{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:57:44Z","timestamp":1790409464031,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Therapeutic goals for hemiplegic patients with neurological impairments are mainly focused on improving their independent lives. Based on the previously reported effectiveness of Wii Fit balance training, this study investigated the most influential outcomes after long-term intensive training (including balance and functional factors) on quality of life in hemiplegic patients. The intervention group (n = 21) received Nintendo Wii Fit balance training under supervision, and control group (n = 20) received conventional balance training by an occupational therapist. Two groups were matched based on age and onset duration. Both groups received a total of 15 treatments for 30 min per session, twice a week for 8 weeks. There were significant improvements not only in balance confidence and activities of daily living, but also in body composition, such as fat proportion and metabolic rate, in the intervention group compared to the control group (p &lt; 0.05). In particular, balance confidence significantly affected EuroQoL Visual Analogue Scale according to stepwise multiple regression analyses in this study. These results demonstrated that Wii Fit balance training using virtual reality improved the quality of life of hemiplegic patients while overcoming the asymmetrical weight distribution of the affected side via the self-modulating biofeedback exercises.<\/jats:p>","DOI":"10.3390\/ijerph19052805","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T20:09:57Z","timestamp":1646078997000},"page":"2805","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of Balance Training Using a Virtual Reality Program in Hemiplegic Patients"],"prefix":"10.3390","volume":"19","author":[{"given":"Jung-Ah","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Occupational Therapy, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5461-660X","authenticated-orcid":false,"given":"Yoon-Kyum","family":"Shin","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"},{"name":"Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0821-0294","authenticated-orcid":false,"given":"Deok-Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, College of Health & Medical Sciences, Cheongju University, Cheongju 28503, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1429-2684","authenticated-orcid":false,"given":"Sung-Rae","family":"Cho","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"},{"name":"Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea"},{"name":"Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul 03722, Korea"},{"name":"Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1053\/apmr.2001.26256","article-title":"Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention","volume":"82","author":"Cheng","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1743-0003-8-30","article-title":"Effectiveness of a wii balance board-based system (ebavir) for balance rehabilitation: A pilot randomized clinical trial in patients with acquired brain injury","volume":"8","author":"Llorens","year":"2011","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_3","first-page":"185","article-title":"Rehabilitation of motor dysfunction in primary brain tumor patients","volume":"2","author":"Kushner","year":"2015","journal-title":"Neurooncol. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.apmr.2005.11.017","article-title":"Balance self-efficacy and its relevance to physical function and perceived health status after stroke","volume":"87","author":"Salbach","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1161\/01.STR.0000162584.39366.1c","article-title":"Body fat distribution and long-term risk of stroke mortality","volume":"36","author":"Tanne","year":"2005","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/S0002-8223(01)00289-9","article-title":"Effects of habitual physical activity on the resting metabolic rates and body compositions of women aged 35 to 50 years","volume":"101","author":"Manore","year":"2001","journal-title":"J. Am. Diet Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.nut.2009.07.004","article-title":"Body composition changes with aging: The cause or the result of alterations in metabolic rate and macronutrient oxidation?","volume":"26","author":"Gallagher","year":"2010","journal-title":"Nutrition"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1000341","DOI":"10.4172\/2155-9562.1000341","article-title":"Reduced resting metabolic rate in adults with hemiparetic chronic stroke","volume":"6","author":"Serra","year":"2015","journal-title":"J. Neurol. Neurophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1586\/erc.09.77","article-title":"Secondary prevention of stroke","volume":"7","author":"MacDougall","year":"2009","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1053\/mr.2000.3839","article-title":"Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized, controlled pilot trial","volume":"81","author":"Dean","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1743-0003-11-12","article-title":"Using the wii fit as a tool for balance assessment and neurorehabilitation: The first half decade of \u201cwii-search\u201d","volume":"11","author":"Goble","year":"2014","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"580861","DOI":"10.1155\/2014\/580861","article-title":"The efficacy of balance training with video game-based therapy in subacute stroke patients: A randomized controlled trial","volume":"2014","author":"Morone","year":"2014","journal-title":"Biomed. Res. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/0269215516631384","article-title":"Play-based interventions improve physical function for people with adult-acquired brain injury: A systematic review and meta-analysis of randomised controlled trials","volume":"31","author":"Saywell","year":"2017","journal-title":"Clin. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1089\/g4h.2019.0016","article-title":"Effects of exergaming on balance of healthy older adults: A systematic review and meta-analysis of randomized controlled trials","volume":"9","author":"Fang","year":"2020","journal-title":"Games Health J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3255","DOI":"10.1111\/jan.14800","article-title":"Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis","volume":"77","author":"Zhang","year":"2021","journal-title":"J. Adv. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.2522\/ptj.20160054","article-title":"Effect of virtual reality training on balance and gait ability in patients with stroke: Systematic review and meta-analysis","volume":"96","author":"Meijer","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_17","first-page":"271","article-title":"Effectiveness of wii fit balance board in comparison with other interventions for post-stroke balance rehabilitation. Systematic review and meta-analysis","volume":"69","year":"2019","journal-title":"Rev. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1207","DOI":"10.1016\/j.physio.2015.03.2135","article-title":"Improvement of balance and gait in patients with stroke after training based on nintendo wii fit\u2122 games: Randomized controlled trial","volume":"101","author":"Oliveira","year":"2015","journal-title":"Physiotherapy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1179\/1074935714Z.0000000017","article-title":"Virtual rehabilitation via nintendo wii(r) and conventional physical therapy effectively treat post-stroke hemiparetic patients","volume":"22","author":"Ferraz","year":"2015","journal-title":"Top. Stroke Rehabil."},{"key":"ref_20","first-page":"6635298","article-title":"Effect of the wii sports resort on mobility and health-related quality of life in moderate stroke","volume":"2021","author":"Iraurgi","year":"2021","journal-title":"Behav. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1590\/0004-282x20190025","article-title":"Virtual reality in the rehabilitation of patients with stroke: An integrative review","volume":"77","author":"Aramaki","year":"2019","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/g4h.2019.0043","article-title":"Game-based virtual reality interventions to improve upper limb motor function and quality of life after stroke: Systematic review and meta-analysis","volume":"9","author":"Salazar","year":"2020","journal-title":"Games Health J."},{"key":"ref_23","first-page":"5480315","article-title":"Effects of video-game based therapy on balance, postural control, functionality, and quality of life of patients with subacute stroke: A randomized controlled trial","volume":"2020","year":"2020","journal-title":"J. Healthc. Eng."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104994","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104994","article-title":"Can robotic gait rehabilitation plus virtual reality affect cognitive and behavioural outcomes in patients with chronic stroke? A randomized controlled trial involving three different protocols","volume":"29","author":"Manuli","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jphys.2015.05.017","article-title":"Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: A systematic review","volume":"61","author":"Corbetta","year":"2015","journal-title":"J. Physiother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"406","DOI":"10.2340\/16501977-2331","article-title":"Effectiveness of wii-based rehabilitation in stroke: A randomized controlled study","volume":"50","author":"Karasu","year":"2018","journal-title":"J. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1589\/jpts.27.1145","article-title":"Wii fit balance training or progressive balance training in patients with chronic stroke: A randomised controlled trial","volume":"27","author":"Yatar","year":"2015","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/ped.12942","article-title":"Effects of nintendo wii-fit\u00ae video games on balance in children with mild cerebral palsy","volume":"58","author":"Tarakci","year":"2016","journal-title":"Pediatr. Int."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bower, K.J., McGinley, J.L., Miller, K.J., and Clark, R.A. (2014). Instrumented static and dynamic balance assessment after stroke using wii balance boards: Reliability and association with clinical tests. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0115282"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/j.1749-6632.2000.tb06474.x","article-title":"Anthropometry in body composition. An overview","volume":"904","author":"Wang","year":"2000","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2340\/1650197719952736","article-title":"The balance scale: Reliability assessment with elderly residents and patients with an acute stroke","volume":"27","author":"Berg","year":"1995","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1177\/1545968309341059","article-title":"Falls in persons with spinal cord injury: Validity and reliability of the berg balance scale","volume":"24","author":"Wirz","year":"2010","journal-title":"Neurorehabil. Neural Repair."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.06.021","article-title":"Performance stability and interrater reliability of culturally adapted 10-meter walking test for danes with neurological disorders","volume":"28","author":"Andersen","year":"2019","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.gaitpost.2018.12.035","article-title":"Concurrent validity of the gaitrite electronic walkway and the 10-m walk test for measurement of walking speed after stroke","volume":"68","author":"Cleland","year":"2019","journal-title":"Gait Posture"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1080\/09638280400008982","article-title":"Measurement properties of the activities-specific balance confidence scale among individuals with stroke","volume":"27","author":"Botner","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1080\/02699052.2018.1482425","article-title":"Reducing redundant testing using the functional independence measure and early functional abilities scale during rehabilitation in patients with brain injury","volume":"32","author":"Pedersen","year":"2018","journal-title":"Brain Inj."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1080\/09638280050191972","article-title":"Parallel reliability of the functional independence measure and the barthel adl index","volume":"22","author":"Svensson","year":"2000","journal-title":"Disabil. Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of eq-5d (eq-5d-5l)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual. Life Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1007\/s11136-014-0834-1","article-title":"Validity of eq-5d-5l in stroke","volume":"24","author":"Golicki","year":"2015","journal-title":"Qual. Life Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1080\/00222895.2014.971699","article-title":"Effect of wii-based balance training on corticomotor excitability post stroke","volume":"47","author":"Omiyale","year":"2015","journal-title":"J. Mot. Behav."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.06.010","article-title":"The use of nintendo wii in the rehabilitation of poststroke patients: A systematic review","volume":"24","author":"Carregosa","year":"2015","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4276\/030802212X13286281650992","article-title":"The use of the wii fit in forensic mental health: Exercise for people at risk of obesity","volume":"75","author":"Bacon","year":"2012","journal-title":"Br. J. Occup. Ther."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2805\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:29:07Z","timestamp":1760135347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19052805"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19052805","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}