Analysis of the role of virtual reality technology in the assessment and rehabilitation of instability in the elderly population

Objective. To analyze the role of virtual reality technology in the assessment andrehabilitation of instability in the elderly population. Specifically, to study the influenceof sensory perception changes on postural control and to design a customized posturalrehabilitation program for each patient in line with the impact of the different sensorystimuli on his/her postural responses.Methods. Fifty-seven patients over 65 years old were studied, recording on line thebehavior of the body center of pressure (COP) when they were subjected to differentkinds of sensory stimulation, which recreated environmental stimuli using a virtual realitysystem (Medicaa System BRU). Postural responses to oculomotor system, optokineticstimulation, and to visual vestibular stimuli were assessed.The COP distribution area and the body sway velocity (SV) were the two mainparameters processed in the postural control evaluation, and wavelets analysis was usedfor time-frequency analysis of the COP behavior.A group of 46 volunteers was studied as control.Thirty-two of these aged patients with instability were also treated under a balancerehabilitation program (BRP) using a protocol of visual, vestibular and somatosensorystimuli, 3 times a week (40 minutes by session) during 1 month measuring COP, SV, and the Dizziness Handicap Inventory Test (DHI) before and after the treatment. WilcoxonRanked Test was used for statistical analysis.Results. The 57 elderly patients with instability showed higher COP and SV valuesin all the evaluated sensory stimulations. They also showed lower values of the Limits ofStability (LOS) in relation with the control group.The 32 patients with instability trained with the protocol of sensory stimulation had adecrease in COP and SV values showing postural adaptation after the balancerehabilitation program.Conclusion The use of a virtual reality system which recreates the environmentalsensory stimulation and records the postural responses with these stimuli could be usefulto understand the postural weaknesses of elderly patients mainly in open spaces, allowingthe design of a customized rehabilitation program. The potential role of sensorystimulation as an intervention in a fall prevention program in aged patients is alsodiscussed.