Using a virtual reality system to study balance and walking in a virtual outdoor environment: a pilot study.

Falls and fall-related injuries are a major problem for elderly persons. Most falls occur during walking and turning, and the risk of falling increases when attention is diverted to something besides walking. It is often difficult to standardize methods for testing balance and fall tendency in a clinically relevant setting. We describe the development of a system using a virtual environment (VE) to assess how attention demanding and unexpected events influence a person's capacity to control balance and movement. The hardware in the system consists of a head-mounted display (HMD), a magnetic tracker system, and two SGI computers. The software consists of the image generation of the VE and the management and visualization of motion tracking data. In a preliminary pilot study eight subjects (age 23-80) participated. Each subject walked on a normal floor and was visually presented a familiar outdoor environment in the HMD. They were exposed to different unexpected events, such as a virtual snowfall and tilting of the VE. Disturbances of balance and walking patterns such as changes in speed, stride length and balance reactions like slipping were observed. Two subjects experienced symptoms of cyber sickness with a SSQ score above 25 points. Walking with sensors only did not affect walking time, but in VE the subjects generally walked more slowly. Virtual tilting of the environment had an impact on balance performance during walking. This effect was not observed while the test subjects were walking in a virtual snowfall. The model needs further development but may hold a potential for clinical use.