The design and exploration of exergames and dynamic visualisations of movement to prevent falls in the elderly

• Main Author: Uzor, Stephen
• Published: Glasgow Caledonian University 2014
• Subjects: 362.6
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.687410

This thesis explores the potential of exergame and visualisation technologies to assist older adults in home-based falls rehabilitation. Rehabilitation, involving strength and balance exercise, has proven effective as part of a multifactorial intervention to significantly reduce the risk of falling in older adults. However, low adherence to rehabilitation progranunes in the home implies that older adults often do not receive the required amount of exercise therapy necessary to reduce their risk of falling. This work proposes that exergames can encourage greater participation in home exercise by facilitating a more enjoyable experience for the user in the home. Furthermore by delivering real-time feedback on user performance, visualisation could improve the quality of therapy (regarding the correct range and pace of movement) that older users, at risk of falling, receive in the home. An interview with health experts and two design workshops with older users were first carried out to gather the requirements necessary to design the technologies, to maximise the effectiveness of these tools with regard to therapy and engagement. This investigation uniquely involved older adults in the collaborative design of assistive technologies for home-based falls rehabilitation. Several useful designs were revealed, through this process, which contributed to the development of the teclmologies, as described in this thesis. Informal and formal user tests, utilising user-centred design methods, were later carried out in the laboratory, and in the home, to improve the usability and accessibility of the technologies for unassisted use by older adults. The findings from these user tests showed high levels of usability and acceptability, and important user recommendations were made regarding the redesign of the teclmologies to facilitate effective long-tenn use in the home. Once the development and testing work had been completed an empirical investigation, based on a randomised controlled trial (RCT) design, was carried out over 12 weeks in the home. The aim of this study was to explore the potential of the exergame and visualisation technologies to improve adherence, functional outcomes of balance and mobility, and balance confidence. The results indicate that the technologies can potentially increase adherence to exercise and reduce fall risk in older users, versus standard rehabilitation care (involving the use of booklets). The users also expressed high levels of usability and acceptance of the technologies for home rehabilitation use; and they made further recommendations for the redesign of the technologies, to enhance their use by older adults in the home. However, the home study discussed in this thesis was a pilot RCT; therefore it was limited mainly by the sample size, and as such these results did not achieve statistical significance. Nevertheless, future work can benefit from this work, as the findings reported on in this thesis can inform the design of a larger conventional RCT. Finally, based on the work presented herein, this thesis makes several recommendations regarding the design of exergame and visualisation technologies to improve the effectiveness of falls rehabilitation programmes in the home. It is believed that designers and researchers can learn from this work and employ these recommendations in the design of effective technology based rehabilitation tools in future.