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BACKGROUND: Gait adaptability training programs to prevent falls in healthy older adults can be proposed in virtual reality. The development of training programs requires the characterization of the target population. RESEARCH QUESTION: Before proposing an innovative training program to develop gait adaptability behavior of healthy older adults in fully immersive virtual reality, we had to compare gait adaptability behavior between healthy older adults and young adults in virtual reality. METHODS: Twenty healthy older adults (with no fall history) and twenty young adults performed a goal-directed locomotion task in a totally secure virtual reality set-up. Gait adaptability behavior was investigated via a set of measures taking into account gait speed, pointing accuracy, and the evolution of the relationship between the participant and the environment through both inter-trial and trial-by-trial analyses. Mann-Whitney tests and linear regressions were performed to determine potential age differences. RESULTS: The results reveal some common and specific strategies in gait adaptability behavior between healthy older and young adults. In both populations, successive gait adjustments depend on the state of the agent-environment system. However, older adults walked more slowly than young adults (p < .001) with a greater coupling at the end of the target approach (p = .003). SIGNIFICANCE: In the context of fall prevention in healthy older adults, fully immersive VR appears as a relevant tool to propose relevant gait training programs to improve gait adjustments.

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Falls in the elderly are a major societal issue. Virtual reality appears as a relevant tool to propose gait training programs to prevent the occurrence of falls. The use of a head-mounted display allows overground walking during fully immersive virtual training sessions. Our long-term ambition is to develop gait training programs with a head-mounted display to propose enjoyable and personalized training content for the elderly. Before proposing these programs, several methodological precautions must be taken. The first concerns the supposed similarity of the adaptive behavior produced in the real world and in virtual reality. The second concerns the acceptance of the virtual reality device before and after use. Twenty older adults performed a locomotor pointing task in three conditions including a real-world condition, a virtual-world condition consisting in a replica of the real-world condition, and a virtual condition in which the locomotor pointing task was performed in a different context. From feet positions in relation to the position of a target, gait adaptability behavior was investigated. In line with previous studies, step adjustments (needed and produced) were investigated through a combination of inter-trial and trial-by-trial analyses. The results highlighted that participants adopted the same gait adaptability behavior whatever the type of environment (real vs. virtual). Gait analyses suggested the use of a generic control mechanism based on information-movement coupling. We also demonstrated that older adults accepted the virtual reality device before and after use. With these methodological locks removed, it is now possible to design training programs in virtual reality to prevent falls in the elderly.

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BACKGROUND: Falls are a common phenomenon among people aged 65 and older and affect older adults' health, quality of life, and autonomy. Technology-based intervention programs are designed to prevent the occurrence of falls and their effectiveness often surpasses that of more conventional programs. However, to be effective, these programs must first be accepted by seniors. OBJECTIVE: Based on the technology acceptance model, this study aimed to examine the acceptance among older adults before a first use of a virtual reality headset (VRH) used in an intervention program designed to prevent falls. METHODS: A sample of 271 French older adults (mean age 73.69 years, SD 6.37 years) voluntarily and anonymously filled out a questionnaire containing the focal constructs (perceived usefulness, perceived enjoyment, perceived ease of use, intention to use, fall-related self-efficacy, and self-avoidance goals) adapted to the VRH, which was designed to prevent falls. RESULTS: The results of the structural equation modeling analysis showed that intention to use the VRH was positively predicted by perceived usefulness, perceived enjoyment, and perceived ease of use. Perceived usefulness of the VRH was also negatively predicted by fall-related self-efficacy (ie, the perceived level of confidence of an individual when performing daily activities without falling) and positively predicted by self-avoidance goals (ie, participating in a physical activity to avoid physical regression). CONCLUSIONS: A better understanding of the initial acceptance among older adults of this VRH is the first step to involving older adults in intervention programs designed to prevent falls using this kind of device.

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