Falls in older people is one of the most researched areas of physiotherapy. It is not surprising when you consider 1 in 3 over the age of 65 will fall once a year and unfortunately they are a major cause of morbidity and mortality. The urgency of research is there but sometimes the feasibility of implementing the findings is a barrier to reaping the clinical rewards. But this novel approach is certainly soon to be available to all institutions helping those vulnerable to falls.
Mirelman et al asked themselves if combining treadmill training AND non-immersive virtual reality would improve cognition, mobility and lead to fewer falls. Tentatively just consider that they compared this to treadmill training alone, which as advised by NICE, is an ineffective treatment to reduce falls in isolation. Encouragingly they allowed anyone with a two or more falls history (in the past 6 months), that were between 60-90 years of age and had a wide range of deficits (cognitive, physical or combined, IPD for example). The participants (n=282) were randomised into a control group or a 6 week intervention group and were stratified considering their past medical histories.
The intervention itself included 3x/45 minute structured training progression per week with the VR system. The system consisted of a camera, screen and the video package which included real-life challenges such as obstacles, multiple pathways, and distracters that required continual adjustment of steps.
The headline to take from this is that the VR training did reduce the number of falls post intervention when compared to treadmill training alone. However just consider that treadmill training alone in inadequate and not advised as a treatment so before this can be conclusive other comparisons need to be made.
Other things to consider:
- Novel approach uptake to those unfamiliar with technology
- Co-operation from those with a cognitive impairment
- Fear / misunderstanding when using VR