V-TIME: A treadmill training program augmented by virtual reality to decrease fall risk in older adults: Study design of a randomized controlled trial

BMC Neurology (Impact Factor: 2.04). 02/2013; 13(1):15. DOI: 10.1186/1471-2377-13-15
Source: PubMed

ABSTRACT Background
Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits. Indeed, everyday walking in complex environments utilizes executive function, dual tasking, planning and scanning, all while walking forward. Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction. The proposed randomized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk.

Three hundred older adults with a history of falls will be recruited to participate in this study. This will include older adults (n=100), patients with mild cognitive impairment (n=100), and patients with Parkinson’s disease (n=100). These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits. Subjects will be randomly assigned to the intervention group (treadmill training with virtual reality) or to the active-control group (treadmill training without virtual reality). Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks. Assessments will take place before, after, and 1 month and 6 months after the completion of the training. A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence (i.e., the number of falls, multiple falls and falls rate). In addition, we will measure gait under usual and dual task conditions, balance, community mobility, health related quality of life, user satisfaction and cognitive function.

This randomized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality reduces fall risk, improves mobility and enhances cognitive function in a diverse group of older adults. In addition, the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit.

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Available from: Alice Nieuwboer, Sep 28, 2015
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    • "Each training session lasted about 45 minutes (30 minutes of training in three bouts and 5 minutes of rest between each bout). Progression was based on a previous study of individualized TT for neurological subjects [8]. In the first session, the treadmill speed was set at 20% less than the subject's overground walking speed, calculated from the 10 meters walk test (10mwt), which was performed prior to the training. "
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    ABSTRACT: Gait disturbances are common in multiple sclerosis (MS) subjects. In particular, a non-physiological reduction of the walking speed and an increase of the gait variability is observed during a concurrent walking and cognitive challenge task. Virtual reality (VR) allows the delivery of challenging environments to train gait of MS individuals. This study aims to investigate the effects of two types of intensive treadmill-based interventions on gait of MS individuals. The two interventions share the same training protocol, except for the use of VR. Seventeen MS patients enrolled in the study were randomized in treadmill training (TT) group and treadmill training with VR (TT-VR) group. Assessments, performed before and immediately after the interventions, included gait analysis (single and dual-task conditions) and motor tests. Gait spatial-temporal parameters significantly improved in both groups. Ankle and hip kinetics improved in dual task only, for the TT-VR group. The preliminary results of this study suggest that TT-VR may significantly improve gait performance during complex conditions of MS individuals. The experimental research is still ongoing and more subjects will be recruited.
    international Conference on Virtual Rehabilitation; 06/2015
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    • "Growing appreciation of the interdependence of cognitive and postural control processes has led to search for multimodal interventions combining motor and cognitive training for improving gait and preventing falls (Mirelman et al., 2013; Kayama et al., 2014; Shema et al., 2014). Tai Chi (TC) is a multi-component mind–body exercise that is growing in popularity, especially among older adults (Wayne and Fuerst, 2013). "
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    ABSTRACT: Tai Chi (TC) exercise improves balance and reduces falls in older, health-impaired adults. TC's impact on dual task (DT) gait parameters predictive of falls, especially in healthy active older adults, however, is unknown. To compare differences in usual and DT gait between long-term TC-expert practitioners and age-/gender-matched TC-naïve adults, and to determine the effects of short-term TC training on gait in healthy, non-sedentary older adults. A cross-sectional study compared gait in healthy TC-naïve and TC-expert (24.5 ± 12 years experience) older adults. TC-naïve adults then completed a 6-month, two-arm, wait-list randomized clinical trial of TC training. Gait speed and stride time variability (Coefficient of Variation %) were assessed during 90 s trials of undisturbed and cognitive DT (serial subtractions) conditions. During DT, gait speed decreased (p < 0.003) and stride time variability increased (p < 0.004) in all groups. Cross-sectional comparisons indicated that stride time variability was lower in the TC-expert vs. TC-naïve group, significantly so during DT (2.11 vs. 2.55%; p = 0.027); by contrast, gait speed during both undisturbed and DT conditions did not differ between groups. Longitudinal analyses of TC-naïve adults randomized to 6 months of TC training or usual care identified improvement in DT gait speed in both groups. A small improvement in DT stride time variability (effect size = 0.2) was estimated with TC training, but no significant differences between groups were observed. Potentially important improvements after TC training could not be excluded in this small study. In healthy active older adults, positive effects of short- and long-term TC were observed only under cognitively challenging DT conditions and only for stride time variability. DT stride time variability offers a potentially sensitive metric for monitoring TC's impact on fall risk with healthy older adults.
    Frontiers in Human Neuroscience 06/2015; 9. DOI:10.3389/fnhum.2015.00332 · 2.99 Impact Factor
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    • "Recently, gait rehabilitation programs, based on the combined use of virtual reality and treadmill, aimed at enhancing gait [14]–[17] and at reducing fall risk [16], [18]– [20] in pathological populations. These studies required the participants to negotiate virtual obstacles [14], [15], [17], [18], [20] and the evaluation focused more on the motor performance than the visual strategy. Since an accurate foot placement requires both intact visual and motor abilities [21], virtual environments, including obstacles, may be used to investigate the relationship between the point of gaze and stepping accuracy. "
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    ABSTRACT: Inaccurate visual sampling and foot placement may lead to unsafe walking. Virtual environments, challenging obstacle negotiation, may be used to investigate the relationship between the point of gaze and stepping accuracy. A measurement of the point of gaze during walking can be obtained using a remote eye-tracker. The assessment of its performance and limits of applicability is essential to define the areas of interest in a virtual environment and to collect information for the analysis of the visual strategy. The current study aims at characterizing a gaze eye-tracker in static and dynamic conditions. Three different conditions were analyzed: a) looking at a single stimulus during selected head movements b) looking at multiple stimuli distributed on the screen from different distances, c) looking at multiple stimuli distributed on the screen while walking. The eye-tracker was able to measure the point of gaze during the head motion along medio-lateral and vertical directions consistently with the device specifications, while the tracking during the head motion along the anterior-posterior direction resulted to be lower than the device specifications. During head rotation around the vertical direction, the error of the point of gaze was lower than 23 mm. The best accuracy (10 mm) was achieved, consistently to the device specifications, in the static condition performed at 650 mm from the eye-tracker, while point of gaze data were lost while getting closer to the eye-tracker. In general, the accuracy and precision of the point of gaze did not show to be related to the stimulus position. During fast walking (1.1 m/s), the eye-tracker did not lose any data, since the head range of motion was always within the ranges of trackability. The values of accuracy and precision during walking were similar to those resulting from static conditions. These values will be considered in the definition of the size and shape of the areas of interest in the virtual environment.
    IEEE Engineering in Medicine and Biology Society, Chicago, Illnois, USA; 08/2014
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