As we age, our bodies change. Those changes include our balance accompanied by an increased fall risk. Falls are a common phenomenon seen most often in the elderly population. According to Franco (2012), this risk increases with each decade over the age of 60. Falls and fall-related injuries among elderly people are major issues for health. The focus of following two studies was to assess elderly falls risks and virtual reality (VR) as an option for vestibular rehab therapy.
In the first study, “Virtual reality balance training for elderly: Similar skiing games elicit different challenges in balance training”, researchers took 60 subjects and assessed how two similar skiing games challenged their balance systems using center of mass (COM) movements relative to their functional limits of stability (FLOS). The 60 subjects were broken into two groups of 30. The first group consisted of healthy young adults 18-35 and the other consisted of healthy elderly participants over the age of 65.
Each group was assigned to participate in two virtual reality skiing games. The first game was on the Wii balance bored, Wiiski. This game used a foot plate to control an avatar down the ski slope. The second game was the Xbox Kinect sensor, Kinski, which used motion tracking to track the participant’s movements to control the game. During the sessions, the objective was for the participant to steer the avatar down a slalom track. Participants would control the avatar with body movements. Each participant was asked to perform each task three times and played the games in a random order. After each game, participants were asked to sit down and take a rest. Using seven MX- T20 opto-electronical cameras at 100 Hz, 3D-kinematics were captured. In addition to the cameras, a full body COM was calculated in Matlab based on a 45-markers, 15-segments full-body linked segment model (de Vries, A. W., Faber, G., Jonkers, I., Van Dieen, J. H., & Verschueren, S. M. (2018).
A Generalized Estimated Equation (GEE) was used to test whether the game, age, group, trial and their interaction effects could explain differences in center of mass displacements. When comparing the two groups, the main effect was found for displacements in the posterior right and posterior directions (De Vries et al. (2018). It was discovered that the elderly used larger COM displacements compared to young adults in both posterior-right and posterior directions. When reading the study, potential issues might have been the experience with the technology. The younger group seemed to be more experienced with computer games when compared to the elderly group. This in turn showed a larger decrease in the center of mass displacement. Additionally, the differences in fitness levels in the elderly population also suggested a need for training programs that are tailored to the individuals’ abilities.
Overall, the study compared two similar VR training interventions, regarding the movement of the COM. Researchers discovered that the Kinski game could produce larger COM displacements when compared to the Wiiski game. The Kinski was proven challenge one’s balance more so than the Wiiski. Due to these results, it was recommended to use the Kinski with a controller that uses kinematics over Wiiski that uses center of pressure when trying to improve balance.
In the second study, “The Effect of the Nintendo Wii Fit and exercise in improving balance and quality of life in community dwelling elders”, researchers took 32 elderly subjects with an average age of 78, and compared two different exercise programs for improving balance. The subjects were randomly assigned in to one of three groups, a WiiFit group, a Matter of Balance Group, and a Control group. This study was structured using a mixed design with one repeated factor which was time pre- and post-intervention and one between subject factor intervention group.
Prior to intervention, informed consent was obtained from participants and most participants needed a translator as English was their second language. The author, Jessie R. Franco, administered the Berg Balance Scale, the Tinetti Gait and Balance Assessment and the SF-36. Interventions varied by group and the participants were separated into three groups. The first intervention group was a Wii Fit group consisting of 11 subjects. These participants completed balance games on the Wii Fit in individual sessions twice a week for 10-15 minutes, along with supplemental home exercises. The second intervention group was the Matter of Balance Group which consisted of 11 subjects. This group completed exercises from the Matter of Balance Program in a group setting twice a week, with a warm-up and cool-down exercises. Each participant completed eight repetitions of each exercise during the first week, 12 during the second week, and 15 during the third week. The third group was the control group composed of 10 subjects. This group received no intervention through the duration of three weeks. After three weeks, all participants were re-evaluated, by the author, using the Berg Balance Scale, the Tinetti Gait and Balance Assessment and the SF-36.
In this study, the Wii Fit exercise program proved to be achievable as well as the most enjoyable to the participants in that group. The results of the study did suggest that exercises along with the Wii Fit may improve upon balance, however, the improvement was small and not significant when compared to the control groups. One of the biggest flaws and limitations of this study was the duration. The participants would only perform the tasks twice a week over a three-week period. This time frame seemed to be too brief and did not provide significant results. Another possible flaw within the study design was the administered of the assessments. The author administered all assessments to all the participants. This could have caused a potential bias within the study. Lastly, the results could also have been effected as the participants did not speak English as their first language. There might have been moments where they did not fully understand the tasks although there were translators.
Per Franco (2012), evidence suggest that the study demonstrated that Wii Fit games are an enjoyable form of exercise for the elderly population. It also provided evidence that the Wii Fit balance games promoted constant exercise participation among participants, as it was mentioned that participants in the study continue to voluntarily use it as an activity.
Although each study had a similar end goal, to assess virtual reality for vestibular rehabilitation, they were both carried out in different manners. The first study compared the young adult and elderly population where the second study only considered the elderly. The population that you are looking at can depend on your study design however I feel that it would have been beneficial to look at both age groups in both studies.
Also in the first study, researchers went with a method of looking at individual trials. Each subject participated in both interventions at random, completing 3 trials of each intervention. While, the second study conducted their research over a 3-week time frame. During this time frame, each subject was randomly divided into 3 groups. Each group was assigned one of possible three intervention methods. Each subject only participated in one of the interventions. Both methods are very different however they worked for their prospective study.
Virtual reality consists of fun games and might just be the future of vestibular rehabilitation. Currently, regarding virtual reality, I believe there is not enough evidence that supports the use of it exclusively for vestibular rehabilitation. Although one of the studies did establish a minor increase in benefit alongside traditional exercises, results were still not statistically significant. It is important that more evidence and future studies are conducted. If more evidence is established with significant findings, then I feel as though VR would be a benefit for all ages.
2018-6-24-1529864853