Immersive Virtual Reality as a Novel Physical Therapy Approach for Nonagenarians: Usability and Effects on Balance Outcomes of a Game-Based Exercise Program

Abstract

Physical exercise has been recognized as an important strategy in the promotion of healthy aging. Positive effects on older adults’ motor ability are brought about by engaging their motor skills and promoting sensorimotor learning and cortical plasticity. These processes could be increased with the use of immersive virtual reality (IVR) technology, since the multisensory stimulation is greater. The aim of this study was to explore the usability and balance effects of an IVR exercise program in community-dwelling nonagenarian people. A sample of 12 women were allocated to an experimental group (EG n = 6; 91.67 ± 1.63 years) and a control group (CG n = 6; 90.83 ± 2.64 years). For 10 weeks, the EG used a commercial IVR exergame three times a week. All the sample completed the program without adverse effects (without Simulator Sickness Questionnaire symptoms). Post-gaming usability was good (System Usability Scale 78.33). The EG improved some balance parameters significantly (Tinetti test: balance (10.97 %; Sig = 0.017), gait (9.23%; Sig = 0.047) and total score (10.20%; Sig = 0.014) and maintained total TUG test times (−0.45%)). There were significant differences between groups (Tinetti test: balance (Sig = 0.004) and total score (Sig = 0.0032)). We successfully demonstrated that IVR training is feasible and is an effective and personalized method to enhance balance and to reduce the risk of falls in community-dwelling nonagenarian women.

In too deep? A systematic literature review of fully‐immersive virtual reality and cybersickness among older adults

“…The studies generally had weak sample generalizability (e.g., selection bias) and methodological design, but strong data collection and sample retention. Using the Effective Public Health Practice Project Quality Assessment Tool, six studies received a rating of strong, 22,27,29,39,40,55 10 studies received a rating of moderate, 24,31,36,41,44,50,51,53,54,57 and 23 studies received a rating of weak. 21,23,25,26,28,30,[32][33][34][35]37,38,42,43,[45][46][47][48][49]52,56,58,59 Participants…”

“…The study samples were generally small, with 19 studies consisting of a sample size of 30 participants or less. 21,23,25,26,28,30,33,38,43,[45][46][47][50][51][52]54,56,57,59 Most study samples were majority female, but the average age varied greatly between 63 years 42,44 to 92 years. 51 While many study samples consisted of community dwelling older adults, 34,35,38,41,44,45 other older adult subpopulations studied included those with cognitive impairment, 21,23,24,27,32,[53][54][55][56]58,59 those hospitalized 21,43,47 or living in an long term care community, 25,26,[28][29][30]48,…”

“…51 While many study samples consisted of community dwelling older adults, 34,35,38,41,44,45 other older adult subpopulations studied included those with cognitive impairment, 21,23,24,27,32,[53][54][55][56]58,59 those hospitalized 21,43,47 or living in an long term care community, 25,26,[28][29][30]48,50,51 and the "oldest-old." 28,51 The studies were implemented in 17 different countries including: Canada (5), 21,24,25,39,59 the United States (4), 35,44,49,57 China (4), 22,43,54,58 Germany (3), 26,38,42 Belgium (3), 36,40,…”

“…Across all studies, the most common study purpose was to assess the feasibility of fully-immersive virtual reality interventions for older adults. The majority of studies (23 studies) utilized a one-time session intervention, 22,24,28,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] whereas 16 studies 21,23,[25][26][27]29,[50][51][52][53][54][55][56][57][58][59] consisted of more than one session. The duration of the virtual reality intervention varied considerably from a one-time seven to 9 min session 38 to 20 min sessions per day for 4 weeks.…”

“…The duration of the virtual reality intervention varied considerably from a one-time seven to 9 min session 38 to 20 min sessions per day for 4 weeks. 27 Most studies' interventions included a virtual task that related to cognitive training or assessment, 22,24,[31][32][33][34]39,41,43,47,[53][54][55][56]58,59 activity or physical rehabilitation, 27,37,38,40,42,[49][50][51][52]57 exploration for purposes such as well-being or reminiscence, 21,23,25,[28][29][30]35,36,46,48 or a combination. 44,45 The most common virtual reality headsets used among the studies were the HTC Vive 32,35,37,[40][41][42]44,47,…”