Usability and Effects of an Exergame-Based Balance Training Program

Abstract

Background: Post-stroke recovery benefits from structured, intense, challenging, and repetitive therapy. Exergames have emerged as promising to achieve sustained therapy practice and patient motivation. This study assessed the usability and effects of exergames on balance and gait. Subjects and Methods: Sixteen elderly participants were provided with the study intervention based on five newly developed exergames. The participants were required to attend 36 training sessions; lasting for 20 minutes each. Adherence, attrition and acceptance were assessed together with (1) Berg Balance Scale, (2) 7-m Timed Up and Go, (3) Short Physical Performance Battery, (4) force platform stance tests, and (5) gait analysis. Results: Thirteen participants completed the study (18.8 percent attrition), without missing a single training session (100 percent adherence). Participants showed high acceptance of the intervention. Only minor adaptations in the program were needed based on the users' feedback. No changes in center of pressure area during quiet stance on both stable and unstable surfaces and no changes of walking parameters were detected. Scores for the Berg Balance Scale (P=0.007; r=0.51), the 7-m Timed Up and Go (P=0.002; r=0.56), and the Short Physical Performance Battery (P=0.013; r=0.48) increased significantly with moderate to large effect sizes. Conclusion: Participants evaluated the usability of the virtual reality training intervention positively. Results indicate that the intervention improves gait- and balance-related physical performance measures in untrained elderly. The present results warrant a clinical explorative study investigating the usability and effectiveness of the exergame-based program in stroke patients.

Figures

FIG. 1.

Exergame difficulty levels. Color images available online at www.liebertonline.com/g4h

FIG. 2.

Screenshot of the exergame “Scarecrow”. Color images available online at www.liebertonline.com/g4h

FIG. 3.

Screenshot of the exergame “Tractor Driver”. Color images available online at www.liebertonline.com/g4h

FIG. 4.

Screenshot of the exergame “Fruit Catcher”. Color images available online at www.liebertonline.com/g4h

FIG. 5.

Screenshot of the exergame “Worm Hurdler”. Color images available online at www.liebertonline.com/g4h

FIG. 6.

Screenshot of the exergame “Mix Soup”. Color images available online at www.liebertonline.com/g4h

FIG. 7.

Research model by Masrom.

FIG. 8.

Study flowchart. BBS, Berg Balance Scale; MMSE, Mini-Mental State Examination; n, sample size; SPPB, Short Physical Performance Battery; TAM, technology acceptance model; TUG, Timed Up and Go.

FIG. 9.

Description of the online exergame adaptations performed. Color images available online at www.liebertonline.com/g4h