Balance Assessment in Fall-Prevention Exergames
Carlos Miguel Dias de Brito, João Tiago Pinheiro Neto Jacob, Rui Nóbrega, António Manuel Nogueira Santos · 2015 · ASSETS '15: Proceedings of the 17th International ACM SIGACCESS Conference on Computers & Accessibility · doi:10.1145/2700648.2811342
Summary
This paper presents two exergames designed to motivate elderly adults to perform fall-prevention exercises while simultaneously collecting balance assessment data using the Nintendo Wii Balance Board (WBB). Falls are a major health concern for older adults, and while exercise is proven to improve balance and reduce fall risk, motivating seniors to exercise regularly remains difficult. The researchers developed two games incorporating exercises from established fall-prevention programs—the Otago Exercise Programme and Fitness and Mobility Exercise (FAME). "Scooter Chase" requires players to perform a heel-to-toe (tandem) stance on the WBB to control a scooter character chasing a cat, with a smartphone simulating the handlebar. "Segway Stroll" has players navigate a virtual Segway through a city by performing forward reaches to accelerate, toe raises to brake, and weight shifts to turn. The WBB serves dual purposes: as a game controller providing natural user interaction, and as a clinical-grade balance assessment instrument. Research has validated that the WBB can measure Center of Pressure (COP) with accuracy comparable to expensive commercial force plates used in clinical settings. The system records COP coordinates throughout gameplay, computing metrics like COP path, amplitude, frequency maps, mean velocity, and total oscillation.
Key findings
The system provides automatic balance scoring based on the Tandem Stance Test (TST): low balance (0-9 seconds maintaining pose), medium (10-29 seconds), or high (30+ seconds). This transforms gameplay data into clinically meaningful assessments that therapists can use to monitor patients over time. Preliminary testing with 17 senior volunteers aged 64-80 showed promising results for motivation. Although participants did not fully understand game mechanics on their first attempt, they reported enjoying the games, expressed desire to play regularly, and stated the experience motivated them to exercise. This addresses a core challenge in fall-prevention: converting the known benefits of exercise into actual sustained practice. The use of consumer hardware (WBB costs a fraction of clinical force plates) makes objective balance assessment feasible in settings like small clinics or homes where expensive equipment is impractical. The games generate visualizations of COP paths that therapists can use for qualitative assessment alongside the quantitative TST scores.
Relevance
This research addresses a critical intersection of aging, accessibility, and health technology. Falls are a leading cause of injury and loss of independence among older adults, yet the population most at risk is often least motivated to perform preventive exercises. Exergames offer a potential solution by making exercise intrinsically rewarding through game mechanics. For accessibility practitioners, this demonstrates how consumer gaming hardware can be repurposed for health applications, democratizing access to assessment tools previously limited to clinical settings. The dual-purpose design—entertainment plus clinical data—is an important model: users engage for enjoyment while generating valuable health information. The research also highlights design considerations for older adult interfaces: participants initially struggled with game mechanics, suggesting that exergames for this population require careful onboarding and simplified interactions. Future work testing with larger populations will be important to validate whether the motivational benefits translate to actual improvements in balance and fall reduction over time.
Tags: exergames · fall prevention · older adults · balance assessment · Wii Balance Board · physical rehabilitation · aging · center of pressure · natural user interfaces · gamification