Evaluating the Nintendo Wii for assessing return to activity readiness in youth with mild traumatic brain injury

Adolescents with mild traumatic brain injuries (MTBI) are at substantial risk for repeat injury if they return to activity too soon. Post-concussion symptoms and impaired balance are two factors that limit return to activity. Post-injury assessments that challenge activity tolerance and balance skills are needed to ensure readiness to return to activity. This cross-sectional study evaluated the Nintendo Wii as a measure of exertion (heart rate [HR], respiration rate [RR], and caloric expenditure) and balance testing for youth with MTBI in a clinical setting. Twenty-four youth with MTBI, ages 9-18, played six Wii games. The Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2) and the Community Balance and Mobility Scale (CBM) were used as balance indicators. The Wii Fit Running game demonstrated the highest caloric expenditure and HR (p = .010). Frequency counts of balance loss during Wii game play did not correlate with performance on the BOT-2 or the CBM. Type, number, and time since injury were predictive of balance performance on the CBM (p = .008). Findings provide preliminary evidence for the use of the Wii as an exertion challenge to evaluate tolerance for exercise post-concussion. Frequency count of balance loss during Wii game play, however, was not a valid measure of balance impairment post-MTBI.

Effect of a folate-binding protein on the plasma transport and tissue distribution of folic acid

Folic acid (3H-pteroylglutamic acid or 75Se-selenofolate) administered free or bound to folate-binding protein (FABP) was rapidly cleared from the plasma but the plasma survival when bound to FABP was longer than unbound during the initial 5 min. 75Se-folate bound to FABP is more rapidly taken up by the liver than when administered as free 75-Se-folate. 125I-labeled FABP was rapidly cleared from the plasma (90% in 5 min). The rapid uptake of FABP, a sialoglycoprotein, was inhibited by the preadministration of desialyzed fetuin. Following the hepatic uptake of 75Se-folate/FABP, only free 75Se-folate was found in the bile. The total biliary secretion of 75Se-folate over 240 min was 63% when administered bound to FABP and 33% when administered as free 75Se-folate. The liver retained 33.5% of the 125I activity 5 min following the administration of 125I-FABP, while only 4.46% of the 125I activity was secreted into the bile over 180 min. This data suggests that FABP may play an important role in the enterohepatic circulation of folates by directing nonmethylated folates to the liver.