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Smartphone Usage and Postural Stability in Individuals With Forward Head Posture: A Nintendo Wii Balance Board Analysis
Weerasak Tapanya, Noppharath Sangkarit
Ann Rehabil Med 2024;48(4):289-300.   Published online July 24, 2024
DOI: https://doi.org/10.5535/arm.230034
Objective
To assess postural stability, specifically center of body sway during single-leg standing balance, among individuals with and without forward head posture (FHP) during smartphone use.
Methods
The research recruited 53 healthy smartphone users, aged 18–25, and categorized them into FHP group comprising 26 subjects and the normal (control) group with 27 subjects. Participants were assigned the task of maintaining balance while engaged in smartphone typing during single-leg standing. The experiment involved four specific conditions according to neck posture and stable of surface. The study meticulously quantified body center of pressure (COP) sway amplitudes using the Nintendo Wii Balance Board.
Results
The research revealed that individuals with FHP exhibited significantly greater body sway compared to the control group when using smartphones. Notably, distinct variations were observed in path length sway, anteroposterior (AP), and mediolateral (ML) sway amplitude, particularly evident when maintaining flexed neck positions on a soft surface while engaged with smartphones.
Conclusion
These findings strongly suggest that individuals with FHP encounter deteriorated postural stability during smartphone use, particularly in challenging head positions.

Citations

Citations to this article as recorded by  
  • Cognitive–motor interference: Effects of smartphone use on static balance and mobility
    Emre Söylemez, Mehmet Dağ
    Applied Neuropsychology: Adult.2026; : 1.     CrossRef
  • The impact of excessive smartphone use on imbalance symptoms: The role of craniovertebral angle and cervical proprioception
    Musa Güneş, Emre Söylemez, Aydın Sinan Apaydın
    WORK: A Journal of Prevention, Assessment & Rehabilitation.2026;[Epub]     CrossRef
  • Impact of Smartphone Usage Duration on Postural Alignment, Neck Pain and Cervical Function Disability Among University Students
    Huma Khan, Pardeep Kumar, Sapna Bai, Ayesha Zafeer, Areej Imran, Syed Alamgir
    The Healer Journal of Physiotherapy and Rehabilitation Sciences.2026; 6(4): 1.     CrossRef
  • Validity of a qualitative visual method for diagnosing forward head posture
    Shohei Shibasaki, Tomonori Kishino, Yoriko Sei, Keiichiro Harashima, Konomi Sakata, Hiroaki Ohnishi, Takashi Watanabe
    Musculoskeletal Science and Practice.2025; 76: 103282.     CrossRef
  • Assessment of balance in overweight and obese young adults: utilizing centre of pressure displacement variables in the single leg sit-to-stand test
    Noppharath Sangkarit, Weerasak Tapanya, Patchareeya Amput, Chananya Muangchuen, Piyaporn Seeta, Worrasak Paleeta
    International Journal of Adolescence and Youth.2025;[Epub]     CrossRef
  • Evaluating fall risk in community-dwelling older adults through balance assessment with the Nintendo Wii Balance Board
    Weerasak Tapanya, Noppharath Sangkarit, Puttipong Poncumhak, Saisunee Konsanit
    Human Movement.2025; 26(1): 161.     CrossRef
  • Knowledge on text neck syndrome among paramedical students
    Anugraha Puthalan Kunnath, Sankeerthana Rameshan, Deena Vachal Sudheendran, Fathima Rouff, Akash Chandran, Sabna Pulikka Kkunnil
    International Journal Of Community Medicine And Public Health.2025; 12(7): 3055.     CrossRef
  • 22,716 View
  • 206 Download
  • 6 Web of Science
  • 7 Crossref
Accuracy of Heart Rate Measurement Using Smartphones During Treadmill Exercise in Male Patients With Ischemic Heart Disease
Eun Sun Lee, Jin Seok Lee, Min Cheol Joo, Ji Hee Kim, Se Eung Noh
Ann Rehabil Med 2017;41(1):129-137.   Published online February 28, 2017
DOI: https://doi.org/10.5535/arm.2017.41.1.129
Objective

To evaluate the accuracy of a smartphone application measuring heart rates (HRs), during an exercise and discussed clinical potential of the smartphone application for cardiac rehabilitation exercise programs.

Methods

Patients with heart disease (14 with myocardial infarction, 2 with angina pectoris) were recruited. Exercise protocol was comprised of a resting stage, Bruce stage II, Bruce stage III, and a recovery stage. To measure HR, subjects held smartphone in their hands and put the tip of their index finger on the built-in camera for 1 minute at each exercise stage such as resting stage, Bruce stage II, Bruce stage III, and recovery stage. The smartphones recorded photoplethysmography signal and HR was calculated every heart beat. HR data obtained from the smartphone during the exercise protocol was compared with the HR data obtained from a Holter electrocardiography monitor (control).

Results

In each exercise protocol stage (resting stage, Bruce stage II, Bruce stage III, and the recovery stage), the HR averages obtained from a Holter monitor were 76.40±12.73, 113.09±14.52, 115.64±15.15, and 81.53±13.08 bpm, respectively. The simultaneously measured HR averages obtained from a smartphone were 76.41±12.82, 112.38±15.06, 115.83±15.36, and 81.53±13 bpm, respectively. The intraclass correlation coefficient (95% confidence interval) was 1.00 (1.00–1.00), 0.99 (0.98–0.99), 0.94 (0.83–0.98), and 1.00 (0.99–1.00) in resting stage, Bruce stage II, Bruce stage III, and recovery stage, respectively. There was no statistically significant difference between the HRs measured by either device at each stage (p>0.05).

Conclusion

The accuracy of measured HR from a smartphone was almost overlapped with the measurement from the Holter monitor in resting stage and recovery stage. However, we observed that the measurement error increased as the exercise intensity increased.

Citations

Citations to this article as recorded by  
  • SPECIAL ISSUE: Improve Client Care by Dispelling HRV Myths
    Fred Shaffer, Zachary Meehan
    Biofeedback.2024; 52(2): 29.     CrossRef
  • Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study
    Tianxi Yu, Min Gao, Guozhen Sun, Guendalina Graffigna, Shenxinyu Liu, Jie Wang
    BMC Cardiovascular Disorders.2023;[Epub]     CrossRef
  • Deep Learning-Based Optimal Smart Shoes Sensor Selection for Energy Expenditure and Heart Rate Estimation
    Heesang Eom, Jongryun Roh, Yuli Sun Hariyani, Suwhan Baek, Sukho Lee, Sayup Kim, Cheolsoo Park
    Sensors.2021; 21(21): 7058.     CrossRef
  • “Weighing Cam”: A New Mobile Application for Weight Estimation in Pediatric Resuscitation
    Joong Wan Park, Hyuksool Kwon, Jae Yun Jung, Yoo Jin Choi, Ji Soo Lee, Woo Sang Cho, Jung Chan Lee, Hee Chan Kim, Se Uk Lee, Young Ho Kwak, Do Kyun Kim
    Prehospital Emergency Care.2020; 24(3): 441.     CrossRef
  • Ambient assistance service for fall and heart problem detection
    Amina Makhlouf, Isma Boudouane, Nadia Saadia, Amar Ramdane Cherif
    Journal of Ambient Intelligence and Humanized Computing.2019; 10(4): 1527.     CrossRef
  • The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review
    Ka Hou Christien Li, Francesca Anne White, Timothy Tipoe, Tong Liu, Martin CS Wong, Aaron Jesuthasan, Adrian Baranchuk, Gary Tse, Bryan P Yan
    JMIR mHealth and uHealth.2019; 7(2): e11606.     CrossRef
  • VALIDATION OF SMARTPHONE FREE HEART RATE MONITORING APPLICATION DURING TREADMILL EXERCISE
    Zulkarnain Jaafar, Aravind Kumar Murugan
    Revista Brasileira de Medicina do Esporte.2019; 25(2): 112.     CrossRef
  • Putting the data before the algorithm in big data addressing personalized healthcare
    Eli M. Cahan, Tina Hernandez-Boussard, Sonoo Thadaney-Israni, Daniel L. Rubin
    npj Digital Medicine.2019;[Epub]     CrossRef
  • Point-of-care technologies in heart, lung, blood and sleep disorders from the Center for Advancing Point-of-Care Technologies
    Eric Y. Ding, Emily Ensom, Nathaniel Hafer, Bryan Buchholz, Mary Ann Picard, Denise Dunlap, Eugene Rogers, Carl Lawton, Ainat Koren, Craig Lilly, Timothy P. Fitzgibbons, David D. McManus
    Current Opinion in Biomedical Engineering.2019; 11: 58.     CrossRef
  • Utilización de smartphone en los programas de rehabilitación cardíaca. Una revisión sistemática
    A. Muzas Fernández, M. Soto González
    Rehabilitación.2018; 52(4): 238.     CrossRef
  • Real-Time Monitoring in Home-Based Cardiac Rehabilitation Using Wrist-Worn Heart Rate Devices
    Javier Medina Quero, María Rosa Fernández Olmo, María Dolores Peláez Aguilera, Macarena Espinilla Estévez
    Sensors.2017; 17(12): 2892.     CrossRef
  • 9,253 View
  • 76 Download
  • 9 Web of Science
  • 11 Crossref
Comparison of the Using Ability Between a Smartphone and a Conventional Mobile Phone in People With Cervical Cord Injury
Seongkyu Kim, Bum-Suk Lee, Ji Min Kim
Ann Rehabil Med 2014;38(2):183-188.   Published online April 29, 2014
DOI: https://doi.org/10.5535/arm.2014.38.2.183
Objective

To investigate the ability of spinal cord injury (SCI) patients in the use mobile cellular devices, especially the smartphone.

Methods

Seventeen people with motor complete cervical SCI participated in the study. The assist-devices deemed most fitting were introduced to the patients: a mouth stick, multifunctional splint, activities of daily living (ADL) splint, universal cuff or none of the above. To determine the effective devices, a Multi-Directional Click Test (MDCT), Phone Number Test (PNT), and individual satisfaction inquiry were used. The most appropriate assist device was selected by MDCT. Subsequently PNT and individual satisfaction inquiry were performed with the conventional model and compared.

Results

Those with C4 cord injury chose mouth stick. Those with C5 cord injury chose multifunctional splint (3 people) and ADL splint (2 people). Those with C6 cord injury chose universal cuff (3 people) or bare hands only. Those with C7 cord injury chose universal cuff (3 people). With a smartphone, all participants were able to complete the PNT. With a conventional model, only twelve participants (71%) were able to complete the same test. While it took 26.8±6.8 seconds with a conventional model to complete PNT, the same test took 18.8±10.9 seconds to complete with a smartphone (p<0.05). Overall, participants expressed higher satisfaction when using a smartphone.

Conclusion

The results offer a practical insight into the appropriate assist devices for SCI patients who wish to use mobile cellular devices, particularly smartphones. When the SCI patients are given the use of a smartphone with the appropriate assist devices, the SCI patients are expected to access mobile cellular device faster and with more satisfaction.

Citations

Citations to this article as recorded by  
  • Enhancing Mouth Stick Usability for People With Tetraplegia: A Quantitative Evaluation of UI Target Size and Placement
    Izumi Mizoguchi, Hiroyuki Kajimoto
    IEEE Access.2026; 14: 71012.     CrossRef
  • Smartphone accessibility: understanding the lived experience of users with cervical spinal cord injuries
    Richard Armstrong-Wood, Chrysovalanto Messiou, Amber Kite, Elisabeth Joyce, Stephanie Panousis, Hannah Campbell, Arnaud Lauriau, Julia Manning, Tom Carlson
    Disability and Rehabilitation: Assistive Technology.2024; 19(4): 1434.     CrossRef
  • Internet of things (IoT)-based assistive system for patients with spinal muscular atrophy (SMA): a case report
    José Varela-Aldás, William Avila-Armijos, Guillermo Palacios-Navarro
    Disability and Rehabilitation: Assistive Technology.2024; 19(7): 2498.     CrossRef
  • Barriers and Facilitators to eHealth Technology Use Among Community-Dwelling Individuals With Spinal Cord Injury: A Qualitative Study
    Gurkaran Singh, Laura Nimmon, Bonita Sawatzky, W. Ben Mortenson
    Topics in Spinal Cord Injury Rehabilitation.2022; 28(2): 196.     CrossRef
  • Patients’ Perspectives on the Usability of a Mobile App for Self-Management following Spinal Cord Injury
    Gurkaran Singh, Megan MacGillivray, Patricia Mills, Jared Adams, Bonita Sawatzky, W. Ben Mortenson
    Journal of Medical Systems.2020;[Epub]     CrossRef
  • Effects of the Computer Desk Level on the Musculoskeletal Discomfort of Neck and Upper Extremities and EMG Activities in Patients with Spinal Cord Injuries
    Bo-Ra Kang, Jin-Gang Her, Ju-Sang Lee, Tae-Sung Ko, Young-Youl You
    Occupational Therapy International.2019; 2019: 1.     CrossRef
  • Towards an Affordable Assistive Device for Personal Autonomy Recovery in Tasks Required of Manual Dexterity
    Edwin Daniel Ona Simbana, Gabriel Barroso de Maria, Carlos Balaguer, Alberto Jardon Huete
    IEEE Access.2018; 6: 26338.     CrossRef
  • Disability and haptic mobile media
    Gerard Goggin
    New Media & Society.2017; 19(10): 1563.     CrossRef
  • 6,143 View
  • 41 Download
  • 9 Web of Science
  • 8 Crossref
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