Effects of balance training using a virtual-reality system in older fallers

Abstract

Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.

Keywords: balance; elderly; falls; postural instability; virtual reality.

Figure 1

Study design. Notes: Vertical lines indicate assessment points. Horizontal arrows indicate exposure to usual care with or without training.

Figure 2

Components of the BRU-training protocol. Each training session lasted 30 minutes and consisted of a combination of visual-vestibular rehabilitation (A) and postural training virtual reality exercises (B). The rehabilitation exercises (A) included saccadic and optokinetic stimulation. Postural training exercises (B) consisted of three different games (maze, breakfast and surfing) with increasing levels of complexity (maximum of 15 levels).

Figure 3

(A) Comparison of limits of stability and mean ellipse of confidence areas before and after 6 weeks of Balance Rehabilitation Unit (BRU) training (in the BRU-training group) and after 9 months of the initial assessment in both BRU-training and control groups. (B and C) Both groups showed a reduction in the number of falls at month 9 postassessment. BRU training induced a significant reduction in number of falls per subject (B) and fear of falling (C) in the BRU-training group compared with the untrained control group. Notes: *P < 0.05 significant intragroup difference from the baseline measure at 0 months; ^#P < 0.05 intergroup difference after 9 months. A total SAFFE fear-of-falling score was generated based on a 5-point Likert (0–4) item response format, with higher scores indicating a greater fear of falling. Abbreviations: BRU, Balance Rehabilitation Unit; SAFFE, Survey of Activities and Fear of Falling in the Elderly.