Wii-Fit For Improving Activity, Gait And Balance In Alzheimer's Dementia

The Berg Balance Scale involves 14 mobility tasks, divided into 3 domains: sitting balance, standing balance, and dynamic balance. In the sitting balance, the task is the evaluation of sitting unsupported. Standing balance consist of standing unsupported, standing with eyes closed, standing with feet together, standing on one foot, turning to look behind, grabbing an object from the floor, reaching forward with outstretched arms, and placing one foot in front of the other. In the last domain, the dynamic balance is evaluated with the individual going from sitting to standing, standing to sitting, transferring, turning 360 degrees, placing one foot on a step. Each task is graded on a 5-point ordinal scale that ranges from 0 to 4 for a maximum score of 56. In general, a score of 0 is given when the individual is unable to perform the task, and a

Biomechanical assessment of balance - center of pressure is assessed while standing on a force platform.

Biomechanical assessment of gait - reflective markers attached to anatomical landmarks are tracked with motion capture cameras that provide body segment position data as subjects walk on a treadmill. The position data is then used to calculate joint movements, velocities, etc.

The Activities of Daily Living are a series of basic activities necessary for independent living at home or in the community. They are performed on a daily basis. There are 5 basic categories.

• Personal hygiene - bathing/showering, grooming, nail care, and oral care.
• Dressing - being able to make appropriate clothing decisions and physically dress and undress oneself.
• Eating - the ability to feed oneself, though not necessarily the capability to prepare food.
• Maintaining continence - being able to mentally and physically use a restroom. This includes the ability to get on and off the toilet and cleaning oneself.
• Transferring/Mobility- being able to stand from a sitting position, as well as get in and out of bed. The ability to walk independently from one location to another.

These are rated on the basis of the level of independence - a) can be performed independently, b) some assistance needed and c) complete assistance needed.

Instrumental Activities of Daily Living are important to being able to live independently, but are not necessarily required on a daily basis. The IADLs include:

• Basic communication skills - such as using a regular phone, mobile phone, email, or the internet.
• Transportation - either by driving oneself, arranging rides, or the ability to use public transportation.
• Meal preparation - meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils.
• Shopping - the ability to make appropriate food and clothing purchase decisions.
• Housework - doing laundry, washing dishes, dusting, vacuuming, and maintaining a clean place of residence.
• Managing medications.
• Managing personal finances.

The QOL-AD is a brief, 13-item measure designed specifically to obtain a rating of the patient's Quality of Life from both the patient and the caregiver. The measure consists of 13 items, rated on a four point scale, with 1 being poor and 4 being excellent. Total scores range from 13 to 52. Items include Memory, Mood, Marriage, Physical Health, etc.

The MMSE is an 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment.

On a scale from 1 to 10, with 1 being very confident and 10 being not confident at all, this scale measures how confident the subject is in performing a list of activities without falling.

Activities-specific balance confidence (ABC) scale is a structured questionnaire that measures an individual's confidence during ambulatory activities without falling or experiencing a sense of unsteadiness. It's a 16-item questionnaire where patients rate their confidence while doing activities. Scoring from 0-100 (0 is no confidence and 100 is full confidence).

It is a 25-item screening tool that yields a single score reflecting a broad array of executive functions. Each item's possible score ranges from 0 to a maximum of 2 points; total scores range from 0 to 50, with higher scores indicating greater ECF impairment. The items test number/letter sequencing; word and design fluency; sentence-repetition; thematic perception; memory with distraction; interference inhibition; grasp and snout reflexes; social habits; motor perseveration; finger-nose repetition; echopraxia; complex hand sequences; complex commands; counting and serial-order reversal; and automatic, utilization, and imitation behavior.