title: A Stroop Stepping Test (SST) using low-cost computer game technology discriminates between older fallers and non-fallers.
abstract: BACKGROUND
  impaired stepping and reduced cognitive functioning have both been identified as fall-risk factors in older people. We developed a Stroop Stepping Test (SST) that combines stepping and response inhibition using low-cost computer game technology to provide a functional measure that reflects real-life behaviour and determined whether this test discriminates between older fallers and non-fallers.
  
  
  METHODS
  a cross-sectional study, including 103-independent living cognitively intact older people (70-93 years), was conducted. Participants were assessed on the SST and other outcome measures associated with fall-risk. The SST presented arrows on a computer screen with words written within them. Participants were asked to step in the direction indicated by the word and ignore the arrow orientation. Participants also reported whether they had fallen or not in the past 12 months.
  
  
  RESULTS
  twenty-eight percent of participants reported falling in the past year. SST mean time per trial [OR: 1.72 (95% confidence interval 1.02-2.91) and SST errors (OR: 1.53 (1.14-2.07)] were associated with falls. After adjusting for other fall-risk factors in a multivariate logistic regression analysis, each error made during SST increased the odds of falling by a factor 1.7 [OR: 1.65 (1.17-2.34)].
  
  
  CONCLUSIONS
  this study shows the SST-a low-cost video game device-is feasible for older people to undertake. The SST was able to distinguish fallers from non-fallers, providing a novel way to explore cognitive mechanisms for fall-risk in older people.
authors.affiliation: Neuroscience Research Australia, Falls and Balance Research Group, Sydney, NSW, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schoene
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Smith
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Davies
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006801:Humans; D057187:Independent Living; D007266:Inhibition, Psychological; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D057190:Stroop Test; D013997:Time Factors; D018910:Video Games; D016138:Walking
keywords: accidental falls; assessment; executive function; inhibition; older people; stepping