Simulating Public Transport Instability: A Novel VR and Stewart Platform-Based Balance Training Approach

Falls during public transportation present a significant risk, especially for older adults and individuals with balance impairments. This study developed and evaluated a novel training system combining a Stewart platform with immersive virtual reality (VR) to replicate real-world destabilizing conditions encountered on public transport. The system was first tested on a single subject under various measurement modalities, revealing that increased sensory and mechanical perturbations led to greater postural instability, with the VR & MOVEMENT & NOISY FLOOR condition being the most challenging. Subsequently, three participants (two healthy and one with a vestibular disorder) completed a single-session perturbation-based balance training (PBT). Balance indicators were assessed using center of pressure (CoP) metrics, including sway velocity, sway area, total power, and mean frequency, extracted from an instrumented Stewart platform. While healthy participants demonstrated postural adaptation across training laps, the vestibular-impaired participant experienced persistent instability, underscoring the need for extended rehabilitation protocols. These findings suggest that VR-integrated PBT may improve postural control in dynamic environments, though further research is required to refine interventions for individuals with sensory deficits.Clinical Relevance - This study introduces a novel VR-integrated PBT system that mimics real-world balance challenges encountered on public transportation. The findings support its potential application in rehabilitation for individuals at risk of falls.