Older Adult Traditional Balance Training vs Traditional Balance Training Plus Neck Strengthening

Time to peak force (s) for right cervical lateral flexion

Time to peak force (s) for right cervical lateral flexion captured via a hand held dynamometer. Patient will be sitting in a chair and resist applied force to the front right side of their head via rotational force.

Time frame: Baseline and at 5 weeks

Peak force (N) for left cervical lateral flexion

Peak force (N) for left cervical lateral flexion captured via a hand held dynamometer. Patient will be sitting in a chair and resist applied force to the front left side of their head via rotational force.

Time frame: Baseline and at 5 weeks

Time to peak force (s) for left cervical lateral flexion

Time to peak force (s) for left cervical lateral flexion captured via a hand held dynamometer. Patient will be sitting in a chair and resist applied force to the front left side of their head via rotational force.

Time frame: Baseline and at 5 weeks

Neck Cervical Repositioning Error

Measured distance (cm) between the target gaze position and the gaze returning after full neck extension. Gaze is marked via a laser pointer secured to the forehead via a headband. Patients will be seated in a chair with no arm rest with the front of the chair 20 cm away from a wall. Patients will then be instructed to find where they believe is a natural head position. Laser pointer position will be marked on the wall. Patients will then close their eyes, perform full neck extension (till the nose is pointed towards the ceiling), and attempt to find the original neck position with their eyes closed. The laser pointer position is then marked. The distance between the two dots is measured. Angular difference in head position can then be calculated using distance and angular mathematics.

Time frame: Baseline and at 5 weeks

Timing error of gaze during smooth pursuits

Timing error of gaze during smooth pursuits captured via an instrumented VR headset that tracks eye movements relative to the presented image. A measure of the standard deviation of the tangential error between the participant's gaze and the target's position

Time frame: Baseline and at 5 weeks

Percentile of timing error during smooth pursuits

Percentile performance for timing error of gaze during smooth pursuits captured via an instrumented VR headset that tracks eye movements relative to the presented image. Based on normative data of the equipment

Time frame: Baseline and at 5 weeks

Spatial error of gaze during smooth pursuits

Spatial error of gaze during smooth pursuits captured via an instrumented VR headset that tracks eye movements relative to the presented image. A measure of the standard deviation of the radial error between the subject's gaze position and the target position.

Time frame: Baseline and at 5 weeks

Percentile of Spatial Error during smooth pursuits

Percentile performance for spatial error of gaze during smooth pursuits captured via an instrumented VR headset that tracks eye movements relative to the presented image.

Time frame: Baseline and at 5 weeks

Horizontal fixation accuracy during saccadic eye movement

Horizontal fixation accuracy during saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image. The average gaze error between the subject's fixations and the target position in the horizontal direction.

Time frame: Baseline and at 5 weeks

Percentile performance for horizontal fixation accuracy during saccadic eye movement

Percentile performance for horizontal fixation accuracy during saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image

Time frame: Baseline and at 5 weeks

Vertical fixation accuracy during vertical saccadic eye movement

Vertical fixation accuracy during vertical saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image.The average gaze error between the subject's fixations and the target position in the vertical direction

Time frame: Baseline and at 5 weeks

Percentile performance for vertical fixation accuracy during vertical saccadic eye movement

Percentile performance for vertical fixation accuracy during vertical saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image

Time frame: Baseline and at 5 weeks

Horizontal fixation precision during saccadic eye movement

Horizontal fixation precision during saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image. A measure of the standard deviation of the gaze error between the subject's fixations of both eyes in the horizontal direction.

Time frame: Baseline and at 5 weeks

Percentile performance for horizontal fixation precision during saccadic eye movement

Percentile performance for horizontal fixation precision during saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image

Time frame: Baseline and at 5 weeks

Vertical fixation precision during vertical saccadic eye movement

Vertical fixation precision during vertical saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image. A measure of the standard deviation of the gaze error between the subject's fixations of both eyes in the vertical direction.

Time frame: Baseline and at 5 weeks

Percentile performance for vertical fixation precision during vertical saccadic eye movement

Percentile performance for vertical fixation precision during vertical saccadic eye movement (rapid eye movement to a presented target) captured via an instrumented VR headset that tracks eye movements relative to the presented image

Time frame: Baseline and at 5 weeks

Center of pressure variability

Center of pressure variability during a double limb task on a firm surface captured via a force plate.

Time frame: Baseline and at 5 weeks

95% Ellipse of center of pressure

95% Ellipse of center of pressure during the double limb 30-second balance task on a firm surface, determined from force plate data.

Time frame: Baseline and at 5 weeks

Average lateral force variability

Average lateral force variability during double limb task on a firm surface captured via a force plate.

Time frame: Baseline and at 5 weeks

Average anterior force variability

Average anterior force variability during double limb task on a firm surface captured via a force plate.

Time frame: Baseline and at 5 weeks

Center of pressure variability on Foam

Center of pressure variability during double limb task on a foam surface captured via a force plate.

Time frame: Baseline and at 5 weeks

95% Ellipse of center of pressure on Foam

95% Ellipse of center of pressure during double limb 30-second balance task on a foam surface determined from force plate data.

Time frame: Baseline and at 5 weeks

Average lateral force variability on Foam

Average lateral force variability during double limb task on a foam surface captured via a force plate.

Time frame: Baseline and at 5 weeks

Average anterior force variability on Foam

Average anterior force variability during double limb task on a foam surface captured via a force plate.

Time frame: Baseline and at 5 weeks

fall self-efficacy index

The fall self-efficacy index measures the patients concern about falling during 16 social and physical activities that are part of daily living. Each of the 16 questions are scored values of 1 to 4; with one having no concern at all, 2 somewhat concerned, 3 fairly concerned, and 4 very concerned.

Time frame: Baseline and at 5 weeks

dizziness handicap inventory

The dizziness handicap inventory (DHI) identifies difficulties that patients may be experiencing because of dizziness for questions about daily life. A follow-up question and the restriction is also assessed. Each of the 25 questions can be answered as Yes (4 points), Sometimes (2 points) or No (0 points). The final score is out of 100.

Time frame: Baseline and at 5 weeks

Time up and Go

Time up and Go is a basic physical therapist method of testing mobility, balance, walking ability, and fall risk. The duration of time it takes to stand walk 5 meters, turn around and sit back down. Scores less than 10 seconds is considered normal and healthy, while scores exceeding 20 seconds may indicate a high risk of falls.

Time frame: Baseline and at 5 weeks

Dynamic Gait index

Dynamic Gait index is a clinical assessment of an individual's dynamic balance and gait performance tested via progressive gait tasks. Each task is scored on a 4-point ordinal scale where 0 represents inability to perform the task, and 3 indicates no impairment. Scores of 19 or less is associated with increased fall risk.

Time frame: Baseline and at 5 weeks

5 times sit to stand

5 times sit to stand is a basic physical therapist method of testing mobility and strength. Patient will be seated and instructed to stand up fully then sit back down as quickly as possible 5 times in a row. The duration of time it takes to complete the task is measured.

Time frame: Baseline and at 5 weeks