Research Bites Vol. 4
Welcome back for another installment of Research Bites! For all of you who missed my research posts on my Instagram (@science_of_falling), you came to the right place. Every few weeks I will be posting a new set of five quick and dirty research reviews with the main findings, how it was performed, and my quick take on it.
The trick is, I only have the space of an Instagram caption (2200 characters) to dive in and extract main points. It makes for a fun challenge! If you want to see these posts sooner, head on over to Instagram and hit that follow button.
Enjoy that tasty research!
A study published by Rebêlo et. al. in 2021 looked to see if immersive virtual reality (IVR) was an effective modality for treatment of balance disorders in older adults.
Study Details
🔸Fully randomized control trial with concealed allocation of participants to groups and blinded assessment
🔸37 older adults with balance disorders; 60-79 years old
🔸All participants randomized into two groups which followed the American College of Sports Medicine (ACSM) balance training guidelines
↪Experimental Group: IVR with Oculus Rift; functional balance training via 4 games (BoxVR, Baskhead, InCell, and Thrills and Chills Roller Coasters); Each game played for 8 mins, 3 min intervals of rest between games
↪Control Group: Conventional balance training (CBT) including balance in straight line, unstable surface training, cone maneuvering, anterior trunk stability training; performed as a circuit with each exercise performed for 2 mins, 3 min rest intervals/repetition, 3 rounds total
🔸Each group underwent 16 total training sessions; 50 min sessions/2x a week
🔸Outcome testing conducted in three phases (initial, final, follow-up) and included the Dynamic Gait Index (DGI), Clinical Test of Sensory Interaction and Balance (CTSIB), Timed Up & Go (TUG), Functional Reach Test (FRT), Dizziness Handicap Inventory (DHI), Falls Efficacy Scale International
↪Initial: Prior to program start
↪Final: One day after final training session
↪Follow-up: Two months after final training session
Study Findings
🔹Inter-group analysis found no statistical differences between the study groups for balance improvement
🔹Statistical intra-group findings showed improvements in DGI, FRT, CTSIB for both groups
🔹The IVR group did have a slightly better improvement in the TUG and DHI during intra-group analysis
🔹DGI score improvements were maintained for 2 months after training sessions
My Take 🤔
Although these findings may seem underwhelming, this is actually a really cool study. Finding that IVR is just as good as CBT opens tons of therapy options. I mean, let's be honest, patients don't like exercising usually. Throw them in VR and watch their interest skyrocket, especially for competitive people.
A systematic review by Nascimento et. al. in 2021 set out to summarize the effectiveness of non-immersive virtual reality (NIVR) on functional mobility, fatigue, quality of life (QoL), and balance in people with multiple sclerosis (MS).
Study Details
🔸Researchers scoured 6 databases for relevant articles: Scielo, Lilacs, Pubmed, Cochrane Library, Embase, and PEDro
🔸Search terms included "virtual reality", "multiple sclerosis", "randomized controlled trial"
🔸Quality of article assessed via PEDro Scale
🔸9 total trials used in final analysis which collectively included 424 participants; aged 23-61 yo; most common MS type relapsing-remitting
🔸4 studies used Nintendo Wii, 5 studies used Microsoft Kinect (both forms of NIVR)
🔸All included studies compared NIVR with either conventional exercises or no exercise at all
🔸All studies were randomized controlled trials
🔸All studies included outcome measures/testing that looked at least one benchmark including functional mobility, fatigue, QoL, and balance
Study Findings
🔹PEDro scores from 5-8 for selected articles
🔹In regards to positive effects on fatigue, QoL, and balance, NIVR is as effective (or more effective) as conventional exercises
🔹NIVR, in the context of these chosen studies, did not show improvements to functional mobility in those with MS
My take 🤔
Gamification of therapy once again shows positive outcomes when compared with conventional exercises. Now it's important to note that NIVR and Oculus Quest type VR are very different. This study does not include head mounted VR devices as variables and cannot directly be applied to that realm. Additionally, NIVR did not seem to be 100% more effective than traditional exercises, but rather just as effective. It is fair to say that patient preference and clinic access should be main drivers in using NIVR as a therapy modality.
A study published by Baccouch et. al. in 2015 set out to determine how static balance was effected by kung-fu and swim training in adolescent athletes compared to controls.
Study Details
🔸36 young adolescent s split into 3 groups based on chosen sport (12 to each group); ages between 10-12 yo; all matched for height, weight, shoe size
🔸Groups: swimmers, kung-fu, control
↪Both swimmers and kung-fu practitioners needed to have at least 5-6 years of experience and a minimum of 4 practice sessions per week to be eligible for study
↪Control group had no experience in either sport
🔸Exclusion from study occured if vestibular or neurological issue present, or injury in the past 12 months
🔸Center of Pressure (CoP) excursions recorded in static upright bipedal and unipedal stances with eyes open (EO) and eyes closed (EC) conditions using a static stabilometric platform as main form of data collection
↪Each condition performed 3 times for 51.2s, followed by 1 min rest
↪Trials randomized to reduce learning effect
🔸During bipedal stance subjects stood on platform barefoot with feet angled at 30deg with heels 5cm apart
🔸During unipedal stance subjects stood on platform barefoot on non-dominant leg with dominant leg flexed to 45deg at the hip and knee
Study Findings
🔹Both the swimming and kung-fu practitioners had ⬇ CoP area and mean velocity compared to control in bipedal posture with EO; essentially the athletes swayed less and slower than controls
🔹EO bipedal was not significantly different between athletic groups
🔹Bipedal EC showed swimmers ⬇ CoP area than controls; Kung-fu had ⬇ CoP velocity than controls
🔹Unipedal EO most improved in Kung-fu with ⬇ CoP area and velocity than other groups
🔹Unipedal EC same in all groups
🔹All groups showed worse balance with EC vs EO and unipedal vs bipedal
My Take 🤔
This is an interesting study because it compared two very different sports. Both swimming and kung-fu seem to increase balance in their own rights. Kung-fu often uses single leg stance for kicks so it makes sense that unipedal was better in this group. Swimming is very much a sensory sport so this may be why the bipedal EC condition was better in this group.
A study by Bhullar in 2016 presented at the Scientific Forum & Scientific Poster Presentations: 2016 Clinical Congress, set out to see if weight status of those 55+, who sustained a fall, affected their overall mortality risk.
Study Details
🔸1544 patients (pts) identified and records retrospectively reviewed
🔸Included if 55+ and sustained a fall from standing between 2012-2015
🔸Patients group based on Body Mass Index (BMI)
↪BMI < 19 = Underweight (UW); 134 pts
↪BMI 19-24.9 = Ideal weight (IW); 580 pts
↪BMI 25-29.9 = Over weight (OW); 499 pts
↪BMI > 30 = Obese (OB); 331 pts
🔸All groups matched with no significant differences in demographics and Injury Severity Score (ISS)
🔸Significance of mortality rate compared to the IW
Study Findings
🔹Mortality rates found via retrospective analysis
↪UW = 15.7%
↪IW = 8.1%
↪OW = 3.5%
↪OB = 2.9%
🔹ICU length of stay and ventilator use longer in the OB group by significant margin
My Take 🤔
In reality, compared to all of the 55+ individuals in the world, this is a relatively small study and should be taken with a grain of salt. Still, with the way we discuss obesity in our society we often think obesity = significant risk factor for EVERYTHING.
This retrospective study shows that is not the case, and in fact the exact opposite of what was found. Underweight individuals may actually be more at risk for overall mortality after a fall. I'm speculating, but perhaps this is due to lower bone densities, decreased metabolic factors for healing, lower muscle mass, and generalized lower energy levels. Whatever the reason is, I find this study and its conclusion unexpected.
P.S. I probably still wouldn't inhale 20 Twinkies in a sitting, but do what makes you happy. 🍩🍰🍪
A study by Adolph et. al in 2012 set out to study why infants who crawl are motivated to walk, how falling and stepping occurrence changes with skill acquisition and test age, and how standard and functional measures of walking skill relate.
Study Details
🔸151 infants; 72 girls, 79 boys; ages 11.8 - 19.3 months old
🔸Majority observed in laboratory playroom filled with furniture varied ground surfaces, and toys
↪20 crawlers (CR), and 116 walkers (WA) observed this way
🔸Remaining 15 infants observed at home to ensure laboratory setting mimicked what was seen in a home setting
🔸Cameras in both settings used to record movements
🔸After laboratory sessions the infants walked a straight line on a 3.6m pressure sensitive mat to obtain two standard measures that assess walking skill
↪step length (in CR done as distance from knee contact)
↪step width
🔸Two independent coders reviewed video for data collection
↪One coder looked at 100% of video, another only estimated based off of 25% of video
Study Findings
🔹Coders showed high inter-rater agreement for time crawling or walking, # of steps, and falls (rs >.95, ps <.01)
🔹Averaged across all of the data, the walking infants took 2367.6 steps/hour, travelled 701.2m/hour, and fell 17.4 times/hour
🔹Infants spent more time walking, took more steps, and fell less frequently during free play over standardized test
🔹Better walkers tended to fall less and travel greater distances than their peers
My take 🤔
This study has a lot of data and I only scratched the surface with the findings I mentioned. Still the main takeaway for our purposes is that infants fall when learning to walk...a lot. The better walkers they become, the less they fall. Or in simple terms, better motor control and balance lead to safer movement.
Not only that, but this is a period when falling is a part of the process. I believe we should capitalize on this and begin fun fall games once a child can comprehend. Perhaps this can help prevent a fear of falling from becoming engrained, and embolden them with early strategies to stay safe as they grow.
Thanks for reading the fourth volume of Research Bites! I hope you learned a tidbit or two. Be sure to follow my Instagram account to see these research bites right away, and comment below on what you think about the findings above.
Happy Falling!
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