Diabetes Forecast

Preventing Falls With Gaming

Will video games help seniors improve balance and security?

researcher Steven Morrison

Steven Morrison, PhD
Photograph by Keith Lanpher

Steven Morrison, PhD

Director of Research, School of Physical Therapy and Athletic Training, Old Dominion University


ADA Research Funding
Clinical Translational Award

As people age, the likelihood they’ll fall rises—along with the harm such tumbles do to the body. The problems start with age-related declines in balance, vision, strength, and posture. After the age of 65, there’s a 1-in-3 risk of falling each year. According to the Centers for Disease Control and Prevention, falls are the leading cause of injury—fatal and otherwise—for people over 65.

For seniors with diabetes who also have neuropathy—nerve damage that makes it hard to feel the feet and hands—the situation is worse. “They lose the ability to detect where their limbs are in space. They can’t judge distances; they trip going over a step,” says Steven Morrison, PhD. “The risk of falling for people with type 2 diabetes over 65 can be 10 to 20 times higher than for people of the same age.”

The threat of a fall can make people afraid to move around, a vicious cycle that does more harm than good. Less activity can lead to a steeper decline in strength and balance, a downward spiral into frailty that can be hard to reverse. “Without a doubt, people who do fall have a decline in activity as they get older,” Morrison says. For individuals who fall often, one treatment is to put them in a wheelchair. “Sure, they’re not going to fall, but they’re not going to move, either.”

Morrison says the best medicine is more activity, not less. “We think one of the best interventions is to get people active. We’re talking very simple balance exercises and stretches,” he says. “Exercise is a form of medicine.” Increased physical activity should lead to better balance and fewer falls over the long term.

With the help of a grant from the American Diabetes Association, Morrison is investigating innovative ways to get older people with diabetes to exercise more. As with anyone, it’s a challenge to motivate older people to exercise. It’s even harder to motivate if you have to overcome the fear of falling. One idea he’s trying is video games.

Video games are rarely thought of as a way to get people off the couch, but the advent of a new generation of game systems—in particular, the Nintendo Wii, which incorporates motion sensors and accelerometers to get the whole body moving—may change that. The Wii, introduced in 2006, uses motion sensors in the controllers to translate body movements into actions on the screen.

Morrison’s experiment makes use of the Wii’s Balance Board, a white plank embedded with sensors. The device attaches to the video game system, a player stands on it, and the sensors detect how players move and adjust their balance. Players can use it to guide a virtual snowboard down a hill, ski, or play dodgeball, for example.

Morrison’s study will follow 120 people over age 65 with type 2 diabetes. Over the course of 12 weeks, half of the participants will visit a clinic three times a week for supervised exercise sessions. The other half will be given a Nintendo Wii and a Balance Board to play with at home, along with a list of suggested games.

At the end of the study period, participants will visit the lab for an evaluation of their gait, balance, reactions, lower-limb strength, and proprioception, or their sense of where their limbs are in space. “We want to know if unsupervised activity leads to an improvement in falls risk,” Morrison says. “We can measure if people’s gait and balance improve. I think we’ll see both.”

There’s an added benefit, Morrison says: The Wii saves a lot of data that help doctors understand how and for how long people are working out at home, from duration of activity to their body weight (and weight loss). “We were pleasantly surprised at how much information we can get about their activity,” says Morrison.

If the patients exercising at home have similar results to the supervised exercisers, it’ll be a sign that such unorthodox treatments are a viable alternative to traditional exercise programs. “It opens up the door to people who might not want to go to a gym or fitness group,” Morrison says. “It’s another alternative, rather than doing nothing. It might then motivate them to do more walking or other activity outside the house.”



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