Fall Prevention in the Elderly: A Unique Exergaming Approach

Alyssa Bray, Jackson Cornelison, Jessi Granone, Dana Sizemore, Meghan Wagner, Nicole WalkerAuburn University

PICO question

Is the use of computerized video games and associated devices (I) effective in the prevention of falls (O) in elderly patients (P) when compared to traditional therapies (C).

This PICO question is significant to nursing practice in numerous ways. Nurses are at the frontline of fall prevention and are chiefly responsible for ensuring the safety of their patients. If the use of computerized video technology gains enough support to become part of standard care for elderly patients, nurses will need to ensure that this therapy is carried out correctly and safely.

Research Strategy

We conducted research for this project using the databases CINAHL, PubMed, ScienceDirect, and Medline (EBSCO). We utilized search terms such as “Nintendo Wii”, “rehabilitation”, “elderly”, “gaming systems”, “reduced”, “fall risk”, “exergaming”, “video games”, “fall prevention”, and “nursing interventions”. Databases that contain articles related to the field of Nursing were specifically searched, within which a time frame for articles that were published within the past five years was specified. Additional search techniques included specifying Evidence-Based Practice articles, Nursing journals, and references from previous sources found. We searched Cochrane, Johanna Briggs, and AHRQ Clinical Practice Guidelines for systematic reviews and clinical practice guidelines in relation to our topic, but no relevant articles or documentations were found.

Discussion

The current therapy used to reduce the risk of falls in the elderly population is general physical therapy. Physical therapy can be expensive, difficult to adhere to, impossible to practice alone, Exergaming is an enjoyable and affordable therapy option that has shown to be effective, and can be used at home or in the clinical setting. In order to change current practice more research needs to be done to evaluate the full effects of computerized gaming systems on fall prevention in the elderly. Off the shelf virtual reality gaming systems have already proven to be effective, but further studies to examine the effects of specialized gaming systems for therapy are needed to prove that they are more effective and efficient than current therapies, and not simply equal in fall prevention outcomes.

Evidence

• Studies using questionnaires to evaluate participants feelings about the gaming systems found they felt the games were easy to use, enjoyable, motivating, and increased confidence in their ability to maintain balance– (Szturm, Betker, Moussavi, Desai, & Goodman, 2011; Franco, Jacobs, Inzerillo, & Kluzik, 2011; Rand, Kizony, & Weiss, 2008; van Diest, Lamoth, Stegenga, Verkerke, & Postema, 2013 ).

• The gaming systems were proven to be valid and reliable tools for measuring balance and stepping ability in older adults. Many of the systems could detect subtle changes in balance, and the scores earned in the games proved to correlate with real life balance ability (Szturm, Betker, Moussavi, Desai, & Goodman, 2011; Schoene, Lord, Verhoef, & Smith, 2011).

• Participants perceived improvements in their balance, and experienced actual, measurable, improvements in balance as indicated by the difference between the control groups and the groups that received therapeutic interventions with the gaming systems. Reaction time, balance, gait, and neuro cognition improved in groups receiving the interventions. – Ingo, (Szturm, Betker, Moussavi, Desai, & Goodman, 2011; Franco, Jacobs, Inzerillo, & Kluzik, 2011; Lai et al., 2012; van Diest, Lamoth, Stegenga, Verkerke, & Postema, 2013).

• Five of the seven articles used had a Level of Evidence (LOE) of II. The sixth article had a LOE of I, and the seventh had a LOE of III.

Recommendations

• Balance board gaming technologies are an enjoyable and affordable therapeutic tool which should be used to improve recovery times after an incidence of falls as they have been shown to hastened restoration of vestibular compensation. Long-term balance improvements after cessation of interventions prove this tool to be useful and effective as a short-term and long-term therapy (Szturm, Betker, Moussavi, Desai, & Goodman, 2011; Lai et al., 2012; Sparrer, Dinh, Ilgner, & Westhofen, 2013).

• Grade B

• Camera gaming systems proved to be enjoyable for all users as well as adaptable for patients with various limitations. Findings also showed that the camera gaming system was as effective, or more effective than current therapeutic methods. For these reasons camera gaming systems should be used as both an assessment and therapeutic tool in the clinical and home setting for elderly patients recovering from, or at risk for, falls (Rand, Kizony, & Weiss, 2008).

• Grade B

• Dance mat gaming technology was found to be a valid and reliable tool for assessing fall risk. Low scores in the game indicated a high risk for falls, making it a useful evaluation tool as well as a useful training tool. Gaming technology using a dance mat should be utilized in the clinical setting to assess patients for fall risks (Schoene, Lord, Verhoef, & Smith, 2011).

• Grade B

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