Virtual Reality and Augmented Reality Exergames for older fallers: considerations about design and applicability by physical therapists
Resumo
This work investigates the application of virtual reality (VR) and augmented reality (AR) exergames for older fallers, through a literature review and an exploratory technological research. We developed an exergame called BALLOONS to understand the main design concerns and to be able to evaluate the applicability based on physical therapists evaluation. Three different immersive systems running the same game BALLONS were implemented, two as VR exergames and one as an AR exergame. Test and evaluation sessions were conducted with eleven physiotherapists. The results point to a positive evaluation by experts in terms of safety, tolerability, and acceptability. The findings also suggest the need for technical improvements, such as the development of lighter and more comfortable headsets, to increase acceptability and the need of a larger variety of cognitive activities and frequency adjustments of physical exercise, to increase applicability and value for rehabilitation.
Palavras-chave:
Aged, Accidental Falls, Virtual Reality, Virtual Reality Exposure Therapy, Rehabilitation
Referências
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J. Li, X. Xu, T. P. Pham, Y.-L. Theng, N. Katajapuu, and M. Luimula, “Exergames designed for older adults: a pilot evaluation on psychosocial well-being,” Games Health J., vol. 6, no. 6, pp. 371–378, 2017.
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K. Sato, K. Kuroki, S. Saiki, and R. Nagatomi, “Improving walking, muscle strength, and balance in the elderly with an exergame using Kinect: A randomized controlled trial,” Games Health J., vol. 4, no. 3, pp. 161–167, 2015.
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A. Darekar, B. J. McFadyen, A. Lamontagne, and J. Fung, “Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review,” J. Neuroeng. Rehabil., vol. 12, no. 1, pp. 1–14, 2015.
Y.-Y. Chao, Y. K. Scherer, and C. A. Montgomery, “Effects of using Nintendo WiiTM exergames in older adults: a review of the literature,” J. Aging Health, vol. 27, no. 3, pp. 379–402, 2015.
N. Skjæret, A. Nawaz, T. Morat, D. Schoene, J. L. Helbostad, and B. Vereijken, “Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy,” Int. J. Med. Inform., vol. 85, no. 1, pp. 1–16, 2016.
L. H. Larsen, L. Schou, H. H. Lund, and H. Langberg, “The physical effect of exergames in healthy elderly—a systematic review,” GAMES Heal. Res. Dev. Clin. Appl., vol. 2, no. 4, pp. 205–212, 2013.
R. Q. M. da Costa et al., “Two new virtual reality tasks for the assessment of spatial orientation Preliminary results of tolerability, sense of presence and usability,” Dement. Neuropsychol., vol. 12, pp. 196–204, 2018.
R. S. Kennedy, N. E. Lane, K. S. Berbaum, and M. G. Lilienthal, “Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness,” Int. J. Aviat. Psychol., vol. 3, no. 3, pp. 203–220, 1993.
M. R. de Carvalho, R. T. da Costa, and A. E. Nardi, “Simulator Sickness Questionnaire: tradução e adaptação transcultural,” J. Bras. Psiquiatr., vol. 60, pp. 247–252, 2011.
J. Brooke, “SUS-A quick and dirty usability scale,” Usability Eval. Ind., vol. 189, no. 194, pp. 4–7, 1996.
G. A. V Borg, “Psychophysical bases of perceived exertion.,” Med. Sci. Sport. Exerc., 1982.
K. M. Sibley, M. K. Beauchamp, K. Van Ooteghem, S. E. Straus, and S. B. Jaglal, “Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review,” Arch. Phys. Med. Rehabil., vol. 96, no. 1, pp. 122–132, 2015.
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Pereira, G., 2021. Considerations about the design and evaluation of immersive exergames for virtual rehabilitation of elderly fallers. [online] Available at: https://www.teses.usp.br/teses/disponiveis/3/3142/tde-20102020-123936/en.php. [Accessed 7 December 2020].
M. Mon-Williams, J. P. Warm, and S. Rushton, “Binocular vision in a virtual world: visual deficits following the wearing of a head-mounted display,” Ophthalmic Physiol. Opt., vol. 13, no. 4, pp. 387–391, 1993.
HMD Odyssey Hardware Specifications, Samsung Electronics America, 2021. [Online]. Available: https://www.samsung.com/us/support/troubleshooting/TSG01111314/ . [Accessed: 01- Jul- 2021].
R. P. Darken, W. R. Cockayne, and D. Carmein, “The OmniDirectional Treadmill: A Locomotion Device for Virtual Worlds,” in Proceedings of the 10th Annual ACM Symposium on User Interface Software and Technology, 1997, pp. 213–221, doi:10.1145/263407.263550.
A. Suh and J. Prophet, “The state of immersive technology research: A literature analysis,” Comput. Human Behav., vol. 86, pp. 77–90, 2018.
"Bundle Up: Why Is the Meta 2 AR Headset Being Resold by Dell? by AndrewWheeler", Engineering.com, 2021. [Online]. Available: [link]. [Accessed: 01- Jul- 2021].
H. Kayama, K. Okamoto, S. Nishiguchi, K. Nagai, M. Yamada, and T. Aoyama, “Concept software based on Kinect for assessing dual-task ability of elderly people,” GAMES Heal. Res. Dev. Clin. Appl., vol. 1, no. 5, pp. 348–352, 2012.
H. Charchat-fichman, P. Caramelli, K. Sameshima, and R. Nitrini, “Declínio da capacidade cognitiva durante o envelhecimento Decline of cognitive capacity during aging,” vol. 27, no. 21, pp. 79–82.
L. Borel, “Posture and cognition in the elderly : Interaction and contribution to the rehabilitation strategies Posture et cognition chez le sujet âgé : interaction et contribution aux stratégies de réhabilitation,” Neurophysiol. Clin. / Clin. Neurophysiol., vol. 44, no. 1, pp. 95–107, 2014, doi: 10.1016/j.neucli.2013.10.129.
K. Y. Sohng, J. S. Moon, H. H. Song, K. S. Lee, and Y. S. Kim, “Fall Prevention Exercise Program for Fall Risk Factor Reduction of the Community-Dwelling Elderly in Korea,” Yonsei Med J, vol. 44, no. 5, pp. 883–891, Oct. 2003.
A. Tiedemann, S. O’Rourke, and C. Sherington, “How is a yoga-based fall prevention program perceived by older people?,” J. Sci. Med. Sport, vol. 18, p. e94, 2014.
H. R. Marston and S. T. Smith, “Interactive Videogame Technologies to Support Independence in the Elderly: A Narrative Review.,” Games Health J., vol. 1, no. 2, pp. 139–152, Apr. 2012, doi: 10.1089/g4h.2011.0008.
A. W. De Vries, J. H. Van Dieën, V. Van Den Abeele, and S. M. P. Verschueren, “Understanding motivations and player experiences of older adults in virtual reality training,” Games Health J., vol. 7, no. 6, pp. 369–376, 2018.
S. Uzor, L. Baillie, D. A. Skelton, and P. J. Rowe, “Falls prevention advice and visual feedback to those at risk of falling: study protocol for a pilot randomized controlled trial,” Trials, vol. 14, no. 1, pp. 1–8, 2013.
J. Li, X. Xu, T. P. Pham, Y.-L. Theng, N. Katajapuu, and M. Luimula, “Exergames designed for older adults: a pilot evaluation on psychosocial well-being,” Games Health J., vol. 6, no. 6, pp. 371–378, 2017.
R. Proffitt, B. Lange, C. Chen, and C. Winstein, “A comparison of older adults’ subjective experiences with virtual and real environments during dynamic balance activities,” J. Aging Phys. Act., vol. 23, no. 1, pp. 24–33, 2015.
M. Van Diest, C. J. C. Lamoth, J. Stegenga, G. J. Verkerke, and K. Postema, “Exergaming for balance training of elderly: state of the art and future developments,” J. Neuroeng. Rehabil., vol. 10, no. 1, pp. 1– 12, 2013.
L. Yardley, M. Donovan-Hall, K. Francis, and C. Todd, “Older people’s views of advice about falls prevention: a qualitative study,” Health Educ. Res., vol. 21, no. 4, pp. 508–517, 2006.
A. S. Fu, K. L. Gao, A. K. Tung, W. W. Tsang, and M. M. Kwan, “Effectiveness of exergaming training in reducing risk and incidence of falls in frail older adults with a history of falls,” Arch. Phys. Med. Rehabil., vol. 96, no. 12, pp. 2096–2102, 2015.
K. Sato, K. Kuroki, S. Saiki, and R. Nagatomi, “Improving walking, muscle strength, and balance in the elderly with an exergame using Kinect: A randomized controlled trial,” Games Health J., vol. 4, no. 3, pp. 161–167, 2015.
J. A. Garcia, D. Schoene, S. R. Lord, K. Delbaere, T. Valenzuela, and K. F. Navarro, “A Bespoke Kinect Stepping Exergame for Improving Physical and Cognitive Function in Older People: A Pilot Study,” Games Health J., 2016, doi: 10.1089/g4h.2016.0070.
N. Skjæret, A. Nawaz, T. Morat, D. Schoene, J. L. Helbostad, and B. Vereijken, “Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy,” Int. J. Med. Inform., vol. 85, no. 1, pp. 1–16, 2016.
J. M. R. Bacha et al., “Effects of Kinect adventures games versus conventional physical therapy on postural control in elderly people: A randomized controlled trial,” Games Health J., vol. 7, no. 1, pp. 24–36, 2018.
S. D. Choi, L. Guo, D. Kang, and S. Xiong, “Exergame technology and interactive interventions for elderly fall prevention: A systematic literature review,” Appl. Ergon., 2017, doi: 10.1016/j.apergo.2016.10.013.
A. Darekar, B. J. McFadyen, A. Lamontagne, and J. Fung, “Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review,” J. Neuroeng. Rehabil., vol. 12, no. 1, pp. 1–14, 2015.
Y.-Y. Chao, Y. K. Scherer, and C. A. Montgomery, “Effects of using Nintendo WiiTM exergames in older adults: a review of the literature,” J. Aging Health, vol. 27, no. 3, pp. 379–402, 2015.
N. Skjæret, A. Nawaz, T. Morat, D. Schoene, J. L. Helbostad, and B. Vereijken, “Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy,” Int. J. Med. Inform., vol. 85, no. 1, pp. 1–16, 2016.
L. H. Larsen, L. Schou, H. H. Lund, and H. Langberg, “The physical effect of exergames in healthy elderly—a systematic review,” GAMES Heal. Res. Dev. Clin. Appl., vol. 2, no. 4, pp. 205–212, 2013.
R. Q. M. da Costa et al., “Two new virtual reality tasks for the assessment of spatial orientation Preliminary results of tolerability, sense of presence and usability,” Dement. Neuropsychol., vol. 12, pp. 196–204, 2018.
R. S. Kennedy, N. E. Lane, K. S. Berbaum, and M. G. Lilienthal, “Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness,” Int. J. Aviat. Psychol., vol. 3, no. 3, pp. 203–220, 1993.
M. R. de Carvalho, R. T. da Costa, and A. E. Nardi, “Simulator Sickness Questionnaire: tradução e adaptação transcultural,” J. Bras. Psiquiatr., vol. 60, pp. 247–252, 2011.
J. Brooke, “SUS-A quick and dirty usability scale,” Usability Eval. Ind., vol. 189, no. 194, pp. 4–7, 1996.
G. A. V Borg, “Psychophysical bases of perceived exertion.,” Med. Sci. Sport. Exerc., 1982.
K. M. Sibley, M. K. Beauchamp, K. Van Ooteghem, S. E. Straus, and S. B. Jaglal, “Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review,” Arch. Phys. Med. Rehabil., vol. 96, no. 1, pp. 122–132, 2015.
R. Tahmosybayat, K. Baker, A. Godfrey, N. Caplan, and G. Barry, “Movements of older adults during exergaming interventions that are associated with the Systems Framework for Postural Control: A systematic review,” Maturitas, vol. 111, pp. 90–99, 2018.
Pereira, G., 2021. Considerations about the design and evaluation of immersive exergames for virtual rehabilitation of elderly fallers. [online] Available at: https://www.teses.usp.br/teses/disponiveis/3/3142/tde-20102020-123936/en.php. [Accessed 7 December 2020].
M. Mon-Williams, J. P. Warm, and S. Rushton, “Binocular vision in a virtual world: visual deficits following the wearing of a head-mounted display,” Ophthalmic Physiol. Opt., vol. 13, no. 4, pp. 387–391, 1993.
HMD Odyssey Hardware Specifications, Samsung Electronics America, 2021. [Online]. Available: https://www.samsung.com/us/support/troubleshooting/TSG01111314/ . [Accessed: 01- Jul- 2021].
R. P. Darken, W. R. Cockayne, and D. Carmein, “The OmniDirectional Treadmill: A Locomotion Device for Virtual Worlds,” in Proceedings of the 10th Annual ACM Symposium on User Interface Software and Technology, 1997, pp. 213–221, doi:10.1145/263407.263550.
A. Suh and J. Prophet, “The state of immersive technology research: A literature analysis,” Comput. Human Behav., vol. 86, pp. 77–90, 2018.
"Bundle Up: Why Is the Meta 2 AR Headset Being Resold by Dell? by AndrewWheeler", Engineering.com, 2021. [Online]. Available: [link]. [Accessed: 01- Jul- 2021].
H. Kayama, K. Okamoto, S. Nishiguchi, K. Nagai, M. Yamada, and T. Aoyama, “Concept software based on Kinect for assessing dual-task ability of elderly people,” GAMES Heal. Res. Dev. Clin. Appl., vol. 1, no. 5, pp. 348–352, 2012.
Publicado
18/10/2021
Como Citar
PEREIRA, Guido Augusto Faria; BACHA, Jéssica Maria Ribeiro; SILVA, Izaura Beatriz Araújo Novais; KIM, Da Hee Chun; POMPEU, José Eduardo; LOPES, Roseli de Deus.
Virtual Reality and Augmented Reality Exergames for older fallers: considerations about design and applicability by physical therapists. In: TRILHA DE SAÚDE – ARTIGOS COMPLETOS - SIMPÓSIO BRASILEIRO DE JOGOS E ENTRETENIMENTO DIGITAL (SBGAMES), 20. , 2021, Online.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2021
.
p. 949-956.
DOI: https://doi.org/10.5753/sbgames_estendido.2021.19734.
