A Novel Video Game-Based Device for Measuring Stepping Performance and Fall Risk in Older People

Schoene D, Lord SR, Verhoef P, Smith ST. A novel video game based device for measuring stepping performance and fall risk in older people. Arch Phys Med Rehabil 2011;92:947-53. Objective: To determine whether a dance mat test of choice stepping reaction time (CSRT) is reliable and can detect differences in fall risk in older adults. Design: Randomized order, crossover comparison. Setting: Balance laboratory, medical research institute, and retirement village. Participants: Older (mean age, 78.87+/-5.90y; range, 65-90y) independent-living people (N=47) able to walk in place without assistance. Interventions: Not applicable. Main Outcome Measures: Reaction (RI), movement, and response times of dance pad based stepping tests, Physiological Profile Assessment (PPA) score, Digit Symbol Substitution Test (DSST) score, time to complete the Trail Making Test (TMT) A+B, Fall Efficacy Scale International (FES-I) score, Activities-specific Balance Confidence (ABC) Scale score, and Incidental and Planned Exercise Questionnaire (IPEQ) incidental IPEQ activity subscore. Results: Test-retest reliability of the dance mat CSRT response time was high (intraclass correlation coefficient model 3,k=.90; 95% confidence interval [CI], .82-.94; P<.001) and correlated highly with the existing laboratory-based measure (r=.86; 95% CI, .75-.92; P<.001). Concurrent validity was shown by significant correlations between response time and measures of fall risk (PPA: r=.42; 95% CI, .15-.63; P<.01; TMT A: r=.61; 95% CI, .39-.77; TMT B: r=.55; 95% CI, .31-.72; DSST: r=-.53; 95% CI, -.71 to -.28; P<.001; FES-I: Spearman rho=.50; 95% CI, .25-.69; ABC Scale: Spearman rho=-.58; 95% CI, -.74 to -.35; P<.01). Participants with moderate/high fall-risk scores (PPA score >1) had significantly slower response times than people with low/mild fall-risk scores (PPA score <1) at 1146+/-182 and 1010+/-132ms, respectively (P=.005), and multiple fallers and single/nonfallers showed significant differences in RT (883+/-137 vs 770+/-100ms; P=.009) and response time (1180+/-195 vs 1031+/-145ms; P=0.017). Conclusions: The new dance mat device is a valid and reliable tool for assessing stepping ability and fall risk in older community-dwelling people. Because it is highly portable, it can be used in clinic settings and the homes of older people as both an assessment and training device.