Age related motor and cognitive disabilities increase the risk of falls and related injuries, a major cause of morbidity and mortality. A new multi-country study, led by Mirelman of Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, has shown that in a diverse group of older adults at high risk for falls, treadmill training plus non-immersive virtual reality component led to reduced fall rates compared with treadmill training alone. The results were published online on 11 August, 2016.
Due to severe health consequences that could result in elders as a result of falls, many interventions have been suggested but only a few prevent falls by focusing on cognitive and motor skills improvement. This study however did just that. A randomized controlled trial was conducted at five clinics across five countries (Belgium, Israel, Italy, the Netherlands, and the UK). Adults aged 60 to 90 years with a high risk of falls based on a history of two or more falls in the 6 months before the study and with varied motor and cognitive deficits were randomly assigned by a computer. The participants were divided in two groups. One group would receive 6 weeks of treadmill training with virtual reality elements, whereas the second group would receive 6 weeks of treadmill training alone. The study was published in The Lancet.
Both groups received three training sessions per week for a total of six sessions, where each session lasted for 45 minutes and structured training progression individualized to the participant’s level of performance. The VR system consisted of a motion-capture camera and a computer-generated simulation projected on to a large screen, which was specifically designed to reduce fall risk in elders by including real-life challenges such as obstacles, multiple pathways, and visual distractions that required continuous step adjustments. The primary measurement of outcome was the incident rate of falls during the 6 months after the training had been completed, which was assessed in a modified intention-to-treat population. Safety was assessed in all patients who were assigned a treatment.
The trial was conducted between Jan 6, 2013, to April 3, 2015, and had a total of 302 participants. Data from 93% of the population was included for the modified intention-to-treat analysis. Before the training period began, the rate of fall was similar in both groups. During the six months after the training period had ended, however, the rate of fall was significantly lower in the treadmill training plus VR group than it was before training. But there wasn’t much significant decrease in the treadmill only group after the training period had been completed. Six months after the training had been completed, the incident rate of falls was also significantly lower in the treadmill training plus VR group than in the treadmill only training group. Moreover, there weren’t many training-related adverse reactions that occurred.
Virtual Reality Is Changing The Way We Look At Diseases
This is not the first time virtual reality was incorporated to treat diseases or improve mental and cognitive functions. WonderTree, a Pakistani startup, specializing in apps for the mentally impaired, greatly helps children with learning disabilities such as Down’s syndrome, attention deficit hyperactivity disorder (ADHD), cerebral palsy, dyslexia, autism, and other mental health problems. The company’s games relied on augmented reality in which players interact with the environment using movements and gestures. These games improve children’s cognitive skills, recall, decision making, memory function and learning skills.
Previous studies which looked at Nintendo Wii as an application for improving balance and motor skills in elders have been conducted. Virtual reality computer-based technology that provides the users with opportunities to interact with virtual objects is quite popular as a source of entertainment. There is a growing interest in the potential of virtual reality-based interventions for balance training in older adults.
Seven relevant studies were examined. Four studies observing the effect of Wii-based exercise compared with no exercise reported positive effects on at least one outcome measure related to balance cognition performance in older adults. Studies comparing Wii-based training with alternative exercise routines generally indicated that the balance improvements achieved by Wii-based training are comparable with those achieved by other exercise programs.
The results showed that Wii-based exercise routines may serve as an alternative to more conventional forms of exercise aimed at improving balance control. However, since there was great difference in methodology, outcome measurement and intervention techniques, combined with limitations of the study, such as low population of test subjects, more trials and researches need to be conducted to check the efficacy of Wii-based exercise routines in elder home scenarios based on safety and effectiveness.