A Stereoscopic Projection System and DDA Serious Game for Motor-Cognitive Intervention in Older Adults
Name: MEILEN JULIANA SALAMANCA JIMENEZ
Publication date: 09/04/2026
Examining board:
Name |
Role |
|---|---|
| ANSELMO FRIZERA NETO | Presidente |
| LUISA FERNANDA GARCIA SALAZAR | Examinador Externo |
| MARIO FERNANDO JIMÉNEZ HERNÁNDEZ | Coorientador |
| RICARDO CARMINATI DE MELLO | Examinador Interno |
Summary: Population aging and sedentary behavior accelerate physical and cognitive decline, increasing frailty and fall risk. dual task training addresses these challenges by targeting the sensorimotor integration required for Activities of Daily Living; however, traditional implementations often show low adherence due to monotony and limited objective performance tracking. As an alternative, Serious Games (SGs) integrate both stimulations in interactive environments that enhance engagement and promote
functional transfer. Combined with Dynamic Difficulty Adjustment (DDA), they maintain balance between therapeutic challenge and individual capacity, sustaining flow and supporting adherence. This research presents the development and validation of an interactive virtual training system integrating a semi-immersive projection environment with a motor-cognitive SG. The system combines Kinect V2 interaction based on a Go/No-Go paradigm with the UFES Smart Treadmill, which provides gait speed self-regulation and bidirectional communication. Six clinical criteria, a DDA algorithm, and a structured three-month training protocol were translated into gameplay mechanics and narrative elements. Five sedentary older adults participated in supervised multidisciplinary validation. DDA complexity in the Kinect-based inhibitory control task increased 407%, while locomotor speed in the treadmill task increased 236%. Exercise intensity remained low to moderate (RPE 3.2/10; self-efficacy 3.9/5), with Percentage of Maximum Heart Rate (%MHR) progressively shifting from low to moderate/high zones. Functional improvements were observed: gait speed increased 62.07%, the Timed Up and Go (TUG) test performance improved 38.82%, and shoulder mobility increased 16.1% and 38.8% in the dominant arm and 5.8% and 17.7% in the non-dominant arm. Stroop inhibitory accuracy improved 115.28%. Technology acceptance was high (SUS >80.4; PXI-Enjoyment 2.6/3; VRNQ-User Experience 5.8/7), while cybersickness was negligible. Five-month follow-up showed 80% adherence to physical activity. These findings suggest that DDA-driven semi-immersive dual task SGs can enable progressive therapeutic overload with low perceived burden, promoting functional transfer and supporting medium-term adherence in older adults.
