Training functional mobility using a dynamic virtual reality obstacle course

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Chanel T. LoJacono (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Christopher Rhea

Abstract: Falling poses a significant risk of injury for older adults, thus decreasing quality of life. Major risk factors for falling include decrements in gait and balance, and adverse patient-reported health and well-being. Virtual Reality (VR) can be a cost-effective, resource-efficient, and highly engaging training tool, and previous research has utilized VR to reduce fall-risk factors in a variety of populations with aging and pathology. However, there are barriers to implementing VR as a training tool to improve functional mobility in older adults that include the manner in which healthy older adults perform in VR relative to younger adults, the effect of extended duration training, and the relation of fall-risk clinical metrics to performance in VR. The purpose of this dissertation is threefold: (1) to compare performance between older and younger adults in VR and in real-world gait and balance tests as a result of a single bout of VR training; (2) to compare performance in VR and gait and balance within younger adults as a result of extended training duration; and (3) to evaluate clinical tests as prerequisite measures for performance within the VR environment. Thirty-five healthy adults participated in this study and were placed into either the older adult training group (n=8; 67.0±4.4yrs), younger training (n=13; 22.1±2.5yrs), or younger control (n=13; 21.7±1.0yrs). All participants completed an online patient-reported survey of balance confidence and health and well-being, as well as a pre-test of clinical assessments and walking and balance tests. The training groups then completed 15 trials of a VR obstacle course, while the controls walked overground for 15 minutes. The VR obstacle course included a series of gait and dynamic balance tasks, such as stepping on irregularly placed virtual stepping stones and walking a virtual balance beam. All participants repeated the walking and balance tests at post-test. The younger training group also completed 3 weeks of training in the same VR obstacle course and a second post-test. Analyses of variance were completed to determine the extent to which participants improved within VR and the walking and balance tests both as a result of a single bout of training, and for the younger adults – three weeks of extended training. Multiple regressions were run to determine the extent to which patient-reports and clinical assessments may predict performance within VR. The results reported in Manuscript I show that although younger adults completed the VR course quicker, their learning rate was not different from older adults; and as a result of extended training, younger adults continued to improve their time to complete the course. For gait and balance tests, age related differences were observed. Both groups showed better performance on some post-tests, indicating that VR training may have had a positive effect on neuromotor control. The results reported in Manuscript II suggest the RAND-1 pain subscale and simple reaction time (SRT) may predict time to complete the VR course, and SRT and BBS Q14 may additionally predict obstacle contact. These data suggest a VR obstacle course may be effective in improving gait and balance in both younger and older adults. It is recommended that future work enroll older adults in the extended training portion of the study and to increase the VR obstacle course difficulty when benchmarks are met.

Additional Information

Language: English
Date: 2020
Balance, Gait, Mobility, Virtual Reality
Falls (Accidents) $x Prevention
Virtual reality in medicine
Equilibrium (Physiology)
Gait in humans

Email this document to