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Virtual reality-Treadmill combined Intervention for enhancing Mobility and reducing falls in the Elderly

Final Report Summary - V-TIME (Virtual reality-Treadmill combined Intervention for enhancing Mobility and reducing falls in the Elderly)

Executive Summary:
V-TIME is a multi-modal intervention that combines treadmill training (TT) with virtual reality (VR). The V-TIME intervention was designed to promote motor control, usual-walking abilities and physical fitness while simultaneously engaging subjects in challenging cognitive tasks that implicitly teach and enhance visual scanning, planning, dual tasking (DT) abilities and obstacle negotiation, maximizing its impact on mobility and fall risk through the application of TT+VR.
Project Context and Objectives:
The major goal of the project was to establish the beneficial effects of V-TIME training on falls and the risk of falls in a relatively large and diverse group of older adults and to identify the added-value of this approach compared to an active-control intervention. We aimed to show that the multi-modal V-TIME solution meets the needs of the millions of Europeans who are affected by age-related changes in gait and cognitive function and are thus prone to an increased fall risk.

V-TIME’s specific objectives were:

1. To conduct a Randomized Controlled Trial (RCT) that will establish the benefits of V-TIME on fall risk, fall risk mediators, and health-related quality of life (QOL) among older people.
2. To evaluate and quantify the effects of different dosing options to inform the most efficient training paradigm.
3. To measure the effects of the V-TIME approach on automaticity, transfer and retention.
4. To quantify the effects of V-TIME on brain plasticity as measured by brain imaging technology.
Project Results:
Three hundred and two participants completed baseline assessment and 245 completed the entire training protocol and all assessments including a 6 month follow up of falls post training in this randomized controlled trial. Data collection was completed in December 2015.

Analysis of the results demonstrated that the V-TIME intervention had a significant, positive impact on fall frequency and fall risk in this large cohort of older adults. There was a significant reduction of approximately 40% in fall frequency after training as compared to the number of falls reported pre training. This represents a large effect size and suggests that intensive training is useful in reducing falls in older adults with a history of falls.

The results also point to the superiority of TT+VR training in reducing fall risk, especially among patients with Parkinson’s disease (PD). For this group, training with virtual reality reduced the risk of falls by 60%, compared to that of the active control comparison, which is a significant and remarkable achievement as the risk of falls in patients with PD is extremely high. There was no significant difference in the effects on fall frequency between training arms in the elderly fallers and mild cognitive impairment (MCI) groups. This suggests that specifically for fall rates, the TT+VR training exhibits its added value most notably in the patients with PD. The motor-cognitive training provided by the VR was focused on increasing step length and foot clearance and teaching obstacle negotiation strategies which apparently had the most added-value in these patients, where it was transferred into real-world fall avoidance. This observation is further supported by results on improvements in both motor and cognitive function and self-perceived quality of life measures. Among the other two cohorts, TT+VR also apparently has a positive impact on fall risk and fall frequency. Participants also reported higher levels of user-satisfaction with TT+VR, as compared to TT, likely a reflection of the more engaging nature of the VR simulation.

Prior to training, all subjects were considered multiple fallers as per the inclusion criteria (2 falls in the 6 months prior to the study). Analysis of fall status revealed that approximately 40% of all participants became non-fallers with no falls reported in the 6 months post intervention period. An additional 20% had only 1 fall in 6 months post-training. Thus, altogether, 60% of all participants became non-fallers or single fallers, a significant improvement after the interventions. This finding is an achievement by itself as it corresponds to improvement in quality of life of this group of older adults. As such, the results of the V-TIME study should be considered meaningful and important.
Potential Impact:
The findings from the V-TIME study provide evidence on the efficacy of an easily exploitable intervention that can greatly impact the lives of European elderly citizens by increasing participation in intensive and relevant physical practice, while also engaging individuals in cognitive activities that are essential to successful, active ageing. The V-TIME intervention does not just provide symptom relief, but rather teaches strategies and skills of movement that enhance and transfer to daily life activities. Our results show that this approach helped to improve independence and confidence, allowing individuals to be more self-sufficient, reduced the number of falls and injurious falls and consequently reduced medical care. As such, the results suggest that the V-TIME approach can impact ageing well, enabling individuals to function more freely and effectively – ‘adding life to years, not just years to life.’

Throughout the study, the consortium heavily engaged in dissemination activities aimed at introducing the approach and the system to researcher, clinicians, potential users and policy makers. With the culmination of the study and the analysis of the results solidifying our hypotheses in a large group of diverse older adults, the consortium intends to take additional measures to exploit the results of the study and make them applicable to a large range of individuals.
List of Websites:

Prof. Jeffrey Hausdorff
Tel-Aviv Souraski Medical Centre
+972-3-697 3081