Is Virtual Reality Training the Missing Link in Fall Prevention for Older Adults?

As we age, we can get trapped in a cycle of frailty that begins with a natural loss of muscle strength and muscle mass, making us susceptible to falls and injury. While research over the past two decades has repeatedly shown that resistance training and fall prevention programs promoting balance through building core strength and muscle memory decrease the rate of falls in senior populations, there is a third contributor to fall risk that, has been largely ignored: A breakdown in executive functioning.

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The Dividat Senso, a scientifically based dual-tasking fall reduction and cognitive training platform designed to support independence, addresses this breakdown through full-body virtual reality gaming. To better understand the science behind the Senso, we sat down with Eva van het Reve, Dr. Sc. ETH, Movement Scientist for Dividat in Zurich.

HUR: Thank you for speaking with me today, Eva. Could you start by explaining briefly what the Dividat Senso is?

Eva: Absolutely. The Dividat Senso is a dual-tasking fall reduction training system engineered to improve physical and cognitive function in older adults. Users stand on a platform and move through interactive games and activities displayed on a screen in front of them. Sensors in the base plate capture each user’s movements and record the data, making automatic adjustments to their personal program to keep the activities challenging but also safe for their ability level.

HUR: Why is cognitive functioning important for fall prevention? Isn’t it enough for older adults to engage in regular resistance training and balance exercises?

Eva: We know that physical exercise is important as we age – particularly strength and balance training. But, even in older adults that are engaged in regular strength and balance training, we still see a lot of falls. Why is that happening? Well, recent research suggests that there is an important link between physical exercise and cognitive abilitiesAnd, it appears that falls are largely a cognitive problem.

Resistance training and balance exercises increase strength and motor control, both of which are extremely important for fall prevention. But, the missing link is training that prevents a decline in executive functioning. Muscle strength is vital to active aging, but it’s only one piece. When we think about age-related muscle loss, we must also think about the nervous system because the two are intrinsically linked. When our ability to quickly respond to a variety of elements in our environment declines the risk of a fall increases – regardless of how strong we are.

HUR: What kind of declines in executive functioning do most people experience as they age and how do those declines impact their life?

Eva: Just as we experience structural changes in our bodies as we age, our brain also changes as we get older. There is a natural loss of brain mass, reduced blood flow to the brain, and declines in functioning, especially in the prefrontal cortex and hippocampus. These areas control executive functioning that governs control over movement, allowing us to react quickly to the world and shift attention from one task to the other so that we can move through the world successfully.

As we age, signals between the brain and the rest of our body move slower and we lose cognitive flexibility. This decline in processing speed means that we have a difficult time reacting to our environment. For older adults experiencing cognitive declines, a slower reaction speed to unexpected obstacles can make day-to-day life challenging and presents a huge fall risk.

This is why interactive cognitive and motor training, is so important for fall prevention. Strength and balance training are incredibly important for fall prevention. But, if our muscles can’t receive information quickly enough to respond, strength alone will not prevent a fall. Training that improves our central nervous system’s ability to transmit that information is the missing link in fall prevention that the Dividat Senso locks into place.

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HUR: How does the Dividat Senso work to improve cognitive functioning and prevent falls?

Eva: Essentially, Senso’s games and activities are designed to target our ability to quickly interact with the environment through effectively processing sensory stimuli. With a full functioning central nervous system, outside stimuli is quickly delivered to the brain. The brain processes the information and creates a movement plan to deal with it effectively. Of course, this needs to happen very fast.

The Senso trains this process of quickly recording, processing, and transmitting information between the brain and the rest of the body. When this process works well, it lowers the risk of falls. Most encouraging, studies show that technology-based training that links cognitive challenges to motor tasks in a virtual learning environment is one of the most effective ways to improve cognitive flexibility and achieve a strong, steady gait. This is what the Senso does.

Users stand on a platform equipped with sensors and the Senso displays a game or activity on the screen in front of them. To play the game, users must complete rapid, goal-directed steps, requiring them to think and move in specific ways that strengthen the mind-body connection and support cognitive strength. As each user trains, the Senso tracks and records their performance, automatically adjusting to maintain an ideal level of challenge and safety.

This is very important because just as you must keep challenging muscles to build physical strength, you must keep challenging the brain to build cognitive strength. But, games that move too quickly or require too complex movements are not safe. The Dividat Senso manages this balance automatically, adjusting the challenge level up or down depending on the user’s real-time performance.

In addition to offering visual and auditory feedback, the Senso also provides the user with tactile stimuli through vibration from the ground platform. And, for individuals with cognitive impairments that make it difficult to follow a game on the screen, LED lights are integrated on the step platform.

HUR: Are the games and activities offered on the Senso fun? How often do you recommend that people train on the Senso and what are the age limitations?

Eva: Yes! They are a lot of fun and there is a lot of variety so people of all ages, interests, and ability levels can find games they will enjoy playing. One thing I hear all the time from seniors who train on the Senso for the first time is that they didn’t think they liked to play video games but had a lot of fun on the Senso. The Dividat Senso automatically adjusts the challenge level of the game every twenty seconds. This not only makes training on the Senso effective, but it also helps maintain interest.

I recommend that seniors train on the Senso at least twice a week for 15 minutes a session. Three times a week is even better. And, there is no age limit! We’ve had people who are over 100 years old train on the Senso. I believe the oldest was 104.

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