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Objectives: The goal of this project is to design and evaluate clinical interventions to train elderly individuals at high risk for falling. These interventions employ techniques to monitor their stepping-over perfomance and response times.
The specific objectives are to develop a clinical system to measure and improve stepping-over performance, train effective movement strategies, and to demonstrate clinical efficacy of the system in a randomized, controlled intervention study.
Clinical Relevance: Death results from 75% of falls in the 12% of the population that are over 65. The United States Public Health service identified the reduction of falls as a national health priority in it's "Healthy People 2000: National Health Promotion Disease Prevention Objectives". The ability to step over objects is an essential component of ambulation that enables a person to reduce the risk of falling. The frail elderly, a growing Veteran population, would benefit from this research.
Methods: Subjects will participate in one of the three inverventions: stepping over a) real, b) imaginary, and c) virtual objects.
Subjects will be asked to step over a course of 10 foam obstacles.
Subjects will be instructed to "step higher" and "step longer" while walking on a motorized treadmill.
Subjects will be asked to step over virtual obstacles while walking on a motorized treadmill. A composite video image of the subjects' lower body and virtual obstacles will be presented in a head mounted display. Subjects will be asked to step over the virtual obstacles. Shoe mounted vibrotactile stimulators will provide feedback of "collisions" with the virtual obstacles.
Subjects' stepping-over performance before and after a 4 week intervention period will be measured on a standard course of foam obstacles.
Results: The pilot work has led to the following preliminary results:
The most successful technique for presenting virtual objects involved displaying a side-view of stepping on a treadmill while the viewer repeatedly negotiated computer-generated obstacles.
Similar stepping strategies are employed in all three interventions.
A small group of elderly subjects were better able to negotiate an overground obstacle course after 3 training sessions using computer-generated obstacles.
Conclusions: Clinical trials are currently underway with a population of Veterans over the age of 60 who have mild to moderate COPD. The completed study will identify the relative merits of the three interventions with this population.
Acknowledgments: VA Merit Review E2167-2RA