Rapid voluntary stepping has been recognized as an important measure of balance control.
The purpose of this study was to assess the feasibility and convergent validity of a Rapid Stepping Test protocol utilizing a virtual reality SeeMeTM system (VR-RST) in elderly ambulatory and independent individuals living in a community residential home.
Associations between step execution times determined by the system and the Activities-specific Balance Confidence (ABC) Questionnaire, and clinical measures of balance performance in the MiniBESTest and Timed Up and Go (TUG) test, were established in 60 participants (mean age 88.2 ± 5.0 years). All participants completed the study.
The correlations of the ABC questionnaire and the clinical tests with VR-RST forward and backward stepping were moderate (ρ rage 0.42-0.52), and weak to moderate with sideward stepping (ρ rage 0.32-0.52). Moderate to strong correlations were found across stepping directions (ρ rage 0.45-0.87).
Findings support the test's feasibility and validity and confirm the utility of the VR-RST as an assessment tool in an elderly population.
Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Web - based Injury Statistics Query and Reporting System (WISQARS). Older adult falls. http://www.cdc.gov/HomeandRecreation- alSafety/Falls/adultfalls.html.
Sterling DA, , O'Connor JA, , Bonadies J. Geriatric falls: Injury severity is high and disproportionate to mechanism. Journal of Trauma - Injury, Infection and Critical Care. 2001; 50(1): 16-119.
Alexander BH, , Rivara FP, , Wolf ME. The cost and frequency of hospitalization for fall - related injuries in older adults. American Journal of Public Health. 1992; 82(7): 1020-1023.
Rao SS. Prevention of falls in older patients. American Family Physician. 2005; 72(1): 81-88.
Stevens JA, , Corso PS, , Finkelstein EA, , Miller TR. The costs of fatal and non-fatal falls among older adults. Injury Prevention. 2006; 12(5): 290-295.
Centers for Disease Control and Prevention CDC, Older Adult Falls: Get the Facts Online: http://www.cdc.gov/home- andrecreationalsafety/falls/adultfalls.html.
U.S. Census Bureau, 2011, Age and sex composition: 2010, by LM Howden and JA Meyer, 2010 Census Briefs, C2010BR-03, available at http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf.
Tinetti ME, , Kumar C. The patient who falls. Journal of the American Medical Association. 2010; 303(3): 258-266.
Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006; 35(2): ii7-ii11.
Zajonc TP, , Roland PS. Vertigo and motion sickness. Part I: vestibular anatomy and physiology. Ear, Nose & Throat Journal. 2005; 84: 581-584.
Herdman S. Vestibular rehabilitation, 3rd edn. F.A. Davis, Philadelphia, PA, 2007.
Shumway-Cook A, , Woollacott MH. Motor control: Translating research into clinical practice, 4th edn. Lippincott, Philadelphia, PA, 2011.
Huxham F, , Goldie P, , Patela A. Theoretical considerations in balance assessment. Australian Journal of Physiotherapy. 2001; 47: 89-100.
Maki BE, , McIlroy WE. Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age and Ageing. 2006; 35(2): ii12-ii18.
Patla E, , Frank JS, , Winter DA et al. Age-related changes in balance control system: initiation of stepping. Clinical Biomechanics. 1993; 8: 179-184.
Maki E, , McIlroy WE, . Effects of aging on control of stability. In: A textbook of audiological medicine: Clinical aspects of hearing and balance. Luxon L, , Martini A, , Furman J, , Stephens D, eds, Martin Dunitz Publishers, London, 2003; 671-690.
Mancini M. Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. European Journal of Physical and Rehabilitation Medicine. 2010; 46(2): 239-249.
Schoene D, , Smith ST, , Davies TA et al. A Stroop Stepping Test (SST) using low-cost computer game technology discriminates between older fallers and non-fallers. Age and Ageing. 2014; 43(2): 285-289. doi: 10.1093/ageing/aft157.
Melzer I, , Kurz D, , Shahar M et al. Application of the voluntary step execution test to identify elderly fallers. Age and Ageing. 2007; 36: 532-537.
Melzer I, , Kurz I, , Sarid O, , Jette AM. Relationship between self-reported function and disability and balance performance measures in the elderly. Journal of Rehabilitation Research & Development. 2007; 44(5): 685-692.
Melzer I, , Shtilman I, , Rosenblatt N, , Oddsson LIE. Reliability of voluntary step execution behavior under single and dual task conditions. Journal of NeuroEngineering and Rehabilitation. 2007; 4: 16.
Lord SR, , Fitzpatrick RC. Choice stepping reaction time: A composite measure of falls risk in older people. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001; 56(10): M627-M632.
Yamaji S, , Demura S, , Sohee S, , Uchiyama M. Reliability of a new rapid step test for older women and its relationship with fall risk and leg muscle function. Health. 2012; 4(1): 703-711. http://dx.doi.org/10.4236/health.2012.429110.
Laufer Y, , Sugarman H, , Burstin A, , Brown R. Age, but not sit or stance, affects rapid reaching movement time to virtual objects in response to a simple or choice cue. Presented at the Joint World Congress of ISPGR and Gait & Mental Function, Trondheim. 2012; http://ispgr.org/fileadmin/templates/_img/norway2012/ISPGR_Detailed_Program_2012_04_26.pdf.
Hutzler Y. Virtual reality and exergaming in rehabilitation: Scientific evidence and practical impact on adapted physical activity (APA), Spor Bilimleru Dergisi. Hacetteppe Journal of Sport Sciences. 24(2): 80-84.
Laufer Y, , Dar G, , Kodesh E. Does a Wii-based exercise program enhance balance control of independently functioning older adults? A systematic review. Clinical Interventions in Aging. 2014; 9: 1803-1813.
Li Z, , Han XG, , Sheng J, , Ma SJ. Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis. Clinical Rehabilitation. 3 Jul 2015. pii: 0269215515593611. [Epub ahead of print].
Ejupi A, , Brodie M, , Gschwind YJ et al. Choice stepping reaction time test using exergame technology for fall risk assessment in older people. Conf Proc IEEE Eng Med Biol Soc. 2014; 2014: 6957-60. doi: 10.1109/EMBC.2014.6945228.
Brown R, , Burstin A, , Laufer Y. Age but not sit or stance affects rapid reaching movement time to virtual objects in response to a simple or go no-no task. PM&R Journal. 2014; 6(8, 2): S126-S127.
Laufer Y, , Burstein A, , Brown R, , Korsensky O, , Hutzler Y. Rapid stepping time on virtual objects correlates with measures of balance and fear of falling in elderly individuals. WCPT Congress, Physiotherapy. 2015; 101, Supplement 1 eS189. doi: http://dx.doi.org/10.1016/j.physio.2015.03.349.
O'Hoski S, , Sibley KM, , Brooks D, , Beauchamp MK. Construct validity of the BESTest, mini-BESTest and briefBESTest in adults aged 50 years and older. Gait & Posture. 2015; 42(3): 301-305. DOI: http://dx.doi.org/10.1016/j.gaitpost.2015. 06.006.
Franchignoni F, , Horak F, , Godi M et al. Using/psychometric techniques to improve the balance evaluation systems test: The mini-BESTest. Journal of Rehabilitation Medicine. 2010; 42(4): 323-231. doi: 10.2340/16501977-0537.
Powell LE, , Myers AM. The activities-specific balance confidence (ABC) scale. Journal of Gerontology, Series A: Biological Sciences & Medical Sciences. 1995; 50(1): 28-34.
Botner EM, , Miller WC, , Eng JJ. Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke. Disability & Rehabilitation. 2005; 27(4): 156-163.
Klima DW, , Newton RA, , Keshner EA, , Davey A. Fear of falling and balance ability in older men: the priest study. Journal of Aging and Physical Activity. 2012; 21(4): 375-386. Epub 2012 Nov 19.
Horak R, , Wrisley DM, , Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical Therapy. 89(5): 484-498.
Godi M, , Franchignoni F, , Caligari M et al. Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders. Physical Therapy. 2013; 93(2): 158-67. doi: 10.2522/ptj.20120171.
Podsiadlo D, , Richardson S. The timed `Up & Go': a test of basic functional mobility for frail elderly persons. Journal of the American Geriatric Society. 1991; 39: 142-148. [PubMed].
Giladi N, , Herman T, , Reider-Groswasser II et al. Clinical characteristics of elderly patients with a cautious gait of unknown origin. Journal of Neurology. 2005; 252: 300-306.
Vereeck L, , Wuyts F, , Truijen S, , Van de Heyning P. Clinical assessment of balance: normative data, and gender and age effects. International Journal of Audiology. 2008; 47: 67-75.
Taylor R. Interpretation of the correlation-coefficient - A basic review. Journal of Diagnostic Medical Sonography. 1990; 6: 35-39.
Cho B, , Scarpace D, , Alexander NB. Tests of stepping as indicators of mobility, balance, and fall risk in balance-impaired older adults. Journal of the American Geriatrics Society. 2004; 52: 1168-1173.
Sturnieks DL, , Menant J, , Delbaere K et al. Force controlled balance perturbations associated with falls in older people: a prospective cohort study. PLoS One. 9 Aug 2013; 8(8): e70981. doi: 10.1371/journal.pone.0070981.
Hsiao ET, , Robinovitch SN. Common protective movements govern unexpected falls from standing height. Journal of Biomechanics. 1998; 31(1): 1-9.
Jiang J, , Long J, , Ling W et al. Incidence of fall-related injury among old people in mainland China. Archives of Gerontolology and Geriatrics. 2015; 61(2): 131-139. doi: 10.1016/j.archger.2015.06.003.Epub 2015 Jun 12.
Cattagni T, , Scaglioni G, , Cornu C et al. What are the effects of the aging of the neuromuscular system on postural stability? Geriatrics Psychol Neuropsychiatr Vieil. 1 Dec 2015; 13(4): 363-380.