Comparison of Virtual Reality And Task Oriented Circuit Training On Gait, Balance and Cognition Among Elderly Population

As the individual ages, numerous physical and functional alterations occur especially frailty, disturbed body balance, physical and cognitive declines, impaired gait hence leading to falls among the elderly population. Fall is defined as an event in which an individual unintentionally loses balance and inadvertently coming to rest on ground or lower surface. While Balance is the ability to maintain the center of mass on the base of support (BOS) without causing a fall. According to WHO survey, falls are the second leading cause of accidental or unintentional injury deaths worldwide. Approximately 40% of older adults >65years fall at least once a year and 10-20% of these falls results in hospitalizations which leads to poor Quality of Life. Women are more prone for age specific fall rates as compared to men. Cognition is referred to as "The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". Optimum cognitive levels are important for successful aging and any deficits should be monitored. Altered cognition affects the Activities of Daily living (ADL), causes disabilities and directly impacts the Quality of Life. A study by Ray et al, deduced that Cognitive training significantly increased the Gait speed and improved the Timed up and go test values, hence Cognitive training slows degradation of balance and improves gait while distracted, rendering it a promising approach to falls prevention.

United States Preventive Service Task Force (USPSTF), evaluated that risk of falls increases with age and include multiple factors: Balance and gait deficits, cognitive impairments, medications, frailty, fear of falling, vision and environmental hazard. USPSTF recommends multifactorial interventions to address the balance and fall related issues among elderly. These protocols include improving Balance and gait, improving cognition, environmental alterations, balanced diet and nutrition along with appropriate medications. Adequate exercises helps to improve general body conditioning to overcome the deteriorating effects of aging hence, better Quality of life QOL. Previously it has been reported that a number of specific approaches are useful in improving balance, gait and cognition as compared to general conventional therapies: they include Virtual Reality, Goal oriented training, Task-oriented training, Kinect training and Visual feedback, Motivational interventions with active participations and Focused repetitive training.

As the technological advancement has occurred in recent years, "Virtual Reality" is being incorporated in the PT management sessions to minimize the limitations in the existing interventions and hence improving the deficits. VR training refers to interactive stimulations enabling the user to experience the virtual environment similar to reality by incorporating computer hardware and software. In comparison to home-based exercise plans, VR training enhances motivation by introducing practical gaming element. A Study conducted by on elderly 60-85yrs and they assessed the effects of Wifiit VR games and found that the scores of body Center of pressure-COP movement area (Romberg test) with eyes open and eyes closed improved among experimental group individuals after 8 weeks of trials hence improved Balance. Likewise as reported , VR game exercises improves balance and gait in elderly over 65 yrs of age - increases the step length while average Sway time and Time up and go test TUG both decreased towards normal as compared to conventional Ball exercises.

Task oriented Circuit training CT is a series of systematically devised protocol, which embodies multiple endurance and strength training parameters with moderate and high intensities and sufficient repetitions of functional tasks. As reported that Circuit training improves the partial O2 concentration, Respiratory rate-RR, HR hence overall cardiac endurance and physical functioning. CT also helps in maintenance of functional Quality of life. Several studies have reported that Virtual Reality and Task-oriented circuit training also assists in motor and balance recovery among the stroke and CP. As documented by Lee et al,(13) they compared the effects of VR against CT among the stroke patients and concluded that static balance and Functional reach test outcomes were higher in VR group as compared to CT group hence making Virtual Reality more feasible for balance training. A study concluded that on older adults and deduced that VR training causes improvement in hip muscle strength of the extensors, flexors, adductors, and abductors after 8 weeks along with greater ground reaction force on the backward stepping test (with eyes opened and closed) and the crossover stepping test( with eyes open and closed).