ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1671477
Visual attention during non-immersive virtual reality balance training in older adults with mild to moderate cognitive impairment: An eye-tracking study
Provisionally accepted
- 1Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- 2Clinica RedSalud Providencia, Providencia, Chile
- 3Universidad del Desarrollo Facultad de Medicina, Santiago, Chile
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Older adults with cognitive impairment often present with co-occurring balance deficits, reduced walking capacity, and impaired attentional control-particularly in executive domains. These interrelated challenges increase fall risk and complicate conventional rehabilitation approaches. While eye-tracking technologies offer objective insights into visual attention through oculomotor behavior, their integration into clinical rehabilitation remains underexplored. This study aimed to explore visual attention patterns using eye-tracking metrics during non-immersive virtual reality (NIVR) balance training in older adults with mild to moderate cognitive impairment.A prospective quasi-experimental study was conducted with seven participants (mean age: 76.9 ± 8.8 years) enrolled in a neurorehabilitation program. Each participant completed 10 NIVR-based balance training sessions using Rehametrics® software, which adjusted task difficulty in real time based on performance. Eye movements were recorded with the Tobii Pro TX300 system during specific motor tasks involving obstacle anticipation and stepping. Clinical outcomes included the Mini-BESTest, Functional Gait Assessment, 6-Minute Walk Test, 4-Meter Walk Test, and Montreal Cognitive Assessment (MoCA). Eye-tracking variables-fixation stability, microsaccades, and pupil diameter-were compared between early (T1) and late (T2) sessions.Results: Across the intervention, participants showed increased tolerance to higher task difficulty levels and greater lower-limb endurance. Some clinical measures, including balance performance and walking speed, showed upward trends over time. Eye-tracking analyses revealed increased fixation stability and reductions in pupil diameter between T1 and T2, suggesting a potential shift toward more efficient attentional allocation and reduced cognitive effort. No consistent changes were observed in microsaccadic activity.Discussion: This exploratory study suggests that eye-tracking can provide valuable insights into attentional strategies during motor training in older adults with cognitive impairment. The combination of NIVR and oculomotor assessment may enhance the understanding of motor-cognitive interactions and inform the design of more personalized rehabilitation protocols. Future research with larger samples is warranted to confirm and expand upon these preliminary observations.
Keywords: Attention, Eye-tracking, cognitive impairment, older adults, virtual reality, Balance training
Received: 23 Jul 2025; Accepted: 17 Sep 2025.
Copyright: © 2025 Maldonado Diaz, Jara- Vargas and Gonzalez-Seguel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marcos Maldonado Diaz, marcosmaldonado.k@gmail.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.