VR-CogMoBal Training for Reducing Falls Among Older Adults With Mild Cognitive Impairment

It is the actual magnitude of a self-initiated movement (i.e., how far did he/she actually reach a target) without taking a step or losing balance measured in percentage under single and dual-task conditions. Higher values indicate better performance.

The total time taken to complete the 4 meters will be noted. Speed will then be determined by using the formula distance (4 meters) covered by time taken to complete the test. Higher speed indicate better performance.

This is an oral trail making test which includes listing alternate letter and number from the cue given in sequence. This test will be performed under single and dual-task conditions.

For the auditory clock test, the participant is provided with cues that include different times of the day (e.g., 3.15) and the participant has to answer a yes if the hour and the minute hand of the clock are on the same side and no if the hour and minute hand are on opposite side of the clock.

For the letter number sequencing test, the participant will be provided sets of letters and numbers (e.g.., A1) and will be asked to list in sequence the consecutive letter and numbers (e.g., B2, C3, D4, E5) until the next cue is provided.

The performance will be measured in terms of accuracy (number of correct responses out of the total responses) for both the tests. Higher accuracy i.e., higher percentage indicates better performance.

List Sorting Memory test to evaluate working memory. This test requires the participant to recall and sequentially list the visually and orally presented stimuli. The accuracy of the participants response is computer generated. Higher value indicate better performance. The total possible responses are 28.

Picture sequence memory test will assess episodic memory of the individual. The number of adjacent pairs of pictures placed correctly will score a point. The scores are computer generated. Higher value indicate better performance.

Flanker inhibitory control and attention test is used to evaluate the participants ability to inhibit the attention to the stimulus flanking it and focus on a particular stimulus. Accuracy of the responses are recorded and the scores are computer generated. Higher value indicate better performance.

Dimensional Change card sort assesses cognitive flexibility and attention. Participants are asked to match a series of bivalent pictures either by colors or shapes accordingly. Responses are computer recorded and accuracy scores are computer generated. Higher value indicate better performance.

Pattern comparison processing speed test is used to evaluate the processing speed. The participants are expected to respond whether the two pictures side-by side are same or not the same. Accuracy will be recorded by the number of correct responses out of the total questions in 90 seconds. Scores are computer generated. Higher value indicate better performance.

It is the average speed of center of gravity movement during intentional movement measured in degrees per second under single and dual-task conditions. Higher values indicate better performance.

It is the magnitude of a self-initiated movement (i.e., how far he/she wills to reach a target) without taking a step or losing balance measured in percentage under single and dual-task conditions. Higher values indicate better performance.

It is the quality of a self-initiated movement (i.e., amount of movement actually exhibited towards the target to the amount of extraneous movement away from the target) measured in percentage under single and dual-task conditions. Higher values indicate better performance.

Reactive balance control will be examined via the stance perturbation test under single and dual-task conditions (simultaneous performance of Letter number sequencing task or auditory stroop task). Postural stability can be defined as simultaneous control of center of mass (COM) position and velocity during slip-like or trip like perturbation relative to the rear edge of base of support (rear heel). The position is normalized with the individual's foot length, and velocity by square root of gravitational acceleration and individual's body height. Larger values indicate greater stability.

This test involves responding to the pitch (high or low) of the words "High" or "Low". This test will be performed under single and dual-task conditions.

Accuracy (number of correct responses out of the total responses) of Auditory stroop will be calculated. Higher accuracy indicates better performance. Higher values indicate better performance.

Dual-task motor and cognitive cost will be calculated using the formula- [(Dual-task performance- Single Task performance)/Single task performance*100]. This will be calculated for dual-task performance during intentional postural sway, reactive balance control and gait conditions. Lower cost indicates better performance.

Spatial and temporal gait parameters like step length, cadence and stride length will be determined during single and dual-task walking performance via the GaitRite mat. Higher values for step length and stride length, and lower cadence indicates better performance.

Interference in the reaction time via visual stroop task where the individual is expected to respond to the color in which the word is printed and not read the word. Performance will be identified via time taken to complete the test. Lower time indicates better performance.

Language fluency via verbal and category task will be administered. Performance will be identified via the total number of appropriate words responded on each of the task. Higher values indicate better performance.

The individual is asked to hit a key on the number keypad when a cue appears on the screen. Performance will be identified with time taken to hit the key after the individual sees the cue in seconds. Lower time indicates better performance.

Paired associated learning via grid task will be administered. Accuracy (number of correct responses out of the total responses) will be represented in percentage. Higher value indicates better performance.

List Sorting Memory test to evaluate working memory. This test requires the participant to recall and sequentially list the visually and orally presented stimuli. The accuracy of the participant's response is computer generated. Higher value indicates better performance. The minimum score is 0% and maximum score is 100%

The individual is asked to hit a key on the number keypad when a cue appears on the screen. Performance will be identified with time taken to hit the key after the individual sees the cue in seconds. Lower time indicates better performance.

Fractional anisotropy (FA) is a scalar measure derived from diffusion tensor imaging (DTI) that quantifies the directional dependence of water molecule diffusion in biological tissues. Ranging from 0 (completely isotropic diffusion, as in cerebrospinal fluid) to 1 (fully anisotropic diffusion, seen in highly organized white matter tracts), FA reflects microstructural properties such as axonal density, myelination, and fiber coherence. Higher values indicate better integrity of white matter tracts

The Berg Balance Scale (BBS) is a standardized clinical assessment tool designed to evaluate static and dynamic balance abilities, primarily in older adults and individuals with neurological conditions. The scale score ranges form a minimum of 0 to a maximum of 56, with higher scores indicating better balance performance

The Physical Activity Scale for the Elderly (PASE) is a validated self-report questionnaire designed to quantify physical activity levels in adults aged 65+ through occupational, household, and leisure activities over a 7-day period. The scores ranges from 0-793 with higher score indicating better performance.