Assessing balance through the use of a low-cost head-mounted display in older adults: a pilot study

Abstract

IntroductionAs the population ages, the prevention of falls is an increasingly important public health problem. Balance assessment forms an important component of fall-prevention programs for older adults. The recent development of cost-effective and highly responsive virtual reality (VR) systems means new methods of balance assessment are feasible in a clinical setting. This proof-of-concept study made use of the submillimeter tracking built into modern VR head-mounted displays (VRHMDs) to assess balance through the use of visual–vestibular conflict. The objective of this study was to evaluate the validity, acceptability, and reliability of using a VRHMD to assess balance in older adults.Materials and methodsValidity was assessed by comparing measurements from the VRHMD to measurements of postural sway from a force plate. Acceptability was assessed through the use of the Simulator Sickness Questionnaire pre- and postexposure to assess possible side effects of the visual–vestibular conflict. Reliability was assessed by measuring correlations between repeated measurements 1 week apart. Variables of possible importance that were found to be reliable (r≥0.9) between tests separated by a week were then tested for differences compared to a control group. Assessment was performed as a cross-sectional single-site community center-based study in 13 older adults (≥65 years old, 80.2±7.3 years old, 77% female, five at risk of falls, eight controls). The VR balance assessment consisted of four modules: a baseline module, a reaction module, a balance module, and a seated assessment.ResultsThere was a significant difference in the rate at which participants with a risk of falls changed their tilt in the anteroposterior direction compared to the control group. Participants with a risk of falls changed their tilt in the anteroposterior direction at 0.7°/second vs 0.4°/second for those without a history of falls. No significant differences were found between pre/postassessment for oculomotor score or total Simulator Sickness Questionnaire score. Both the force plate and the head-mounted display balance-assessment system were able to detect differences between conditions meant to mask visual and proprioceptive information.ConclusionThis VRHMD is both affordable and portable, causes minimal simulator sickness, and produces repeatable results that can be used to assess balance in older adults.

Effects of body visualization on performance in head-mounted display virtual reality

“…Several studies in VR exist, which analyzed static balance (e.g. [44]), or dynamic balance using force plates (e.g. [45]).…”

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform

“…Rather, with this feasibility demonstrated, it can be discussed how smartglasses could have specific advantages over other COTS devices for assessment and rehabilitation of balance dysfunction related to brain injury. Recently, it was reported that a fully immersive head-mounted virtual reality (VR) system was successfully used to obtain repeatable balance assessment measurements in an elderly population [ 67 ]. Higher fall risk participants were found to change their tilt in the AP direction at a significantly higher rate.…”

“…A comprehensive characterization of measures obtainable from smartglasses against a clinical force plate system would provide a more thorough assessment of the concurrent validity of head-based measurement. Recently published pilot results from an elderly population using a force plate system support the potential for head-based measurement using COTS hardware in clinical assessment of balance [ 67 ].…”

An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study

“…VR systems have been used as assessment tools [9,10] for physical activity [11], cognitive assessment [12], and balance assessment [13]. Studies on nonimmersive virtual environments (VEs) found those effective for assessments [8] because of being accessible and feasible while providing controlled settings for conducting cognitive sessions.…”