CHAPTER 2. STATE OF THE ART-LITERATURE REVIEW
2.7 R ESEARCH GAP AND OPPORTUNITY
In general, different researchers have shown their appreciation for the application of the EXG in the fall research field and attempted to address
state-of-the-art review and field study conducted, shown in previous sections of this chapter, provides some thought-provoking directions for this thesis to understand how emerging EXG technologies can be applied in India for the elderly fall research. The process of finding a research gap and research questions is shown in figure 2.14. Several restraints and limitations have been observed in the field-survey sessions and through a literature survey summarised in figure 2.15, and this requires a human- centered approach for investigation. In this thesis, the user’s perspective in fall intervention is captured a qualitative aspect using Grounded Theory.
Figure 2. 14. Process of finding Research Gap for this thesis
Muscle strengthening and balance retraining programs can improve flexibility, leg strength, and balance for fall prevention [27, 26]. Among the elderly population, “Stepping” exercises significantly impact balance improvement [33]. The implications of self-paced exercises for exercise prescription are most in need of interventions to enhance adherence to exercise programs [64, 34]. Even low-intensity exercises improve the balance in deconditioned elders sustaining a severe injury and a high risk of falling [32]. The exercise needs an accumulated time span to show its benefits. The elderly have to do the prescribed exercise sets with the time properly. Previous pilot studies (section 2.2.4, 2.2.5) and literature have suggested that the elderly do not exercise as prescribed. In the exercise domain, the elderly show a lack of motivation, negative aging stereotypes (negative self-views such as physical self-worth), and attitudes of the elderly; literature review also supported these problems [99, 104]. Most of the elderly do not exercise at recommended levels [30, 22]. Digital games address issues like cognitive, motivational, emotional, and social benefits that have been associated with digital games [105, 106]. It can provide a meaningful and cherished activity that caters to healthy older adults on a motivational, emotional, and social level [30].
The literature reported that there is still a need for further refinement of both traditional balance assessment and balance training techniques for the prevention of falls in the elderly [67]. As seen from the literature review, there are significant research gaps, which are depicted in Figure 2.15. These need to be addressed. It invokes significant research questions that are described in the following Section 2.8.
Figure 2. 15. Research gap and opportunity
Research gaps regarding exercise intervention required newness in the process, like helping the elderly understand the improvement balance precisely (quantitative output), and older adults can feel motivated by knowing their own improvement/ benefits from exercise (quantitative way). The quantitative data can also help physiotherapists/doctors on the matter.
Secondly, from pieces of literature, it is also identified that in EXG like Wii has a narrow board due to which the elderly might fall while they are playing the game, and it is not designed for the elderly [76, 75, 107]. In the case of studies [89], it is observed that such complex games are likely to be affected by age-related changes and impairments on various levels.
Further, there is a higher number of elderly interacting with EXG than the home-based training, real-time interaction is not as successful, and in the case of elderly, in group playing, co-player quit is not as exciting as a younger adult [76, 5, 104, 85, 99, 89]. We find that design guidelines
mainly focus on interaction design, and the studies have not considered cultural aspect, availability of accessing such advanced accessories for EXG (like Kinect, internet, etc.). EXGs available are Kinect based or tablet-based. It needs a camera to capture the whole-body movements [108]. As in the Indian household environment for buying Kinect, / availability of the internet and installing is not that convenient as the developed countries. In the Indian context, the technology is not widely accepted by the elderly in India (due to the combined effect of the lack of awareness, experience, facilitating arrangements, economic and social environment). The existing EXG is not related to the real-life scenario of the elderly in India, which is an essential aspect in theoretical guidelines [99, 89, 76, 102, 85, 84]. There is a need to gain more insight into how to use exergames for older adults as an exercise and rehabilitation tool [109].
EXG in the Indian context can be a novel way to address elderly fall research in terms of exercise and technological intervention. This can increase the period engaged by the elderly in the exercise by exercising fun than the traditional form of exercise and improving their balance.
Therefore, this thesis proposes to use EXG as a fall preventive tool by improving balance among the elderly in India. To measure balance, Y- Balance Test is used [110, 111]. The Technology Acceptance Decision Tree (TADT) tool is proposed to be used in this thesis to design our proposed stepping exercise intervention. The Activities-specific Balance Confidence (ABC) Scale [112, 113] and Falls Efficacy Scale-International (FES-I) [23] are used to assess the elderly’s balance confidence and their FOF before and after using the intervention. Technology acceptance of the designed EXG is measured using the Unified Theory of Technology Acceptance and Use of Technology (UTAUT2) developed by Venkatesh 2003 is used [114, 115, 11].
Here, the EXG prototype is a solution to improve the elderly’s balance in a self-motivated way, to assist themselves in finding their improvement in finish time. The assistance is delivered to the elderly through the on-screen display of the finish time after each session automatically records the data.
The design heuristics require an understanding of how emerging technologies –balance exercise (fall preventive) be utilized and explicitly designed for the elderly in India.