Rapid stepping test towards virtual visual objects: Feasibility and convergent validity in older adults
Abstract
BACKGROUND:
Rapid voluntary stepping has been recognized as an important measure of balance control.
OBJECTIVE:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSION:
Findings support the test's feasibility and validity and confirm the utility of the VR-RST as an assessment tool in an elderly population.
References
[1] | 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. |
[2] | 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. |
[3] | 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. |
[4] | Rao SS. Prevention of falls in older patients. American Family Physician. (2005) ; 72: (1): 81-88. |
[5] | 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. |
[6] | Centers for Disease Control and Prevention CDC, Older Adult Falls: Get the Facts Online: http://www.cdc.gov/home- andrecreationalsafety/falls/adultfalls.html. |
[7] | 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. |
[8] | Tinetti ME, , Kumar C. The patient who falls. Journal of the American Medical Association. (2010) ; 303: (3): 258-266. |
[9] | 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. |
[10] | Zajonc TP, , Roland PS. Vertigo and motion sickness. Part I: vestibular anatomy and physiology. Ear, Nose & Throat Journal. (2005) ; 84: : 581-584. |
[11] | Herdman S. Vestibular rehabilitation, 3rd edn. F.A. Davis, Philadelphia, PA, (2007) . |
[12] | Shumway-Cook A, , Woollacott MH. Motor control: Translating research into clinical practice, 4th edn. Lippincott, Philadelphia, PA, (2011) . |
[13] | Huxham F, , Goldie P, , Patela A. Theoretical considerations in balance assessment. Australian Journal of Physiotherapy. (2001) ; 47: : 89-100. |
[14] | 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. |
[15] | Patla E, , Frank JS, , Winter DA et al. Age-related changes in balance control system: initiation of stepping. Clinical Biomechanics. (1993) ; 8: : 179-184. |
[16] | 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. |
[17] | 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. |
[18] | 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. |
[19] | 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. |
[20] | 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. |
[21] | 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. |
[22] | 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. |
[23] | 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. |
[24] | 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. |
[25] | 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. |
[26] | 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. |
[27] | 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]. |
[28] | 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. |
[29] | 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. |
[30] | 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. |
[31] | 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. |
[32] | 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. |
[33] | 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. |
[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. |
[35] | 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. |
[36] | Horak R, , Wrisley DM, , Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical Therapy. 89: (5): 484-498. |
[37] | 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. |
[38] | 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]. |
[39] | 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. |
[40] | 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. |
[41] | Taylor R. Interpretation of the correlation-coefficient - A basic review. Journal of Diagnostic Medical Sonography. (1990) ; 6: : 35-39. |
[42] | 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. |
[43] | 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. |
[44] | Hsiao ET, , Robinovitch SN. Common protective movements govern unexpected falls from standing height. Journal of Biomechanics. (1998) ; 31: (1): 1-9. |
[45] | 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. |
[46] | 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. |
