially liked about this paper is that they never referred to using the Wii Fit as exercise, they considered it playing, and using a game. This can also speak to human psychology, we are more likely to be motivated to play a game rather than do exercise. Nilsagard et. al conclude their article by saying “Interactive video games seem to provide an enjoyable way to exercise, which is inline with the aim of increasing physical activity level in general and for people with MS in particular”. I can attest to this statement; between work, school, raising a child, and having MS, I am more likely to “exercise” if I’m doing something fun such as playing with my son at the park, walking at the zoo or playing a game.
Nilsagård, Y. E., Forsberg, A. S., & von Koch, L. (2013). Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Multiple Sclerosis Journal, 19(2), 209-216.
Multiple Sclerosis (MS): Symptoms and Cure. (n.d.). Retrieved February 24, 2016, from http://www.emedicinehealth.com/multiple_sclerosis/article_em.htm