Using virtual reality to prevent falls in older adults

Annually, one in four senior citizens seek emergency care from a fall-related injury. Traditionally, conventional physical therapy rehabilitation approaches have been used to help prevent falls, which are often the result of poor balance. However, many in the physical therapy field now view immersive virtual reality (VR) technology as an intriguing option. While laboratory-based experiments provide promising findings, to date this technology has yet to be translated into clinical settings. 

Tiphanie Raffegeau of George Mason University ’s School of Kinesiology in the College of Education and Human Development, and Christopher Rhea, Old Dominion University’s associate dean for Research and Innovation in Ellmer College of Health Sciences, envisioned a future where clinicians could use affordable VR technology to outperform traditional diagnostics, therapeutics, and pharmaceutical approaches in fall prevention. They saw an opportunity to develop effective uses of VR technology to detect cognitive-motor function in older adults and identify fall-risk factors for this population. They were awarded a 4-VA grant for the project. 

Raffegeau’s prior research focused on inducing anxiety during walking to study the fear of falling with an elevated height VR paradigm, while Rhea has primarily concentrated on examining how people adapt their steps to avoid obstacles in virtual environments. Through a 4-VA partnership, they aimed to increase accessibility to rehabilitative VR technology for interventions focused on reducing older adult fall-risk, while developing a framework for future scalable and fundable research. 

Raffegeau hired three student programmers, Trevor Hsu, Chara Canfield, and Micah D Williams, from George Mason’s Virginia Serious Game Institute (VSGI) to help. The student programmers were supervised by VSGI research faculty member Jacob Enfield. Two George Mason University graduate students are also working on the project: Kelly Poretti and Mackenzie Barrowman.  

After a year of research, Raffegeau noted, “Our testing proved fruitful, and we identified a number of important results.”  

First, they found that experiencing fall-related anxiety in immersive VR can further impair a senior’s walking performance. Interestingly, they also found that the anxiety response tapers over time, suggesting that experiencing virtual high-elevation settings may reduce fall-related anxiety overall. They also saw that anxiety-provoking VR settings could promote stability-related adaptations during non-VR walking in impaired populations. This suggested that the VR experience could serve as a clinical intervention to improve walking.  

They shared their findings at the Gait and Clinical Movement Analysis Society’s annual meeting, the American Society of Biomechanics annual meeting, and the College of Education and Human Development’s Research Symposium. 

Poretti, who is working on a PhD in Education, was awarded the Switzer Research Fellowship for Doctoral Dissertation Research by the Administration for Community Living for her dissertation “Using Virtual Reality to Reduce Mobility-Related Anxiety in Lower-Limb Prosthetic Users,” which uses preliminary data from the VR project. 

“This 4-VA funding provided crucial funds to support my work as an early investigator, and it has made my future grant applications stronger as evidence of institutional support for my career trajectory,” Raffegeau said. 

Raffegeau and Rhea will continue to pursue this line of research. They recently submitted a proposal to the National Institutes on Aging on “Investigating Biobehavioral Responses to Mobility-Specific Anxiety Across the Menopause Transition and the Effects on Mobility and Fall-Risk,” focusing on the effect of VR-induced fall-related anxiety on walking in pre- and post-menopausal older women.