A Bespoke Kinect Stepping Exergame for Improving Physical and Cognitive Function in Older People: A Pilot Study

Background: Systematic review evidence has shown that step training reduces the number of falls in older people by half. This study investigated the feasibility and effectiveness of a bespoke Kinect stepping exergame in an unsupervised home-based setting. Materials and methods: An uncontrolled pilot trial was conducted in 12 community-dwelling older adults (mean age 79.3 ± 8.7 years, 10 females). The stepping game comprised rapid stepping, attention, and response inhibition. Participants were recommended to exercise unsupervised at home for a minimum of three 20-minute sessions per week over the 12-week study period. The outcome measures were choice stepping reaction time (CSRT) (main outcome measure), standing balance, gait speed, five-time sit-to-stand (STS), timed up and go (TUG) performance, and neuropsychological function (attention: letter-digit and executive function:Stroop tests) assessed at baseline, 4 weeks, 8 weeks, and trial end (12 weeks). Results: Ten participants (83%) completed the trial and reassessments. A median 8.2 20-minute sessions were completed and no adverse events were reported. Across the trial period, participants showed significant improvements in CSRT (11%), TUG (13%), gait speed (29%), standing balance (7%), and STS (24%) performance (all P < 0.05). There were also nonsignificant, but meaningful, improvements for the letter-digit (13%) and Stroop tests (15%). Conclusions: This study found that a bespoke Kinect step training program was safe and feasible for older people to undertake unsupervised at home and led to improvements in stepping, standing balance, gait speed, and mobility. The home-based step training program could therefore be included in exercise programs designed to prevent falls

A Bespoke Kinect Stepping Exergame for Improving Physical and Cognitive Function in Older People: A Pilot Study

© 2016 Mary Ann Liebert, Inc. Background: Systematic review evidence has shown that step training reduces the number of falls in older people by half. This study investigated the feasibility and effectiveness of a bespoke Kinect stepping exergame in an unsupervised home-based setting. Materials and Methods: An uncontrolled pilot trial was conducted in 12 community-dwelling older adults (mean age 79.3 ± 8.7 years, 10 females). The stepping game comprised rapid stepping, attention, and response inhibition. Participants were recommended to exercise unsupervised at home for a minimum of three 20-minute sessions per week over the 12-week study period. The outcome measures were choice stepping reaction time (CSRT) (main outcome measure), standing balance, gait speed, five-time sit-to-stand (STS), timed up and go (TUG) performance, and neuropsychological function (attention: letter-digit and executive function:Stroop tests) assessed at baseline, 4 weeks, 8 weeks, and trial end (12 weeks). Results: Ten participants (83%) completed the trial and reassessments. A median 8.2 20-minute sessions were completed and no adverse events were reported. Across the trial period, participants showed significant improvements in CSRT (11%), TUG (13%), gait speed (29%), standing balance (7%), and STS (24%) performance (all P < 0.05). There were also nonsignificant, but meaningful, improvements for the letter-digit (13%) and Stroop tests (15%). Conclusions: This study found that a bespoke Kinect step training program was safe and feasible for older people to undertake unsupervised at home and led to improvements in stepping, standing balance, gait speed, and mobility. The home-based step training program could therefore be included in exercise programs designed to prevent falls

A scoping review and a taxonomy of the use of motion-based technology centered on the end user. A special focus on elderly health

Motion-based technology (MBT) has been applied in the last decades with enormous success in a high number of applications. Its use continues growing and is specially interesting in the health area. Nowadays, its employment is being more and more specialised with respect to the profile of the end user (i.e., child, adolescent/teenager, adult or elderly). This paper first reviews the use of MBT centered in the end user from a global perspective. It also proposes a taxonomy that allows cataloguing the MBT employment directed to the end user. Then, from these results, the paper centers the review on the MBT application aiming to improve the health of elderly. The results highlighted in this paper can help to a better understanding of MBT, especially when it is applied thinking in elderly as the end users.This study is partially funded by the Universidad de Málaga with the national project Bio4Res (PID2021-125184NB-I00) from the Ministerio de Ciencia e Innovaci ́on de Espa ̃na (MCIN). Funding for open access charge: Universidad de Málaga / CBUA

The role of motivation factors in exergame interventions for fall prevention in older adults: A systematic review and meta-analysis

Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance

Fall prevention intervention technologies: A conceptual framework and survey of the state of the art

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.The Royal Society, grant Ref: RG13082

Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems

Effects of Combining Physical and Cognitive Training on Older Adults’ Physical Performance and Functional Abilities: A Systematic Review

Background: The combination of physical and cognitive training effectively enhances the physical function of the elderly by preventing and reducing the incidence of falls as well as increasing independence in daily activities. However, the optimal combination of strategies to achieve the best physical performance and functional capacity in healthy elderly is still being explored. Objective: This study aimed to explore effective combinations to improve physical function. Methods: A comprehensive database search was done through Web of Science, Medline, Embase and PubMed, and was supplemented with Google scholar since September 2022. Titles and abstracts were used to search for keywords, and data were extracted using the Participants; Interventions; Comparisons, and Outcomes (PICO). Results: The 23 included studies recruited subjects aged 65 and older, comprising 872 females and 497 males, while some research did not identify the gender of 216 participants. Among the included studies, 16 were of high quality while 7 were of low quality. Ten studies showed a significant improvement in gait among older adults who underwent combined physical-cognitive training, while two studies found no positive effect on dual-task gait performance. All five studies showed a significant improvement in strength. Out of the four studies conducted, only one showed no improvement in endurance. All five studies showed improved mobility, while only one study found no effect on agility. However, eight out of the eleven papers showed a significant improvement in balance for older adults who underwent combined cognitive and physical training. The three papers that effectively reduced the fear of falling were also significant. Two studies showed that those who received combined training exhibited a significantly better quality of life compared to those who did not. Conclusion: Combined motor-cognitive training is an advanced, feasible and effective method that can promote the improvement of gait, balance and overall health in the elderly. This type of training has a more significant impact on the elderly’s fall response compared to general physical or cognitive training. Additionally, it contributes to promoting functional independence

The role of concern about falling on stepping performance during complex activities

Background There is limited understanding of the underlying mechanisms explaining the role of concern about falling on fall risk in older people. Anxiety is known to interact with cognitive resources and, as people get older, they require more cognitive resources to maintain balance. This might affect an individual's ability to perform cognitive-motor tasks concurrently. The aim of this study was to investigate the effect of a visuospatial dual-task on stepping performance in older people with and without concern about falling and the impact of repeating this task in those with high concern about falling. Methods Three-hundred-eight community-dwelling older people, aged 70 to 90 years old, participated in the study. Participants were asked to perform a Choice Stepping Reaction Time (CSRT) task in two conditions; once without any other tasks (single task condition), and once while simultaneously performing a visuospatial task (dual-task condition). Participants were asked to rate their levels of concern and confidence specifically related to each of the 25 stepping trials (before/after). We also measured general concern about falling, affect, and sensorimotor and cognitive functioning. Results Total stepping reaction times increased when participants also performed the visuospatial task. The relation between general concern about falling and stepping reaction time, was affected by sensorimotor and executive functioning. Generalised linear mixed models showed that the group with moderate to high levels of general concern about falling had slower total stepping reaction times than those with lower levels of concern about falling, especially during the dual-task condition. Individuals with greater general concern about falling showed reduced confidence levels about whether they could do the stepping tasks under both conditions. Repeatedly performing the stepping task reduced the immediate task-specific concern about falling levels and increased confidence in all participants. Conclusions These findings reveal that people with higher general concern about falling experienced more difficulties during a dual-task condition than people with lower levels of concern. Of further interest, better sensorimotor and cognitive functioning reduced this effect. Graded exposure has potential to reduce concern about falling during fear-evoking activities, especially in conjunction with therapies that improve balance, mood and cognitive function