smart±step – balance and brain training


What is smart±step?

  • smart±step is a system that uses a wireless step mat and a series of interactive computer games to reduce falls risk in older people. It was developed for people over the age of 65 years, using over 15 years of research from the Falls Balance and Injury Research Centre at NeuRA.
  • smart±step features eight fun and engaging games that challenge balance, as well as thinking, skills of attention, inhibition and visual-spatial. The system is designed to be played at home, and connects easily to a TV or computer monitor.
  • Two pilot randomised controlled trials of an early version of smart±step showed the intervention group had improved balance, step reaction times and central processing ability, compared to the control group.
  • We recently completed two large randomised controlled trials to examine the effects of smart±step on falls, physical and cognitive functions. One study involved 750 older people living in the community. Another multi-site trial involved almost 500 people with multiple sclerosis living in NSW, ACT, Vic and Tas. Results from these trials are now being analysed.
  • NeuRA is currently partnering with Allity to assess the usability of smart±step amongst aged care residents. NeuRA’s long-term goal is to partner with community and assisted living services, as well as hospital inpatient and outpatient departments.


How it works

  • smart±step comes with a wireless step mat and computer system which connect to a television screen or monitor. Players navigate the games, which appear on the screen in front of them, by stepping in the correct direction at the correct time. For example, in one of the games named Toad Runner, players must help their toad avatar to cross busy roads, footpaths and rivers whilst timing their moves to avoid obstacles. The quicker and more precise their steps are, the more likely users are to progress through the game.
  • Each of the eight games contains five levels of difficulty: very easy, easy and moderate through to hard and very hard – very hard is a challenge for a young and healthy person. There are a range of stepping activities to choose from, such as squashing cockroaches and shooting aliens. Each game challenges a different cognitive function, with some requiring more advanced processing ability and quicker reaction times. Players compete with themselves, and are encouraged to get the highest score they can before playing another game. While all games train the brain and body, players who complete multiple games will get the most diverse cognitive training.
  • Accurate and appropriately timed stepping is crucial for avoiding falls, as is sharp mental processing. By training balance and reaction, as well as attention, working memory and task execution, smart±step helps to prevent people from falling in the real world.


The smart±step games

     Smartstep Computer Games


Game title Description
Stepmania Players steps are guided by arrows and dance tracks to make them feel as if they aren’t exercising at all
La Cucaracha Set in a desert, players need to squash cockroaches and avoid the cacti, which zoom past at an increasingly speedy rate
Brick Stacker Players use their feet to rotate and align the falling bricks so that rows can be cleared before they build up to the top of the screen
Alien Invasion Just like the retro arcade game, players use their feet to fire lasers at fast-approaching aliens
Greek Village Players navigate a three dimensional village in Greece and are required to choose the correct path whilst avoiding obstacles as the pace quickens
Anaconda Players step to control the direction of the snake, taking care not to bump into walls or the snake’s own body
Toad Runner Players use their feet to guide the frog across the river, avoiding the obstacles
Dot Muncher Players guide the dot muncher through the maze, using their feet, with the aim to reach the cherry and avoid the four floating ghosts.


See what’s going on at NeuRA


ReacStep – novel balance training programs to prevent falls in older adults

The ReacStep study is investigating the short-term effects of two balance training programs (i.e. reactive balance training and conventional balance training) on balance recovery from slips and trips in older adults. These programs are designed from evidence-based research and offer a challenging and unique experience to improving balance. The ReacStep team are calling on volunteers who: are aged 65 and over living independently in the Sydney metropolitan community can walk 500m comfortably with mobility aids or rest have not been advised by a medical practitioner not to exercise have no neurological conditions (e.g. Parkinson’s Disease, multiple sclerosis, Alzheimer’s, dementia, etc.) have no history or lower limb, pelvic or vertebral fracture(s) and/or lower limb joint replacement(s) in the past 6 months have no other existing conditions that may prevent them from exercising (e.g. injury, pain, fatigue, etc.) Eligible volunteers will be subjected to a health and safety screening before they are enrolled and randomly allocated into one of the two groups. Both groups will undertake a 3-week training program with an exercise physiologist, at NeuRA (i.e. in Randwick) as well as a balance recovery assessment at the 4-week time point. Reactive balance training involves intentionally stepping on a sliding tile, stepping over obstacles, trigger-release recovery as well as strength training. Participants will be wearing a full-body safety harness to ensure safety. Conventional balance training involves keeping balance in varying foot positions (i.e. feet together, in tandem or on one leg) whilst performing secondary tasks such as throwing a ball, card sorting, solving a maze or playing computer games. For more detailed information, read the Participant Information Statement and watch the video below. To get involved or to register your interest, click HERE. For all other queries, please contact the ReacStep Team on 02 9399 1002 or HC210350