Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study

Abstract

Objective: Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals' performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults.

Methods: Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games' scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period.

Results: Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games' scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group.

Conclusion: Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.

Keywords: Exergames; inertial sensors; motor-cognitive assessment; older adults; serious games; stepping.

Figure 1.

Stepping-based minigames. Cognitive games: (a) Healthy Snacks (cognitive inhibition), (b) Shopping List (short-term memory), (c) Pizza (selective attention), (d) Shopping (cognitive flexibility). Balance games: (e) Labyrinth, (f) Mommy Chicken, (g) Falling Books, and (h) Music.

Figure 2.

Progression within cognitive games: (left) difficulty levels over time, and (right) reaction times across difficulty levels. Error bands represent 95% confidence intervals.

Figure 3.

Step speed across difficulty levels presented for all balance and cognitive games. Error bands represent 95% confidence intervals.