Triggering Postural Movements With Virtual Reality Technology in Healthy Young and Older Adults: A Cross-Sectional Validation Study for Early Dementia Screening

Abstract

With the ultimate aim of early diagnosis of dementia, a new body balance assessment system with integrated head-mounted display-based virtual reality (VR) has been developed. We hypothesized that people would sway more in anterior-posterior (AP) direction when they were exposed to a VR environment where we intentionally provoked movements in forward and backward directions. A total of 14 healthy older adults (OA) (73.14±4.26 years) and 15 healthy young adults (YA) (24.93±1.49 years) were assessed for group differences in sway behavior. Body sway speed in 22 different conditions with and without VR environments was analyzed. Significant differences and large effect sizes were observed in AP sway under the VR environments (OA with P < 0.02; effect size> 0.61, YA with P < 0.003; effect size> 0.72) compared to the baseline condition without the VR environments. In addition, significant differences were found between the two groups in AP sway in all test conditions ( P < 0.01). Our study shows that a VR environment can trigger body sway in an expected direction, which may indicate that it is possible to enhance the sensitivity of balance assessment by integrating immersive VR environments. The result of this study warrants a cross-sectional study in which OA diagnosed with and without dementia are compared on their sway behavior.

A Perspective on Implementation of Technology-Driven Exergames for Adults as Telerehabilitation Services

“…Recently VR exergames for adults that monitor and train physical activity have been developed for: posture ( Solis-Escalante et al, 2019 ; Carr et al, 2020 ; Imaoka et al, 2020 ), falls ( Chen et al, 2020 ; Liston et al, 2021 ), dual-task walking ( Kizony et al, 2017 ; Janouch et al, 2018 ; Kafri et al, 2021 ). As well as assessing cognitive health and providing comfort in patients with neurological diseases and communication difficulties (e.g., Stasolla et al, 2021 ).…”

“…As well as assessing cognitive health and providing comfort in patients with neurological diseases and communication difficulties (e.g., Stasolla et al, 2021 ). In addition, various exergames investigate the correlation of multisensory stimulation and age on realistic daily-life activities ( Wechsler et al, 2018 ; Souza-Silva et al, 2019 ; Carr et al, 2020 ; Imaoka et al, 2020 ). Some also investigate the maintenance of posture and the response to fall and how they are age-dependently influenced by sound and vision (e.g., Stapleton et al, 2014 ; Lupo and Barnett-Cowan, 2018 ).…”

“…The index correlates strongly with standard cognitive and physical activity measurements. Changes in postural sway by older adults are also indicative of cognitive impairment, and several VR exergames have been addressing this issue ( Carr et al, 2019 ; Liao et al, 2019 ; Imaoka et al, 2020 ). Interestingly, 12 weeks training significantly improved dual-task gait performance in older mildly cognitively impaired adults ( Liao et al, 2019 ).…”

“…It also should be noted that recent research indicates that particular implemented VR exergames can yield biomarkers for early detection of various CNDs (e.g., Imaoka et al, 2020 ; Jiang et al, 2021 ; Pieruccini-Faria et al, 2021 ). These have the potential to be developed and integrated into rehabilitation programs.…”

Linking cognitive functioning and postural balance control through virtual reality environmental manipulations

“…A study analyzing postural sway behaviors of people with AD also found that attentional demand during dual-task activity and visual challenge contributed to the postural instability of the AD population (Bahureksa et al, 2017 ; Mesbah et al, 2017 ). With the aim of improving body balance assessment for dementia screening using a visual challenge, we have created a new assessment system combining a stabilometer and head-mounted display (HMD)-based virtual reality (VR) technology (Imaoka et al, 2020a ). The new system was developed to trigger postural sway in anterior-posterior direction intentionally by giving a visual flow of moving VR environments forwards and backwards.…”