Cognitive-motor exergame training on a labile surface in stroke inpatients: study protocol for a randomized controlled trial

 Labile is an adjective used to describe something that is easily or frequently changed.

 

Didn't your competent? doctor start using these unstable shoes for balance recovery a decade ago? NO? So you don't have a functioning stroke doctor, do you?

Unstable Shoes Increase Energy Expenditure of Obese Patients

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Cognitive-motor exergame training on a labile surface in stroke inpatients: study protocol for a randomized controlled trial

Joel Büttiker¹Detlef Marks²Manuel Hanke³Sebastian Ludyga³Petra Marsico⁴Benjamin Eggimann⁵Eleftheria Giannouli^1*

• ¹Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
• ²Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht, Switzerland
• ³Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
• ⁴Research Department, Swiss Children’s Rehab, University Children’s Hospital Zurich, Zurich, Switzerland
• ⁵OST – Eastern Switzerland University of Applied Sciences, Rapperswil, Switzerland

Background: Cognitive-motor training in form of exergames has been found to be feasible and effective for the improvement of motor and cognitive functioning in older adults and several patient populations. Exergame training under unstable conditions might increase the proprioceptive resources needed and thus might be a superior training approach compared to exergame training on stable ground for stroke patients, who often have proprioceptive deficits.

Objective: Aim of this study is to assess the feasibility and effects of exergame-based cognitive-motor training on a labile platform on physical and cognitive functioning in stroke inpatients.

Methods: This is two-armed pilot randomized controlled trial taking place in an inpatient neurologic rehabilitation clinic. A total of 30 persons that are undergoing inpatient rehabilitation due to a stroke will be randomly assigned to either the intervention group (IG) or the control group (CG). Participants of the IG will receive exergame-based motor-cognitive training on a labile surface, whereas participants of the CG will train on a stable surface. Primary outcome is feasibility comprising measures of adherence, attrition, safety and usability. Secondary outcomes will be measures of cognitive (psychomotor speed, inhibition, selective attention, cognitive flexibility, brain activity) and motor (functional mobility, gait speed, balance, proprioception) functioning.

Results: Data collection started in February 2024 and is expected to be completed by August 2024.

Conclusion: This is the first study looking into exergame training on labile surface in stroke patients. It will give valuable insights into the feasibility and potential added value of this type of training and thus inform further implementation efforts in the context of inpatient rehabilitation.

Clinical trial registration: ClinicalTrials.gov, NCT06296069.

1 Introduction

With the growing number of older adults due to the demographic shift, the risk of cardiovascular and neurologic diseases and especially stroke rises (1). Due to an increasing prevalence and a shift to younger age groups, stroke is the second-leading cause of death and third-leading cause of death and disability combined worldwide (2). The inpatient care, rehabilitation and follow up care of stroke patients is over 3% of the value of lost welfare/gross domestic product in certain regions (3). Twenty-six percent of the persons who suffered a stroke remain with limited ability to perform activities of daily living (ADLs) and 50% have reduced mobility due to hemiparesis (4). Post-stroke cognitive impairment (PSCI) is the occurrence of cognitive deterioration after a stroke, which can range from minor impairment to dementia. Studies show that PSCI occurs in up to 60% (cumulative incidence) in the first year (5) as well as 10 years (6) after stroke. PSCI can severely limit the motor and cognitive functioning of the patients and reduce their independence by affecting memory, attention and executive functions (7). Furthermore, the presence of any degree of cognitive impairment (MCI) be a risk factor for falls and other comorbidities of the musculoskeletal system (8).

As a result of the impairment in cognitive and motor functioning after a stroke, the balance ability worsens and gait becomes unsteady. Of all complications following a stroke, falls are one of the most prevalent. Between 14–65% of people with stroke fall at least once during hospitalization and between 37–73% fall during the first six-months after discharge (9). Fall risk is up to two times higher even at later stages after stroke compared to similarly aged individuals (10). Thus, there is also an increased need for interventions in this population.

Balance training is an established form of exercise in people suffering from stroke and other neurological disabilities (11). However, cognitive-motor training is superior to single physical training in improving motor functioning, e.g., gait speed and walking endurance in stroke patients (12). More specifically, compared to sequential (e.g., cycling followed by cognitive training) and simultaneous-additional (e.g., cycling while solving an arithmetical task), simultaneous-incorporated motor-cognitive training (e.g., any type of training in which the cognitive task is “incorporated” into the motor task, i.e., the cognitive task is a relevant prerequisite to successfully solve the motor-cognitive task) (13) seems to be the most promising training type for improving gait speed, walking endurance, cadence and stride length in stroke patients (12).

Exergames (video games which are played by body movements) are an excellent tool for the delivery of simultaneous-incorporated cognitive-motor training and they have already been used in the context of several frail and neurologic populations (14–18), including stroke patients (19, 20).

Proprioception is used to stabilize the body by sensing its position in space via the sense of joint and limb positioning. Proprioception training addresses the balance and somatosensory stimulation and can therefore build a possible prevention strategy for further falls and of managing ADLs (21). Combining proprioceptive training with simultaneous cognitive tasks could have additional positive outcomes in stroke rehabilitation. Indeed, a recent systematic review concluded that proprioceptive combined with dual-task exercises stimulate and promote postural balance, gait, and quality of life and reduce the risk of falls in stroke patients compared with traditional rehabilitation programs (22).

There is currently just one study that has looked into the effects of exergame-based cognitive-motor training with the additional proprioceptive stimulation by playing the exergames on a labile platform (23). They found that compared to the training on a stable platform and to a passive control group, training on an instable platform is more effective for the improvement of reactive balance and functional mobility under dual-task conditions in healthy, community-dwelling older adults. The feasibility and effects of this type of exergame training on labile surface and thus rich in proprioceptive stimulation in stroke patients remains unknown.

Therefore, the aim of this study is to assess the feasibility and effects of exergame-based cognitive-motor training on a labile platform on physical and cognitive functioning in stroke inpatients.

We hypothesize that exergame-based cognitive-motor on a labile surface will be feasible within the context of inpatient rehabilitation of stroke patients. In addition, we hypothesize that compared to training on stable surface, training on a labile platform will be more effective for the improvement of motor and cognitive functioning in stroke inpatients.

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Exergames as a rehabilitation tool to enhance the upper limbs functionality and performance in chronic stroke survivors: a preliminary study

Ask your doctor to get the protocols for this. FAILURE IS NOT AN OPTION!

Exergames as a rehabilitation tool to enhance the upper limbs functionality and performance in chronic stroke survivors: a preliminary study

Luca Vismara^1†Claudia Ferraris^2*†Gianluca Amprimo^2,3Giuseppe Pettiti²Francesca Buffone^4,5Andrea Gianmaria Tarantino⁴Alessandro Mauro^1,6Lorenzo Priano^1,6

• ¹Division of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, S. Giuseppe Hospital, Piancavallo, Italy
• ²Institute of Electronics, Information Engineering and Telecommunication, National Research Council, Turin, Italy
• ³Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
• ⁴Division of Paediatric, Manima Non-Profit Organization Social Assistance and Healthcare, Milan, Italy
• ⁵Principles and Practice of Clinical Research, Harvard T.H. Chan School of Public Health–ECPE, Boston, MA, United States
• ⁶Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy

Introduction: Post-stroke hemiplegia commonly occurs in stroke survivors, negatively impacting the quality of life. Despite the benefits of initial specific post-acute treatments at the hospitals, motor functions, and physical mobility need to be constantly stimulated to avoid regression and subsequent hospitalizations for further rehabilitation treatments.

Method: This preliminary study proposes using gamified tasks in a virtual environment to stimulate and maintain upper limb mobility through a single RGB-D camera-based vision system (using Microsoft Azure Kinect DK). This solution is suitable for easy deployment and use in home environments. A cohort of 10 post-stroke subjects attended a 2-week gaming protocol consisting of Lateral Weightlifting (LWL) and Frontal Weightlifting (FWL) gamified tasks and gait as the instrumental evaluation task.

Results and discussion: Despite its short duration, there were statistically significant results (p < 0.05) between the baseline (T0) and the end of the protocol (TF) for Berg Balance Scale and Time Up-and-Go (9.8 and −12.3%, respectively). LWL and FWL showed significant results for unilateral executions: rate in FWL had an overall improvement of 38.5% (p < 0.001) and 34.9% (p < 0.01) for the paretic and non-paretic arm, respectively; similarly, rate in LWL improved by 19.9% (p < 0.05) for the paretic arm and 29.9% (p < 0.01) for non-paretic arm. Instead, bilateral executions had significant results for rate and speed: considering FWL, there was an improvement in rate with p < 0.01 (31.7% for paretic arm and 37.4% for non-paretic arm), whereas speed improved by 31.2% (p < 0.05) and 41.7% (p < 0.001) for the paretic and non-paretic arm, respectively; likewise, LWL showed improvement in rate with p < 0.001 (29.0% for paretic arm and 27.8% for non-paretic arm) and in speed with 23.6% (p < 0.05) and 23.5% (p < 0.01) for the paretic and non-paretic arms, respectively. No significant results were recorded for gait task, although an overall good improvement was detected for arm swing asymmetry (−22.6%). Hence, this study suggests the potential benefits of continuous stimulation of upper limb function through gamified exercises and performance monitoring over medium-long periods in the home environment, thus facilitating the patient's general mobility in daily activities.

1 Introduction

Stroke is a clinical syndrome characterized by acute loss of focal brain function, with symptoms lasting longer than 24 h or bearing to death, caused by reduced or interrupted blood supply to a brain area (ischemic stroke) or bleeding inside brain parenchyma (hemorrhagic stroke). Despite advances in wellness, prevention, and treatment, there is an increasing incidence of stroke events in the global population, as reported by several global reports (1, 2). In addition to well-known risk factors, aging is one of the more relevant non-modifiable conditions: reports indicate that incidence doubles with age (3). The consequences of the acute event are the leading causes of various functional deficits, both in the physical and cognitive domains, resulting in a significant long-term burden on healthcare systems (4) and poor quality of life for stroke survivors (5). Indeed, stroke survivors exhibit typical motor disabilities that limit their overall mobility, directly impacting activities of daily living and active social participation (6). Specifically, hemiparesis of the contralateral upper limb is one of the most disabling manifestations: this impairment affects more than 80% of stroke survivors, causing an acute or chronic limitation of mobility, control, and coordination in the upper limbs that hinders common daily actions (e.g., reaching and picking up objects) (7). Moreover, it has been shown that the upper limbs influence gait due to the altered coordination and limited stability, being an important aspect that prevents the achievement of a normal walking speed (8).

After the acute event, specific rehabilitation protocols are promptly activated to restore lost functions, activate compensatory strategies, and improve patients' independence in daily life. Some rehabilitative therapies focus on gait, posture, and balance to reduce the risk of falls and improve patient safety (9–11). Focusing on the upper limbs, several studies pointed out how therapies based on physical exercises play a crucial role after stroke: ad-hoc strategies are commonly established by varying the duration, workload, and frequency according to the patient's condition and implementing dedicated training sessions based on goal-, task-, or repetition-oriented approaches (6). For example, bilateral training (i.e., exercises that stress both sides concurrently) is a recent strategy to improve motor coordination that is based on well-established knowledge. Indeed, with this approach, the non-paretic arm can stimulate the motor function of the paretic arm when simultaneous movements are performed (12).

Recently, training and rehabilitation of the upper limb through technological approaches have gained increasing interest, and various solutions have been proposed to address the severity of motor impairment in post-stroke conditions. The most widely adopted technological solutions mainly involve assistive devices (13) and robots (14, 15) exploit for the most severe conditions. Several innovative methodologies for less severe conditions include virtual reality (16, 17); serious games, exergames, and gamification techniques (14, 18); and motion tracking using vision-based systems (19–23).

In this context, we present a solution for proposing and monitoring physical activities based on gamified tasks and exercises suitable for domestic use. The primary goal is to solicit upper limb mobility through gamified tasks promoting the improvement or maintenance of upper limb motor functions, including range of motion, motor control, and coordination. The gamified tasks are offered in two modes, unilateral and bilateral execution, and can be appropriately configured for game difficulty according to subjects' motor conditions. One of the platforms implemented during the REHOME project (24) was used for the study, specifically the Motor Rehabilitation and Exergames platform (MREP) (25). MREP leverages a single RGB-Depth camera (specifically, Microsoft Azure Kinect DK) and its innovative body tracking algorithm that captures body movements in real-time through a deep learning approach. Several works have recently analyzed the performance of the device compared with gold-standard motion capture systems (MOCAP), verifying its higher accuracy compared with predecessors and other optical sensors (26–28). Other studies have also analyzed the performance of the new body-tracking algorithm, verifying its accuracy, robustness, and reliability in capturing 3D movements and poses (29–31), including the analysis of the upper limb mobility (32–34). The good agreement with MOCAPs has led to using Azure Kinect in preliminary clinical studies and rehabilitation protocols (35–38). MREP offers various exercises (grouped into assessment tasks, gamified tasks, and rehabilitative exergames) to automatically assess upper and lower limb motor impairment related to neurological disorders. However, for the purposes of this preliminary study, we included only two of the available gamified tasks and one of the assessment tasks (i.e., walking) in the experimental protocol since we intended to focus only on upper limb stimulation using gamified tasks to evaluate the potential benefits on arm swing during walking on stroke survivors, as previously done on subjects with Parkinson's disease (39). The results obtained on the cohort of stroke survivors highlight the overall improvement in upper limb mobility for both the paretic and non-paretic arms. In particular, substantial improvement in speed, number of movements per minute, coordination metrics, and reduction of asymmetry in arm swing during walking was observed, thus confirming the initial hypothesis of the potential benefits of physical activities using gamified tasks. In addition, an implicit adaptation of the performance of the non-paretic arm to the paretic arm was also observed, as in (6). It is relevant to note that these findings agree with the overall clinical improvement (scales and tests) assessed at the end of the experimental protocol, despite the specific treatment response shown by each participant. Hence, this preliminary study aimed to evaluate whether a limited number of training sessions (precisely six) with exergames could, however, contribute to improving the functionality and performance of the upper limbs in post-stroke patients over a relatively short period (2 weeks): the positive and promising results obtained from the experimental study seem to confirm this trend.

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Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis

 You'll have to ask your doctor and hospital what they have done to test this in a stroke population.  No testing, you don't have a functioning stroke hospital. It's just zombies running around doing the status quo and completely failing at getting survivors recovered(10% full recovery is complete failure).  Don't like that comment, prove me wrong. Fall prevention is a secondary problem which you wouldn't have to address if you correctly solved the primary problem of 100% recovery. Solve the correct thing, you're just wasting time and money otherwise. Does anyone in the stroke world actually think?

Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis

• Yan Chen,
• Yuan Zhang,
• Zhenxiang Guo,
• Dapeng Bao &
• Junhong Zhou 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 164 (2021) Cite this article

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Abstract

Objective

Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis.

Methods

A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers.

Results

Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = − 0.66, 95% CI − 0.91 to − 0.41, P < 0.001, I² = 0%; sway speed, SMD = − 0.49, 95% CI − 0.71 to − 0.27, P < 0.001, I² = 42%) and dynamic balance (SMD = − 0.19, 95% CI − 0.35 to − 0.03, P = 0.02, I² = 0%) in healthy older adults. The EI with 90–119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003).

Conclusion

The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the “dose-effect” relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.

Introduction

Falls are a global public health problem in the older adult population, oftentimes leading to mobility limitation, diminished quality of life, as well as increased mortality and morbidity [1,2,3,4]. One of the main factors leading to falls is the loss of balance when standing and walking [5,6,7]. Therefore, strategies designed to improve standing and walking performance will ultimately help reduce fall risk in older adults.

Numerous efforts have been made to improve the capacity of maintaining balance when standing and walking. Studies have shown that traditional physical training (PT), such as balance and strength training, as well as Tai Chi, can help reduce fall risks by improving the standing and walking performance [8,9,10]. For example, El-Khoury et al. [8] found that a 2-year balance intervention could reduce the incidence of injurious falls in older women compared to the control, and the participants showed improved balance as measured by faster time to complete the timed-up-and-go test and walk 6-m test, and longer time in single-leg stance test. However, studies also suggested that the traditional PT is time-consuming, and the training procedure is not always enjoyable for older adults, oftentimes resulting in low compliance and high drop-out rate of participants [11, 12].

Recently, exergame intervention (EI) has been implemented as a novel rehabilitative strategy for those who have cognitive-motor impairments (e.g., Parkinson and stroke) and demonstrated the great potential of enhancing balance control [13,14,15]. Interactive exergaming consists of a series of cognitive and motor tasks with biofeedback technology (e.g., virtual reality, step-mat, sensor) interacting with users in real-time fashion [16]. As compared to traditional PT, the biofeedback technology (e.g., virtual reality) in EI enables creating different types of the training environment and task protocol as needed, achieving a more convenient completion of intervention; and such technology provides real-time biofeedback, allowing users to adjust their motion or body movements during the training [17, 18]. More recently, several studies have shown that using EI only or EI in combination with other types of exercises could help improve balance by augmenting musculoskeletal strength, executive cognitive function, and motor control, thus helping reduce fall risk [19,20,21]. Stanmore et al. [21], for example, reported that as compared to using the physical exercise intervention targeting strength and balance only, a tailored 12-week of EI in combination with this type of PT (i.e., combined intervention) induced greater improvement in the performance of balance control and significantly reduced falls in people aged 55 years and older.

However, a large variance has been observed across these studies in the design of EI (e.g., EI only or EI in combination with other types of intervention) and study protocol [e.g., intervention duration, the type of control group (i.e., blank or active control)]. Such variance consequently results in inconsistent findings. For example, Bateni [22] showed that physical therapy training induced greater improvement in balance control as measured by Berg Balance Scale (BBS), when in comparison with Wii Fit training; while Chen et al. [23] showed that compared to traditional Tai-Chi exercise, reality-assisted training with selected Tai-Chi movements induced greater improvement in balance control measured by BBS, timed-up-and-go test, and functional reach test. The efficacy of EI thus remains unclear, and the underlying mechanisms through which EI influences functional performance are not fully understood. Therefore, this study aims to quantitatively analyze the effects of EI on the performance of balance control and fall prevention in older adults by completing a systematic review and meta-analysis based on the available peer-reviewed publications, with the intent to highlight recent efforts, advances, and possible avenues for future research in this important area.

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Recalibrating disparities in perceived and actual balance abilities in older adults: a mixed-methods evaluation of a novel exergaming intervention

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

• Toby J. EllmersEmail author,
• Ioannis Th. Paraskevopoulos,
• A. Mark Williams and
• William R. Young

Journal of NeuroEngineering and Rehabilitation201815:26

https://doi.org/10.1186/s12984-018-0369-8

©  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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