The effectiveness of virtual reality exercise for improving balance control, reducing fall risk and incidence among the frail elderly with a history of falls

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The effectiveness of virtual reality exercise for improving balance control, reducing fall risk and incidence among the frail elderly with a history of falls

 

Author: Tung, Ka Kei
Title: The effectiveness of virtual reality exercise for improving balance control, reducing fall risk and incidence among the frail elderly with a history of falls
Degree: D.H.Sc.
Year: 2012
Subject: Equilibrium (Physiology).
Exercise for older people.
Falls (Accidents) in old age -- Prevention.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: ii, 104 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2551434
URI: http://theses.lib.polyu.edu.hk/handle/200/6841
Abstract: Introduction: Aging is a world-wide problem that is getting worse in many societies. With the increasing number of elderly persons there is an increasing number of frail elderly and a continuous need for elderly home service to take care of those who cannot live independently in the community. Falls are today the second leading cause of accidental deaths worldwide, and adults older than 65 suffer the greatest number of fatal falls. Non-lethal falls affect the quality of life of the elderly, who tend to incur fractures or other severe injuries in falls. An exercise program aimed at fall prevention among the frail elderly population is therefore important. Virtual reality (VR) technologies have been used as an assessment and treatment tool in rehabilitation. Some VR training environments have been enhanced by the addition of video games. Nintendo® released the Wii Fit® platform that includes a built-in center of pressure (COP) sensor incorporating strength training, aerobics, and balance games. Although there is some evidence of the effectiveness of virtual reality and the use of video games in enhancing balance control, empirical evidence is still lacking. Also there has been little research on the effectiveness of the Wii Fit® apparatus in the treatment of balance dysfunction among the frail elderly who are at risk of recurrent falls. This study was therefore designed to investigate the effect of interactive VR training exercise on balance control, fall risk factors and the incidence of falls among frail elderly persons living in a nursing home.
Methods: A randomized clinical trial was performed with a Wii Fit® balance training group, and a balance training group as controls. Sixty frail elderly subjects aged over 65 years living in a nursing home with a Functional Ambulatory Category (FAC) of 2 or 3 participated in this study. The subjects who were assigned to the balance training group received three one hour sessions of balance training each week for six weeks. The subjects who were assigned to the Wii Fit® balance training group received three one hour sessions of playing balance training gamesnamely Soccer Heading, Table Tilt and Balance Bubblealso for six weeks. The outcome measures were: 1) Berg Balance Scale scores; 2) Timed-Up-and-Go test times; 3) Limits of stability test results; 4) Physiological Profile Assessment (PPA) scores; and 5) Fall incidence for 12 months post-intervention. Results: Group by time interactions were found in the Berg Balance Scale scores, the PPA z-scores and the fall incidence data. Interactions were also found in two of the four balance components of the limits of stability testthe maximum excursion and the end point excursion. More importantly, their incidence of fall in the subsequent 12 months also differed. Discussion and Conclusions: The results show that both groups could improve the Berg Balance Scale ratings, Timed-up-and-go test times, PPA z-scores and falls incidence of such frail and institutionalized elderly persons with a history of falls. Wii Fit® training led to statistically significant greater improvements in the Berg Balance Scale results, PPA z-scores and fall incidence. It was also able to expand the subjects’ excursion stability limits while standing. The differences in the outcomes between the two groups may be due to the real-time performance feedback and cueing stimuli to support error-free learning in virtual reality training. Overall, Wii Fit® balance training was more effective than the balance training in improving balance control and reducing falls among this group of institutionalized, frail, elderly people who had a history of falls.

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