Walking It Off: Habituation of Gait at Virtual High Elevation Settings

Fear and anxiety about falling can disrupt gait control, leading to activity restriction and increased fall risk. Virtual reality (VR) is increasingly used to deliver exposure therapy for various anxiety disorders and can induce postural threat by simulating high elevation settings within a controlled laboratory environment, inducing fall-related anxiety and cautious gait (i.e. slower, shorter steps) in young and older adults. However, existing studies feature short exposures and data averaged across trials, so it is unknown how emotional and motor responses to VR postural threat adapt across time. The purpose of this study was to investigate compensatory changes to gait within a one-minute exposure to VR-induced fall-related anxiety. Eighteen healthy participants (mean age = 24.5 ± 6.4 years standard deviation) walked at self-selected speeds in low VR elevations (ground level) and high VR elevations (~ 15-m elevation) along a wooden walkway (0.4 x 5.2m) for one minute. Spatiotemporal metrics for the first six (T1) and last six straight steps (T2) of each trial were calculated from 3D foot position. Results revealed significant interactions between Height and Time for step length ( p  < .001), gait speed ( p  < .001), single support time ( p  < .001), and double support time ( p  < .001). Significant changes to gait between settings indicates that participants exhibited more cautious gait at high versus low virtual elevations. Changes within a trial at high virtual elevation suggest gait became less cautious over time with exposure to postural threat. Habituation of gait with exposure to postural threat conditions shows the potential use of VR as an intervention to reduce fall-related anxiety in vulnerable populations.