1
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Agathos CP, Shanidze NM. Visual Field Dependence Persists in Age-Related Central Visual Field Loss. Invest Ophthalmol Vis Sci 2024; 65:22. [PMID: 38345555 PMCID: PMC10866173 DOI: 10.1167/iovs.65.2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/07/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose To examine whether the age-related increase in visual field dependence persists in older adults with central field loss (CFL). Methods Twenty individuals with CFL were grouped into participants with age-related binocular CFL (CFL, n = 9), age-related monocular CFL/relative scotomata (mCFL, n = 8), and CFL occurring at a young age (yCFL, n = 3). Seventeen controls were age-matched to the older CFL groups (OA) and three to the yCFL group (yOA). Participants judged the tilt direction of a rod presented at various orientations under conditions with and without a visual reference. Visual field dependence was determined as the difference in judgment bias between trials with and without the visual reference. Visual field dependence was examined between groups and relative to visual acuity and contrast sensitivity. Results All older groups performed similarly without the visual reference. The CFL group showed greater visual field dependence than the OA group (Mann-Whitney U test; U = 39, P = 0.045). However, there was no group difference when considering all three older groups (Kruskal-Wallis ANOVA; H(2, N = 34) = 4.31, P = 0.116). Poorer contrast sensitivity correlated with greater visual field dependence (P = 0.017; ρ = -0.43). Conclusions Visual field dependence persists in older adults with CFL and seems exacerbated in those with dense binocular scotomata. This could be attributed to the sensitivity of the spared peripheral retina to orientation and motion cues. The relationship with contrast sensitivity further suggests that a decline in visual function is associated with an increase in visual field dependence beyond the effects of normal aging. These observations can guide tailored care and rehabilitation in older adults with CFL.
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Affiliation(s)
- Catherine P. Agathos
- The Smith-Kettlewell Eye Research Institute, San Francisco, California, United States
| | - Natela M. Shanidze
- The Smith-Kettlewell Eye Research Institute, San Francisco, California, United States
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2
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Wibble T, Pansell T. Clinical characteristics of visual motion hypersensitivity: a systematic review. Exp Brain Res 2023:10.1007/s00221-023-06652-3. [PMID: 37341755 DOI: 10.1007/s00221-023-06652-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
This qualitative systematic review presents an overview of the state of the research relating to visual motion hypersensitivity (VMH) and offers a reference tool for future studies in the field. The study set out to identify and collate articles investigating risk groups with aberrant responses to visual motion as compared to healthy control groups, presenting evidence for risk factors associated with visual motion hypersensitivity. Data were synthesized into the state of the research and analyzed in the context of the clinical characteristics of each risk factor. Literature searches were performed on Medline Ovid, EMBASE, Web of Science, and Cinahl, identifying a total of 586 studies of which 54 were finally included. Original articles published between the dates of commencement for each database and 19th January 2021 were included. JBI critical appraisal tools were implemented for each corresponding article type. In total, the following number of studies was identified for each respective risk factor: age (n = 6), migraines (n = 8), concussions (n = 8), vestibular disorders (n = 13), psychiatric conditions (n = 5), and Parkinson's disease (n = 5). Several studies described VMH as the primary concern (n = 6), though these primarily included patients with vestibulopathies. There were considerable differences in the nomenclature employed to describe VMH, depending largely on the investigating group. An overview of investigated risk factors and their evaluation methods was presented in a Sankey diagram. Posturography was the most implemented methodology but due to diverse measurements meta-analyses were not possible. One may however note that while the easily implemented Vestibular Ocular Motor Screening (VOMS) was designed for concussed patients, it may prove useful for other risk groups.
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Affiliation(s)
- Tobias Wibble
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden.
- St. Erik Eye Hospital, Stockholm, Sweden.
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
- St. Erik Eye Hospital, Stockholm, Sweden
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3
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Renaux A, Clanché F, Muhla F, Duclos K, Meyer P, Colnat-Coulbois S, Gauchard G. Age-related decrease in functional mobility score when performing a locomotor task in an immersive environment. Front Bioeng Biotechnol 2023; 11:1141507. [PMID: 37346797 PMCID: PMC10279850 DOI: 10.3389/fbioe.2023.1141507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
In recent years, immersive virtual reality technology has emerged in the field of health. Its use could allow the assessment of the motor behavior of individuals in adaptable and reproducible immersive environments, simulating real situations. This study aimed to assess the effect of an immersive scenario on functional mobility during a simple locomotor task according to age. Sixty young adults and 60 older volunteers, who were autonomous and without cognitive and neurological impairment participated. A locomotor task based on the "Timed Up and Go" task was performed in real and virtual conditions. A functional mobility score was calculated by combining the time and the number of steps used and compared between young and older people. Results showed that correlations between time and the number of steps were the same in VR and real conditions, but the locomotor performance decreased significantly in VR for both populations. Additionally, older people exhibited a more reduced locomotor performance in a virtual environment than young adults, thereby their functional mobility score decreased more to complete the task, reflecting the adoption of a more secure locomotion strategy often related to the fear of falling, with an increase in time and number of steps to support balance. The major difference between reality and VR is the visual immersion with an HMD, and visual information is more important in the sensory integration of older people. Therefore, the reduction in visual field and lack of visual exproprioceptive information about the body segments in the virtual environment could explain these results. Finally, the effect of immersion in a virtual scenario on mobility exists for both populations but is accentuated by the aging process and is therefore age dependent.
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Affiliation(s)
- Alexandre Renaux
- Development, Adaptation, and Handicap, Faculty of Medicine, Université de Lorraine, Lorraine, France
- CARE Grand Est, Research and Expertise Support Center, Nancy, France
| | - Fabien Clanché
- Development, Adaptation, and Handicap, Faculty of Medicine, Université de Lorraine, Lorraine, France
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Lorraine, France
| | - Frédéric Muhla
- CARE Grand Est, Research and Expertise Support Center, Nancy, France
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Lorraine, France
| | - Karine Duclos
- Development, Adaptation, and Handicap, Faculty of Medicine, Université de Lorraine, Lorraine, France
- CARE Grand Est, Research and Expertise Support Center, Nancy, France
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Lorraine, France
| | | | - Sophie Colnat-Coulbois
- Centre de Recherche en Automatique de Nancy CRAN, Université de Lorraine, Campus Sciences, Lorraine, France
| | - Gérome Gauchard
- Development, Adaptation, and Handicap, Faculty of Medicine, Université de Lorraine, Lorraine, France
- CARE Grand Est, Research and Expertise Support Center, Nancy, France
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Lorraine, France
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4
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Almajid R, Appiah-Kubi KO, Cipriani D, Goel R. Dual-tasking interference is exacerbated outdoors: A pilot study. Front Sports Act Living 2023; 5:1077362. [PMID: 36891128 PMCID: PMC9986320 DOI: 10.3389/fspor.2023.1077362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Walking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments. Methods Twenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments. Results While there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008). Discussion Dual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, Stockton University, Galloway, United States
- Department of Physical Therapy, West Coast University, Los Angeles, CA, United States
| | | | - Daniel Cipriani
- Department of Physical Therapy, West Coast University, Los Angeles, CA, United States
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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5
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Almajid R, Goel R. Assessment of dual-tasking during a dynamic balance task using a smartphone app: a pilot study. J Phys Ther Sci 2022; 34:115-121. [PMID: 35221514 PMCID: PMC8860690 DOI: 10.1589/jpts.34.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
[Purpose] To assess if the instrumented Timed Up and Go (iTUG) task score calculated
with an iPhone application can detect gait changes under dual-tasking conditions.
[Participants and Methods] Twenty participants (age 38.30 ± 12.54, 12 females) were asked
to complete the TUG as a single task and under two dual-tasking conditions: 1) verbal
fluency and 2) mental calculation. We used a smartphone, stopwatch, digital camera, and
wearable sensor to calculate the dependent variables which included time, step count, gait
speed, and iTUG score and, the dual-tasking cost (DTC) of those variables. We used
Friedman analyses of variance and Wilcoxon tests for statistical analyses. [Results] the
iTUG score, step count, gait speed, and the time measured by the stopwatch and wearable
sensor differed significantly for all tasks, but the smartphone time did not. [Conclusion]
We conclude that the iTUG score could be used as a sensitive measure for identifying gait
changes under dual-tasking conditions. With the growing demands of telehealth, using
technology as an objective tool for movement analysis is needed for clinicians and payers.
Our findings demonstrate the potential value of the iTUG score to assess and track
patient’s progress.
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Affiliation(s)
- Rania Almajid
- Physical Therapy Program, Stockton University: 101 Vera King Farris Drive, Galloway, New Jersey 08205, USA
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, USA
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6
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Horsak B, Simonlehner M, Schöffer L, Dumphart B, Jalaeefar A, Husinsky M. Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics. Front Bioeng Biotechnol 2021; 9:780314. [PMID: 34957075 PMCID: PMC8693458 DOI: 10.3389/fbioe.2021.780314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Virtual reality (VR) is an emerging technology offering tremendous opportunities to aid gait rehabilitation. To this date, real walking with users immersed in virtual environments with head-mounted displays (HMDs) is either possible with treadmills or room-scale (overground) VR setups. Especially for the latter, there is a growing interest in applications for interactive gait training as they could allow for more self-paced and natural walking. This study investigated if walking in an overground VR environment has relevant effects on 3D gait biomechanics. A convenience sample of 21 healthy individuals underwent standard 3D gait analysis during four randomly assigned walking conditions: the real laboratory (RLab), a virtual laboratory resembling the real world (VRLab), a small version of the VRlab (VRLab-), and a version which is twice as long as the VRlab (VRLab+). To immerse the participants in the virtual environment we used a VR-HMD, which was operated wireless and calibrated in a way that the virtual labs would match the real-world. Walking speed and a single measure of gait kinematic variability (GaitSD) served as primary outcomes next to standard spatio-temporal parameters, their coefficients of variant (CV%), kinematics, and kinetics. Briefly described, participants demonstrated a slower walking pattern (-0.09 ± 0.06 m/s) and small accompanying kinematic and kinetic changes. Participants also showed a markedly increased gait variability in lower extremity gait kinematics and spatio-temporal parameters. No differences were found between walking in VRLab+ vs. VRLab-. Most of the kinematic and kinetic differences were too small to be regarded as relevant, but increased kinematic variability (+57%) along with increased percent double support time (+4%), and increased step width variability (+38%) indicate gait adaptions toward a more conservative or cautious gait due to instability induced by the VR environment. We suggest considering these effects in the design of VR-based overground training devices. Our study lays the foundation for upcoming developments in the field of VR-assisted gait rehabilitation as it describes how VR in overground walking scenarios impacts our gait pattern. This information is of high relevance when one wants to develop purposeful rehabilitation tools.
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Affiliation(s)
- Brian Horsak
- Center for Digital Health and Social Innovation, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Mark Simonlehner
- Department of Health, Institute of Health Sciences, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Lucas Schöffer
- Department of Media and Digital Technologies, Institute of Creative∖Media/Technologies, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Bernhard Dumphart
- Department of Health, Institute of Health Sciences, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Arian Jalaeefar
- Department of Media and Digital Technologies, Institute of Creative∖Media/Technologies, St. Pölten University of Applied Sciences, St Pölten, Austria
| | - Matthias Husinsky
- Department of Media and Digital Technologies, Institute of Creative∖Media/Technologies, St. Pölten University of Applied Sciences, St Pölten, Austria
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7
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Muhla F, Duclos K, Clanché F, Meyer P, Maïaux S, Colnat-Coulbois S, Gauchard GC. Does the Management of Visual and Audible Motion Information during an Immersive Virtual Reality Timed Up and Go Test Impact Locomotor Performance in the Elderly? Gerontology 2021; 68:456-464. [PMID: 34365451 DOI: 10.1159/000517286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Falling among the elderly is a major public health issue, especially with the advancing age of the baby boomers. The fall risk assessment tests for many lack a context that would bring them closer to everyday life. Thus, immersive virtual reality, which makes it possible to simulate everyday situations, could make it possible to strengthen the quality of the assessment of the risk of falls. However, it is necessary to understand how the use of a virtual reality device influences the motor control of elderly participants. If vestibular physiotherapists use VR to virtualize their tools, what impact would a visual simulation of movement have on motor control in a locomotor task, if this simulation were plausible? METHODS Sixty-two elders (70.8 ± 6.7 years old) completed a Timed Up and Go task under 3 conditions: real, virtual reality, and virtual reality with visual and sound movement information. The virtual reality task takes place in a train either stationary at a station or in uniform linear motion. The time and number of steps were recorded using video, and comparisons between conditions were made using Friedman's test. RESULTS The results show a significant increase in the time and number of steps in "virtual reality" condition compared to the "real" condition. They do not show significant differences between the 2 virtual conditions. CONCLUSION The use of a running virtual train to provide plausible movement is particularly distinguished from vestibular physiotherapy applications with first a fixed visual support partially obscuring the optical flow. This visual aid coupled with the attention dedicated to the task inhibits the effect of the moving environment on locomotion. However, the visual optical flow will potentially have an effect in people with fear of falling. Virtual reality shows great potential for the simulation of realistic environments for the assessment of the risk of falls and opens up avenues for the development of tests.
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Affiliation(s)
- Frédéric Muhla
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Villers-lès- Nancy, France, .,EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine, Université de Lorraine, Vandœuvre-lès-Nancy, France,
| | - Karine Duclos
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Villers-lès- Nancy, France.,EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Fabien Clanché
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Villers-lès- Nancy, France.,EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Philippe Meyer
- Office d'Hygiène Sociale de Lorraine Centre Florentin, Nancy, France
| | - Séverine Maïaux
- Office d'Hygiène Sociale de Lorraine Centre Florentin, Nancy, France
| | - Sophie Colnat-Coulbois
- EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Gérome C Gauchard
- UFR STAPS, Faculty of Sport Science, Université de Lorraine, Villers-lès- Nancy, France.,EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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8
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Nobari H, Rezaei S, Sheikh M, Fuentes-García JP, Pérez-Gómez J. Effect of Virtual Reality Exercises on the Cognitive Status and Dual Motor Task Performance of the Aging Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158005. [PMID: 34360294 PMCID: PMC8345705 DOI: 10.3390/ijerph18158005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022]
Abstract
Aging is a global phenomenon affecting numerous developed and developing countries. During this process, the functional state of the body, especially the cognitive state, declines. This research investigated the impact of virtual reality exercises on the cognitive status and dual-task performance in the elderly of Tabriz city, Iran. Forty men with a mean age of 71.5 were selected and assigned to either the experimental (n = 20) or control groups (n = 20). Both groups completed the Mini-Mental State Examination for cognitive status. The pre-test was performed through the Timed Up and Go test (TUG) along with a countdown of numbers. Then, the experimental group practiced virtual driving for six weeks, while the control group received no treatment. After the treatment, both groups completed the post-test. At each stage, the test was performed as a dual motor task as well. Data were analyzed using the paired t-test and the independent sample t-test to show the intra-group and inter-group differences, respectively. The results showed a significant improvement in the cognitive status and dual-task performance of the elderly men after the six-week training period, which was also significant compared to the control group. Virtual reality driving can be used to improve the cognitive status and dual task performance of elderly men.
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Affiliation(s)
- Hadi Nobari
- Department of Physical Education and Sports, University of Granada, 18010 Granada, Spain
- HEME Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
- Correspondence: (H.N.); (M.S.)
| | - Saeed Rezaei
- Departments of Physical Education and Sport Sciences, University of Tehran, Tehran 6619-14155, Iran;
| | - Mahmoud Sheikh
- Departments of Physical Education and Sport Sciences, University of Tehran, Tehran 6619-14155, Iran;
- Correspondence: (H.N.); (M.S.)
| | - Juan Pedro Fuentes-García
- Didactic and Behavioral Analysis of Sports (ADICODE) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
| | - Jorge Pérez-Gómez
- HEME Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain;
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9
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Keshner EA, Lamontagne A. The Untapped Potential of Virtual Reality in Rehabilitation of Balance and Gait in Neurological Disorders. FRONTIERS IN VIRTUAL REALITY 2021; 2:641650. [PMID: 33860281 PMCID: PMC8046008 DOI: 10.3389/frvir.2021.641650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Dynamic systems theory transformed our understanding of motor control by recognizing the continual interaction between the organism and the environment. Movement could no longer be visualized simply as a response to a pattern of stimuli or as a demonstration of prior intent; movement is context dependent and is continuously reshaped by the ongoing dynamics of the world around us. Virtual reality is one methodological variable that allows us to control and manipulate that environmental context. A large body of literature exists to support the impact of visual flow, visual conditions, and visual perception on the planning and execution of movement. In rehabilitative practice, however, this technology has been employed mostly as a tool for motivation and enjoyment of physical exercise. The opportunity to modulate motor behavior through the parameters of the virtual world is often ignored in practice. In this article we present the results of experiments from our laboratories and from others demonstrating that presenting particular characteristics of the virtual world through different sensory modalities will modify balance and locomotor behavior. We will discuss how movement in the virtual world opens a window into the motor planning processes and informs us about the relative weighting of visual and somatosensory signals. Finally, we discuss how these findings should influence future treatment design.
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Affiliation(s)
- Emily A. Keshner
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
- Correspondence: Emily A. Keshner,
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Virtual Reality and Mobility Laboratory, CISSS Laval—Jewish Rehabilitation Hospital Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, QC, Canada
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10
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Almajid R, Tucker C, Keshner E, Vasudevan E, Wright WG. Effects of wearing a head-mounted display during a standard clinical test of dynamic balance. Gait Posture 2021; 85:78-83. [PMID: 33517040 DOI: 10.1016/j.gaitpost.2021.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 10/24/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of virtual reality (VR) in clinical settings has increased with the introduction of affordable, easy-to-use head-mounted displays (HMDs). However, some have raised concerns about the effects that HMDs have on posture and locomotion, even without the projection of a virtual scene, which may be different across ages. RESEARCH QUESTION How does HMD wear impact the kinematic measures in younger and older adults? METHODS Twelve healthy young and sixteen older adults participated in two testing conditions: 1) TUG with no HMD and 2) TUG with an HMD displaying a scene of the actual environment (TUGHMD). The dependent variables were the pitch, yaw, and roll peak trunk velocities (PTVs) in each TUG component, turning cadence, and the time to complete the TUG and its components - SIT-TO-STAND, TURN, WALK, and STAND-TO-SIT. RESULTS Wearing the HMD decreased turning cadence and pitch and yaw PTVs in all TUG components, decreased roll PTV in SIT-TO-STAND and TURN, and increased the time taken to complete all TUG components in all participants. Wearing the HMD decreased the pitch PTV in SIT-TO-STAND in older relative to younger adults. Wearing an HMD affected TUG performance in younger and older adults, which should be considered when an HMD is used for VR applications in rehabilitation. SIGNIFICANCE Our findings highlight the importance of considering the physical effect of HMD wear in clinical testing, which may not be present with non-wearable VR technologies.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, West Coast University, 590 N Vssermont Ave, Los Angeles, CA, 90004, USA; Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Carole Tucker
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Emily Keshner
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Erin Vasudevan
- Department of Health and Rehabilitation Sciences, School of Health Technology and Management, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, 11794, USA.
| | - William Geoffrey Wright
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA; Department of Bioengineering, Temple University 1801 N Broad St., Philadelphia, PA, 19122, USA.
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11
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Soltani P, Andrade R. The Influence of Virtual Reality Head-Mounted Displays on Balance Outcomes and Training Paradigms: A Systematic Review. Front Sports Act Living 2021; 2:531535. [PMID: 33634259 PMCID: PMC7902044 DOI: 10.3389/fspor.2020.531535] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Falls are the leading causes of (non)fatal injuries in older adults. Recent research has developed interventions that aim to improve balance in older adults using virtual reality (VR). Purpose: We aimed to investigate the validity, reliability, safety, feasibility, and efficacy of head mounted display (HMD) systems for assessing and training balance in older adults. Methods: We searched EBSCOhost, Scopus, Web of Science, and PubMed databases until 1 September 2020 to find studies that used HMD systems for assessing or training balance. The methodological quality was assessed using a modified version of Downs and Black. We also appraised the risk of bias using Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). Results: A total of 19 articles (637 participants) were included for review. Despite heterogenous age ranges and clinical conditions across studies, VR HMD systems were valid to assess balance and could be useful for fall prevention and for improving postural control and gait patterns. These systems also have the capacity to differentiate healthy and balance-impaired individuals. During VR versions of traditional balance tests, older adults generally acquire a cautious behavior and take more time to complete the tasks. Conclusion: VR HMD systems can offer ecologically valid scenarios to assess and train functional balance and can be used alone or in addition to other interventions. New norms and protocols should be defined according to participants' age, health status, and severity of their illness when using VR HMD systems for balance assessment and training. For safe and feasible training, attention must be given to display type, VR elements and scenarios, duration of exposure, and system usability. Due to high risk of bias and overall poor quality of the studies, further research is needed on the effectiveness of HMD VR training in older adults.
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Affiliation(s)
- Pooya Soltani
- Department of Computer Science, Department of Health, Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom.,Department of Physical Education and Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sport, University of Porto, Porto, Portugal
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12
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Unger EW, Histing T, Rollmann MF, Orth M, Herath E, Menger M, Herath SC, Grimm B, Pohlemann T, Braun BJ. Development of a dynamic fall risk profile in elderly nursing home residents: A free field gait analysis based study. Arch Gerontol Geriatr 2020; 93:104294. [PMID: 33217640 DOI: 10.1016/j.archger.2020.104294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/12/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
Falls in nursing home residents are associated with a significant individual and socioeconomic burden of disease. To trigger and tailor individual intervention programs, solid early detection measures of residents at risk are needed. Aim of this study was thus to test the capability of a free field gait analysis insole to determine its usefulness in determining fall risk. In an observational study gait data of 22 nursing home residents over the age of 75 years was collected over one week with a measuring insole. Clinical scores were performed at baseline (POMA; DGI, TUG). For 6 months before and after the insole measurement, the fall events per resident were recorded. Correlation analysis as well as receiver operating characteristic curve analysis were performed. The average resident age was 88.2 years (range 78-99), 15 had at least one fall event. There was no significant correlation between clinical assessment and fall risk. Moderate correlations between different temporospatial parameters and fall risk were seen. Pressure distribution during gait was markedly changed in fallers. Differences between fallers and non-fallers as well as cut off values for increased fall risk in the ROC analysis could be determined. The introduced measurement protocol suggests that patients at risk for falling can be detected without any additional office visits. Based on the introduced protocol in a limited patient setting, further large scale studies should now determine the effect of prevention measures triggered by gait analysis, the specific risk reduction and the associated personal and socioeconomic advantages.
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Affiliation(s)
- Eduard Witiko Unger
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Faculty of Medicine, BG Hospital Tübingen, Germany
| | - Mika Frieda Rollmann
- Department of Trauma and Reconstructive Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Faculty of Medicine, BG Hospital Tübingen, Germany
| | - Marcel Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Esther Herath
- Department of Gastroenterology and Endocrinology, Saarland University Hospital, Germany
| | - Maximilian Menger
- Department of Trauma and Reconstructive Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Faculty of Medicine, BG Hospital Tübingen, Germany
| | - Steven Christian Herath
- Department of Trauma and Reconstructive Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Faculty of Medicine, BG Hospital Tübingen, Germany
| | | | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Benedikt Johannes Braun
- Department of Trauma and Reconstructive Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Faculty of Medicine, BG Hospital Tübingen, Germany.
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Reimann H, Ramadan R, Fettrow T, Hafer JF, Geyer H, Jeka JJ. Interactions Between Different Age-Related Factors Affecting Balance Control in Walking. Front Sports Act Living 2020; 2:94. [PMID: 33345085 PMCID: PMC7739654 DOI: 10.3389/fspor.2020.00094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/12/2020] [Indexed: 12/30/2022] Open
Abstract
Maintaining balance during walking is a continuous sensorimotor control problem. Throughout the movement, the central nervous system has to collect sensory data about the current state of the body in space, use this information to detect possible threats to balance and adapt the movement pattern to ensure stability. Failure of this sensorimotor loop can lead to dire consequences in the form of falls, injury and death. Such failures tend to become more prevalent as people get older. While research has established a number of factors associated with higher risk of falls, we know relatively little about age-related changes of the underlying sensorimotor control loop and how such changes are related to empirically established risk factors. This paper approaches the problem of age-related fall risk from a neural control perspective. We begin by summarizing recent empirical findings about the neural control laws mapping sensory input to motor output for balance control during walking. These findings were established in young, neurotypical study populations and establish a baseline of sensorimotor control of balance. We then review correlates for deteriorating balance control in older adults, of muscle weakness, slow walking, cognitive decline, and increased visual dependency. While empirical associations between these factors and fall risk have been established reasonably well, we know relatively little about the underlying causal relationships. Establishing such causal relationships is hard, because the different factors all co-vary with age and are difficult to isolate empirically. One option to analyze the role of an individual factor for balance control is to use computational models of walking comprising all levels of the sensorimotor control loop. We introduce one such model that generates walking movement patterns from a short list of spinal reflex modules with limited supraspinal modulation for balance. We show how this model can be used to simulate empirical studies, and how comparison between the model and empirical results can indicate gaps in our current understanding of balance control. We also show how different aspects of aging can be added to this model to study their effect on balance control in isolation.
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Affiliation(s)
- Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Rachid Ramadan
- Institute for Neural Computation, Ruhr University, Bochum, Germany
| | - Tyler Fettrow
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Jocelyn F. Hafer
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Hartmut Geyer
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, United States
| | - John J. Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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Almajid R, Goel R, Tucker C, Keshner E. Balance confidence and turning behavior as a measure of fall risk. Gait Posture 2020; 80:1-6. [PMID: 32454377 DOI: 10.1016/j.gaitpost.2020.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Diminished balance confidence increases the risk of a fall and falls that occur when turning during walking are associated with an eightfold increase in hip fractures compared to when walking in a straight trajectory. Although an effect of aging on turning is revealed, the role of gender during turning is not yet clear. RESEARCH QUESTION How can balance confidence impact turning behavior in younger, middle-aged, and older men and women? METHODS This cross-sectional study included 22 young adults (11 women), 13 middle-aged adults (9 women), and 13 older adults (6 women). Participants ranked their balance confidence using the activities-specific balance confidence (ABC) scale and completed two different turns: Turn1 (around the cone) and Turn2 (turn to sit). Measures obtained for each turn included: turning time, step count, and peak trunk velocities (PTV) in pitch, yaw, and roll. RESULTS In Turn1, older adults exhibited an increase in turning time and step count relative to younger adults (both p < 0.03). In Turn2, older adults showed an increase in turning time and roll PTV compared to the middle-aged group (both p < 0.02). Lower scores in ABC were significantly correlated with an increase in Turn1 time (p < 0.001) and step count (p = 0.04) in middle-aged and older adults, respectively. Bivariate correlations revealed that women with lower scores on the ABC took more time to complete both turns (both p = 0.01). SIGNIFICANCE Older adults demonstrated longer turning time, more steps, and higher roll PTV while turning that were associated with decreased balance confidence scores. The association between decreased balance confidence and turning kinematics implies a relationship between turning and increased fall risk. These results suggest that testing for fall risk requires tests of activities that are performed outside traditional clinical settings and gait laboratories.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, West Coast University, 590 N Vermont Ave, Los Angeles, CA 90004, USA; Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA 19122 USA.
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Carole Tucker
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA 19122 USA
| | - Emily Keshner
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA 19122 USA
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