Barn Ruins Virtual Reality-Based Serious Game as a Rehabilitation Tool for Older Adults with Mild and Moderate...

This study evaluates the potential of a serious game, called Barn Ruins, as a spatial learning rehabilitation tool for older adults with mild to moderate cognitive impairment (MCI). The game's user navigates a maze environment on a laptop screen using a gaming controller (a joystick). It progresses through easy, medium, and hard routes, and has an error-based spatial learning score. The intervention spanned eight weeks, during which participants played the game for 30 minutes, three times a week. Pre-and post-intervention assessments were conducted using two independent and validated spatial orientation measures: VRNHouse as the primary and the Clock Orientation Test as the secondary outcome.Seven participants (86.3 ± 4.9 years, 2 males) completed the study. Although no statistically significant changes were observed in VRNHouse or Clock Orientation Test scores, 71.4% of participants improved or maintained their performance in the primary outcome measure, while 66.7% demonstrated improvement or stability in the secondary measure. Analysis of spatial learning scores within the Barn Ruins game revealed significant improvements over time (p = 0.0046, Kendall's W = 0.42), particularly in easy (p = 0.023) and hard (p = 0.01) routes. Performance on medium routes fluctuated, suggesting greater difficulty with these trials.Post-hoc comparisons revealed that by Weeks 7 and 8, participants' overall spatial learning scores were significantly higher compared to those in Week 1. Notably, easy routes exhibited a ceiling effect after Week 4, while harder routes showed consistent improvement after Week 5.Despite modest results in independent outcome measures, the game's significant performance gains suggest its utility in improving spatial skills. Future research with larger samples is needed to validate these findings.Clinical Relevance- These findings highlight the potential of the Barn Ruins game as a novel rehabilitation tool for enhancing spatial learning in older adults with MCI.