A balance board accessory for a widely used video game console can help people with multiple sclerosis (MS) reduce their risk of accidental falls, new research published in the journal Radiology reports. MRI scans indicate that training with the Nintendo Wii Balance Board promotes beneficial changes in brain connections involved in balance and movement.
Balance impairment is one of the most common and disabling symptoms of multiple sclerosis, a chronic condition of the central nervous system in which the immune system damages the protective myelin sheath that surrounds nerve fibers. Rehabilitation to preserve and restore balance is a key component of care for many people with MS. One accessible, task-oriented tool that has shown promise is the Wii Balance Board system — a battery-powered device roughly the size and shape of a bathroom scale. Users stand on the board and shift their weight while following visual feedback from games such as slalom skiing, which provides repetitive, goal-directed balance practice.
Although prior clinical reports suggested that Wii balance board training can improve balance in people with MS, the biological basis for these improvements has been unclear. To investigate the underlying neural mechanisms, researchers applied diffusion tensor imaging (DTI), a specialized MRI technique that maps the microarchitecture of white matter tracts — the bundles of nerve fibers that conduct signals throughout the brain and spinal cord.
The study enrolled 27 patients with MS who completed a 12-week training program using Wii balance board–based visual feedback exercises. Pre- and post-training DTI scans were analyzed to detect microstructural changes in nerve tracts associated with balance and motor control. In addition to imaging, participants’ balance performance was measured with quantitative posturography, a clinical assessment that evaluates the body’s ability to maintain stability by recording sway and weight distribution during standing tasks.
Results showed significant changes on DTI in white matter pathways relevant to posture and movement. Importantly, the imaging changes correlated with measurable improvements in balance on posturography assessments. These findings suggest that the balance training not only improves functional performance but also corresponds with structural adaptations in brain connections.
Lead author Luca Prosperini, M.D., Ph.D., of Sapienza University in Rome, interprets these observations as evidence of neural plasticity — the brain’s capacity to reorganize and form new connections in response to experience and training. According to Dr. Prosperini, task-oriented, repetitive training that targets a specific impairment can be particularly effective at driving these adaptive changes. He notes that the improvements produced by the Wii Balance Board program have practical significance: by improving balance, the training may reduce the risk of accidental falls and associated consequences such as injuries and fractures.
Although similar plasticity has been observed in people who engage in video gaming and other visuomotor activities, the exact cellular mechanisms remain under investigation. Dr. Prosperini and colleagues suggest that changes may involve processes such as remyelination or other microstructural remodeling in white matter, but more research is needed to define the precise biological steps.
One important practical finding from the study is that gains diminished after participants stopped training, indicating that continued practice is likely necessary to sustain both functional performance and the underlying neural adaptations. This highlights an important implication for clinical rehabilitation: ongoing, regular exercise and balance practice may be required to maintain the benefits achieved through targeted interventions.
The published study is titled “Multiple Sclerosis: Changes in Microarchitecture of White Matter Tracts after Training with a Video Game Balance Board.” Collaborators listed with lead author Luca Prosperini include Fulvia Fanelli, M.D.; Nikolaos Petsas, M.D., Ph.D.; Emilia Sbardella, M.D., Ph.D.; Francesca Tona, M.D.; Eytan Raz, M.D.; Deborah Fortuna, M.S.; Floriana De Angelis, M.D.; Carlo Pozzilli, M.D., Ph.D.; and Patrizia Pantano, M.D. The findings were reported in the journal Radiology and were disseminated by the Radiological Society of North America.
Implications for patients and clinicians are clear: accessible, task-specific balance training — including commercially available tools like the Wii Balance Board used within a structured program — can promote measurable improvements in balance in people with MS, and these functional gains are accompanied by detectable changes in brain white matter. To preserve benefits, rehabilitation programs should emphasize ongoing practice and integration of balance exercises into long-term care plans for people with MS.