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Report: Treadmill Training Combined With Virtual Reality Helps To Prevent Falls In Elderly Who Had Previously Fallen

Improving cognitive function in addition to physical mobility is very important for safe walking.

Photo of Bettina Fliegel
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Scientists have found that older people at a high risk of falling can be trained to stay on their feet more consistently, using a treadmill and virtual reality.

Why do the elderly tend to fall?

Falls in older people often occur because of tripping and poor obstacle negotiation while walking. Older people’s ability to negotiate obstacles can be impaired because of age-related decline in cognitive abilities like motor planning, divided attention, executive control, and judgment, yet current interventions for falls in older adults typically focus on improving muscle strength, balance, and gait.  Dr. Mirelman

Many community centers, hospitals, rehabilitation centers, old age homes, etc. utilize treadmills to help the elderly improve their walking skills in a safe environment.

Walking skills can be improved even more with the addition of a virtual reality element to the exercise mix, a study led by Mirelman and recently published in The Lancet showed.  The approach combined treadmill exercise and virtual reality to help improve both physical mobility and cognitive aspects that are important for safe walking.

Source:  The Times of Israel 

THE STUDY:  Researchers from 5 institutions enrolled 282 volunteers, age 60 - 90.  Participants included patients with Parkinson's Disease and also a few with mild cognitive impairment.

Criteria For Inclusion:

  • Must be able to walk for at least 5 minutes unassisted.
  • Had fallen more than 2x in the six months prior to the study.

TWO STUDY GROUPS - Training was over a 6 week period, 16 sessions, 45 minutes each.

  1. Group A received VR + Treadmill Training.
  2. Group B received Treadmill Training alone.


Virtual Reality + Treadmill Training – How Did This Work?

  • A camera captured the movement of the participant’s feet which was projected onto a screen so that the patient could see their feet walking in real time.  The simulation included real life obstacles such as puddles, bumps and pathways that one had to navigate
WIRED UK

RESULTS Reported in Lancet Journal 2016

TRAINING Week 1

wired.co.uk 

TRAINING Week 6

wired.co.uk 

Combined training helped to decrease fall risk, and fall frequency, for at least 6 months after training. The incidence rate of falls decreased in both groups but was only notable in the combined group - VR + Treadmill where the incidence of falls  decreased by 42%.                               

Next Steps:

The scientists said the training could be used in gyms, rehabilitation centers, or nursing homes to improve safe walking and prevent falls in older adults or people with disorders, which affect movement.

"Further studies will need to examine whether treadmill training plus virtual reality could be used as part of a prevention package to treat fall risk before falls become common and before injuries occur." Mirelman

 Source: WIRED UK 

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Sources:

WIRED UK 16 August 2016

Times of Israel 16 August 2016  

Lancet 11 August 2016

Medicine Today September 2016

What is a provocation or insight that might inspire others during this challenge?

Cognitive function affects one's ability to walk safely. How might we design to positively impact cognitive function? Practicing walking is an important method to preserve and gain skills. What safe environments and experiences might be designed for this purpose?

Tell us about your work experience:

I am a pediatrician and have practiced as a clinician, educator and administrator. I am a HCD enthusiast! I mentor for the Design For America Club at NYU, and have been a Community Mentor on OI.

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Photo of Kate Rushton

Really interesting post, Bettina! I wonder if this could be used in places like the YMCA gyms and centres where older adults congregate.

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Photo of Bettina Fliegel

Definitely! The discussion in the journal article says that this would be relatively easy to implement and not costly as there are treadmills in the community, in community centers which include YMCA, rehabilitation centers, gyms, nursing homes etc.
The subject group were people who had already fallen and they still fell after training but much less often. My understanding of what it said in the discussion was that this approach will still need to be assessed as to whether this could prevent falls to begin with.
Would it make sense to try this in the community without virtual reality, for patients who had not yet fallen, as a preventive measure? Create a safe path for walking in a park or schoolyard, using paint, where there are flat "obstacles" to negotiate? Water, rocks etc. painted on the pathway in different colors?

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