111 Summary and general discussion environment is ensured by a safety harness that prevents them from falling. To test the assumption that people with HSP and maladaptive fear of falling benefit more from C-Mill training than from conventional gait training, fear of falling could be used as a critical inclusion criterion. This can be done by using the newly developed Updated Perceived Control over Falling Scale, where a predetermined cut-off value of 13 points or lower is assumed to identify elderly persons in whom fear of falling can be considered maladaptive. Of note, this scale has not yet been validated for people with HSP. An important limitation of treadmill-based training is that not all domains of gait adaptability can be included, such as terrain demands (e.g., walking over uneven surfaces), postural transitions (e.g., turning while walking), and interaction with physical obstacles. These limitations could be overcome by overground gait adaptability training. An example of such training is the Nijmegen Falls Prevention Program, 31 a five-week exercise program that focuses on overground obstacle negotiation, walking exercises, in addition to training fall techniques. This program was proven beneficial compared to usual care in community-dwelling elderly. 27,31 It is reasonable to assume that, as the basic principles of this training program are sound, people with HSP may also benefit from this type of overground training program. Moreover, overground-based programs are accessible for a broader population, such as people with HSP who have limited access to technically supported gait rehabilitation tools. Indeed, gait training devices are often only available at specialized hospitals or rehabilitation centers. For people with HSP living in rural areas or suffering from enhanced fatigability, the efforts to participate in technically supported gait training may be higher than the expected benefits, which limits adherence and feasibility. These considerations underline the relevance of also evaluating the efficacy, feasibility, and cost-effectiveness of overground gait adaptability training programs for people with HSP that can preferably be administered by community-based physiotherapists. Recently, there has been an increasing interest in home-based serious gaming, i.e., performing games to promote physical activity and train specific motor skills. Several reviews on the feasibility and efficacy of serious gaming in neurodegenerative conditions have reported promising results. 32,33 It was found that a home-based intervention using commercially available hardware (e.g., Nintendo Wii Fit Balance Board or Microsoft Kinect) was perceived as joyful, which resulted in a high adherence rate and improved balance capacity, gait capacity, and mobility. The home-based setting was generally reported as safe, but the studies used different approaches to ensure safety, for instance conducting a risk assessment at the participant’s home, supervising the first session, or starting with an introduction at a specialized clinic. The recent introduction of balance and gait training through commercially available augmented reality goggles (HoloLens 2 and Magic Leap 7
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