What is your doctors' protocol on balance? Or is it just 'wing it' and hope you figure out how to stay upright? If you don't have a SPECIFIC PROTOCOL your doctor is incompetent.
Recalibrating disparities in perceived and actual balance abilities in older adults: a mixed-methods evaluation of a novel exergaming intervention
Journal of NeuroEngineering and Rehabilitation201815:26
© The Author(s). 2018
Received: 8 December 2017
Accepted: 11 March 2018
Published: 22 March 2018
Abstract
Background
Published reports suggest a disparity between perceived and actual balance abilities, a trait associated with increased fall-risk in older adults. We investigate whether it is possible to ‘recalibrate’ these disparities using a novel gaming intervention.
Methods
We recruited 26 older adults for a 4-week intervention in which they participated in 8-sessions using a novel gaming intervention designed to provide explicit, augmented feedback related to postural control. Measures of perceived balance abilities (Falls Efficacy Scale-International) and actual postural control (limits of stability) were assessed pre- and post-intervention. We used focus groups to elicit the opinions of participants about how the game may have influenced balance abilities and confidence.
Results
A stronger alignment was observed between postural control and perceived balance capabilities post-intervention (i.e., significant correlations between Falls Efficacy Scale-International scores and limits of stability which were not present pre-intervention). Also, significant improvements in measures of postural control were observed, with these improvements confined to the aspects of postural control for which the exergame provided explicit, augmented feedback. Qualitative data revealed that the intervention made participants more “aware” of their balance abilities.
Conclusions
Our results demonstrate that it is possible to recalibrate the perceptions of older adults relating to their balance abilities through a targeted, short-term intervention. We propose that the post-intervention improvements in postural control may have been, in part, the result of this recalibration; with altered perceptions leading to changes in balance performance. Findings support the application of novel interventions aimed at addressing the psychological factors associated with elderly falls.
Keywords
Self-efficacyBalance confidencePerceived balance abilitiesExergame intervention
Background
Bandura’s [1] Self-Efficacy Theory states that it is our perceived, rather than actual, capabilities which determine the actions we select. However, an accurate awareness of our physical abilities—both our strengths and our weakness—is critical to ensuring that we avoid taking any unnecessary risks when navigating our environment. For example, before deciding which walking path to select—a shorter, ‘risky’ path covered in ice, or a longer, ‘safer’ path—we need to appraise our physical capabilities. However, approximately one-third of older adults misjudge their balance abilities, either over- or under-estimating their physical capabilities [2].
Disparities between perceived and actual balance abilities
A discrepancy between perceived and actual capabilities will likely lead to these individuals engaging in either unduly cautious or risky behaviours; both of which may increase the likelihood of a fall occurring. For example, a cautious approach will likely lead to activity avoidance, which in turn is associated with a reduction in physical activity and increased risk of falls [3], while an overly risky approach may increase the likelihood that an individual will attempt a task which they are unable to safely complete. As elderly falls are the leading cause of injury, and mortality from injury, in those aged 65 years and older [4], the development of cost-effective methods to reduce falls is an important public health challenge. One potential method for reducing falls may be through addressing the inaccurate perceptions of fall-risk made by elderly people. While physical training is a commonplace method to target falls in the elderly, modifying inappropriate levels of confidence relative to physical ability is both novel and theoretically achievable through employing principles of motor learning, such as augmented feedback.
Fear of falling is negatively associated with numerous markers of wellbeing in older adults, including a restriction in physical activities, social isolation, decreased quality of life and increased fall-risk [2, 3, 5, 6, 7]. These attributes have led to the common view that fear of falling is maladaptive and should be reduced through interventions. However, fear of falling may not always be associated with an increased risk of falling, particularly if this fear represents an accurate appraisal of one’s balance abilities. In these cases, this fear may even reduce the risk of falls by encouraging the individual to avoid exposing themselves to unnecessary risk [8]. Therefore, designing interventions to indiscriminately reduce this fear of falling may have a detrimental effect on actual falls. Furthermore, while approximately 10% of the older adults in the sample studied by Delbaere and colleagues [2] were under-confident in relation to their balance abilities, 20% over-estimated their physical capabilities. Therefore, reducing fear of falling in individuals who have either accurate or over-confident perceptions of their balance abilities may even increase the risk of falls by encouraging these individuals to perform tasks beyond their physical capabilities.
As a result, it might be more important for “intervention programmes to help elderly people develop a realistic appraisal of fall risk or improve physical functioning in concert with addressing fear, rather than just reduce fear of falling” ([2], p.1). Yet, the majority of interventions that address fear of falling in older adults are designed to indiscriminately reduce fear (i.e. [9]), rather than attempting to ‘recalibrate’ these individuals’ perceptions of their balance abilities. Therefore, the aim in this present research is to determine if it is possible to recalibrate perceptions amongst older adults of their balance capabilities through a carefully designed, short-term exergaming intervention.
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