01 Jan 2012
By: Jacqueline Chia
It is a well-known outcome of Humpty Dumpty’s tale: neither the king’s horses nor men can put Humpty Dumpy back together again after his fall. Truth to be told, Humpty Dumpty couldn’t have prevented his fall even if he were to work a little harder on his balance when seated on the wall. He was, after all, an egg.
For older adults who face mobility problems from osteoporosis or symptomatic knee osteoarthritis, the ability to maintain their balance when walking, standing or sitting is vital to preventing or lowering their chances of falling.
But just how important is the relation between the ability to balance and the prevention of various symptoms found in the elderly with osteoporosis or knee osteoarthritis? That is what a team from Singapore General Hospital’s (SGH) Physiotherapy Department, led by Principal Physiotherapist Pua Yong Hao, sought to investigate.
“Our population is ageing and when old people fall, they can become disabled or even die as a result. For this reason, our studies have two overarching aims – to identify older adults with an increased risk of falls, and potential intervention targets to improve their balance,” said Mr Pua.
Started in 2009, the project comprises five concurrent studies and aims to establish a standard and accurate measurement of standing balance, and identify the causes of instability and how to prevent falls or instability in the elderly.
One study looks at the relationship between body posture and leg strength in older women suffering from osteoporosis, while another study compares the effectiveness of a new prevention programme with that of a traditional, supervised exercise programme for older patients who are prone to falls.
A third study examines and measures physical function, standing balance and knee strength in healthy older adults. The last two studies look at therapy for patients with mild-to-moderate knee osteoarthritis and those who have had a total knee replacement.
A key component of the studies is the accurate measurement of balance. Although laboratory force plates are the “gold standard” equipment, they are expensive, bulky and heavy.
“Thankfully, we found a solution in the (Nintendo) Wii gaming board,” said Mr Pua. “The Wii board has several advantages – it is affordable, portable and connectable via the Bluetooth protocol. Importantly, the board’s measures of standing balance are reliable and they agree with the measurements of laboratory force plates.”
In its study examining rehabilitation for patients after knee replacement surgery, the team was able to use the Wii board to measure patients’ standing balance accurately, and is planning to use the results to develop a guide to help determine the most appropriate walking aid for patients.
“From these measurements, we know precisely what type of walking aid, whether it should be a walking stick or frame, is best for each patient during the recovery period. Obviously, if your standing balance is poor, you require a walking aid with a larger base of support,” he said.
The portability of the 3.5kg Wii board offers several advantages. Because a laboratory force plates (typically weighing 30 to 50kg) cannot be lifted or transported easily, it is difficult or near impossible to use it to measure seated balance,” said Mr Pua.
Before the team’s project, seated balance could not be measured objectively. Hip extension strength could only be reliably measured with a device known as an isokinetic dynamometer, which is expensive, tedious to set up and cannot be carried around. The team is hoping to utilise the Wii board to measure a variety of physical variables to help guide medical professionals in their management of patients. SGH uses seven Wii boards to measure physical balance.
The team is also looking at expanding their research to young adults who sustain knee injuries. “Sports people with knee injuries (which have not fully healed) are at risk of becoming young people with old knees,” Mr Pua said.
“Hopefully, the low cost and portable nature of the Wii board as a screening tool can facilitate its widespread use across various clinical settings,” he added.
Despite its many advantages, Mr Pua said the Wii board cannot replace laboratory force plates as the “gold-standard” research equipment. Although the board is able to provide standing or sitting data that is as good as what the force plate provides, it is not built to withstand the high forces produced during more dynamic activities such as jumping or walking.
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