Evaluation of applicability, safety, tolerability and acceptance of an immersive virtual reality system COGMIS g for cognitive-motor training of elderly

• Grant number: 19/07986-5
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: May 01, 2020
• End date: April 30, 2021
• Field of knowledge: Interdisciplinary Subjects
• Principal Investigator: José Eduardo Pompeu
• Grantee: Da Hee Chun Kim
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

The demographic transition process is a worldwide phenomenon characterized by an increase in the number and proportion of elderly people in the population. Aging contributes significantly to the increased risk of falls and comorbidities due to the impairment of the systems involved in postural control. Falls in the elderly can cause serious consequences such as fractures, pain, fear of falling, worsening mobility and greater risk of suffering another fall. The costs of treating the consequences of falls in the elderly are high. Thus, effective interventions for improving postural control in the elderly and consequent prevention of falls have been proposed. Recent studies show that video games can be as effective as conventional physical therapy in reducing the risk and incidence of falls in the elderly. However, commercial video games are non-immersive, that is, the gaming environment is projected on a screen. Studies show that immersive environments promote a greater sense of presence in the virtual scenario and increase the user's sensory and emotional stimulation, being a potential resource for training postural control in the elderly. However, there are no immersive systems developed specifically for training postural control in the elderly. Objective: The objective of the present study will be to evaluate the applicability, safety, tolerability and acceptability of an immersive virtual reality system developed specifically for training postural control in elderly fallers. Method: this is a cross-sectional study in which 20 elderly, 60 to 80 years old, with a history of at least one fall in the last year, will be included. The eligibility criteria will be: individuals of both sexes aged between 60 and 80 years old, with normal or corrected visual and hearing acuity, not having color blindness, having normal gait capacity without the need to use auxiliary devices, and that agree to sign the informed consent form for the study. Individuals with previous diseases or complaints associated with vestibular dysfunctions such as labyrinthitis, benign paroxysmal positional vertigo and motion sickness will be excluded from the study. These changes will be screened using the Pre-Virtual Reality Discomfort Questionnaire. Color blind individuals will also be excluded from the study (who will be identified by self-declaration and / or application of the Adapted Ishihara Test), individuals weighing more than 120kg and individuals with systolic pressure greater than 120 mmHg and diastolic pressure less than 80 mmHg. The clinical and sociodemographic characteristics of the participants will be assessed. Participants will be characterized in relation to cognition through the Montreal Cognitive Assessment. Mobility will be assessed using the Timed Up and Go. The level of physical activity will be assessed using the IPAQ (International Physical Activity Questionary). Before the test starts, the participant will answer a questionnaire about vestibular symptoms and familiarity with the technology. Then, the elderly will test the system for 10 minutes. The system consists of immersive virtual reality glasses and 2 manual controls. The cognitive-sensory-motor task consists of popping colored and numbered balloons that float around the user. At each stage, the participant needs to pop the balloons to solve mathematical calculations. In this way, the system stimulates the movement of reach, rotation of the head and trunk, steps in different directions, squatting and lifting, among other movements. In addition, there is a cognitive demand for attention and calculation. After the test, the elderly will answer questionnaires about applicability, safety and tolerability. The results will be presented by means of descriptive statistics mean, median, standard deviation, confidence interval and interquartile interval as well as the absolute and relative number of occurrence of adverse events.