Exergaming in a Moving Virtual World to Train Vestibular Functions and Gait; a Proof-of-Concept-Study With Older Adults

Jaap Swanenburg, Karin Wild, Dominik Straumann, Eling D de Bruin, Jaap Swanenburg, Karin Wild, Dominik Straumann, Eling D de Bruin

Abstract

Background: The use of Exergames designed to improve physical and cognitive functioning is relatively new in rehabilitation. Exergaming allows the training of skills, the handling of tools, and procedures; however, often, the potential of these aspects are not assessed before they are adopted in clinical settings. This study aimed at exploring the effects of exergaming on vestibular functions and gait in healthy community dwelling older adults using a proof-of-concept study design registered under ClinicalTrials.gov NCT03160352. Methods: A pre-test-post-test one-group study design comprising 10 older adults (mean age of 73.5 ± 7.6 years, four males) investigated the feasibility of eight exergaming training sessions (for 160 min) and the effects on dynamic visual acuity (DVA), functional gait assessment (FGA), and extended timed get-up-and-go (ETGUG). The simulator sickness questionnaire (SSQ) and the game scores were evaluated for the feasibility of the intervention. Wilcoxon test and Cohen's d (d) were chosen to test for differences and for effect size estimation. Results: Exergaming led to a significantly improved DVA (z = -2.50, p = 0.01, d = 1.35) with improvements in 9 out of 10 participants. In addition, the FGA significantly improved with a large effect size (z = -2.25, p = 0.02, d = 1.17). Specifically, component tasks such as walking with horizontal head turns (p = 0.03), gait with a narrow base of support (p = 0.03), ambulating backward (p = 0.05) significantly improved. The ETGUG component task Gait initiation significantly improved (p = 0.04). No change was found in gait speed and SSQ. The game scores of the participants improved continuously during the course of the intervention for every game. Discussion: This proof-of-concept study suggests that the use of exergaming that requires active stepping movements and that contains moving game projection is feasible and facilitates gaze stability during head movements in healthy community dwelling older adults. Aspects of functional gait and gait initiation also improved. Future research aimed at testing this exergaming intervention in patients suffering from vestibular impairments is warranted.

Keywords: dynamic visual acuity; exergaming; head turns; older adult; vestibular loss.

Figures

FIGURE 1
FIGURE 1
The Senso exercise system with moving beamer (arrows show motion extent of game projection).
FIGURE 2
FIGURE 2
The game Simple trains focussed attention – the ability to concentrate on certain stimuli and react as quickly as possible to them.
FIGURE 3
FIGURE 3
The game Targets which helps training reaction time (speed and accuracy).
FIGURE 4
FIGURE 4
Flexi supports training of shifting attention.
FIGURE 5
FIGURE 5
The Snake game which supports training of spatial orientation in a 2D virtual environment.
FIGURE 6
FIGURE 6
Baseline and post-intervention VA-Loss results of each participant.

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