## 2 Materials and Methods
### Study Overview
#### 2.1.3 Pre- and Post-Training Assessments  
Assessments were conducted pre-training (or at 0 weeks) and post-training after completing 12 sessions (or at 6 weeks). Participants were blinded to their pre-training assessment results when attempting the post-training assessment. Our study evaluated balance using a multifaceted assessment approach. To assess mobility and standing balance, the Timed Up and Go (TUG) test and the Balance Error Scoring System (BESS), respectively, were examined. The TUG was used to evaluate pre- and post-VR training functional capacity, mobility, and dynamic balance in our study. The TUG test involved timing how long it took the participant to: (1) get up from a chair, (2) walk 10 ft, (3) turn around, (4) go back, (5) stop and (6) sit down (Figure 3a). The threshold value for fall risk is \(\geq\)13.5 s [10]; a shorter time to finish the TUG test suggests that the VR interventions have improved mobility, balance, and overall functional capacity. To assess standing balance, measures were taken utilizing the BESS. The BESS is a widely employed clinical test for evaluating static balance and postural stability, encom  
Figure 2: (a) Oculus VR headset; (b) VR headset environment; (c) example of VR and control group training in UDC CBRE. passing double-leg, single-leg, and tandem stances on both firm and foam surfaces to challenge one's balance during several (5) 20 s trials per stance [11]. This system is commonly used in, for example, concussion management, rehabilitation, and sports medicine to assess changes in balance and intervention effectiveness. The test conditions are shown in Figure 3b. Participants receive scores based on specific error criteria, such as opening eyes when instructed to be closed or stepping out of the designated stance. The scoring system quantifies errors made during each stance, with a lower score indicating, potentially, better postural stability. Errors are characterized by opening the eyes, removing hands from the iliac crest, taking a step to regain balance, stumbling or falling out of position, lifting the forefoot or heel, abducting or flexing the hip by over 30 degrees, or failing to return to the test position within 5 s [11]. To measure psychological and emotional aspects of balance and falling, we used the Activities-Specific Balance Confidence (ABC) Scale [13], the Tinetti Falls Efficacy Scale (FES) [6], and the Geriatric Depression Scale (GDS) [14]. The ABC scale is a self-reporting assessment designed to evaluate an individual's confidence (0% meaning no confidence and 100% meaning completely confident) in their ability to carry out different tasks (both at home and outside) without falling or losing their balance. The questionnaire consisted of several questions that were geared towards how confident one was in doing activities in and out of one's home. Some of the questions included the following: \"How confident are you that you will not lose your balance or become unsteady when you: walk up or down the stairs? Reach for a small can off a shelf at eye level? Sweep the floor? Walk across the parking lot to the mall?\". The FoF was assessed by the FES (a 10-item questionnaire), where on a scale from 1 to 10, with 1 being very confident and 10 being not confident at all, the participants are asked about their fear of falling during in-home activities. Examples of scenarios are taking a bath or shower, reaching into cabinets or closets, and walking around the house. A total score of greater than 70 indicates that the person has a fear of falling [6]. The Geriatric Depression Scale (GDS) is a self-reporting measure of depression in older adults. Users respond in a \"Yes/No\" format [14]. The GDS, which consisted of 10 questions, included questions such as the following: \"Are you basically satisfied with your life? Have you dropped many of your activities and interests?\". A score of 5 or more suggests depression.