The StepKinnection Game for Fall Prevention


StepKinnection is an interactive video game that delivers stepping exercises for the elderly. This system combines a set of appropriate age-related features and a hybrid version of the Choice Stepping Reaction Time (CSRT) task [5], a time-based clinical test that has shown to reliably predict falls in older adults. 

The combination of these two dimensions make this game potentially useful as an effective tool to reduce the risk of falling in older people as:

  1. it directly appeals to the aged cohort;
  2. it trains specific physical and cognitive functions associated with falls; and
  3. it allows for a continuous assessment of their health outcomes in order to evaluate their progression.

To the best of our knowledge, none of these characteristics is available in current commercial games. 

Game Description

In this game, the player is an explorer who travels around the globe visiting colorful countries, hunting for treasures and seeking different adventures. Each country presents a challenge where the player gets to experience their traditional music and collect exotic fruits. Completing each challenge takes the player one step closer to winning a trophy. However, the further they travel the more difficult it gets. Game play starts with a series of basic levels where players will have the chance to familiarize with the game and coordinate their movements accordingly. Once they have finished these levels, players can move up to more challenging ones related to speed, precision and cognitive complexity.

In order to play the game, the player needs to stand in front of the TV facing the Kinect. Shortly after, the main menu will be presented (Figure 1), where players can select from a list of counties to visit. The player can wave either hand to move the cursor to navigate the menu (Figure 2). Once the level is selected the user moves to the main stepping task.

The Stepping Task

Throughout the game, fruits will appear on the screen every now and then, and the player is expected to collect them. In order to achieve this, the player needs to reach the fruits by stepping on them (Figure 3). 

As the user moves through the levels, the speed of the appearance and the size of the fruits decrease. This is to encourage players to perform quicker and more accurate steps (i.e., increase in skill) as they advance to higher levels. This hence reinforces the ability to take proactive steps that could help an individual to regain balance and avoid falls. Also, as the stepping area decreases, the user needs to be more coordinated to be able to step on the fruits. 

Training Motor Inhibition

In the mid-levels, a lady bug might randomly appear on the screen (Figure 4). Stepping on the lady bug will take 2 penalty points off their current score reducing their chances of winning. However, if the player remains in position, 1 point will be awarded.

This motor inhibition task is incorporated with the purpose of adding varied difficulty to the game by slightly increasing its cognitive demand. According to [8], adequate motor inhibition plays an important role in avoiding falls. Training this ability is therefore ideal for situations where avoiding an obstacle can prevent a fall from occurring.

Stimulating the Ability to Take Quick Reactive Steps

In the higher levels, dollar coins will randomly appear on the screen for split-second amounts of time (Figure 5). These coins are bonus points that can help players to move faster in the game, with the purpose of encouraging them to step faster. For each dollar coin that they collect, 2 bonus points will be added to their current score to reward the player. This feature trains the ability to respond quickly to a hazardous situation [7]. Ideal for circumstances where the person has initiated a step but the environment suddenly changes 

For all the above stepping tasks in the game, the accuracy of the responses is automatically processed by the hybrid clinical test for fall risk assessment that is embedded in the game [2].


  1. GARCIA, J., LAWRENCE, E., NAVARRO, K.F., and SAX, C., 2011. Heuristic Evaluation for Interactive Games within Elderly Users. In Proceedings of the eTELEMED 2011, The Third International Conference on eHealth, Telemedicine, and Social Medicine (Gosier, Guadeloupe, France, February 23, 2011 2011), 130-133.
  2. GARCIA, J.A., PISAN, Y., TAN, C.T., and NAVARRO, K.F. Assessing the Kinect’s Capabilities to Perform a Time-based Clinical Test for Fall Risk Assessment in Older People.
  3. GERLING, K., LIVINGSTON, I., NACKE, L., and MANDRYK, R., 2012. Full-body motion-based game interaction for older adults. In Proceedings of the 2012 ACM annual conference on Human Factors in Computing Systems ACM, 1873-1882.
  4. KIM, J., SON, J., KO, N., and YOON, B., 2012. Unsupervised Virtual Reality-Based Exercise Program Improves Hip Muscles Strength and Balance Control in the Elderly: A Pilot Study. Archives of physical medicine and rehabilitation.
  5. LORD, S.R. and FITZPATRICK, R.C., 2001. Choice Stepping Reaction Time A Composite Measure of Falls Risk in Older People. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56, 10, M627-M632.
  6. NEUFELDT, C., 2009. Wii play with elderly people. IISI.
  7. PAVOL, M.J., RUNTZ, E.F., and PAI, Y.-C., 2004. Young and older adults exhibit proactive and reactive adaptations to repeated slip exposure. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 59, 5, M494-M502.
  8. POTOCANAC, Z., HOOGKAMER, W., CARPES, F.P., PIJNAPPELS, M., VERSCHUEREN, S.M., and DUYSENS, J., 2014. Response inhibition during avoidance of virtual obstacles while walking. Gait & Posture 39, 1, 641-644.
  9. UZOR, S. and BAILLIE, L., 2014. Investigating the long-term use of exergames in the home with elderly fallers. In Proceedings of the 32nd annual ACM conference on Human factors in computing systems ACM, 2813-2822.