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 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

Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

Background: There has been a rapid increase in research on the use of virtual reality (VR) and gaming technology as a complementary tool in exercise and rehabilitation in the elderly population. Although a few recent studies have evaluated their efficacy, there is currently no in-depth description and discussion of different game technologies, physical functions targeted, and safety issues related to older adults playing exergames. Objectives: This integrative review provides an overview of the technologies and games used, progression, safety measurements and associated adverse events, adherence to exergaming, outcome measures used, and their effect on physical function. Methods: We undertook systematic searches of SCOPUS and PubMed databases. Key search terms included “game”, “exercise”, and “aged”, and were adapted to each database. To be included, studies had to involve older adults aged 65 years or above, have a pre-post training or intervention design, include ICT-implemented games with weight-bearing exercises, and have outcome measures that included physical activity variables and/or clinical tests of physical function. Results: Sixty studies fulfilled the inclusion criteria. The studies had a broad range of aims and intervention designs and mostly focused on community-dwelling healthy older adults. The majority of the studies used commercially available gaming technologies that targeted a number of different physical functions. Most studies reported that they had used some form of safety measure during intervention. None of the studies reported serious adverse events. However, only 21 studies (35%) reported on whether adverse events occurred. Twenty-four studies reported on adherence, but only seven studies (12%) compared adherence to exergaming with other forms of exercise. Clinical measures of balance were the most frequently used outcome measures. PEDro scores indicated that most studies had several methodological problems, with only 4 studies fulfilling 6 or more criteria out of 10. Several studies found positive effects of exergaming on balance and gait, while none reported negative effects. Conclusion: Exergames show promise as an intervention to improve physical function in older adults, with few reported adverse events. As there is large variability between studies in terms of intervention protocols and outcome measures, as well as several methodological limitations, recommendations for both practice and further research are provided in order to successfully establish exergames as an exercise and rehabilitation tool for older adults.© 2015 Elsevier Ireland Ltd. All rights reserved. This is the authors' accepted and refereed manuscript to the article. Locked until januar 2017-01-01 due to the copyright restrictions

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

Designing for movement quality in exergames: Lessons learned from observing senior citizens playing stepping games

-Background: Exergames are increasingly used as an exercise intervention to reduce fall risk in elderly. However, few exergames have been designed specifically for elderly, and we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions important for fall risk reduction. Objective: This study investigates game elements and older players' movement characteristics during stepping exergames in order to inform exergame design for movement quality in the context of fall preventive exercise. Methods: Fourteen senior citizens (mean age 73 years ± 5.7, range 65 - 85) played 3 stepping exergames in a laboratory. Each of the exergames was described with respect to 7 game elements (physical space, sensing hardware technology, game graphics and sound, model of user, avatar/mapping of movements, game mechanism and game narrative). Five movement characteristics (weight shift; variation in step length, speed, and movement direction; visual independency) were scored on a 5-point Likert scale based on video observations of each player and each game. Disagreement between raters was resolved by agreement. Differences in scores for the 3 exergames were analyzed with a multivariate one-way ANOVA. Results: The Mole received the highest sum score and the best score on each of the 5 movement characteristics (all p values <0.0005). LightRace scored the lowest of the 3 exergames on weight shift and variation in movement direction (both p values <0.0005), while DanceDanceRevolution scored lowest on step length variation and visual independency (p < 0.03 and p < 0.0005, respectively), and lower than The Mole on speed variation (p < 0.05). The physical space players used when exergaming and the on-screen representation of the player, affected movement quality positively as indexed by multiple weight shifts and variation in stepping size, direction, and speed. Furthermore, players' movements improved when playing speed-affected game progression and when the game narrative was related to a natural context. Conclusion: Comparing differences in game elements with associated differences in game movement requirements provides valuable insights about how to design for movement quality in exergames. This provided important lessons for the design of exergames for fall-preventive exercise in senior citizens and illustrates the value of including analyses of movement characteristics when designing such exergames

Impact of Serious Games on Health and Well-being of Elderly: A Systematic Review

Besides their entertainment value, serious games can have beneficial therapeutic effects for elderly people that improve their health and well-being. Games are likely to be accepted by elderly persons who have enjoyed games their lives, and because there are more and more of such elderly, it is important to investigate games as a therapeutic device. This research reviewed the literature focusing on the effects of games on elderly persons in three main types of effects: physical, cognitive, and social effects. The majority of reviewed papers focused on physical and cognitive effects, and were published in recent years, which emphasizes the relative novelty of this topic and suggests that future research will need to address social impact as well. In addition, while many papers claimed positive impacts as a result of using games, our review found that more attention should be given to research designs

Long-term use of motion-based video games in care home settings

Recent research suggests that motion-based video games have the potential to provide both mental and physical stimulation for older adults in residential care. However, little research has explored the practical challenges and opportunities that arise from integrating these games within existing schedules of activities in these contexts. In our work, we report on a qualitative enquiry that was conducted over a three month period at two long-term care facilities. Findings suggest that older adults enjoyed playing video games, and that games can be a valuable means of re-introducing challenge in late life, but that the impact of age-related changes and impairment can influence people’s ability to engage with games in a group setting. We outline core challenges in the design for care context and discuss implications of our work regarding the suitability of games as a self-directed leisure activity

Automating senior fitness testing through gesture detection with depth sensors

Sedentarism has a negative impact on health, life expectancy and quality of life, especially in older adults. The assessment of functional fitness helps evaluating the effects of ageing and sedentarism, and this assessment is typically done through validated battery tests such as the Senior Fitness Test (SFT). In this paper we present a computer-based system for assisting and automating SFT administration and scoring in the elderly population. Our system assesses lower body strength, agility and dynamic balance, and aerobic endurance making use of a depth sensor for body tracking and multiple gesture detectors for the evaluation of movement execution. The system was developed and trained with optimal data collected in laboratory conditions and its performance was evaluated in a real environment with 22 elderly end-users, and compared to traditional SFT administered by an expert. Results show a high accuracy of our system in identifying movement patterns (>95%) and consistency with the traditional fitness assessment method. Our results suggest that this technology is a viable low cost option to assist in the fitness assessment of elderly that could be deployed for at home use in the context of fitness programs.info:eu-repo/semantics/publishedVersio

Ageing playfully: advancing research on games for older adults beyond accessibility and health benefits

Games for older adults have previously been explored with a focus on improving older adults’ well-being by fostering social interaction, and providing cognitive and physical stimulation, suggesting that they are a means of encouraging older adults to better themselves and introducing an overly functionalist perspective on play. In this workshop, we aim to shift perspectives on games for older adults on hedonic aspects that extend beyond benefits they provide. We will explore challenges and opportunities in the design and development of games for older adults that primarily focus on entertainment to create empowering and engaging experiences, and we will explore how to consolidate efforts that aim to deliver benefits of games with a purpose beyond entertainment to older adults