Validity and Reliability of VR-based Cable Car simulation for balance assessment using the Nintendo Wii balance board

The aging population has become a global challenge and is causing an increase in chronic diseases and associated health problems. This age group has been associated with conditions such as reduced mobility, prolonged hospitalizations, elevated morbidity rates, and an increased incidence of falls. Balance assessment tools are used to assess the postural movements, risk of falls and balance impairments. One example is the WII Balance Board (WBB), or Home Balance Posturography, a computerized tool to examine balance in home environments. Using virtual reality ( VR) technology with balanced assessment tools may enhance the instruments' ecological validity, increase performance and standardization, and reduce administration time. We created a VR-based Cable Car simulation (CCS) using a WBB for the balance assessment with four different speeds and five angles of the Cable Car. The 23 participants participated in this study using a repeated measures sample design. The participants first experienced Cable Car Simulation and then the posturography test (mCTSIB). The maximum excursion of Center of Pressure (COP), usability and participants' level of presence were measured through WBB, SUS, and Witmer and Singer Presence instruments, respectively. Results showed no impact of the angles of the Cable Car on the maximum excursion of COP of participants. However, a significant difference was found on COP in the anterior-posterior axis when the speed of the Cables was increased three times. We found a positive correlation between the mean speed from CCS and the Posturography test. No correlation was found between the maximum excursion of COPs for the anterior-posterior and medial- lateral axis. The sense of presence score was moderate, while the usability score was good. These results suggest that VR technology and WBB can be used to implement balance assessment tools with high ecological validity.