Comparing Virtual Reality and Robotic Training Effects on Balance Ability and Confidence in Older Adults

Falls are the leading cause of injury and mortality among older adults-one in four individuals 65 years old and above experiences falls. Thus, balance training interventions that improve balance ability and reduce the risk of falls are of critical importance. Through two complementary interventions, our research sought to determine the effects of Virtual Reality (VR) compared to Robotic-Assisted Balance Training (RABT) on balance ability and balance confidence in older adults. The VR intervention utilized Oculus headsets to create immersive balance exercises, while the RABT employed a multidirectional overground robotic system (NaviGAITor). Participants (aged 60-85 years old) underwent a 6-week training protocol consisting of two 30 min sessions per week. Balance ability was quantified using center of pressure (COP) parameters and the Balance Error Scoring System (BESS), while balance confidence was measured using the Activities-Specific Balance Confidence (ABC) scale. Results indicated no statistically significant differences between the training methods. However, the RABT group showed trends toward enhanced balance performance, with observed decreases in mediolateral (ML) maximum displacement during wide stance conditions and reductions in BESS errors on both firm and foam surfaces. The VR group demonstrated significant changes in ML RMS values during tandem stance (p = 0.045) and improved participants' relationship with perceived and actual balance ability (increased correlation between BESS errors and ABC scores from R² = 0.00 pre-training to R² = 0.65 post-training). Balance confidence did not significantly increase in either group. These findings suggest that while RABT may trend toward improvements in objective balance parameters, VR training appears to enhance participants' perceptual accuracy of their balance capabilities.