Innovative app-based games boost exercise performance for vestibular hypofunction patients

In a recent study published in Frontiers in Medicine, a group of researchers evaluated the impact of a gaming app on exercise performance accuracy and patient engagement in vestibular rehabilitation exercises for individuals with vestibular hypofunction.

Study: A gaming app developed for vestibular rehabilitation improves the accuracy of performance and engagement with exercises. Image Credit: Ground Picture/Shutterstock.comStudy: A gaming app developed for vestibular rehabilitation improves the accuracy of performance and engagement with exercises. Image Credit: Ground Picture/Shutterstock.com

Background 

The National Health and Nutrition Examination Survey (2001–2004) indicates that 35.4% of American adults currently experience vestibular problems, and this percentage increases with age.

Present data validates these observations, with almost one-third of people above 50 years having vestibular-based dizziness. This can cause vestibular hypofunction and thus dizziness, visual disturbance, and instability, increasing fall risk. A vestibular rehabilitation exercise can reduce these symptoms and the chances of falling.

As suggested by Clinical Practice Guidelines, three to five home exercises per day are desirable for maximum effectiveness. Unfortunately, only about half of the patients follow up with those practices due to boredom, failure to understand, fear, and no feedback.

Older and neurologically diverse populations have demonstrated increased adherence to technology-based interventions. Hence, further research is needed to create and test innovative, engaging technological interventions for vestibular rehabilitation, targeting the improvement of adherence and effectiveness in older adults with vestibular dysfunction.

About the study 

In the present study, researchers developed a gaming app to evaluate its effectiveness in enhancing the accuracy of exercise performance. The study involved forty healthy adults (aged 67) diagnosed with unilateral/bilateral symptomatic vestibular hypofunction.

They were required to complete vestibular-ocular reflex (VOR) exercises in various planes, along with weight-shift and single-leg balance exercises. The exercises used an inertial motion unit (IMU) to control a character on a tablet screen, responding to the participants' physical movements.

The participants were thoroughly chosen according to their age, diagnosis of vestibular hypofunction, and physical status. Still, those who had a history of neurological disorders or underwent surgeries within a week that might impair balance exercise performance were excluded. Recruitment of participants came from various sources, including clinics, databases, and the community.

The study was conducted at the University of Kansas Medical Center and included several participants taking evaluations before the exercises’ commencement. The orders of the exercises were also randomized to enable them to work with and without the app. The app, installed on an Android tablet, utilized the IMU for interactive gameplay.

The participants were provided control of the character on the screen during VOR exercises and received feedback on accurate movement. This experimental design enabled a complete comparison of exercise performance and engagement with and without the app.

Study results 

The study's results assessing the effectiveness of a gaming app for vestibular rehabilitation showed significant improvements in exercise performance and participant engagement.

During VOR exercises, participants using the app achieved the prescribed head motion frequency in the yaw plane (p ≤ 0.001). They exhibited reduced variability in head movement frequency in both yaw and pitch planes (p ≤ 0.001) compared to the no-app condition. This suggests a more consistent and controlled performance with the app's assistance.

In weight-shifting exercises, significantly greater motions along with the anteroposterior and mediolateral axis were observed compared to the app-based intervention (p < 0.05).

The frequency of whole-body motion was also significantly different between the no-app and app conditions for these exercises (p ≤ 0.001). However, in this instance, a lower frequency indicated more controlled movements while using the fitness app.

The study showed that there was significantly less body movement in the app condition for single-leg balance exercises compared to the no-app condition (p = 0.02). Still, the fluency of body movement was similar in both conditions. This finding suggests that the app may help achieve more stable single-leg stances.

Common errors identified during VOR exercises with the app included jerky head motion (13% of participants), excessive chin motion (7%), and head motion exceeding the prescribed range (9%).

These errors were less prevalent than in the no-app condition, where excessive head motion was noted in 28% of participants. This demonstrates the app's effectiveness in reducing exercise errors through auditory and written feedback.

Participant feedback was overwhelmingly positive, and over 90% of participants agreed that the app was helpful and easy to use. They also indicated that the app made the rehabilitation process more engaging and enjoyable, with 97% feeling motivated by the in-app rewards like trophies and scores.

However, 10% of participants reported worry, nervousness, and frustration while using the app. The app's user interface received high ratings, with all average responses scoring seven or higher on a scale of 0 to 9, indicating a user-friendly design.

Participants highlighted the app’s interactivity and feedback as positive aspects, appreciating the real-time monitoring of their movements and the system’s responsiveness to their actions.

Some negative feedback focused on sensor response times, with a few participants feeling that the app did not respond quickly enough to their movements. Suggestions for improvement included a preference for auditory over written feedback to avoid interrupting the flow of exercises.

Equipment availability was mentioned as a potential barrier, with concerns that not everyone can access a tablet or a stand for optimal app use.

Journal reference:
Vijay Kumar Malesu

Written by

Vijay Kumar Malesu

Vijay holds a Ph.D. in Biotechnology and possesses a deep passion for microbiology. His academic journey has allowed him to delve deeper into understanding the intricate world of microorganisms. Through his research and studies, he has gained expertise in various aspects of microbiology, which includes microbial genetics, microbial physiology, and microbial ecology. Vijay has six years of scientific research experience at renowned research institutes such as the Indian Council for Agricultural Research and KIIT University. He has worked on diverse projects in microbiology, biopolymers, and drug delivery. His contributions to these areas have provided him with a comprehensive understanding of the subject matter and the ability to tackle complex research challenges.    

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