Designing computer games to prevent falls
Exergames are helping older patients to stay active and reduce the risk of injury from falls.
Falls affect one third of over-65s. They can lead to life-changing injuries, premature care home admittance and are the most common cause of injury-related death for this age group.
Dr Emma Stanmore, Reader in Healthy Ageing at The University of Manchester, is working with local NHS trusts to deliver falls prevention exercises in the form of a computer game which helps older people avoid injury and increase their mobility.
Dr Emma Stanmore
Dr Stanmore is a Reader in the University’s Division of Nursing, Midwifery and Social Work.
Her research and teaching focus on healthy ageing and health innovation to deliver care using new ways or working including digital health technologies.
Having specialised in falls prevention for many years, Dr Stanmore has conducted numerous research projects to investigate the challenges facing people injured by falls.
“Those with more minor injuries can experience loss of confidence and they can become socially isolated, leading to a more sedentary lifestyle and reduced mobility,” Dr Stanmore explains.
“In turn this puts them at higher risk of having a secondary fall, so the cycle continues.”
The issue of falls isn’t just problematic for the injured individual but also for the wider healthcare system. Falls cost the NHS more than £2.3 billion annually and this figure is set to rise along with our country’s growing ageing population.
Prevention is better than cure
“Research has shown that certain strength and balance exercise can reduce falls by up to a third,” Dr Stanmore explains. “However access to physiotherapists is usually time limited and, when people can get to see one, the problem with traditional falls prevention exercises is that many people struggle to engage with them long-term.”
Inspired by the popularity of video games such as those on the Nintendo Wii, Emma worked with software company MIRA Rehab to gamify therapy-based exercises so that they could be used in conjunction with computer games.
“When we spoke to patients about using off-the-shelf video games to keep active, they reported finding them too fast-paced and tricky to operate, so we needed to create a tailored solution for older people with long term conditions,” Emma says.
“The video games that we’ve developed, or ‘exergames’, improve strength and balance and can be played at home.”
How the exergames work
Using just a screen, a laptop and a sensor, users play along while having their range of movement tracked.
“Clinicians can monitor their progress and tailor the exercise programme specifically to the patient’s needs, while assessing them as they usually would face-to-face,” says Dr Stanmore.
“One of the main benefits is that the patients become immersed in the games, so they’re focusing on enjoying themselves rather than completing a list of prescribed exercises written down on a leaflet.”
The exergames are being used by Manchester Royal Infirmary, Trafford General Hospital, Guy’s and St Thomas’ NHS Foundation Trust, community falls prevention teams and sheltered housing associations to name but a few.
“Whilst the exergames are being used in hospitals across the country, they can be used independently in a home setting as well,” Dr Stanmore explains.
“They’re more cost-effective than face-to-face physio appointments, so we’re improving healthcare efficiency while giving patients an enjoyable therapy programme.”
“I use a walking stick to steady myself and have had a couple of falls. The exergames are helping with my balance, confidence and in keeping me alert. ”
Improved physical fitness is just one of the benefits to emerge for patients who have been using the games. Patients who used the games became less dependent on mobility equipment such as walking frames and walking sticks. Some were even able to start driving their car again, enabling them to regain independence and confidence.
“One lady had dementia and was living in sheltered housing where her daughter was helping her to play the exergames,” Dr Stanmore says. “She said that it really helped her mother to make friends. Using exergames improved her mood and helped her to get involved in exercise whereas she might not otherwise have done so.”
Although some patients were initially apprehensive about using the new exergames, many reported feeling more confident thanks to their newly acquired technology skills, as they had overcome a challenge and learned something new by interacting with the game’s interface.
Among the first group to test the exergames back in 2016 was 90-year-old Bert from Sale.
“I use a walking stick to steady myself and have had a couple of falls. The exergames are helping with my balance, confidence and in keeping me alert,” said Bert.
His neighbour Joy, a former professional dancer, 80, also took part. She said: “I’ve always been quite fit and tried to exercise, but as I got older I found that I could quite easily lose my balance when I turn.
“For me, exergames provided a structure to encourage me to exercise more regularly. I found that as a result I could get up more easily after kneeling down. I feel healthy and positive that I’m doing something to help prevent problems that might otherwise occur.”
The key to success
Dr Stanmore credits the input of the patients themselves for much of her innovation’s success. Participants contributed to focus groups and interviews, with more than 170 people helping to shape the game design and features.
Now more than 10,000 people are using the exergames as part of their rehabilitation programme.
She says: “Our end users were at the core of the development process. That’s why the exergames work so well and that’s why they’re helping so many people to stay healthy and active long-term.”
Helping people stay active during COVID-19
During the coronavirus pandemic, Dr Stanmore has been using her expertise in falls prevention to help older adults take control of their wellbeing when isolating due to COVID-19. In collaboration with partner organisations, she developed an evidence-based app called ‘Keep On Keep Up’ to help people stay active and reduce their risk of falling while in isolation.
The pandemic has confined thousands of older people to their homes, but many have used it as an opportunity to improve their technical skills, using video calls to connect with friends and family. The app, which is free to download, enables users to maintain their balance and strength at home.
Dr Stanmore adds: “Our aim is to support physical wellbeing as well as mental wellbeing, and to improve fitness and mobility. By using the app, people can keep fit in the safety of their own homes.”
Find out more about the Keep On Keep Up app.