Stepping, cognition and fall risk - The identification of fallers and amelioration of fall risk through interactive dance pad games in older people

With aging, sensorimotor and specific cognitive functions decline with one consequence being an increased fall risk. Taking rapid and wellcoordinated steps is important for safely moving around in a challenging environment and requires functional sensorimotor and cognitive ability to avoid falling.Interactive cognitive-motor training, such as exergaming (exercise within video games) is a recent development from the field of video games. They involve stimuli presented on a projection screen and human gross motor movements as responses. A step pad is an exergame response device that requires players to step in different directions depending on the presented stimuli with step times and errors recorded. Hence, step pad systems combine sensorimotor and cognitive abilities in a functional context.The main aims of the project were:1. To investigate whether an easily administered step test that combines stepping and cognition can predict falls in older people without major cognitive impairment2. To explore whether games/tasks that combine stepping and specific cognitive functions are beneficial in improving sensorimotor and cognitive risk factors for falls in older people.To answer the first question, several step tests were developed based on evidence regarding the importance of specific cognitive functions on fall risk and validated in cross-sectional and cohort studies.To answer the second question, two randomised controlled trials were conducted using different exergames. During both interventions participantsexercised unsupervised at home.The main findings of this project were:- Step tests that include an inhibitory component discriminate between fallers and non-fallers- ‘iCSRT’, a test that combines rapid step initiation with inhibition and response selection predicts falls in older people- Playing a modified open source stepping exergame improved sensorimotor functions- Playing a range of stepping exergames improved some tests of cognitive functioningFindings of this PhD demonstrate that the combination of stepping and executive functioning is associated with falls in older people. An easy-to administer step test using exergame technology can be used as a fall risk screen. Stepping exergames can also be used to improve important sensorimotor and cognitive risk factors for falls. This intervention can be carried out unsupervised in the home setting