A virtual reality exposure therapy (VRET) scenario for the reduction of fear of falling and balance rehabilitation training of elder adults with hip fracture history

It is known that elderly who fall can suffer serious injuries. The American Geriatrics Society Panel on Falls Prevention has included in its specific recommendations for single intervention exercises including a component of balance training. Studies have shown that training programs such as tai chi, biofeedback, and virtual reality training can improve balance in elderly people (Nyberg et al., 2006; Bisson et al., 2007). Previous studies have indicated that the gait pattern in older people may be affected by fear of falling, and that perceived postural threat induces a stiffening strategy in the ankle joint. The interconnections between phobic disorders, anxiety and postural anomalies have already been clearly established. Our main aim was to investigate the reduction of fear of falling in older people with hip fracture history using a virtual reality exposure therapy scenario with graduate postural threat on gait parameters. To pursue this aim we developed a virtual "shopping list" performing scenario that included a gradual exposure to different challenging postural threats (e.g. changing treadmill surface height, virtual "slippery" streets) across some multi-tasking conditions (e.g. walking while counting backward aloud and carrying a virtual glass of water) and measured gait adaptation. Sixty eight community-dwelling older people (31 males, 37 females) with a mean age of 76.8 (SD=5.2) walked at a self-selected comfortable speed across a treadmill wearing (GAITRite) shoes and a KEO hmd (Proview XL-50).