Effects of balance training using a virtual-reality system in older fallers

[Effect of training with immersive virtual reality on the risk of falling in the elderly: a systematic review]

Aging entails changes in the human body, generating a decrease in physical capabilities, including the risk of falls. New therapies are currently emerging for the risk of falls and immersive virtual reality is one of them, giving the user a realistic feeling of a virtual environment. This systematic review aims to investigate the effects of immersive virtual reality on the risk of falling in older people. Randomized controlled clinical trials were included, with at least one intervention group that used immersive virtual reality, age >60 years and without multiple serious pathologies. Articles published until November 2023 were included, in accordance with the PRISMA guideline and including the PICO strategy, in the electronic databases PubMed, Scielo, Scopus, Semantic Scholar and Science Direct. From a total of 413 articles, 7 studies were selected, which met the pre-established inclusion and exclusion criteria. Of the studies reviewed, the majority found significant improvements in tests that measure risk of falls, only one study did not find improvements in this variable but did find improvements for walking speed and functional reach test. Despite the limited literature, it seems that these interventions can have a positive effect, becoming a good tool to reduce the risk of falling in older people.

Effects of immersive virtual reality training on balance, gait and mobility in older adults: A systematic review and meta-analysis

OBJECTIVE

To examine whether immersive virtual reality (VR) can improve balance, gait, mobility and fear of falling in older people.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, ProQuest Central (Engineering and Computer Science) and reference lists of included articles.

STUDY SELECTION

Randomised controlled trials that administered immersive VR training and assessed balance, gait and mobility outcomes in older adults without neurological disorders (mean age ≥ 65). Primary outcomes were standing balance (e.g. postural sway), multi-item balance scales (e.g. Berg Balance Scale), gait (e.g. gait speed) and mobility (e.g. Timed Up and Go test). Secondary outcomes comprised measures of enjoyment, fear of falling, adherence (e.g. dropout rate), feasibility/usability and adverse effects (e.g. motion sickness).

RESULTS

Meta-analyses showed that immersive VR training significantly improved standing balance (SMD: 0.51, 95% CI: .15, 0.86, p = 0.005, I2 = 28% - 3 studies, n = 79) and performance on the Berg Balance Scale (MD: 2.36, 95% CI: 1.17, 3.56, p=0.0001, I2=0% - 4 studies, n = 190). No significant improvement in gait, mobility or fear of falling was found. Subgroup analyses revealed higher training doses (≥4.5 total hours) and VR interventions using non-head mounted displays were more likely to improve standing balance. No meta-analyses were conducted for enjoyment, adherence, feasibility/usability and adverse events.

CONCLUSIONS

The findings indicate immersive VR has beneficial effects on balance, but not gait, mobility or fear of falling. Further research is required to examine these outcomes in trials that also include quantitative measurements of enjoyment, adherence, clinical feasibility, usability and adverse effects.

Exploring new balance and gait factors that are associated with osteosarcopenia in patients with a previous fall and/or fracture history

Osteosarcopenic individuals have poor muscle function and increased bone fragility, which results in a severe detriment to health outcomes. Hence, there is a necessity to discover easily accessible factors associated with osteosarcopenia to develop timely interventions. This study aimed to determine new sensitive balance and/or gait variables that are associated with osteosarcopenia in a population of older people with a history of falls and/or fractures. In a cross-sectional cohort study, 306 men and women aged ≥65 years completed a series of questionnaires, clinical assessments and muscle strength and function tests. Subsequently, participants were separated into osteopenia, osteoporosis and osteosarcopenia, groups for comparison and further analysis. Osteosarcopenia performed worse than osteopenia and osteoporosis in grip strength, gait speed, physical function scores and in multiple gait and balance indices (p<0.001). During posturography testing, there were larger elliptical areas with eyes open (p = 0.003), and eyes closed (p = 0.043) and increased sway velocity on a firm platform (p = 0.007) in the osteosarcopenia group, compared to osteoporosis. Limits of stability and eyes open ellipse area significantly contributed to the multivariable model (p = 0.029 and p = 0.038, respectively), suggesting that these balance parameters, along with grip strength, may be useful in identifying older adults with osteosarcopenia from those with only osteopenia/osteoporosis. Older adults with osteosarcopenia and a history of falls and/or fractures demonstrated inferior strength, function, and gait characteristics. This study identified indices of balance that were sensitive discriminators for osteosarcopenia and could be easily implemented into routine assessment.

Effectiveness of Virtual Reality Therapy on Balance and Gait in the Elderly: A Systematic Review

Virtual reality (VR) therapies are presently utilized to treat physical and cognitive impairments among elderly people. This systematic review aims to collect the most recent evidence on the effectiveness of VR in improving balance and gait among healthy elderly individuals, in comparison with other therapies. A literature search was conducted using the PubMed, SCOPUS, PEDro, and WoS databases, by selecting randomized clinical trials that evaluated balance, both static and dynamic, as well as gait in a population of healthy older adults who underwent virtual reality therapy. The methodological quality of the studies was assessed using the PEDro scale. After eligibility criteria were applied and duplicates were removed, 20 studies were selected out of 1705 initially identified. The present systematic review concludes that virtual reality therapy is more effective than minimal intervention or usual care in enhancing static balance, dynamic balance, and gait in healthy elderly individuals. Moreover, virtual reality therapy yields better outcomes compared to traditional balance training and physical exercise in improving balance and gait in this demographic. However, both methods have shown effectiveness.

Exploring the Psychological Nexus of Virtual and Augmented Reality on Physical Activity in Older Adults: A Rapid Review

With the global population of older adults projected to double to 2.1 billion by 2050, it becomes crucial to promote healthy aging to alleviate the associated disease burden. In this context, technology, particularly virtual reality (VR) and augmented reality (AR), has garnered attention for its potential to augment physical activity in older adults. These immersive technologies offer interactive and enjoyable exercise experiences, making physical activity more appealing. However, the effectiveness of these interventions is not solely attributed to technology itself but is deeply intertwined with psychological processes. This rapid review examines the effectiveness of VR and AR interventions in enhancing physical exercise among healthy older adults while exploring the role of psychological variables, including mood, self-efficacy, and motivation. The results of the study show that technology-enhanced physical activity interventions hold great promise but call attention to the need for a comprehensive understanding of psychological dynamics that will pave the way for more tailored and effective interventions. Future research endeavors should aim to bridge these gaps in knowledge to optimize the impact of technology on healthy aging.

From 65 to 103, Older Adults Experience Virtual Reality Differently Depending on Their Age: Evidence from a Large-Scale Field Study in Nursing Homes and Assisted Living Facilities

There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing studies examining the experiences and challenges facing those who facilitate VR for older adults (e.g., caregiving staff). We address these limitations through two studies. In study 1, we explore variation within older adults' experiences with VR through a field study of VR use among a large (N = 245) and age-diverse (Mage = 83.6 years, SDage = 7.9, range = 65-103 years) sample of nursing home and assisted living facility residents across 10 U.S. states. Age was negatively associated with the extent to which older adults enjoyed VR experiences. However, the negative relationship between age and older adults' attitudes toward VR was significantly less negative than the relationship between age and their attitudes toward other technologies (cell phones and voice assistants). In study 2, we surveyed caregiving staff (N = 39) who facilitated the VR experiences for older adult residents and found that the caregiving staff generally enjoyed the activity relative to other activities and felt it to be beneficial to their relationship with residents.

Visual Cues for a Steadier You: Visual Feedback Methods Improved Standing Balance in Virtual Reality for People with Balance Impairments

Users of head-mounted displays (HMDs) for virtual reality (VR) sometimes have balance issues since HMDs impede their view of the outside world. This has a greater impact on people with balance impairments since many rely more heavily on their visual cues to keep their balance. This is a significant obstacle to the universal usability and accessibility of VR. Although previous studies have verified the imbalance issue, not much work has been done to diminish it. In this study, we investigated how to increase VR balance by utilizing additional visual cues. To examine how different visual approaches (static, rhythmic, spatial, and center of pressure (CoP) based feedback) affect balance in VR, we recruited 100 people (50 with balance impairments due to multiple sclerosis and 50 without balance impairments) across two different geographic locations (United States and Bangladesh). All people completed both standing visual exploration as well as standing reach and grasp tasks. Results demonstrated that static, rhythmic, and CoP visual feedback approaches enhanced balance significantly ( ) in VR for people with balance impairments. The methods described in this study could be applied to design more accessible virtual environments for people with balance impairments.

Effectiveness of Balance Rehabilitation Unit (BRU) Posturography Versus Conventional Rehabilitation in Patients With Unilateral Peripheral Vestibular Dysfunction

BACKGROUND

Patients with unilateral peripheral vestibular deficit (UPVD) experience vertigo, dizziness, disability, negative influences on their quality of life, anxiety, and depression. In vestibular rehabilitation, virtual reality (VR) has proven to be effective. This investigation sought to evaluate the efficacy of the Balance Rehabilitation Unit (BRUTM) (MedicaaTM Montevideo, Uruguay, Balance Suite, version BRU 415) in patients with UPVD.

METHODS

A prospective, randomized, controlled study involved 38 patients from the Otoneurologic Service at the National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra" in Mexico. A physician specialist diagnosed the patients with UPVD and assigned them randomly to one of two groups. Group 1 (n = 19) received traditional vestibular rehabilitation, whereas Group 2 (n = 19) received BRUTM-supported vestibular rehabilitation. Both groups were monitored by medical professionals. Patients were evaluated with the Dizziness Handicap Inventory, static and dynamic balance assessments, the dynamic gait index, and the sensory organization test. The statistical analysis was conducted using the Student's t-test, with p 0.05 considered statistically significant.

RESULTS

The difference in mean age between the conventional therapy and BRUTM groups was not statistically significant. Both conventional vestibular rehabilitation and the BRUTM led to statistically significant improvements in all assessed parameters, with no statistically significant differences between the two groups.

CONCLUSION

Balance, mobility, and quality of life were enhanced similarly in UPVD patients by BRUTM-supported vestibular rehabilitation and conventional vestibular rehabilitation. In addition, BRUTM facilitated patient motivation, exercise feedback, and confidence enhancement.

3D Virtual Reality Rehabilitation Therapy for Patients with Vertigo Due to Peripheral Vestibular Dysfunction

This study aimed to evaluate 3D virtual reality rehabilitation therapy in patients with vertigo due to peripheral vestibular dysfunction. The subjects were 20 patients with peripheral vestibular dysfunction confirmed by Videonystagmography, Divided into 2 groups: Group 1 (study group) underwent vestibular rehabilitation therapy using 3D virtual reality in a customised VR lab with specific headset (Oculus rift and htc vive) with software application, which allows vestibular rehabilitation treatment using high quality immersive virtual reality console in which environment appears real and in 3D. The exercises are designed for gaze stability, increase postural stability, improve vertigo and daily activities, through sensory stimuli and in addition to conventional Cawthorne-Choksey exercises. Group 2 (control group) are treated by conventional Cawthorne-Choksey exercises alone. A VSS-SF (Vertigo Symptom Scale-short form) questionnaire and VAS (Visual Analog Scale) were used to assess the levels of patient satisfaction compared before and after each treatment session in both groups. A significant higher level of subjective satisfaction was observed in patients who underwent 3D virtual reality rehabilitation therapy with conventional therapy (group 1) compared to patients who underwent conventional cawthorne-Choksey exercises alone (group 2). The study gave a substantial subjective satisfaction in patients using 3D virtual reality rehabilitation therapy with conventional therapy (group1) than conventional Cawthorne-Choksey exercises alone (group 2). Future of VR rehabilitation therapy brings a revolutionary novelty in field of rehabilitation therapy were it involves real time stimulation and interaction between sensory, motor and cognitive channels.

Examining technology-assisted rehabilitation for older adults' functional mobility: a network meta-analysis on efficacy and acceptability

Technological advancements facilitate feedback adaptation in rehabilitation through virtual reality (VR) exergaming, serious gaming, wearables, and telerehabilitation for older adults fall prevention. Although studies have evaluated these technologies, no comparisons of their effectiveness have been conducted to date. Thus, this study aims to assess the differences in effectiveness of these interventions on balance and functional mobility in the older adults. A systematic review and network meta-analysis (NMA) were conducted to identify the most effective interventions for improving balance and functional mobility in adults aged 60 and over. The search was conducted in five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) up to June 10, 2023. The eligibility criteria were: (1) older adults, (2) functional mobility, balance, or gait as the primary outcome, (3) new technology intervention, and (4) randomized study design. New technology interventions were classified into five categories: exergaming with balance platforms or motion capture technologies, other serious gaming, interventions with wearables, and telerehabilitation. Additionally, two categories of control interventions (conventional exercises and no treatment) were extracted. The NMA was performed for the aggregated results of all outcomes, and separately for clinical functional scales, functional mobility, and gait speed results. Fifty-two RCTs with 3081 participants were included. Exergaming with motion capture was found to be statistically significant in producing a better effect than no treatment in the analysis of the functional mobility with an SMD of -0.70 (P < 0.01). The network meta-analysis revealed that exergaming with motion capture offers greater therapeutic benefits for functional mobility and balance compared to no treatment control. The effectiveness of this approach is similar to that of conventional exercises. Further RCTs are needed to provide a more definitive conclusion, particularly with respect to the effectiveness of serious games, telerehabilitation, and interventions with wearables.

Effectiveness of Virtual Reality in Balance Training for Fall Prevention in Older Adults: Systematic Review

OBJECTIVE

The purpose of this study was to determine the effectiveness of virtual reality (VR) in balance training for the prevention of falls in older adults.

METHODS

We included studies with experimental designs, cohort studies, and quasi-experimental studies of older adults who underwent balance training associated with the use of VR for the prevention of falls. The comparison of control and intervention groups in the studies reported statistically significant improvements in terms of balance for VR.

RESULTS

The effects and benefits from the use of VR were seen by the fourth week of intervention, with significant improvements in balance and lower fall rates, the improvements became greater for groups using VR.

CONCLUSIONS

The benefits presented by the studies were related not only to balance but also to fear of falling, reaction time, gait, physical fitness, independence in activities of daily living, muscle strength, and even quality of life.

Improved Balance, Gait, and Lower Limb Motor Function in a 58-Year-Old Man with Right Hemiplegic Traumatic Brain Injury Following Virtual Reality-Based Real-Time Feedback Physical Therapy

BACKGROUND This report presents the case of a 58-year-old man with right hemiplegia who improved his gait and lower limb motor function following virtual reality (VR)-based physical therapy. The use of augmented reality or VR-based technology is being increasingly used to support physical therapy in patients with motor deficits and to improve gait, and can be used in small hospitals and outpatient departments. CASE REPORT A 58-year-old man was diagnosed with left hemiplegia due to traumatic brain injury (TBI). He received 20 minutes of VR-based real-time feedback gait training and 30 minutes of general physical therapy, 5 times a week for 8 weeks. BioRescue was used for measurement of balance, GAITRite was used for measurement of gait, and Fugl-Meyer assessment was used for lower extremity motor function measurement. These were measured before the intervention and at 2, 4, 6, and 8 weeks after the intervention. After the intervention, center of pressure and limits of stability also increased. The affected step length, stride length, affected single support, and cadence were significantly increased after VR-based real-time feedback. Additionally, his lower extremity motor function score increased from 18 to 23 points. CONCLUSIONS This case report supports recent studies that have shown the value of VR-based methods as part of a physical therapy program in patients with problems with gait and motor function, including patients with stroke. VR-based real-time feedback showed favorable effects on rehabilitation following a TBI.

Task-Oriented and Imitation-Oriented Movements in Virtual Reality Exercise Performance and Design

OBJECTIVE

This study investigated the influence of game features and practice type on human kinematic and muscular performance in a virtual reality exercise (VRE). Participants demonstrated changes in shoulder flexion angle and muscle activation under different virtual scenarios.

BACKGROUND

Conventional VRE studies often compared the outcomes between an experimental group that underwent exercise in VR and a real-world exercise control group, whereas comparisons between VRE programs are lacking. Besides, the attributes of VREs received little attention.

METHOD

Thirteen able-bodied participants performed upper extremity exercise movements in immersive VR using a head-mounted display. Participants performed task-oriented and imitation-oriented movements with different game features. Shoulder muscle activity (the deltoid, supraspinatus, and infraspinatus) and shoulder motion were collected.

RESULTS

Practice type (task-oriented, imitation-oriented) significantly influenced the flexion angle of the shoulder complex (F(1,11) = 9.53, p = .01), and the muscle activity of the supraspinatus (F(1,9) = 12.61, p = .006) and the infraspinatus (F(1,9) = 12.71, p = .006). Game features did not have a statistically significant effect on shoulder flexion angle or shoulder muscles' activations.

CONCLUSIONS

Compared to imitation-oriented practice, task-oriented practice elicited more intensive shoulder movements and muscular efforts but also induced greater movement variations. Substantial differences across game features levels should be further investigated to have significant effects.

APPLICATIONS

This research may help guide the design of future VREs. For strength training or rehabilitation where intensive practice is required, task-oriented practice should be considered; for movement learning where movement consistency is required, imitation oriented practice should be adopted.

Gymnastic skills on a balance beam with simulated height

Virtual reality (VR) is a valuable tool for simulating dangerous situations and training under these conditions with a reduced possibility of injury. This could be beneficial within different sports scenarios. In gymnastics, the height of the balance beam can be dangerous and frightening, especially for beginners. Here, a simulated height can reduce the participant's risk of injury and facilitate entry to balance beam gymnastics. However, the investigation of sports performance in a virtual environment is rare. Therefore, the current study aims to compare beginners' performance in balance beam tasks between the real world (RW) and VR. 34 sports students executed gymnastic balancing forward, backward and the extension of one leg to the front, the side and the back on a regular balance beam in the RW and on a balance beam with simulated height in VR (using a head-mounted display). We analyzed beginners' performance in both conditions (RW and VR) regarding different criteria for each balance beam task. Statistical analyses show significant differences in performance with better results in RW (p < .05). Especially the body tension and the upper body posture were superior in RW. One explanation can be the more difficult regulation of the balance in VR. For the tasks where the motion took part in a fixed position on the beam, the further performance aspects were similar for RW and VR. When the participants moved along the beam, further performance aspects, like the leg extension, were better in RW. In total, the participants executed the VR balance beam tasks with decreased danger of injury due to the simulated height of the balance beam, but their performance was slightly limited. We conclude that for the first contact with the height of a balance beam, VR is a suitable tool to reduce the danger of injury occurring from falling off the beam and facilitate entry to balance beam gymnastics.

The effect of six week virtual reality training on the improvement of functional balance in women with type-I osteoporosis: A preliminary study

Purpose

This preliminary study aimed to investigate the effects of exergames in a virtual reality environment to improve functional balance during goal-directed functional tasks in postmenopausal women with osteoporosis.

Methods

Twelve volunteer postmenopausal women with osteoporosis were randomly assigned to virtual reality (VRT, n = 6) and conventional multimodal (CMT, n = 6) training groups. The exercise was performed for 6 weeks, 3 days weekly, and 18 sessions. Using a force platform, functional balance assessments were made through four dynamic tasks, including performance-based limits of stability (LOS), curve tracking (CT), sit-to-stand (STS), and turning before and after 18 sessions of treatment. Each task's time-dependent center of pressure (COP) variables was separately calculated via Kistler-Mars software.

Results

The COP variables of LOS and CT tasks were significantly improved after 6 weeks of CMT and VRT (P ≤ 0.05). In the VRT group, the rising index (P < 0.00), COP sway velocity in STS, and Turn sway were significantly reduced (P < 0.05). Following the VRT, the mean difference of forwarding maximum COP excursion increased (P = 0.03), and errors in CT (P = 0.03) significantly decreased.

Conclusion

The VRT and CMT improved the COP sway parameters during weight-shifting tasks. The VRT was more effective than CMT in increasing the ability to control weight-shifting and dynamic functional tasks in postmenopausal women with osteoporosis. This approach in training has suitable potential to provide convenient error feedback learning.

Exergaming delivery of a balance and fall prevention program for older adults: A feasibility study

Objective

Older adults are at high risk of falls and this problem calls for efficient and scalable interventions. This study investigated whether a motion capture system paired with balance training exergaming software is a feasible strategy to deliver therapeutic exercise to older adults in an aged care facility.

Methods

This study analyzed data from a quality improvement rehabilitation initiative. Two convenience samples of older adults were included: a usual care group (n = 12), admitted to a rehabilitation hospital and receiving standard in-patient therapy 5×/week and the Evolv group (n = 12), admitted to an aged care facility, prescribed exergaming 3×/week. All participants performed 30-minute exercise sessions based on a fall prevention program over 3 months. The Short Physical Performance Battery (SPPB) and Tinetti Performance Oriented Mobility Assessment test were administered pre- and post-treatment.

Results

No adverse events were recorded during the interventions. Mean SPPB increase for Evolv participants was 2.25 ± 1.35 (p < .001, CI for mean = 1.39 to 3.11, d = 1.66), compared with a non-significant change in the usual care group (mean increase = 2.25 ± 3.82, p = .066, CI for mean = -0.18 to 4.68, d = 0.59). Tinetti improvement was significant for the individuals receiving usual care (3.83 ± 2.82, p = .012, CI for mean = 1.01 to 6.66, d = 0.86) but there were no significant between-group differences in outcomes.

Conclusions

Exergaming with the Evolv system for balance and strength training may be a feasible strategy to improve physical function for older adults recovering in an aged care facility.

Virtual and augmented reality applications to improve older adults’ quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults’ quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

Virtual Reality-A Supplement to Posturography or a Novel Balance Assessment Tool?

Virtual reality (VR) is a well-established technology in medicine. Head-mounted displays (HMDs) have made VR more accessible in many branches of medical research. However, its application in balance evaluation has been vague, and comprehensive literature on possible applications of VR in posture measurement is scarce. The aim of this review is to conduct a literature search on the application of immersive VR delivered using a head-mounted display in posturographic measurements. A systematic search of two databases, PubMed and Scopus, using the keywords "virtual reality" and "posturography," was performed following PRISMA guidelines for systematic reviews. Initial search results returned 89 non-duplicate records. Two reviewers independently screened the abstracts. Sixteen papers fulfilled the inclusion criteria and none of the exclusion criteria and were selected for complete text retrieval. An additional 16 records were identified from citation searching. Ultimately, 21 studies were included in this review. virtual reality is often used as additional visual stimuli in static and dynamic posturography evaluation. Only one study has attempted to evaluate a VR environment in a head-mounted display as an independent method in the assessment of posture. Further research should be conducted to assess HMD VR as a standalone posturography replacement.

Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre−post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.

Associations between Muscle Strength, Physical Performance and Cognitive Impairment with Fear of Falling among Older Adults Aged ≥ 60 Years: A Cross-Sectional Study

(1) Background: Fear of falling has become a significant health problem in older adults and is already considered as important as falling because of its long-term detrimental effects on older adults' physical and psychosocial functioning. The aim of this study was to analyze the associations between both upper and lower limb strength, gait parameters and cognitive impairment with fear of falling in older adults. (2) Methods: A cross-sectional study involving 115 older-adult participants was used to assess the impact of both upper (Handgrip dynamometer, TKK 5401 Grip-D, Takey, Tokyo, Japan) and lower limb strength (Chair stand test), gait parameters (OptoGait-System Bolzano, Bolzano, Italy) and cognitive impairment (COWAT word association test) with fear of falling in older adults (Falls Efficacy Scale-International FES-I). (3) Results: Multivariate linear regression analysis showed several independent associations with the fear of falling. A higher time to perform the Chair Stand test was associated with higher scores in FES-I (R² = 0.231), while a lower score in both Semantic Fluency (S COWA) and Phonologic Fluency (P COWA) was associated with a decreased score in FES-I (R² = 0.052 and 0.035). (4) Conclusions: Both higher step and stride length (OptoGait), lower body strength (Chair test) and both poorer semantic (S COWA) and phonologic (P COWA) fluency were all associated with fear of falling.

Slower velocity perception with stronger optokinetic nystagmus: A paradoxical perception in virtual reality

BACKGROUND

Optokinetic nystagmus (OKN) was studied in an immersive virtual reality (VR) environment with both typical optokinetic stimulation (OKs) wherein the head-tracking is active (similar to be sitting in front of a rotating drum) or a unique stimulus (VR-OKs) wherein the head-tracking is turned off, so head movements do not update the visual image (which moves with the head).

OBJECTIVE

To study both the perception of the stimulus velocity and eye movements while subjects rotated their head from side to side and the visual scene was either a typical OKs or VR-OKs.

METHODS

9 healthy participants (aged 23 ± 2.4 y/o) had head and eye movements recorded under typical OKs and VR-OKS while smoothly rotating their head horizontally from side to side. Stimulation was delivered using a virtual reality setup on top of an eye movements recording system.

RESULTS

Under VR-OKs participants perceived faster stimulus velocity when the head and stimulus had the same direction as compared to the head and stimulus in opposite directions. When the head turned in the same direction as the stimulus, there were fewer fast phase eye movements than when it rotated counter to stimulus motion direction. Conversely, with typical OKs, participants perceived faster stimulus velocity when the head and stimulus had opposite directions as compared to the head and stimulus having the same direction.

CONCLUSIONS

The seemingly paradoxical results in which slower stimulus velocity is perceived in tandem with stronger nystagmus can be explained by the simultaneous activation of the Vestibulo-Ocular Reflex and OKN in accordance with the various visual and vestibular stimuli.

The effectiveness of exergames on fear of falling in community-dwelling older adults: a systematic review

ObjectivesFear of falling is common among older adults and can increase fall-risk through premature activity restriction. Exergames, an emerging tool in fall prevention, combine exercise with interactive and adaptive game elements. This review examines the extent to which exergame interventions reduce fear of falling among community-dwelling older adults. Method: Guided by the PRISMA methodology, we reviewed peer-reviewed studies that were published in English between 2006 and 2019 and employed a comparative design to test the effect of exergames on fear of falling in community-dwelling older adults. Two reviewers screened the literature and extracted data on the exergame platform, participants, study design, and results. A modified PEDro scale was used to assess study quality. Disagreements were resolved through discussion with the third reviewer. Results: Our literature search resulted in 23 eligible studies on exergame interventions where fear of falling was the primary or secondary outcome. Most interventions (35%) occurred within hospitals and were delivered via a Wii-based system (61%). Fear of falling was most commonly measured using the Falls Efficacy Scale, the Activities-specific Balance Scale and their modified versions. A total of 15 of the 23 studies reported statistically significant changes in fear of falling. Quality assessment showed 10 studies to be rated as 'good.' Conclusion: This review showed that exergame may have a positive effect in reducing fear of falling in community-dwelling older adults. The finding provides a direction for clinical practice in the research area of intervention on fear of falling in older adults.

Implementation of a Virtual Reality recreation program in long-term care

Introduction

This manuscript describes the implementation of a Virtual Reality (VR) recreation program at long-term care sites across Ontario, Canada, using the RE-AIM Framework to guide the implementation and its evaluation.

Methods

We developed a VR recreation program to enhance the lives of long-term care residents, through 3 sequential phases. In Phase 1, we learned about resident and staff needs through focus groups, staff surveys and observations. In Phase 2, we developed 10 VR experiences, based on the data from Phase 1. In Phase 3, we implemented the VR experiences and supporting manual and measured their implementation, using the RE-AIM Framework.

Results

We found the VR program to be highly (but not consistently) implementable across all sites. Factors that supported implementation were the following: resident interest in the content and technology, relative ease of use for staff to implement and formally integrating VR into the recreation calendar. Factors that impeded implementation were the following: the size of the headset, inability for the headset to cast given the sites' Information Technology infrastructure and some content that was not engaging.

Conclusions

VR programs are highly implementable and this implementation is enhanced by integration of the program into existing recreational systems, ease of use and resident engagement.

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.

The effect that the Otago Exercise Programme had on fear of falling in community dwellers aged 65-80 and associated factors

BACKGROUND

Falls are a major public health problem. Fear of falling is highly prevalent amongst community-dwelling older adults who have already fallen and it is also a risk factor for recurrent falls. There has been limited research about the impact that exercises programs have on the fear of falling. The aim of this study was to evaluate whether the Otago Exercise Programme (OEP) reduced the fear of falling in non-institutionalised people aged 65-80 years in Spain. It also evaluated the factors associated with the fear of falling.

METHODS

This was a quasi-experimental study that focused on people aged 65-80 who attended 21 primary healthcare centres, lived in the community, were able to walk independently and provided written, informed consent. They were recruited from September 2017 to December 2019. The OEP sessions took place at the primary healthcare centres and were provided on an individual or group basis by trained OEP instructors. The participants attended five weekly sessions, where they were given exercises to develop their strength, balance and endurance. They then continued the programme at home. The subjects were followed up 12 months after baseline and the analyses included a bivariate analysis and a multivariate analysis with logistic regression.

RESULTS

We enroled 498 patients (67.07% female) with an average age of 71.81 years. More than two-thirds (65.06%) lived with a partner and 42.37% were overweight. Significant reductions were observed in the mean level of fear of falling between baseline and 12 months (p = 0.000). A number of factors associated with fear of falling also showed significant differences. These were: age (p = 0.033), sex (p = 0.000), living alone (p = 0.000), body mass index (p = 0.003) and whether psychotropic drugs were used (p = 0.000). The multivariate analysis showed a moderate to high fear of falling amongst participants who were female (p = 0.000), 72-80 years of age (p = 0.017), obese (p = 0.045) and used psychotropic drugs (p = 0.021).

CONCLUSIONS

Taking part in the OEP reduced the overall fear of falling. There were significant associations between fear of falling and being female, taking psychotic drugs and having a history of falls. This study is a quasi-experimental sign nested an experimental study (randomized controlled trial previously published and registered on ClinicalTrials.org (NCT03320668)). Retrospectively registered on 25/10/2017.

A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults

OBJECTIVE

Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF.

METHODS

Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis.

RESULTS

Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23).

CONCLUSION

This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials.

IMPACT

These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.

Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis

AIM

To analyse the effects of active video games on physical function in independent community-dwelling older adults.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication.

REVIEW METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software.

RESULTS

The analysis included 22 randomized controlled trials with a total of 1208 participants (all ≥55 years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and-go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and-Go or velocity.

CONCLUSIONS

Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and-go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited.

IMPACT

Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.

Exergame training-induced neuroplasticity and cognitive improvement in institutionalized older adults: A preliminary investigation

BACKGROUND

Prior research has reported cognitive improvements in elderly individuals when mental and physical exercise are practiced simultaneously, as in exergaming. However, the molecular mechanisms driving this beneficial response remain unclear. Moreover, there is robust evidence that regular exercise increases neurotrophic factors and promotes neuroplasticity, contributing to cognitive improvement. This research aimed to assess the impact of a 6-week Xbox 360 Kinect exergame protocol on cognitive function and brain-derived neurotrophic factor (BDNF) levels in institutionalized older individuals.

METHODS

Participants living in a long-term care facility were included. The intervention (Xbox 360 Kinect exergame protocol) was conducted individually and consisted of two sessions per week (40 min each) over 6 weeks. Participants' cognitive function (Montreal Cognitive Assessment, MoCA) was evaluated before and after the intervention. Blood samples (15 ml) were collected at the same time to measure BDNF levels.

RESULTS

Although there were no changes in total MoCA scores, exergame training improved the "language" domain and demonstrated a tendency toward an improvement in the "abstraction" and "memory/delayed recall" domains. Furthermore, BDNF levels were significantly increased after the intervention.

CONCLUSION

BDNF enhancement might mediate, at least in part, the cognitive changes induced by a 6-week Xbox 360 Kinect exergame protocol in institutionalized older adults.

Effectiveness of conventional versus virtual reality-based vestibular rehabilitation exercises in elderly patients with dizziness: a randomized controlled study with 6-month follow-up

OBJECTIVES

To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness.

METHODS

In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n=16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n=16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment.

RESULTS

Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p<0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p<0.05).

CONCLUSION

The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness.

Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study

Background

Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames.

Objective

We aim to evaluate the effects of kinesiotherapy with exergaming on older women’s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy.

Methods

We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages.

Results

The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021.

Conclusions

Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions.

Trial Registration

Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw.

International Registered Report Identifier (IRRID)

DERR1-10.2196/32729

Virtual reality versus optokinetic stimulation in visual vertigo rehabilitation

BACKGROUND

Visual vertigo (VV) is a condition at which there is worsening or triggering of vestibular symptoms in certain visual environments with large size (full field) repetitive or moving visual patterns as shopping malls.

PURPOSE

This work was designed to study effect of virtual reality and optokinetic stimulation on rehabilitation of VV.

METHOD

A total of 60 subjects divided into 2 groups that were simply randomized by the concealed envelope method: Group I consisted of 30 VV patients underwent vestibular rehabilitation using virtual reality. Group II consisted of 30 VV patients underwent vestibular rehabilitation using optokinetic stimulation.

RESULTS

Significant improvement in performance in the two groups after rehabilitation with no statistically significant difference when comparing both groups.

CONCLUSIONS

A combined intense rehabilitation program including OPK stimulation or VR rehabilitation combined with home-based exercises appeared to be equally effective for management of patients with VV and improving their quality of life.

Virtual Reality: Is It Helping Children Cope with Fear and Pain During Vaccination?

Background

Virtual reality (VR) is an innovative distraction technology in health care, but little is known about this topic in Saudi Arabia. The aim of this study was to assess the effectiveness of using VR to reduce pain and fear among children during vaccination.

Methods

It is a cross-sectional study design. A total of 104 children (ages 4–6 years) receiving routine vaccinations in a single primary health care in Eastern Region, Saudi Arabia, participated in the study and grouped to a VR technology intervention group or vaccination as usual without VR distraction. The primary outcome is the difference in the child’s self-rated fear and pain scores between those who have been vaccinated with or without VR distraction, measured by the two validated international facial expressions scales Wong–Baker FACES Pain Scale and Children’s Fear Scale.

Results

In the two-month study period, 53 children were vaccinated using the VR technology and 50 children were vaccinated without VR. Bivariate analysis showed a significantly lower pain score among the VR group (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\overline {\bf{\it{x}}} $$ \end{document}=1.36, SD 2.06) compared with the group without VR (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\overline {\bf{\it{x}}} $$ \end{document}=6.90, SD 3.47) (P-value < 0.001). Similarly, fear score was lower in the VR group (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\overline {\bf{\it{x}}} $$ \end{document}=0.64, SD 0.92) compared with the group without VR (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\overline {\bf{\it{x}}} $$ \end{document}=2.88, SD1.55) (P < 0.001). In multivariable regression models adjusted for age and gender, children vaccinated using the VR technology had significantly lower pain and fear scores compared with those who were vaccinated as usual without VR distraction.

Conclusion

VR technology showed a positive impact on reducing pain and fear among children aged 4–6 years during vaccination. Policymakers are encouraged to expand the use of this distraction tool in primary health centers to improve the vaccination experience among children.

Immersive Virtual Reality Exergame Promotes the Practice of Physical Activity in Older People: An Opportunity during COVID-19

Life expectancy has increased in recent years. Physical activity has been postulated as a key element in active aging strategies. However, adherence to physical exercise programs has traditionally been low among the elderly, and the current situation of the COVID-19 pandemic has added extra impediments. Immersive virtual reality (IVR) devices could motivate this population to practice exercise. This study aimed to analyse the use of IVR exergames as a tool to facilitate physical exercise in older people. Four healthy older adults (males, 65–77 years) participated in the study. They carried out two exergaming sessions with HTC Vive ProTM. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), System Usability Scale (SUS), Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. All participants completed the sessions without adverse effects, with no SSQ symptoms reported. SUS scores were high in both sessions (SUS > 85/100). Post-game GEQ scores were 3.08–3.41/4 (positive experiences) and 0.08–0.16/4 (negative experiences). Opinions showed high levels of satisfaction with the experience. Exergaming programs, based on commercial head-mounted displays, are a feasible alternative to traditional senior exercise, and could be a solution to the current situation that has arisen from the impact of the COVID-19 pandemic.

Exergames Training Effects on Gait During Single and Dual Tasks in Sexagenarian Women

Objective: This study was designed to analyze the effects of an exergames training program on gait parameters while holding a cellphone conversation at self-selected walking speed (SSWS) and fast walking speed (FWS). Materials and Methods: Twenty-one older women (66.3 ± 4.0 years) practiced exergames for 12 weeks and were assessed for spatiotemporal gait parameters at SSWS and FWS under single task and dual task. The strength of the lower limbs was measured by an isokinetic dynamometer (Byodex System 3). The cognitive function was assessed with the Montreal Cognitive Assessment (MoCA). The tests were assessed 4 weeks before the start of the exergames training (baseline, T₀), immediately before (pretraining, T₁), and at the end of 12 weeks of the exergame training (post-training, T₂), except for the MoCA test that was assessed at T₀ and T₂. Results: The spatiotemporal gait parameters at SSWS and FWS showed extensive changes when a cellphone conversation was sustained (e.g., 6.5% and 5.8% reduction in walking speed, respectively). Exergames training was not effective in minimizing these changes or improving muscle strength after 12 weeks (<3.0%). Minor cognitive improvements (0.5 points) were observed in response to training. Conclusion: Holding a cellphone conversation while walking changed several gait parameters, irrespective of the walking speed. The spatiotemporal gait parameters and lower limb muscle strength in sexagenarian women remained unchanged after the exergames training program.

Can Immersive Virtual Reality Videogames Help Parkinson's Disease Patients? A Case Study

Video games have proven useful in physical rehabilitation therapy. Accessibility, however, is limited for some groups such as the elderly or patients with Parkinson’s disease (PD). We explore the potential of fully immersive video games as a rehabilitation tool in PD patients. Four patients with mild-moderate PD (3 males:1 female, 53–71 years) participated in the study. Training consisted in two immersive virtual reality video gaming sessions. Outcomes were evaluated using System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), Game Experience Questionnaire-post game (GEQ), an ad hoc satisfaction questionnaire and perceived effort. All participants completed the sessions without adverse effects (100%), without SSQ symptoms reported. Post-gaming SUS was >75% in both sessions (range 75–80%). Post-gaming GEQ scores were 3.3–4.0/4 in both sessions. Immersive virtual reality video gaming is feasible in patients with mild-moderate PD, with positive usability and patient satisfaction, and no adverse effects.

The Effect of Mixed Reality Technologies for Falls Prevention Among Older Adults: Systematic Review and Meta-analysis

BACKGROUND

Falling is one of the most common and serious age-related issues, and falls can significantly impair the quality of life of older adults. Approximately one-third of people over 65 experience a fall annually. Previous research has shown that physical exercise could help reduce falls among older adults and improve their health. However, older adults often find it challenging to follow and adhere to physical exercise programs. Interventions using mixed reality (MR) technology could help address these issues. MR combines artificial augmented computer-generated elements with the real world. It has frequently been used for training and rehabilitation purposes.

OBJECTIVE

The aim of this systematic literature review and meta-analysis was to investigate the use of the full spectrum of MR technologies for fall prevention intervention and summarize evidence of the effectiveness of this approach.

METHODS

In our qualitative synthesis, we analyzed a number of features of the selected studies, including aim, type of exercise, technology used for intervention, study sample size, participant demographics and history of falls, study design, involvement of health professionals or caregivers, duration and frequency of the intervention, study outcome measures, and results of the study. To systematically assess the results of the selected studies and identify the common effect of MR interventions, a meta-analysis was performed.

RESULTS

Seven databases were searched, and the initial search yielded 5838 results. With the considered inclusion and exclusion criteria, 21 studies were included in the qualitative synthesis and 12 were included in meta-analysis. The majority of studies demonstrated a positive effect of an MR intervention on fall risk factors among older participants. The meta-analysis demonstrated a statistically significant difference in Berg Balance Scale score between the intervention and control groups (ES: 0.564; 95% CI 0.246-0.882; P<.001) with heterogeneity statistics of I2=54.9% and Q=17.74 (P=.02), and a statistical difference in Timed Up and Go test scores between the intervention and control groups (ES: 0.318; 95% CI 0.025-0.662; P<.001) with heterogeneity statistics of I2=77.6% and Q=44.63 (P<.001). The corresponding funnel plot and the Egger test for small-study effects (P=.76 and P=.11 for Berg Balance Scale and Timed Up and Go, respectively) indicate that a minor publication bias in the studies might be present in the Berg Balance Scale results.

CONCLUSIONS

The literature review and meta-analysis demonstrate that the use of MR interventions can have a positive effect on physical functions in the elderly. MR has the potential to help older users perform physical exercises that could improve their health conditions. However, more research on the effect of MR fall prevention interventions should be conducted with special focus given to MR usability issues.

The effect of video game-based training on postural control during gait initiation in community-dwelling older adults: a randomized controlled trial

PURPOSE

The aim was to investigate the effect of video game training as compared to dual-task training on gait initiation (GI) which is a sensitive indicator of balance deficiency in older adults.

METHOD

Sixty-six older adults were allocated to the video game-based training (intervention group) or the motor-cognitive dual-task training (active control group). The outcome measures were the mediolateral (ML)/anteroposterior (AP) displacement and velocity of COP during the phases of GI (anticipatory, weight transition, and locomotor).

RESULTS

The results indicated in the anticipatory phase, the ML & AP COP displacement were significantly increased at post-training relative to pre-training across both groups (p < 0.041). In the weight transition phase, the AP COP displacement & ML COP velocity were significantly increased at post-training than pre-training (p < 0.032). However, in the locomotor phase, within the intervention group, the ML COP displacement & ML COP velocity were significantly increased at follow-up as compared to pre-training (p < 0.05), while no such differences were observed within the control group.

CONCLUSION

Both treatments were effective in improving COP trajectory during the phases of anticipatory and weight transition, while the intervention group was more effective during the phase of locomotor. So, these treatments can be recommended for clinical settings.Implications for rehabilitationThe video game and dual task training were effective in improving COP trajectory during the phases of anticipatory and weight transition.The video game-based training was more effective during the phase of locomotor.The study findings could have useful implications to further introduce cognition-based rehabilitation programs such as video games for older adults.Rehabilitation professionals could use the video game to improve the postural control of older adults.

Virtual Reality (VR) Applications in Cardiology: A Review

Virtual reality (VR) has applications in cardiology to create enhancement, thereby improving the quality of associated planning, treatment and surgery. The need is to study different applications of this technology in the field of cardiology. We have studied research papers on VR and its applications in cardiology through a detailed bibliometric analysis. The study identified five significant steps for proper implementation of this technology in cardiology. Some challenges are to be undertaken by using this technology, and they can provide some benefits; thus, authors contemplate extensive research and development. This study also identifies 10 major VR technology applications in cardiology and provided a brief description. This innovative technology helps a heart surgeon to perform complex heart surgery effectively. Thus, VR applications have the potential for improving decision-making, which helps save human life. VR plays a significant role in the development of a surgical procedure. This technology undertakes 3D heart model information in full colour, which helps to analyze the overall heart vane, blockage and blood flow. With the help of this digital technology, a surgeon can improve the accuracy of heart surgery, and he can simulate the surgery. A surgeon can undertake surgery in a virtual environment on a virtual patient. The unique purpose of this technology is to practice pre-operatively on the specific circumstance. A cardiologist can also check the proper status of inner and outer heart wall layer. Thus, by using this 3D information, the surgeon can now interact with heart data/information without any physical touch. This technology opens a new opportunity to improve the heart surgery and development in cardiovascular treatment to improve patient outcome.

Longitudinal fixel-based analysis reveals restoration of white matter alterations following balance training in young brain-injured patients

BACKGROUND AND OBJECTIVES

Traumatic brain injury (TBI) is one of the leading causes of death and disability in children and adolescents. Young TBI patients suffer from gross motor deficits, such as postural control deficits, which can severely compromise their daily life activities. However, little attention has been devoted to uncovering the underlying white matter changes in response to training in TBI. In this study, we used longitudinal fixel-based analysis (FBA), an advanced diffusion imaging analysis technique, to investigate the effect of a balance training program on white matter fibre density and morphology in a group of young TBI patients.

METHODS

Young patients with moderate-to-severe TBI (N = 17, 10 females, mean age = 13 ± 3 years) and age-matched controls (N = 17) underwent a home-based balance training program. Diffusion MRI scans together with gross motor assessments, including the gross motor items of the Bruininks-Oseretsky Test of Motor Proficiency, the Activities-Specific Balance Confidence (ABC) Scale, and the Sensory Organization Test (SOT) were administered before and at completion of 8-weeks of training. We used FBA to compare microstructural differences in fibre density (FD), macrostructural (morphological) changes in fibre cross-section (FC), and the combined FD and FC (FDC) metric across the whole brain. We then performed a longitudinal analysis to test whether training restores the white matter in the regions found to be damaged before treatment.

RESULTS

Whole-brain fixel-based analysis revealed lower FD and FC in TBI patients compared to the control group across several commissural tracts, association fibres and projection fibres, with FD reductions of up to 50%. Following training, TBI patients showed a significant interaction effect between Group and Time for the SOT test, as well as significant increases in macrostructural white matter (i.e., FC & FDC) in left sensorimotor tracts. The amount of change in FC and FDC over time was, however, not associated with behavioural changes.

DISCUSSION

Our fixel-based findings identified both microstructural and macrostructural abnormalities in young TBI patients. The longitudinal results provide a deeper understanding of the neurobiological mechanisms underlying balance training, which will allow clinicians to make more effective treatment decisions in everyday clinical practice with brain-injured patients.

Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis

BACKGROUND

The accessibility, versatility and motivation provided by virtual reality technology (VRT) have fostered its rapid expansion as a rehabilitation technique to improve functional mobility. The aim of this study was to investigate the effectiveness of rehabilitation programmes using VRT, specific virtual reality technology (VRT-S) and non-specific virtual reality technology (VRT-NS), to improve functional mobility in individuals aged >60 years versus conventional treatment (CT) or no intervention.

METHODS

Nine databases (Cochrane Library, Scopus, PEDro, Medline, CSIC, Web of Science, OT Seeker, NGCH and CINAHL) were searched to identify randomised trials up to December 2019. Results of clinical trials that used VRT-S and VRT-NS in rehabilitation were combined, using a random effects model with inverse variance weighting of the studies. GRADE was used to assess the quality of evidence. The protocol was registered in PROSPERO: CRD42019131630. Overall, there was moderate quality of evidence for the functional mobility results, which means that the estimate of effect is likely to change.

RESULTS

Sixteen of the 18 studies selected (n = 568) provided data for the subgroup meta-analysis. VRT-NS was more effective in improving functional mobility than no intervention [standardised mean difference (SMD) = -1.02; 95% confidence interval (CI) -1,91 to -0,14). VRT-NS was also more effective than CT in improving resistance in ambulation (SMD = -1.20; 95% CI -1.93 to 0.46). No significant differences were found between VRT-S and CT or no intervention. Programmes in which >18 sessions were applied were more beneficial (SMD = -0.89; 95% CI -1.71 to -0.08; <0.001) than programmes with ≤18 sessions (SMD = 0.04; 95% CI -0.51 to 0.59) versus no intervention.

CONCLUSIONS

Our results suggest that VRT is an effective intervention for improving functional mobility in older persons compared with CT. VRT-NS proved to be more effective than VRT-S. However, these results are still not conclusive due to the low methodological quality of the studies. Thus, new studies and analyses are required.

The Effects of Exergaming Training on Balance in Healthy Elderly Women-A Pilot Study

Our aim was to observe, through objective testing using an assessment module incorporated in a new exergaming system, whether elderly people's static and functional balance is improved by a balance exergaming training program based on movements performed in everyday life. Thirteen healthy elderly women participated in 12 sessions of balance-based exergaming training (three times a week, 30 min per session). All objective outcomes, the quiet standing test, functional balance test (FBT), and limit of stability (LOS) test, were measured on three occasions: before intervention, after six training sessions, and after the completion of the four-week program. The results showed a significant improvement in LOS performance after the intervention. In FBT, participants exhibited a significant decrease (p < 0.01; Kendall's W = 0.5) in the average time to target hit after six trainings. The average center of pressure velocity increased after six and 12 sessions, however did not reach significance (p = 0.053); nevertheless the size of the effect was large (η_p2 = 0.22). The parameters of the quiet standing test were not significantly affected by the training. The results support the need for more definite and objective studies assessing exergaming for balance in elderly.

Virtual Reality Vestibular Rehabilitation in 20 Patients with Vertigo Due to Peripheral Vestibular Dysfunction

Background

Vestibular compensation is disrupted in patients with chronic vestibular syndrome. Vestibular rehabilitation is an exercise therapy that optimizes the process of vestibular compensation. This study aimed to evaluate virtual reality (VR) vestibular rehabilitation in 20 patients with vertigo due to peripheral vestibular dysfunction at a single center.

Our study aim was to initially assess the impact of using virtual reality technology in vestibular rehabilitation.

Material/Methods

The subjects were 20 patients with unilateral vestibular hypofunction (UVH), as confirmed by videonystagmography. These were divided into 2 groups: Group 1 underwent vestibular rehabilitation using virtual reality and Group 2 was treated by conventional therapy. A VSS-SF questionnaire and the VAS scale were used to assess the effects and levels of patient satisfaction with therapy.

Results

Both groups demonstrated significantly (P<0.001) lower values on the VSS-SF scales and VAS scales when assessed after treatment as compared to before treatment. Those undergoing conventional therapy reported significantly more severe symptoms on the VAS scale than did Group 1 at their second and third therapy visits. Indeed, Group 1 patients that underwent rehabilitation with the virtual reality component awarded significantly higher (P=0.015) levels of subjective satisfaction when compared to Group 2.

Conclusions

We found that virtual reality vestibular rehabilitation in patients with vertigo due to peripheral vestibular dysfunction was as effective as conventional rehabilitation, with significantly increased levels of patient satisfaction.

Hedonic and Utilitarian Motivations of Home Motion-Sensing Game Play Behavior in China: An Empirical Study

As an important branch of video games and the integration of emerging motion-sensing technology, home motion-sensing games cannot only bring hedonic entertainment but also promote utilitarian benefits including exercise and social interaction for people to improve their physical and psychological health. As one of the most populous countries in the world, China has the largest number of households in the world but quite a low home game penetration rate due to the 13 year game industry winter for international enterprises. Whether Chinese customers have the intention of using motion-sensing games to improve their health status in the home environment will directly determine the commercial potential of the relevant industry in the Chinese market. In order to understand the motives of users and explore the market possibility and prospects of the game industry, this study adopts empirical research and structural equation modeling to construct a motivation model of Chinese consumers toward motion-sensing gameplay behavior in the household environment. We distributed 515 questionnaires to conduct a survey; 427 valid responses have been received, and 203 data, which meet the inclusion criteria of the required game experience, have been analyzed by SPSS25.0 and AMOS25.0. A structural equation model for the gameplay motivation has been constructed. The result shows that the three functional motivators, exercise (Path efficient = 0.40, p < 0.01), entertainment (Path efficient = 0.27, p < 0.01), and social interaction (Path efficient = 0.36, p < 0.01) of home motion-sensing games have a significantly positive impact on the user's intention to play. Furthermore, the diversity and the time-and-place flexibility variables exert an important positive influence on the users' gameplay behavior through their effects on the three main functional motive variables. To sum up, (1) exercise, (2) entertainment, and (3) social interaction are the main functional motivations of the Chinese consumers' gameplay behaviors; (4) diversity and (5) time-and-place flexibility are the two main attribute motivators. The acceptance of Chinese users for home motion-sensing games remains positive and high. The motion-sensing game industry has broad market prospects in China through its potential in promoting consumer's wellness and health in the home environment.

Age-related alterations on the capacities to navigate on a bike: use of a simulator and entropy measures

Studying the impact of age is important to understand the phenomenon of aging and the disorders that are associated with it. In this work, we analyze age-related alterations on the capacities to navigate on a bike. For this purpose, we use CycléoONE, a bike simulator, and entropy measures. We thus record navigation data (handlebar angle and speed) during the ride. They are processed with two cross-distribution entropy methods (time-shift multiscale cross-distribution entropy and multiscale cross-distribution entropy). We also analyze the time series with a detrended cross-correlation analysis to determine which method can best underline age-related alterations. Our results show that methods based on cross-distribution entropy may be efficient to stress the decrease in navigation capacities with age. The results are very encouraging for our future goal of adding medical benefits to a leisure equipment. They also show the value of using virtual reality to study the impact of age. Graphical Abstract This study deals with the use of the signal processing methods (multiscale cross-entropy and multiscale cross-correlation) applied on naviagtion data, acquired with a bike simulator, to study the impact of age on two populations (young healthy subjects and older adults with loss of autonomy).

Immersive Virtual Tasks With Motor and Cognitive Components: A Feasibility Study With Young and Older Adults

OBJECTIVE

To analyze the feasibility, safety, and acceptability of immersive virtual tasks.

METHODS

The authors recruited 11 young adults and 10 older adults. The participants performed three virtual reaching tasks while walking on a virtual path. The descriptive analysis and comparison between participants were performed using the Mann-Whitney U test and chi-square test for nonparametric and nominal variables, respectively. The authors also used analysis of variance for a between-groups comparison for normal variables.

RESULTS

Twenty percent of older adults and 81.8% of young adults completed all three tasks (chi-square test; p = .005). Both groups reported minor symptoms, with no significant differences. The older adults were more motivated to practice the tasks (Mann-Whitney U test; p = .015) and would be more likely to suggest them to others (chi-square test; p = .034).

CONCLUSION

All three tasks were feasible for young adults. All participants, except for one, had cybersickness. The symptoms were mostly mild and subsided once the interaction was complete.