A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Active video games (AVGs), also known as exergames, are video games that involve active body movement as part of the gameplay. Nintendo Wii is an example of gaming console with several options for AVGs. One popular AVG controller, the Wii Fit Balance Board, allows players to make moves in the video games by adjusting their balance on a platform. This type of AVG may help people with physical disabilities get exercise and improve their balance while also having fun. However, a previous study found that many people with physical disabilities have difficulty using the conventional Wii Fit Balance Board because the conventional board is too small to accommodate a wheelchair or walker and users must step up onto the platform. In addition, it requires the ability to move in all directions while maintaining one’s balance, as well as the ability to shift weight or jump on the platform to control a game.  In a recent NIDILRR-funded study, researchers designed and tested an adapted Wii Fit Balance Board built to be accessible for players who use wheelchairs and other assistive devices. They wanted to find out how people with physical disabilities felt about the usability of the adapted Balance Board as compared to the conventional Balance Board.

Researchers at the Rehabilitation Engineering Research Center on Interactive Exercise Technologies and Exercise Physiology for People with Disabilities (RecTech) enrolled 25 people with physical disabilities aged 10-60 in this study. All of the participants had limited use of their legs or difficulties with balance and coordination, and about half used assistive devices for mobility such as a wheelchair, walker, or cane.

To create the adapted Balance Board for the study, theresearchers reconstructed both the platform and the internal electronics. First, they designed a wider, square platform, about 36 inches on each side, and added a ramp to accommodate wheelchair users and those who could not step up onto the platform. Second, height-adjustable handrails were added to the platform to help stabilize a player while standing on the platform. Third, adjustable controls were added so that the player could customize how sensitive the board was to shifts in movement. This feature allowed players with limited trunk movement to activate the controls using smaller movements. Fourth, a “jump” button was added that the player could press instead of physically jumping during the game.

Figure 1: The adapted Balance Board features a wider platform, height-adjustable rails, a shallow ramp, and a control panel to adjust the sensitivity of the sensors. Photo source: JMIR and RecTech

Each participant visited the Center three times. At the first visit, each participant completed an evaluation to measure how much difficulty they experienced with tasks requiring use of their legs, such as squatting, standing, and running. In the second and third visit, the participants played two sets of games using both the conventional and the adapted Balance Board. Some used the conventional board first, some used the adapted board first. Then, the participants rated the usability of both systems. After using each Balance Board, the participants answered 10 usability questions rating their level of agreement with items such as “I thought that the system was easy to use” and “I think that I would like to use this system frequently.” Total scores were converted to an overall evaluation, where a score between 70 and 75 was considered “good” while a score above 75 was considered “excellent.”

 The researchers found that all participants could use the adapted Balance Board, while only about half of the participants could use the conventional Balance Board. Most participants rated the adapted Balance Board as “good” or “excellent,” with those who were unable to use conventional Balance Board consistently  or at all rated the adapted Balance Board as “excellent.” Most of the participants gave the adapted Balance Board a higher score, even those who could use the conventional Balance Board. The participants who had more severe physical limitations gave a bigger difference in ratings between the two Balance Boards when compared to the participants with less severe physical limitations.

The authors noted that the adapted Wii Fit Balance Board doubled the number of participants in this study who could participate in active game play. They found that the adapted Balance Board was especially useful for individuals with the most significant mobility limitations. Adaptation of other AVG controllers may enable individuals with physical disabilities to build more exercise into their daily lives and improve their health and wellness. Future studies may examine the impact of adapted AVG controllers on levels of physical activity and health outcomes for people with mobility disabilities who might not otherwise use these systems. AVG designers may wish to actively seek feedback from individuals with physical disabilities throughout the design process when developing new AVG hardware.

To Learn More

RecTech has partnered with the University of Alabama at Birmingham School of Engineering to develop several adapted AVG controllers, including a Wii Mat.

• See examples of these adaptations, including videos of users playing off-the-shelf games.

AbleData’s database of assistive technology includes listings for commercial and do-it-yourself adapted game controllers.

AbleGamers promotes inclusive gaming by partnering developers, programmers, assistive technologists, and avid gamers with disabilities to find solutions for gamers with all abilities.

To Learn More About this Study

Thirumalai, M., Kirkland, W.B., Misko, S.R., Padalabalanarayanan, S., & Malone, L.A. (2018) Adapting the Wii Fit Balance Board to enable active video game play by wheelchair users: User-centered design and usability evaluation. JMIR Rehabilitation and Assistive Technologies, 5(1). This article is available free in full text from the publisher and from the NARIC Collection under Accession Number J78660.