Desenvolvimento e usabilidade de um jogo digital para reabilitação do equilíbrio postural de idosos

Abstract

Introduction: Aging causes physiological changes that may compromise the adaptation to daily living demands, leading to restrictions on postural balance and their functional independence. A variety of therapeutic approaches have prioritized postural balance restoration or maintenance, highlighting the Virtual Reality-based therapies (VR). In this sense, serious games have been developed in order to adapt the virtual environment to the patient's therapeutic demands and needs, reflecting positively on the effectiveness and usability of this type of tool. Objectives: 1) To develop a systematic review aiming to summarize the evidence of the use of serious and commercial digital games on postural balance of the older adults; 2) Develop a serious game for balance training of older adults using a low cost motion capture system. 3) To perform a content validity of the game. 4) To test, in a pilot study, the applicability and the effect of the game on the balance and physical performance of older adults. Methodology: This study involved four types of methodological modalities: 1) Systematic Review; 2) Game Development; 3) Validity of a utility model (digital game) for postural balance rehabilitation and 4) Pilot study with an experimental design with 50 older adults. The participants of the pilot study were subjected to a balance assessment by using a Force Plate and the Berg Balance Scale (BBS) and a physical performance assessment with the Short Physical Performance Battery (SPPB). Participants’ were ramdomly allocated in experimental or control group. The experimental group performed an intervention protocol using the digital game developed by the researchers of this study - called VirtualTer (Virtual Therapy), 3 times a week for two weeks and duration of 20 minutes each session. The control group received a booklet with 5 exercises based on the Otago protocol to be performed at home with the same duration and frequency as the experimental group. At the end of the intervention period, participants were reevaluated, using the same procedures as the initial assessment. Results: 1) Systematic Review - 12 studies comparing exergames with no intervention were included. A total of 1520 older adults were included in the studies, with a mean age of 76±6 in the experimental groups and 76±5 in control groups. three studies found significant improvements in balance considering the BBS and center of pressure oscillation. Three studies found improvements in mobility, considering the Timed up and Go test, 30-second sit-to-stand test and the alternate step test. 2) Game development: VirtualTer was developed by a team of physiotherapists and computer scientists from Federal University of Rio Grande do Norte. The main objective of this serious game was to promote balance training for older adults in a motivating and representative environment. VirtualTer uses Kinect for motion capture in tasks involving stationary walk, lateral reaching, and go up and down steps, divided in 03 phases with different levels of difficulty. 3) Content Validity: The content of the game was validated by 11 specialists (45.5% physiotherapists and 54.5% science and technology professionals). The total CVI of the game was 0.8 and Cronbach's alpha coefficient was 0.924. 4) Pilot Study: Fifty older adults participated in the pilot study. VirtualTer group showed statistically significant withingroup differences for eyes close test on CoP velocity (p = 0,04) and CoP total trajectory (p = 0,03) and both groups showed significant increase in BBS and SPPB. No between-group difference was observed. Virtualter had 75.2% of satisfaction according to SUS. Conclusion: Although there is a wide offer of digital games for rehabilitation, VirtualTer raised a discussion about the importance of multidisciplinarity in the development of this type of games. In addition, VirtualTer is a product with good usability and has a valid content, corresponding to a motivating technological tool suitable for training postural balance of older adults. Additional studies should be performed to investigate whether a longer period of intervention may influence on CoP changes.