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Tsai YC, Hsu WL, Kantha P, Chen PJ, Lai DM. Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease. J Neuroeng Rehabil 2024; 21:74. [PMID: 38724981 PMCID: PMC11080234 DOI: 10.1186/s12984-024-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Degenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD. METHODS Fourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment. RESULTS After the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05). CONCLUSION This is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.
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Affiliation(s)
- Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No. 17, Xuzhou Rd., Zhongzheng Dist, Taipei, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Hao J, Buster TW, Cesar GM, Burnfield JM. Virtual reality augments effectiveness of treadmill walking training in patients with walking and balance impairments: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:603-619. [PMID: 36366806 DOI: 10.1177/02692155221138309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To systematically summarize and examine current evidence regarding the combination of virtual reality and treadmill training in patients with walking and balance impairments. DATA SOURCES English language randomized controlled trials, participants with walking and balance impairments, intervention group used virtual reality and treadmill, control group only used treadmill with the same training frequency and number of sessions. Six bioscience and engineering databases were searched. METHODS Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Sixteen randomized controlled trials including 829 participants were identified. Compared to treadmill-only training, virtual reality augmented treadmill training induced significantly faster walking (p < 0.001; standardized mean difference (SMD) = 0.55, 95%CI: 0.30 to 0.81), longer step length (p < 0.001; SMD = 0.74, 95%CI: 0.42 to 1.06), narrower step width (p = 0.03; SMD = -0.52, 95%CI: -0.97 to -0.06), longer single leg stance period (p = 0.003; SMD = 0.77, 95%CI: 0.27 to 1.27), better functional mobility (p = 0.003; SMD = -0.44, 95%CI: - 0.74 to -0.15), improved balance function (p = 0.04; SMD = 0.24, 95%CI: 0.01 to 0.47), and enhanced balance confidence (p = 0.03; SMD = 0.73, 95%CI: 0.08 to 1.37). Walking endurance did not differ significantly between groups (p = 0.21; SMD = 0.13, 95%CI: -0.07 to 0.34). CONCLUSIONS Virtual reality augmented treadmill walking training enhances outcomes compared to treadmill-only training in patients with walking and balance impairments. The results of this review support the clinical significance of combining virtual reality with treadmill training with level 1A empirical evidence.
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Affiliation(s)
- Jie Hao
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
- Division of Physical Therapy Education, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Thad W Buster
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Guilherme M Cesar
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, 20936Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Cho KH, Park JB, Kang A. Metaverse for Exercise Rehabilitation: Possibilities and Limitations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085483. [PMID: 37107765 PMCID: PMC10138806 DOI: 10.3390/ijerph20085483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES This study aimed to obtain a consensus agreement from an expert panel on the metaverse for exercise rehabilitation in stroke patients using the Delphi technique. METHODS This study recruited twenty-two experts and conducted three rounds of online surveys between January and February 2023. The Delphi consensus technique was performed online to review and evaluate the framework module. A panel of experts, including scholars, physicians, physical therapists, and physical education specialists in the Republic of Korea, was invited to participate in this study. For each round, the expert consensus was defined as more than 90% of the expert panel agreeing or strongly agreeing with the proposed items. RESULTS A total of twenty experts completed the three Delphi rounds. First, virtual reality-assisted (VR) treadmill walking could improve cognitive function, concentration, muscular endurance, stroke prevention, proper weight maintenance, and cardiorespiratory function. Second, related technology, safety, price, place, and securing experts would be obstacles or challenges in VR-assisted treadmill walking for stroke patients. Third, the role of exercise instructors in exercise planning, performance, and assessment for VR-assisted treadmill walking is equally important, and reeducation for them is required. Fourth, VR-assisted treadmill walking for stroke patients requires an exercise intensity of at least five times a week, about one hour each time. CONCLUSIONS This study showed that the metaverse for exercise rehabilitation for stroke patients could be successfully developed and would be feasible to be implemented in the future. However, it would have limitations in terms of technology, safety, price, place, and expert factors to be overcome in the future.
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Affiliation(s)
- Kyoung-Hwan Cho
- Department of Special Physical Education, Daelim University College, Anyang 13916, Republic of Korea
| | - Jeong-Beom Park
- Department of Special Physical Education, Daelim University College, Anyang 13916, Republic of Korea
| | - Austin Kang
- Department of Medicine, Seoul National University, Seoul 08826, Republic of Korea
- Correspondence: ; Tel.: +82-1027230519
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Darekar A. Virtual Reality for Motor and Cognitive Rehabilitation. Curr Top Behav Neurosci 2023; 65:337-369. [PMID: 37041455 DOI: 10.1007/7854_2023_418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Virtual Reality (VR) affords clinicians the ability to deliver safe, controlled, task-specific customised interventions that are enjoyable, motivating and engaging. Elements of training in VR comply with principles of learning implicated in new skill acquisition and re-learning skills post-neurological disorders. However, heterogeneity in the description of VR systems and the description and control of 'active' ingredients of interventions (like dosage, type of feedback, task specificity, etc.) have led to inconsistency in the synthesis and interpretation of evidence related to the effectiveness of VR-based interventions, particularly in post-stroke and Parkinson's Disease (PD) rehabilitation. This chapter attempts to describe VR interventions with respect to their compliance with principles of neurorehabilitation, with the goal of optimising interventions for effective training and facilitation of maximum functional recovery. This chapter also advocates using a uniform framework to describe VR systems to promote homogeneity in literature in order to help in the synthesis of evidence. An overview of the evidence revealed that VR systems are effective in mediating deficits in upper extremity, posture and gait function seen in people post-stroke and PD. Generally, interventions were more effective when they were delivered as an adjunct to conventional therapy and were customised for rehabilitation purposes, in addition to complying with principles of learning and neurorehabilitation. Although recent studies imply that their VR intervention is compliant with principles of learning, only a few explicitly describe how these principles are incorporated as 'active ingredients' of the intervention. Finally, VR interventions targeting community ambulation and cognitive rehabilitation are yet limited and therefore warrant attention.
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Lee Y, Kim K. The influence of Gait Training Combined with Portable Functional Electrical Stimulation on motor function, balance and gait ability in stroke patients. J Back Musculoskelet Rehabil 2022; 35:1171-1178. [PMID: 35754258 DOI: 10.3233/bmr-210154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Problems with motor functions, balance and gait ability commonly occur in stroke patients and cause asymmetric posture imbalance and gait patterns. OBJECTIVE We examined the effects of gait training (GT) combined with portable functional electrical stimulation (FES) on motor functions, balance and gait ability of stroke patients. METHODS A single blind, randomized control trial was conducted with 34 post stroke patients who were randomly allocated to two groups: 1) FES + GT group (n= 17) and the placebo FES + GT (PLBO + GT) group (n= 17). All interventions were given for 30 minutes, 5 days a week for 4 weeks. Fugl-Meyer assessment (FMA) was used to measure motor function of lower extremity. Performance oriented mobility assessment (POMA) was used to balance and gait ability. OptoGait was used to analyze gait ability. RESULTS Both groups showed significant improvements in motor function, balance and gait ability. The FES + GT group showed significantly greater improvement in motor function, balance and gait abilities after four weeks compared to the PLBO + GT group. CONCLUSION It was found that the gait training applied with FES is effective in improving the motor function, balance and gait abilities of stroke patients.
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Affiliation(s)
- Yangjin Lee
- Department of Physical Therapy, Kyungbuk College, Gyeongsangbuk-do, Korea
| | - Kyunghun Kim
- Department of Physical Therapy, Gimcheon University, Gyeongsangbuk-do, Korea
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Tefertiller C, Ketchum JM, Bartelt P, Peckham M, Hays K. Feasibility of virtual reality and treadmill training in traumatic brain injury: a randomized controlled pilot trial. Brain Inj 2022; 36:898-908. [PMID: 35834738 DOI: 10.1080/02699052.2022.2096258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of treadmill training with virtual reality compared to treadmill training alone and standard of care balance and mobility treatment in chronic traumatic brain injury (TBI). PARTICIPANTS AND DESIGN Thirty-one individuals with chronic TBI with self-reported and objective balance deficits participated in a 4-week 12 session intervention of treadmill training with virtual reality, treadmill training alone, or standard of care overground therapy. OUTCOME MEASURES Primary measures included recruitment and enrollment rates, retention, tolerance to intervention, completeness of outcome measures, and adverse events. Secondary measures included the Community Balance and Mobility Scale, 10 Meter Walk Test, 6 Minute Walk Test, and Timed Up and Go. RESULTS No serious adverse events were reported. All participants completed all training sessions and assessments at all time points. Recruitment, enrollment, and retention rates were high. All groups showed a trend toward improvement in all balance and mobility measures following treatment. CONCLUSION Virtual reality and treadmill training are safe and feasibile for individuals with TBI. Participants show improvements on balance and mobility measures following a 4-week intervention. Future research is needed to evaluate the efficacy of this intervention compared to other modes of balance and mobility training.
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Affiliation(s)
| | | | | | | | - Kaitlin Hays
- Research Department, Craig Hospital, Englewood, Colorado, USA
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Apriliyasari RW, Van Truong P, Tsai PS. Effects of proprioceptive training for people with stroke: A meta-analysis of randomized controlled trials. Clin Rehabil 2021; 36:431-448. [PMID: 34821158 DOI: 10.1177/02692155211057656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of proprioceptive training on balance performance, trunk control, and gait speed in people with stroke. METHODS We searched PubMed, Science Direct, Cochrane, Embase, and Medline for randomized controlled trials that evaluated the effects of proprioceptive training for patients with stroke from the date of each database's inception to July 26, 2021. Two reviewers independently screened the titles and abstracts of potentially eligible articles that were identified on the basis of the search criteria. Methodological quality was determined using version 2 of the Cochrane risk of bias tool for randomized trials. Data were analyzed using Comprehensive Meta-Analysis software. The treatment effect was estimated by calculating Hedges' g and 95% confidence intervals (CIs) using a random-effects model. Statistical heterogeneity was assessed according to the I2 value. The primary outcome was balance performance and secondary outcomes were trunk control, gait speed, and basic functional mobility. RESULTS In total, 17 trials involving 447 people with stroke were included. Proprioceptive training had a significant effect on balance performance (Hedges' g = 0.69, 95% CI = 0.36-1.01), gait speed (Hedges' g = 0.57, 95% CI = 0.19-0.94), trunk control (Hedges' g = 0.75, 95% CI = 0.33-1.17), and basic functional mobility (Hedges' g = 0.63, 95% CI = 0.31-0.94) among people with stroke. CONCLUSION Proprioceptive training may be effective in improving balance performance, gait speed, trunk control, and basic functional mobility among people with stroke.
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Affiliation(s)
- Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan.,Department of Nursing, 188386Cendekia Utama Kudus, Kudus, Central Java, Indonesia
| | - Pham Van Truong
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Vinmec Times City International Hospital, 507149Vinmec Health Care System, Hanoi, Vietnam
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan.,Department of Nursing, 63499Wan Fang Hospital, 38032Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice, Wan Fang Hospital, 38032Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, 38032Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, 63474Taipei Medical University Hospital, Taipei, Taiwan
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Head-Mounted Display-Based Therapies for Adults Post-Stroke: A Systematic Review and Meta-Analysis. SENSORS 2021; 21:s21041111. [PMID: 33562657 PMCID: PMC7915338 DOI: 10.3390/s21041111] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Immersive virtual reality techniques have been applied to the rehabilitation of patients after stroke, but evidence of its clinical effectiveness is scarce. The present review aims to find studies that evaluate the effects of immersive virtual reality (VR) therapies intended for motor function rehabilitation compared to conventional rehabilitation in people after stroke and make recommendations for future studies. Data from different databases were searched from inception until October 2020. Studies that investigated the effects of immersive VR interventions on post-stroke adult subjects via a head-mounted display (HMD) were included. These studies included a control group that received conventional therapy or another non-immersive VR intervention. The studies reported statistical data for the groups involved in at least the posttest as well as relevant outcomes measuring functional or motor recovery of either lower or upper limbs. Most of the studies found significant improvements in some outcomes after the intervention in favor of the virtual rehabilitation group. Although evidence is limited, immersive VR therapies constitute an interesting tool to improve motor learning when used in conjunction with traditional rehabilitation therapies, providing a non-pharmacological therapeutic pathway for people after stroke.
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Kurul R, Cankaya T, Yildirim NU. Kinesio taping techniques for ankle stabilisation in patients with stroke: a single-blinded randomised controlled study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/AimsAnkle proprioception and neuromuscular feedback from this region provides the sensory input needed for balance. The aim of this study was to investigate the effects of repeated correction taping applied on the ankle and peroneus longus and peroneus brevis muscles on balance and gait in patients with stroke.MethodsA total of 61 patients with stroke with a mean age of 62.25 ± 7.04 years were included in this study. The patients were randomly divided into two groups. The control group (n=30) received 1 hour of rehabilitation, which took place during weekdays over the course of 2 weeks. The intervention group (n=31) received 1 hour of daily rehabilitation as well as having kinesio tape applied to their ankle. Both groups were assessed with the Balance Evaluating Systems Test, Timed Up and Go Test, Functional Reach Test, Tetrax Balance System and Barthel Index. Clinical assessments were performed at baseline, immediately after the first application, 1 week and 2 weeks later, following the first taping.ResultsThere was a significant improvement in the Balance Evaluating Systems and Functional Reach Tests scores between the first and last measurements in favour of the intervention group (P<0.05). There were no significant changes between baseline and immediately after assessment for all measurements (P>0.05). There was no significant difference in Tetrax scores, Timed Up and Go Test and Barthel Index scores (P>0.05).ConclusionsIn this study, it was found that dynamic balance was improved by taping the peroneus longus and peroneus brevis muscles, but the static balance did not change. One week of kinesio taping would be beneficial; however, prolonged use would not provide further improvement.
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Affiliation(s)
- Ramazan Kurul
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Tamer Cankaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Necmiye Un Yildirim
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Saglık Bilimleri University, Ankara, Turkey
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Lee K. Virtual Reality Gait Training to Promote Balance and Gait Among Older People: A Randomized Clinical Trial. Geriatrics (Basel) 2020; 6:geriatrics6010001. [PMID: 33375012 PMCID: PMC7838785 DOI: 10.3390/geriatrics6010001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022] Open
Abstract
Falls are the leading cause of injury and injury-related death in the elderly. This study evaluated the effect of virtual reality gait training (VRGT) with non-motorized treadmill on balance and gait ability of elderly individuals who had experienced a fall. Fifty-six elderly individuals living in local communities participated in this study. Subjects who met the selection criteria were randomly divided into a VRGT group (n = 28) and a control group (n = 28). The VRGT group received VRGT with non-motorized treadmill for 50 min a day for 4 weeks and 5 days a week. The control group received non-motorized treadmill gait training without virtual reality for the same amount of time as the VRGT group. Before and after the training, the one-leg-standing test, Berg Balance Scale, Functional Reach test, and Timed Up and Go test were used to assess balance ability, and the gait analyzer system was used to evaluate the improvement in gait spatiotemporal parameters. In the VRGT group, the balance ability variable showed a significant decrease in the one-leg-standing test and a significant improvement in the Timed Up and Go test. With respect to spatiotemporal gait parameters, velocity and step width decreased significantly in the VRGT group (p < 0.05), and stride length and step length were significantly improved in the VRGT group (p < 0.05). VRGT with non-motorized treadmill has been shown to improve balance and gait ability in the elderly. This study is expected to provide basic data on exercise programs for the elderly to prevent falls.
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Affiliation(s)
- Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Kyungdong University, Gosung 24764, Korea
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11
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Enam N, Veerubhotla A, Ehrenberg N, Kirshblum S, Nolan KJ, Pilkar R. Augmented-reality guided treadmill training as a modality to improve functional mobility post-stroke: A proof-of-concept case series. Top Stroke Rehabil 2020; 28:624-630. [PMID: 33342389 DOI: 10.1080/10749357.2020.1864987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To provide a proof-of-concept for a novel stroke-gait-specific augmented reality (AR)-guided treadmill intervention by evaluating its effect on temporospatial and functional outcomes of mobility.Methods: Two females with hemiplegia post stroke were recruited for participation in a 4-week intervention, and a single healthy control was recruited for baseline comparisons. The stroke-intervention (SI) participant (aged 54-years), completed 12 sessions of AR-guided treadmill intervention. The stroke-control (SC) participant (aged 59-years) completed 12 sessions of conventional treadmill intervention. Temporospatial and functional mobility were assessed pre-intervention, post-intervention, and at 1-month follow-up. Physical ACtivity Enjoyment Scale (PACES) was administered post-intervention.Results: The SI participant showed clinically meaningful improvements in functional outcomes post-intervention and at 1-month follow-up (Berg balance score (BBS): +6 and +10 points; Dynamic Gait Index (DGI): +2 at post-intervention only; walking speed: +0.19 and +0.24 m/s; 6-minute walk test (6MWT): +51.9 and +38.9) respectively. The SC showed clinically meaningful improvements in BBS (+3 and +3) and walking speed (+0.06 at post-intervention). The PACES scores showed that the SI participant had a significantly higher (23 points) enjoyment level during the intervention compared to the SC participant. The SI participant was more asymmetric compared to the SC participant at pre and post-intervention visits.Conclusions: The SI participant showed greater improvement in functional assessments compared to the SC participant post intervention. The AR-guided approach may have added benefits compared to traditional treadmill training, while providing better customization, patient enjoyment, and engagement. Further investigation with a larger sample is warranted.
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Affiliation(s)
- Nabela Enam
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Akhila Veerubhotla
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Naphtaly Ehrenberg
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA.,Center for Spinal Stimulation Research, Kessler Foundation, West Orange, NJ, USA.,Spinal Cord Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Karen J Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Rakesh Pilkar
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
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Effectiveness of virtual reality games for falls, postural oscillations, pain and quality of life of individual HAM/TSP: a randomized, controlled, clinical trial. J Neurovirol 2020; 26:676-686. [PMID: 32737862 DOI: 10.1007/s13365-020-00880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/17/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
People with HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP) have sensorimotor losses and postural instability, resulting in frequent falls. These findings stimulate the use of exercise protocols associated with postural control. This study investigated the effectiveness of a balance training exercise protocol through a virtual game. This is a randomized crossover clinical trial performed in subjects with imbalance disorders (HAM/TSP). To evaluate postural oscillations by baropodometry (total area, anterior, posterior and lateral projection), the Footwork® system was used and by cinemetry (angle of the body, hip and ankle alignment in the lateral view), the CVMob system. In addition, the Brief Pain Inventory and the WHOQoL Bref were used to measure pain intensity and quality of life. Comparison tests of the averages (intra and inter groups) and correlations were applied considering an alpha of 5% and power of 80%. The study was approved by the Ethics Committee of the Catholic University of Salvador and registered in the Clinical Trials database (NCT02877030). The final sample consisted of 26, predominantly female subjects. An increase in the postural oscillations of the control subjects (p < 0.05), a reduction in the occurrence of falls (p = 0.039) and an improvement in the quality of life of the control-test group (p < 0.05) were observed. Virtual game training did not improve the static balance, promoting an increase in postural oscillations. Immediately after the application of the protocol, there was a reduction in fall occurrence and improvement in the quality of life.
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Ghai S, Ghai I, Lamontagne A. Virtual reality training enhances gait poststroke: a systematic review and meta-analysis. Ann N Y Acad Sci 2020; 1478:18-42. [PMID: 32659041 DOI: 10.1111/nyas.14420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
Virtual reality (VR)-based interventions are gaining widespread attention for managing neurological disorders such as stroke. A metastatistical consensus regarding the intervention is strongly warranted. In this study, we attempt to address this gap in the literature and provide the current state of evidence for the effects of VR on gait performance. We conducted both between- and within-group meta-analyses to provide a state of evidence for VR. Moreover, we conducted a search adhering to PRISMA guidelines on nine databases. Out of 1866 records, 32 studies involving a total of 809 individuals were included in this review. Considering all included studies, significant enhancements in gait parameters were observed with VR-based interventions compared with conventional therapy. A between-group meta-analysis reported beneficial significant medium effects of VR training on cadence (Hedge's g = 0.55), stride length ((STrL; Hedge's g = 0.46), and gait speed (Hedge's g = 0.30). Similarly, a within-group meta-analysis further revealed positive medium effects of VR on cadence (Hedge's g = 0.76), STrL (Hedge's g = 0.61), and gait speed (Hedge's g = 0.69). Additional subgroup analyses revealed beneficial effects of joint application of VR and robot-assisted gait training on gait speed (Hedge's g = 0.50). Collectively, findings from this review provide evidence for the effectiveness of VR-based gait training for stroke survivors.
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Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, Quebec, Canada
| | | | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, Quebec, Canada
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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15
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Cho H, Kim K. Effects of Action Observation Training with Auditory Stimulation on Static and Dynamic Balance in Chronic Stroke Patients. J Stroke Cerebrovasc Dis 2020; 29:104775. [PMID: 32205026 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/28/2020] [Accepted: 02/20/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the effects of action observation physical training accompanied by rhythmic auditory stimulation on the balance abilities of patients with stroke. METHOD In total, 30 patients with stroke at more than 6 months after the onset of the disease were included in the present investigation. Experimental programs were employed for 30 minutes a day, 3 times a week for 8 weeks. The audiovisual action observation training (AAO) group received action observation training with rhythmic auditory stimulation at a comfortable speed and physical training, and the visual action observation training (VAO) group received action observation training and physical training. The balance was assessed using a Biodex balance system. RESULTS In overall balance index, anteroposterior balance index, mediolateral balance index, and fall risk, there were significant improvements in both groups after intervention. A greater degree of changes were observed in the AAO group than those in the VAO group (P< .05). CONCLUSIONS The simultaneous application of action observation physical training and rhythmic auditory training seems to be an effective treatment method for patients with stroke. Furthermore, it is presented as a more effective therapeutic intervention method for those with motor disorders, such as patients with stroke.
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Affiliation(s)
- HoYoung Cho
- Department of Rehabilitation Science, Graduate School, Daegu University, Gyeongsan-si, Gyeongsangbuk-do 38453, Republic of Korea.
| | - Kyoung Kim
- Department of Physical Therapy, College Rehabilitation Science, Daegu University, Gyeongsan-si, Gyeongsangbuk-do 38453, Republic of Korea.
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16
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Ha SY, Kim SY, Sung YH. Effects of visual feedback training using transient Fresnel prism glasses on balance ability in stroke patients without hemispatial neglect. J Exerc Rehabil 2019; 15:683-687. [PMID: 31723557 PMCID: PMC6834707 DOI: 10.12965/jer.1938498.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 11/22/2022] Open
Abstract
The center of mass of the body in patients with stroke was oriented toward the nonparetic side. Abnormal weight shift increases the risk of falls. Therefore, many therapists make an effort to help their functional recovery through balance training. Our aim was to investigate the effect of visual feedback intervention using a Fresnel prism on static and dynamic balance in stroke patients without hemispatial neglect. Participants were assigned to control group (n=10) and experimental group (n=9). In the control group, neurodevelopmental therapy was performance for 30 min. In the experimental group, Fresnel prism glasses were applied with neurodevelopmental therapy for 30 min. We executed motor-free visual perception test for visual perception, balancia for static balance ability, and functional reach test and Berg balance test for dynamic balance ability, respectively. All tests were measured immediately after intervention. The visual perception function showed significant difference between unaffected side performance behaviors and visual perceptual processing time (P<0.05). In the static balance, there was a significant difference in sway velocity and sway distances (P<0.05). Dynamic balance was also significant different between groups (P<0.05). Visual feedback using Fresnel prism helps to control the static and dynamic balance ability by inducing weight shift toward the affected side in stroke patients. Therefore, a Fresnel prism may be suggested as an intervention tool to assist weight training for patients with stroke.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon, Korea
| | - Su-Young Kim
- Department of Physical Therapy, Graduate School of Industry & Business Administration, Kyungnam University, Changwon, Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon, Korea.,Department of Physical Therapy, Graduate School of Industry & Business Administration, Kyungnam University, Changwon, Korea
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17
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Short- and Mid-Term Improvement of Postural Balance after a Neurorehabilitation Program via Hippotherapy in Patients with Sensorimotor Impairment after Cerebral Palsy: A Preliminary Kinetic Approach. Brain Sci 2019; 9:brainsci9100261. [PMID: 31569505 PMCID: PMC6826615 DOI: 10.3390/brainsci9100261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022] Open
Abstract
There is still a lack of studies focused on trunk neurorehabilitation. Accordingly, it is unclear which therapeutic modalities are the most effective in improving static/dynamic balance after brain damage. We designed a pilot study on hippotherapy to assess its short- and mid-term effect on dynamic postural balance in patients with moderate-to-severe sensorimotor impairment secondary to cerebral palsy. Five patients aged 15.4 ± 6.1 years old were recruited. All of them had moderate-to-severe alterations of the muscle tone with associated postural balance impairment. Standing and walking were also impaired. Ten minutes horse riding simulator followed by twenty minutes hippotherapy session were conducted during five session days separated by one week each. We analyzed the displacement of the Center of Pressure (COP) on the sitting surface of the simulator’s saddle by means of a customized pressure pad. We measured the general behavior of the COP displacement as well as the postural adjustments when pace changed from walk to trot to walk during the sessions and among sessions. Statistical analysis revealed an improved postural control both by the end of the session and from session 1 to session 5. These results suggest that hippotherapy might support regularization of postural control in a long-term neurorehabilitation context.
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18
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Tefertiller C, Hays K, Natale A, O'Dell D, Ketchum J, Sevigny M, Eagye CB, Philippus A, Harrison-Felix C. Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1409-1416. [PMID: 31009598 PMCID: PMC8594144 DOI: 10.1016/j.apmr.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an in-home 12-week physical therapy (PT) intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI). SETTING Home-based exercise program (HEP). PARTICIPANTS Individuals (N=63; traditional HEP n=32; VR n=31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving PT services. MAIN OUTCOME MEASURES Primary: Community Balance and Mobility Scale (CB&M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS No significant between-group differences were observed in the CB&M over the study duration (P=.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (P=.8822); ABC (P=.4343) and PART-O (P=.8822). However, both groups demonstrated significant improvements in CB&M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all P's <.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change of 8 points on the CB&M at 24 weeks and 38% met or exceeded the minimal detectable change of 7.81 points on the BESTest. CONCLUSION This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment.
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Affiliation(s)
| | - Kaitlin Hays
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Audrey Natale
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Denise O'Dell
- Department of Physical Therapy, Regis University, Denver, Colorado
| | | | - Mitch Sevigny
- Department of Research, Craig Hospital, Englewood, Colorado
| | - C B Eagye
- Department of Research, Craig Hospital, Englewood, Colorado
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19
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Miranda CS, Oliveira TDP, Gouvêa JXM, Perez DB, Marques AP, Piemonte MEP. Balance Training in Virtual Reality Promotes Performance Improvement but Not Transfer to Postural Control in People with Chronic Stroke. Games Health J 2019; 8:294-300. [PMID: 31009243 DOI: 10.1089/g4h.2018.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: In people with chronic stroke, we investigated the transfer of gains obtained after balance training with virtual reality (VR) to an untrained task with similar balance demands. Materials and Methods: This study included 29 people with chronic stroke randomized into two groups: experimental (EG, n = 16) and control (CG, n = 13). The EG performed three sessions of balance training with VR using a platform-based videogame (Nintendo Wii Fit system™) for 1 week. The CG received no intervention. Transfer was evaluated through balance tests on the force platform Balance Master™, performed before and after the intervention period, for both groups. Results: The analysis of variance for repeated measures for game performance in the EG showed statistically significant improvement in scores in all five games after training (AT). In contrast, similar analysis for balance tests for the EG and CG showed no significant differences in performance index scores derived from the Balance Master tests after the intervention period for both groups. Conclusion: People with chronic stroke showed performance improvement AT with VR, but there was no transfer of the gains obtained to an untrained task with similar balance demands.
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Affiliation(s)
- Camila Souza Miranda
- 1Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo-SP, Brazil
| | - Tatiana de Paula Oliveira
- 1Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo-SP, Brazil
| | | | | | - Amélia Pasqual Marques
- 1Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo-SP, Brazil
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20
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De Keersmaecker E, Lefeber N, Geys M, Jespers E, Kerckhofs E, Swinnen E. Virtual reality during gait training: does it improve gait function in persons with central nervous system movement disorders? A systematic review and meta-analysis. NeuroRehabilitation 2019; 44:43-66. [DOI: 10.3233/nre-182551] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Emma De Keersmaecker
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Nina Lefeber
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Marion Geys
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elise Jespers
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
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21
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Silva de Sousa JC, Torriani-Pasin C, Tosi AB, Fecchio RY, Costa LAR, Forjaz CLDM. Aerobic Stimulus Induced by Virtual Reality Games in Stroke Survivors. Arch Phys Med Rehabil 2018; 99:927-933. [PMID: 29428343 DOI: 10.1016/j.apmr.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/10/2018] [Accepted: 01/13/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether virtual reality games (VRGs) in stroke survivors produce significant and reproducible heart rate and oxygen consumption (V˙o2) responses during their execution, corresponding to an intensity between the anaerobic threshold (AT) and the respiratory compensation point (RCP). DESIGN Single-subject, repeated-measure design. SETTING Stroke survivors registered from a rehabilitation program. PARTICIPANTS Chronic hemiparetic stroke survivors (N=12; 10 men; mean age ± SD, 58±12y) rated at 3 or 4 in the Functional Ambulation Categories. INTERVENTIONS Participants underwent, in a random order, 2 identical sessions of VRGs (console Xbox 360 + Kinect) and 1 control session (38min watching a movie). The VRG sessions were composed of 4 sets of VRGs (3min of tennis, 1min for changing the game, and 4min of boxing) interspaced with 2 minutes of rest. MAIN OUTCOME MEASURES Heart rate and V˙o2 were measured during the experimental sessions and compared with heart rate and V˙o2 obtained at AT and RCP assessed during a maximal cardiopulmonary exercise test. RESULTS Heart rate and V˙o2 during VRGs had good reproducibility (intraclass correlation coefficients, ≥.91 and ≥.85, respectively; coefficients of variation, ≤6.7% and ≤13.7%, respectively). Heart rate during VRGs was similar to AT and significantly lower than RCP (P≤.05), while V˙o2 was significantly lower than AT and RCP (P<.05). CONCLUSIONS An acute session of VRGs composed of tennis and boxing games using the console XBox 360 + Kinect promotes reproducible responses of heart rate and V˙o2 that corresponded, respectively, to AT and below AT, characterizing a low-intensity aerobic stimulus.
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Affiliation(s)
- Julio Cesar Silva de Sousa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Camila Torriani-Pasin
- Motor Behaviour Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Amanda Barboza Tosi
- Motor Behaviour Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Rafael Yokoyama Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Augusto Riani Costa
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | - Cláudia Lúcia de Moraes Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil.
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22
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Bolognini N, Russo C, Edwards DJ. The sensory side of post-stroke motor rehabilitation. Restor Neurol Neurosci 2018; 34:571-86. [PMID: 27080070 DOI: 10.3233/rnn-150606] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Contemporary strategies to promote motor recovery following stroke focus on repetitive voluntary movements. Although successful movement relies on efficient sensorimotor integration, functional outcomes often bias motor therapy toward motor-related impairments such as weakness, spasticity and synergies; sensory therapy and reintegration is implied, but seldom targeted. However, the planning and execution of voluntary movement requires that the brain extracts sensory information regarding body position and predicts future positions, by integrating a variety of sensory inputs with ongoing and planned motor activity. Neurological patients who have lost one or more of their senses may show profoundly affected motor functions, even if muscle strength remains unaffected. Following stroke, motor recovery can be dictated by the degree of sensory disruption. Consequently, a thorough account of sensory function might be both prognostic and prescriptive in neurorehabilitation. This review outlines the key sensory components of human voluntary movement, describes how sensory disruption can influence prognosis and expected outcomes in stroke patients, reports on current sensory-based approaches in post-stroke motor rehabilitation, and makes recommendations for optimizing rehabilitation programs based on sensory stimulation.
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Affiliation(s)
- Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milano, Italy
| | - Cristina Russo
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy
| | - Dylan J Edwards
- Burke-Cornell Medical Research Institute, White Plains, New York, NY, USA
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23
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Uhm YH, Yang DJ. The effects of whole body vibration combined biofeedback postural control training on the balance ability and gait ability in stroke patients. J Phys Ther Sci 2017; 29:2022-2025. [PMID: 29200649 PMCID: PMC5702839 DOI: 10.1589/jpts.29.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effect of biofeedback postural
control training using whole body vibration in acute stroke patients on balance and gait
ability. [Subjects and Methods] Thirty stroke patients participated in this study and were
divided into a group of 10, a group for biofeedback postural control training combined
with a whole body vibration, one for biofeedback postural control training combined with
an aero-step, and one for biofeedback postural control training. Biorescue was used to
measure the limits of stability, balance ability, and Lukotronic was used to measure step
length, gait ability. [Results] In the comparison of balance ability and gait ability
between the groups for before and after intervention, Group I showed a significant
difference in balance ability and gait ability compared to Groups II and III. [Conclusion]
This study showed that biofeedback postural control training using whole body vibration is
effective for improving balance ability and gait ability in stroke patients.
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Affiliation(s)
- Yo-Han Uhm
- Mokpo Rehabilitation Hospital: 627 Yeongsan-ro, Mokpo-si, Jeollanam-do, Republic of Korea.,Department of Special Education, Sehan University, Republic of Korea
| | - Dae-Jung Yang
- Department of Physical Therapy, Sehan University, Republic of Korea
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24
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Haarman JAM, Maartens E, van der Kooij H, Buurke JH, Reenalda J, Rietman JS. Manual physical balance assistance of therapists during gait training of stroke survivors: characteristics and predicting the timing. J Neuroeng Rehabil 2017; 14:125. [PMID: 29197402 PMCID: PMC5712141 DOI: 10.1186/s12984-017-0337-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background During gait training, physical therapists continuously supervise stroke survivors and provide physical support to their pelvis when they judge that the patient is unable to keep his balance. This paper is the first in providing quantitative data about the corrective forces that therapists use during gait training. It is assumed that changes in the acceleration of a patient’s COM are a good predictor for therapeutic balance assistance during the training sessions Therefore, this paper provides a method that predicts the timing of therapeutic balance assistance, based on acceleration data of the sacrum. Methods Eight sub-acute stroke survivors and seven therapists were included in this study. Patients were asked to perform straight line walking as well as slalom walking in a conventional training setting. Acceleration of the sacrum was captured by an Inertial Magnetic Measurement Unit. Balance-assisting corrective forces applied by the therapist were collected from two force sensors positioned on both sides of the patient’s hips. Measures to characterize the therapeutic balance assistance were the amount of force, duration, impulse and the anatomical plane in which the assistance took place. Based on the acceleration data of the sacrum, an algorithm was developed to predict therapeutic balance assistance. To validate the developed algorithm, the predicted events of balance assistance by the algorithm were compared with the actual provided therapeutic assistance. Results The algorithm was able to predict the actual therapeutic assistance with a Positive Predictive Value of 87% and a True Positive Rate of 81%. Assistance mainly took place over the medio-lateral axis and corrective forces of about 2% of the patient’s body weight (15.9 N (11), median (IQR)) were provided by therapists in this plane. Median duration of balance assistance was 1.1 s (0.6) (median (IQR)) and median impulse was 9.4Ns (8.2) (median (IQR)). Although therapists were specifically instructed to aim for the force sensors on the iliac crest, a different contact location was reported in 22% of the corrections. Conclusions This paper presents insights into the behavior of therapists regarding their manual physical assistance during gait training. A quantitative dataset was presented, representing therapeutic balance-assisting force characteristics. Furthermore, an algorithm was developed that predicts events at which therapeutic balance assistance was provided. Prediction scores remain high when different therapists and patients were analyzed with the same algorithm settings. Both the quantitative dataset and the developed algorithm can serve as technical input in the development of (robot-controlled) balance supportive devices.
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Affiliation(s)
- Juliet A M Haarman
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands. .,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. .,Roessingh Research and Development, Roessinghsbleekweg 33b, PO Box 310, 7500 AH, Enschede, the Netherlands.
| | - Erik Maartens
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Herman van der Kooij
- Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Jasper Reenalda
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
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25
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. MAIN RESULTS We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. PRIMARY OUTCOME results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). SECONDARY OUTCOMES when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Belinda Lange
- Flinders UniversitySchool of Health Sciences, Discipline of PhysiotherapyAdelaideAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkNew JerseyUSA
| | - Gustavo Saposnik
- University of TorontoDepartment of Medicine (Neurology), St Michael's HospitalTorontoCanadaM5C 1R6
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
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Abstract
BACKGROUND Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of the Cochrane review first published in 2003 and updated in 2005 and 2014. OBJECTIVES To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait-training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 14 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (the Cochrane Library 2017, Issue 2), MEDLINE (1966 to 14 February 2017), Embase (1980 to 14 February 2017), CINAHL (1982 to 14 February 2017), AMED (1985 to 14 February 2017) and SPORTDiscus (1949 to 14 February 2017). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists, and contacted trialists to identify further trials. SELECTION CRITERIA Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias and methodological quality. The primary outcomes investigated were walking speed, endurance, and dependency. MAIN RESULTS We included 56 trials with 3105 participants in this updated review. The average age of the participants was 60 years, and the studies were carried out in both inpatient and outpatient settings. All participants had at least some walking difficulties and many could not walk without assistance. Overall, the use of treadmill training did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; 18 trials, 1210 participants; P = 0.94; I² = 0%; low-quality evidence). Overall, the use of treadmill training in walking rehabilitation for people after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.06 m/s (95% CI 0.03 to 0.09; 47 trials, 2323 participants; P < 0.0001; I² = 44%; moderate-quality evidence) and the pooled MD for walking endurance was 14.19 metres (95% CI 2.92 to 25.46; 28 trials, 1680 participants; P = 0.01; I² = 27%; moderate-quality evidence). Overall, the use of treadmill training with body weight support in walking rehabilitation for people after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up. The pooled MD (random-effects model) for walking velocity was 0.03 m/s (95% CI -0.05 to 0.10; 12 trials, 954 participants; P = 0.50; I² = 55%; low-quality evidence) and the pooled MD for walking endurance was 21.64 metres (95% CI -4.70 to 47.98; 10 trials, 882 participants; P = 0.11; I² = 47%; low-quality evidence). In 38 studies with a total of 1571 participants who were independent in walking at study onset, the use of treadmill training increased the walking velocity significantly. The pooled MD (random-effects model) for walking velocity was 0.08 m/s (95% CI 0.05 to 0.12; P < 0.00001; I2 = 49%). There were insufficient data to comment on any effects on quality of life or activities of daily living. Adverse events and dropouts did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. AUTHORS' CONCLUSIONS Overall, people after stroke who receive treadmill training, with or without body weight support, are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve slightly in the short term. Specifically, people with stroke who are able to walk (but not people who are dependent in walking at start of treatment) appear to benefit most from this type of intervention with regard to walking speed and walking endurance. This review did not find, however, that improvements in walking speed and endurance may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations, or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory participants, but not in dependent walkers.
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Affiliation(s)
- Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Simone Thomas
- Klinik Bavaria KreischaWissenschaftliches InstitutKreischaGermany01731
| | - Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
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Cerebral Reorganization in Subacute Stroke Survivors after Virtual Reality-Based Training: A Preliminary Study. Behav Neurol 2017; 2017:6261479. [PMID: 28720981 PMCID: PMC5506482 DOI: 10.1155/2017/6261479] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/12/2017] [Accepted: 05/31/2017] [Indexed: 11/17/2022] Open
Abstract
Background Functional magnetic resonance imaging (fMRI) is a promising method for quantifying brain recovery and investigating the intervention-induced changes in corticomotor excitability after stroke. This study aimed to evaluate cortical reorganization subsequent to virtual reality-enhanced treadmill (VRET) training in subacute stroke survivors. Methods Eight participants with ischemic stroke underwent VRET for 5 sections per week and for 3 weeks. fMRI was conducted to quantify the activity of selected brain regions when the subject performed ankle dorsiflexion. Gait speed and clinical scales were also measured before and after intervention. Results Increased activation in the primary sensorimotor cortex of the lesioned hemisphere and supplementary motor areas of both sides for the paretic foot (p < 0.01) was observed postintervention. Statistically significant improvements were observed in gait velocity (p < 0.05). The change in voxel counts in the primary sensorimotor cortex of the lesioned hemisphere is significantly correlated with improvement of 10 m walk time after VRET (r = −0.719). Conclusions We observed improved walking and increased activation in cortical regions of stroke survivors after VRET training. Moreover, the cortical recruitment was associated with better walking function. Our study suggests that cortical networks could be a site of plasticity, and their recruitment may be one mechanism of training-induced recovery of gait function in stroke. This trial is registered with ChiCTR-IOC-15006064.
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Lee J, Lee K, Song C. Speed-Interactive Treadmill Training Using Smartphone-Based Motion Tracking Technology Improves Gait in Stroke Patients. J Mot Behav 2017. [PMID: 28632106 DOI: 10.1080/00222895.2016.1271300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study was conducted to investigate the effects of speed-interactive treadmill training (SITT) using smartphone-based motion tracking technology on gait in stroke patients. Thirty-four chronic stroke patients were randomly divided into a SITT group (n = 18) and a standard treadmill training (control) group (n = 16). The SITT group underwent smartphone-based SSIT while the control group underwent standard treadmill training. Both groups performed the training for 35 min per session, 3 times per week, for 6 weeks. Both groups used nonmotorized treadmills so that patients could control the speed. Evaluation was conducted during the week before and after the training. The OptoGait system measured gait spatiotemporal parameters. Both groups showed significant improvement in the temporal and spatial gait parameters (p < .05). In the SITT group, compared to the control group, the two-way analysis of variance with repeated measures showed an improvement in the temporal and spatial gait parameters after the intervention period (p < .05). This study confirmed that SITT improved the gait function of stroke patients. Based on this result, the authors propose that SITT, by improving gait, can be used as an effective training method to improve patients' functional activities in the clinic.
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Affiliation(s)
- Junyoung Lee
- a Department of Physical Therapy , College of Health Science, Sahmyook University , Seoul , Republic of Korea
| | - Kyeongjin Lee
- b Department of Physical Therapy , Kyungdong University , Gangwon Province , Republic of Korea
| | - Changho Song
- a Department of Physical Therapy , College of Health Science, Sahmyook University , Seoul , Republic of Korea
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A meta-analysis and systematic literature review of virtual reality rehabilitation programs. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.01.013] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ferreira dos Santos L, Christ O, Mate K, Schmidt H, Krüger J, Dohle C. Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review. Biomed Eng Online 2016; 15:144. [PMID: 28105952 PMCID: PMC5249036 DOI: 10.1186/s12938-016-0289-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as well as facilitating motor learning through multimodal sensory information. Several previous studies have shown positive effect of VR-based treatments for lower extremity motor rehabilitation in neurological conditions, but the characteristics of these VR applications have not been systematically investigated. The visual information on the user's movement in the virtual environment, also called movement visualisation (MV), is a key element of VR-based rehabilitation interventions. The present review proposes categorization of Movement Visualisations of VR-based rehabilitation therapy for neurological conditions and also summarises current research in lower limb application. METHODS A systematic search of literature on VR-based intervention for gait and balance rehabilitation in neurological conditions was performed in the databases namely; MEDLINE (Ovid), AMED, EMBASE, CINAHL, and PsycInfo. Studies using non-virtual environments or applications to improve cognitive function, activities of daily living, or psychotherapy were excluded. The VR interventions of the included studies were analysed on their MV. RESULTS In total 43 publications were selected based on the inclusion criteria. Seven distinct MV groups could be differentiated: indirect MV (N = 13), abstract MV (N = 11), augmented reality MV (N = 9), avatar MV (N = 5), tracking MV (N = 4), combined MV (N = 1), and no MV (N = 2). In two included articles the visualisation conditions included different MV groups within the same study. Additionally, differences in motor performance could not be analysed because of the differences in the study design. Three studies investigated different visualisations within the same MV group and hence limited information can be extracted from one study. CONCLUSIONS The review demonstrates that individuals' movements during VR-based motor training can be displayed in different ways. Future studies are necessary to fundamentally explore the nature of this VR information and its effect on motor outcome.
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Affiliation(s)
- Luara Ferreira dos Santos
- Rehabilitation Robotics Group (TU Berlin/ Fraunhofer IPK), Department of Industrial Automation Technology, Technische Universität Berlin, Pascalstr. 8-9, 10587 Berlin, Germany
- DFG Research Training Group Prometei, Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany
| | - Oliver Christ
- Institute Humans in Complex Systems, School of Applied Psychology, University of Applied Sciences and Arts Nortwestern Switzerland, Riggenbachstrasse 16, Olten, Switzerland
| | - Kedar Mate
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler Montreal, Quebec, H3G 1Y5 Canada
| | - Henning Schmidt
- Rehabilitation Robotics Group (Fraunhofer IPK/ TU Berlin), Department of Automation Technology, Fraunhofer Institute for Production Systems and Design Technology (IPK), Pascalstr. 8-9, 10587 Berlin, Germany
| | - Jörg Krüger
- Rehabilitation Robotics Group (TU Berlin/ Fraunhofer IPK), Department of Industrial Automation Technology, Technische Universität Berlin, Pascalstr. 8-9, 10587 Berlin, Germany
- Rehabilitation Robotics Group (Fraunhofer IPK/ TU Berlin), Department of Automation Technology, Fraunhofer Institute for Production Systems and Design Technology (IPK), Pascalstr. 8-9, 10587 Berlin, Germany
| | - Christian Dohle
- Department of Neurological Rehabilitation, MEDIAN Klinik Berlin-Kladow, Kladower Damm 223, 14089 Berlin, Germany
- Center for Stroke Research Berlin, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7309272. [PMID: 28053988 PMCID: PMC5174165 DOI: 10.1155/2016/7309272] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/06/2016] [Indexed: 01/28/2023]
Abstract
Objective. To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population. Method. A systematic review of randomized controlled trials published between January 2006 and December 2015 was conducted. Databases searched were PubMed, Scopus, and Web of Science. Studies must have involved adult patients with stroke during acute, subacute, or chronic phase. All included studies must have assessed the impact of virtual reality programme on either static or dynamic balance ability and compared it with a control group. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. Results. Nine studies were included in this systematic review. The PEDro scores ranged from 4 to 9 points. All studies, except one, showed significant improvement in static or dynamic balance outcomes group. Conclusions. This review provided moderate evidence to support the fact that virtual reality training is an effective adjunct to standard rehabilitation programme to improve balance for patients with chronic stroke. The effect of VR training in balance recovery is less clear in patients with acute or subacute stroke. Further research is required to investigate the optimum training intensity and frequency to achieve the desired outcome.
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Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis. Phys Ther 2016; 96:1905-1918. [PMID: 27174255 DOI: 10.2522/ptj.20160054] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Virtual reality (VR) training is considered to be a promising novel therapy for balance and gait recovery in patients with stroke. PURPOSE The aim of this study was to conduct a systematic literature review with meta-analysis to investigate whether balance or gait training using VR is more effective than conventional balance or gait training in patients with stroke. DATA SOURCES A literature search was carried out in the databases PubMed, Embase, MEDLINE, and Cochrane Library up to December 1, 2015. STUDY SELECTION Randomized controlled trials that compared the effect of balance or gait training with and without VR on balance and gait ability in patients with stroke were included. DATA EXTRACTION AND SYNTHESIS Twenty-one studies with a median PEDro score of 6.0 were included. The included studies demonstrated a significant greater effect of VR training on balance and gait recovery after stroke compared with conventional therapy as indicated with the most frequently used measures: gait speed, Berg Balance Scale, and Timed "Up & Go" Test. Virtual reality was more effective to train gait and balance than conventional training when VR interventions were added to conventional therapy and when time dose was matched. LIMITATIONS The presence of publication bias and diversity in included studies were limitations of the study. CONCLUSIONS The results suggest that VR training is more effective than balance or gait training without VR for improving balance or gait ability in patients with stroke. Future studies are recommended to investigate the effect of VR on participation level with an adequate follow-up period. Overall, a positive and promising effect of VR training on balance and gait ability is expected.
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Lendraitienė E, Tamošauskaitė A, Petruševičienė D, Savickas R. Balance evaluation techniques and physical therapy in post-stroke patients: A literature review. Neurol Neurochir Pol 2016; 51:92-100. [PMID: 27884459 DOI: 10.1016/j.pjnns.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
A stroke (cerebrovascular accident - CVA) is a significant social-economic issue. Approximately 15-30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients' daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results.
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Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Tamošauskaitė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Petruševičienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Palma GCDS, Freitas TB, Bonuzzi GMG, Soares MAA, Leite PHW, Mazzini NA, Almeida MRG, Pompeu JE, Torriani-Pasin C. Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review. Top Stroke Rehabil 2016; 24:269-278. [PMID: 27796177 DOI: 10.1080/10749357.2016.1250373] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated. METHOD A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials. RESULTS In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component. DISCUSSION The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.
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Affiliation(s)
- Gisele Carla Dos Santos Palma
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - Tatiana Beline Freitas
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - Giordano Márcio Gatinho Bonuzzi
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - Marcos Antonio Arlindo Soares
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - Paulo Henrique Wong Leite
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - Natália Araújo Mazzini
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - Murilo Ruas Groschitz Almeida
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
| | - José Eduardo Pompeu
- b Department of Neuroscience and Behavior , Psychology Institute, Medicine School, University of São Paulo , São Paulo , Brazil
| | - Camila Torriani-Pasin
- a Motor Behavior Research in Neurorehabilitation (GEPENEURO), Laboratory of Motor Behavior (LACOM) , University of São Paulo , São Paulo , Brazil
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In T, Lee K, Song C. Virtual Reality Reflection Therapy Improves Balance and Gait in Patients with Chronic Stroke: Randomized Controlled Trials. Med Sci Monit 2016; 22:4046-4053. [PMID: 27791207 PMCID: PMC5098932 DOI: 10.12659/msm.898157] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Virtual reality reflection therapy (VRRT) is a technically enhanced version of the mirror therapy concept. The aim of this study was to investigate whether VRRT could improve the postural balance and gait ability of patients with chronic stroke. Material/Methods Twenty-five patients with chronic stroke were randomly allocated into the VRRT group (n=13) and the control group (n=12). The participants in both groups performed a conventional rehabilitation program for 30 minutes. The VRRT group also performed a VRRT program for 30 minutes, five times a week for 4 weeks. The control group performed conventional rehabilitation program and a placebo VRRT program. Outcome measures included Berg Balance Scale (BBS), the Functional Reaching Test (FRT), and the Timed Up and Go (TUG) test (for dynamic balance ability), postural sway (for static balance ability), and 10 meter walking velocity (10 mWV) for gait ability. Results There were statistically significant improvements in the VRRT group compared with the control group for BBS, FRT, TUG, postural sway (mediolateral sway distance with eyes open and eyes closed, anteroposterior and total sway distance with eyes open but not with eyes closed), and 10 mWV (p<0.05). Conclusions Applying VRRT (even as a home treatment) along with a conventional rehabilitation program for patients with chronic stroke might be even more beneficial than conventional rehabilitation program alone in improving affected lower limb function. Future studies should investigate the effectiveness of VRRT with optimal patient selection, and duration and intensity of training.
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Affiliation(s)
- Taesung In
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea
| | - Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea
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Kim SL, Lee BH. Effect of Mulligan's mobilization with movement technique on gait function in stroke patients. J Phys Ther Sci 2016; 28:2326-9. [PMID: 27630424 PMCID: PMC5011588 DOI: 10.1589/jpts.28.2326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We examined the effectiveness of Mulligan's mobilization with movement (MWM) technique on spatiotemporal variables of gait in individuals who had a stroke. [Subjects and Methods] Twenty-four subjects were randomly divided into 2 groups: Mulligan's mobilization with movement group (n=12) and "weight-bearing with placebo" mobilization with movement group (n=12). The subjects in the mobilization with movement group performed 5 sets of 10 glides a day, 5 times a week for 4 weeks. The mobilization with movement technique comprised grade III movements that involved gliding and resting. The control group subjects performed lunges in the same conditions as those of the experimental group. Gait function was measured in terms of spatiotemporal parameters to determine the effect of mobilization with movement. [Results] The mobilization with movement group showed significant improvements in velocity, cadence, stride length, single-support time, and step length of the affected side, and step length and stride length of the non-affected side. Overall, the mobilization with movement group showed significantly greater improvements than the control group in terms of velocity, cadence, and single-support time of the affected side. [Conclusion] Mobilization with movement can be used to improve the gait function of patients recovering from stroke.
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Affiliation(s)
- Sang-Lim Kim
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Borrego A, Latorre J, Llorens R, Alcañiz M, Noé E. Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters. J Neuroeng Rehabil 2016; 13:68. [PMID: 27503112 PMCID: PMC4977644 DOI: 10.1186/s12984-016-0174-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though virtual reality (VR) is increasingly used in rehabilitation, the implementation of walking navigation in VR still poses a technological challenge for current motion tracking systems. Different metaphors simulate locomotion without involving real gait kinematics, which can affect presence, orientation, spatial memory and cognition, and even performance. All these factors can dissuade their use in rehabilitation. We hypothesize that a marker-based head tracking solution would allow walking in VR with high sense of presence and without causing sickness. The objectives of this study were to determine the accuracy, the jitter, and the lag of the tracking system and its elicited sickness and presence in comparison of a CAVE system. METHODS The accuracy and the jitter around the working area at three different heights and the lag of the head tracking system were analyzed. In addition, 47 healthy subjects completed a search task that involved navigation in the walking VR system and in the CAVE system. Navigation was enabled by natural locomotion in the walking VR system and through a specific device in the CAVE system. An HMD was used as display in the walking VR system. After interacting with each system, subjects rated their sickness in a seven-point scale and their presence in the Slater-Usoh-Steed Questionnaire and a modified version of the Presence Questionnaire. RESULTS Better performance was registered at higher heights, where accuracy was less than 0.6 cm and the jitter was about 6 mm. The lag of the system was 120 ms. Participants reported that both systems caused similar low levels of sickness (about 2.4 over 7). However, ratings showed that the walking VR system elicited higher sense of presence than the CAVE system in both the Slater-Usoh-Steed Questionnaire (17.6 ± 0.3 vs 14.6 ± 0.6 over 21, respectively) and the modified Presence Questionnaire (107.4 ± 2.0 vs 93.5 ± 3.2 over 147, respectively). CONCLUSIONS The marker-based solution provided accurate, robust, and fast head tracking to allow navigation in the VR system by walking without causing relevant sickness and promoting higher sense of presence than CAVE systems, thus enabling natural walking in full-scale environments, which can enhance the ecological validity of VR-based rehabilitation applications.
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Affiliation(s)
- Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain
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Lee MM, Shin DC, Song CH. Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study. J Phys Ther Sci 2016; 28:2019-24. [PMID: 27512255 PMCID: PMC4968497 DOI: 10.1589/jpts.28.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was aimed at investigating the preliminary therapeutic efficacy and usefulness of canoe game-based virtual reality training for stroke patients. [Subjects and Methods] Ten stroke patients were randomly assigned to an experimental group (EG; n=5) or a control group (CG; n=5). Patients in both groups participated in a conventional rehabilitation program, but those in the EG additionally participated in a 30-min canoe game-based virtual reality training program 3 days a week for 4 weeks. Therapeutic efficacy was assessed based on trunk postural stability, balance, and upper limb motor function. In addition, the usefulness of canoe game-based virtual reality training was assessed in the EG and therapist group (TG; n=20), which consisted of physical and occupational therapists, by using the System Usability Scale (SUS). [Results] Improvements in trunk postural stability, balance, and upper limb motor function were observed in the EG and CG, but were greater in the EG. The mean SUS scores in the EG and TG were 71 ± 5.2 and 74.2 ± 4.8, respectively. [Conclusion] Canoe game-based virtual reality training is an acceptable and effective intervention for improving trunk postural stability, balance, and upper limb motor function in stroke patients.
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Affiliation(s)
- Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Republic of Korea
| | - Doo-Chul Shin
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Chang-Ho Song
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Iruthayarajah J, McIntyre A, Cotoi A, Macaluso S, Teasell R. The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2016; 24:68-79. [DOI: 10.1080/10749357.2016.1192361] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gibbons EM, Thomson AN, de Noronha M, Joseph S. Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke – a systematic review with meta-analysis. Top Stroke Rehabil 2016; 23:440-457. [DOI: 10.1080/10749357.2016.1183349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Viñas-Diz S, Sobrido-Prieto M. Realidad virtual con fines terapéuticos en pacientes con ictus: revisión sistemática. Neurologia 2016; 31:255-77. [DOI: 10.1016/j.nrl.2015.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
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Chang CJ, Yang TF, Yang SW, Chern JS. Cortical Modulation of Motor Control Biofeedback among the Elderly with High Fall Risk during a Posture Perturbation Task with Augmented Reality. Front Aging Neurosci 2016; 8:80. [PMID: 27199732 PMCID: PMC4848299 DOI: 10.3389/fnagi.2016.00080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/29/2016] [Indexed: 12/29/2022] Open
Abstract
The cerebral cortex provides sensorimotor integration and coordination during motor control of daily functional activities. Power spectrum density based on electroencephalography (EEG) has been employed as an approach that allows an investigation of the spatial–temporal characteristics of neuromuscular modulation; however, the biofeedback mechanism associated with cortical activation during motor control remains unclear among elderly individuals. Thirty one community-dwelling elderly participants were divided into low fall-risk potential (LF) and high fall-risk potential (HF) groups based upon the results obtained from a receiver operating characteristic analysis of the ellipse area of the center of pressure. Electroencephalography (EEG) was performed while the participants stood on a 6-degree-of-freedom Stewart platform, which generated continuous perturbations and done either with or without the virtual reality scene. The present study showed that when there was visual stimulation and poor somatosensory coordination, a higher level of cortical response was activated in order to keep postural balance. The elderly participants in the LF group demonstrated a significant and strong correlation between postural-related cortical regions; however, the elderly individuals in the HF group did not show such a relationship. Moreover, we were able to clarify the roles of various brainwave bands functioning in motor control. Specifically, the gamma and beta bands in the parietal–occipital region facilitate the high-level cortical modulation and sensorimotor integration, whereas the theta band in the frontal–central region is responsible for mediating error detection during perceptual motor tasks. Finally, the alpha band is associated with processing visual challenges in the occipital lobe.With a variety of motor control demands, increment in brainwave band coordination is required to maintain postural stability. These investigations shed light on the cortical modulation of motor control among elderly participants with varying fall-risk potentials. The results suggest that, although elderly adults may be without neurological deficits, inefficient central modulation during challenging postural conditions could be an internal factor that contributes to the risk of fall. Furthermore, training that helps to improve coordinated sensorimotor integration may be a useful approach to reduce the risk of fall among elderly populations or when patients suffer from neurological deficits.
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Affiliation(s)
- Chun-Ju Chang
- Department of Biomedical Engineering, National Yang-Ming University Taipei, Taiwan
| | - Tsui-Fen Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General HospitalTaipei, Taiwan; Department of Physical Therapy and Assistive Technology, National Yang-Ming UniversityTaipei, Taiwan
| | - Sai-Wei Yang
- Department of Biomedical Engineering, National Yang-Ming University Taipei, Taiwan
| | - Jen-Suh Chern
- Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University Taipei, Taiwan
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Kalron A, Fonkatz I, Frid L, Baransi H, Achiron A. The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial. J Neuroeng Rehabil 2016; 13:13. [PMID: 26925955 PMCID: PMC4772661 DOI: 10.1186/s12984-016-0124-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/11/2016] [Indexed: 01/09/2023] Open
Abstract
Background Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Imbalance appears in most people with multiple sclerosis (PwMS). A popular balance training tool is virtual reality (VR) with several advantages including increased compliance and user satisfaction. Therefore, the aim of this pilot RCT (Trial registration number, date: ISRCTN14425615, 21/01/2016) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment (CAREN) system (Motek Medical BV, Amsterdam, Netherlands) on balance measures in PwMS. Results were compared with those of a conventional balance exercise group. Secondary aims included the impact of this program on the fear of falling. Methods Thirty-two PwMS were equally randomized into the VR intervention group or the control group. Each group received balance training sessions for 6 consecutive weeks, two sessions per week, 30 min sessions. Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination. Results Final analysis included 30 patients (19 females, 11 males; mean age, (S.D.) = 45.2 (11.6) years; mean EDSS (S.D.) = 4.1 (1.3), mean disease duration (S.D.) = 11.0 (8.9) years). Both groups showed a main effect of time on the center of pressure (CoP) path length with eyes open (F = 5.278, P = .024), sway rate with eyes open (F = 5.852, P = .035), Functional Reach Test (F = 20.841, P = .001), Four Square Step Test (F = 9.011, P = .031) and the Fear of Falls self-reported questionnaire (F = 17.815, P = .023). In addition, significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test (F = 10.173, P = .009) and fear of falling (F = 6.710, P = .021). Conclusions We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS.
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Recovery of Posture Stability at Different Foot Placements in Patients Who Underwent Minimally Invasive Total Hip Arthroplasty: A One-Year Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:463792. [PMID: 26583110 PMCID: PMC4637047 DOI: 10.1155/2015/463792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 12/02/2022]
Abstract
To understand the progression of recovery in postural stability and physical functioning after patients received the minimally invasive total hip arthroplasty (MTHA), we monitor the pain level, functional capacity, and postural stability before and after operation within one year. In total of 23 subjects in our study, we found out that MTHA was effective in relieving pain in first 2 weeks and restoring the hip joint integrity, but the postural stability was influenced especially in tandem stand in both anterior-posterior and medial-lateral directions. The recovery of postural stability and functional capacity in one year duration fluctuated and no consistent improvement tendency was found. We suggested clinicians designing postsurgery rehabilitation program for consistent and progressive long-term recovery of postural stability and fall prevention to optimize surgical results and prevent undesired postoperative consequences.
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Effects of walking on bilateral differences in spatial attention control: a cross-over design. Arch Physiother 2015; 5:12. [PMID: 29340181 PMCID: PMC5759909 DOI: 10.1186/s40945-015-0012-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Walking requires a high attentional cost for balance control and interferes with the control of attention. However, it is unclear whether the performance of visual spatial attention control, which is one of the functions of attention control, is also decreased during walking. In addition, although previous studies have shown right-hemispheric dominance and lower ability of left side visual spatial attention control during sitting, it remains unknown whether walking accentuates bilateral differences in visual spatial attention control. We tested the hypothesis that walking interferes with visual spatial attention control on both sides and accentuates its bilateral differences. Methods Twenty healthy right-handed subjects (24.3 ± 2.0 years) participated in this study. Subjects performed a random stimulus–response compatibility (SRC) task during both sitting and walking situations. To evaluate the effects of walking, reaction time was measured on both sides for the two situations. In comparison to the both situations (sitting and walking), the amount of change of the SRC effect on both sides was used. In the comparing the bilateral difference (left and right), the difference of the SRC effect was evaluated in each situation. The paired t-test was applied to both comparisons for statistical analysis. Results The SRC effect on both sides during walking was significantly larger than during sitting (P < 0.05). In addition, walking significantly accentuated the bilateral differences in visual spatial attention control (P < 0.05). Conclusions These results suggest that walking affects the performance of visual spatial attention control on both sides and accentuates its bilateral differences. These results have implications for development of practice methods of gait disorder with higher brain dysfunction.
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Hollands KL, Pelton TA, Wimperis A, Whitham D, Tan W, Jowett S, Sackley CM, Wing AM, Tyson SF, Mathias J, Hensman M, van Vliet PM. Feasibility and Preliminary Efficacy of Visual Cue Training to Improve Adaptability of Walking after Stroke: Multi-Centre, Single-Blind Randomised Control Pilot Trial. PLoS One 2015; 10:e0139261. [PMID: 26445137 PMCID: PMC4596478 DOI: 10.1371/journal.pone.0139261] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/04/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Given the importance of vision in the control of walking and evidence indicating varied practice of walking improves mobility outcomes, this study sought to examine the feasibility and preliminary efficacy of varied walking practice in response to visual cues, for the rehabilitation of walking following stroke. DESIGN This 3 arm parallel, multi-centre, assessor blind, randomised control trial was conducted within outpatient neurorehabilitation services. PARTICIPANTS Community dwelling stroke survivors with walking speed <0.8m/s, lower limb paresis and no severe visual impairments. INTERVENTION Over-ground visual cue training (O-VCT), Treadmill based visual cue training (T-VCT), and Usual care (UC) delivered by physiotherapists twice weekly for 8 weeks. MAIN OUTCOME MEASURES Participants were randomised using computer generated random permutated balanced blocks of randomly varying size. Recruitment, retention, adherence, adverse events and mobility and balance were measured before randomisation, post-intervention and at four weeks follow-up. RESULTS Fifty-six participants participated (18 T-VCT, 19 O-VCT, 19 UC). Thirty-four completed treatment and follow-up assessments. Of the participants that completed, adherence was good with 16 treatments provided over (median of) 8.4, 7.5 and 9 weeks for T-VCT, O-VCT and UC respectively. No adverse events were reported. Post-treatment improvements in walking speed, symmetry, balance and functional mobility were seen in all treatment arms. CONCLUSIONS Outpatient based treadmill and over-ground walking adaptability practice using visual cues are feasible and may improve mobility and balance. Future studies should continue a carefully phased approach using identified methods to improve retention. TRIAL REGISTRATION Clinicaltrials.gov NCT01600391.
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Affiliation(s)
- Kristen L. Hollands
- School of Health Sciences, University of Salford, Allerton Building, Salford, M6 6PU, United Kingdom
- * E-mail:
| | - Trudy A. Pelton
- Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Andrew Wimperis
- Birmingham Community Health Care NHS Trust, (BCHCT), Moseley Hall Hospital, Birmingham, B13 8JL, United Kingdom
| | - Diane Whitham
- University of Nottingham, Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C-floor, South Block, Queen’s Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | - Wei Tan
- University of Nottingham, Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C-floor, South Block, Queen’s Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | - Sue Jowett
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Catherine M. Sackley
- King’s College London, Capital House, Guy’s Campus, London, SE1 3QD, United Kingdom
| | - Alan M. Wing
- Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Sarah F. Tyson
- School of Nursing, Midwifery & Social Work, University of Manchester,Oxford Rd, Manchester, M13 9PL, United Kingdom
| | - Jonathan Mathias
- Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Marianne Hensman
- Colleges of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Paulette M. van Vliet
- School of Health Sciences, Hunter Building, University Drive, University of Newcastle, Callaghn, New South Wales, 2308, Australia
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Abstract
This review covers the rationale, mechanisms, and availability of commercially available virtual environment-based interventions for stroke rehabilitation. It describes interventions for motor, speech, cognitive, and sensory dysfunction. Also discussed are the important features and mechanisms that allow virtual environments to facilitate motor relearning. A common challenge is the inability to translate success in small trials to efficacy in larger populations. The heterogeneity of stroke pathophysiology has been blamed, and experts advocate for the study of multimodal approaches. Therefore, this article also introduces a framework to help define new therapy combinations that may be necessary to address stroke heterogeneity.
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Affiliation(s)
- Michael J Fu
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, 2123 Martin Luther King Jr. Blvd., Cleveland, OH 44106, USA; Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA.
| | - Jayme S Knutson
- Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 4229 Pearl Road, Suite N2, Cleveland, OH 44109, USA
| | - John Chae
- Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 4229 Pearl Road, Suite N2, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, 309 Wickenden Bldg, Cleveland, OH, USA
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Li Z, Han XG, Sheng J, Ma SJ. Virtual reality for improving balance in patients after stroke: A systematic review and meta-analysis. Clin Rehabil 2015; 30:432-40. [PMID: 26141808 DOI: 10.1177/0269215515593611] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/07/2015] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effectiveness of virtual reality interventions for improving balance in people after stroke. Design: Systematic review and meta-analysis of randomized controlled trials. Methods: Studies were obtained by searching the following databases: MEDLINE, CINAHL, EMBASE, Web of Science and CENTRAL. Two reviewers assessed studies for inclusion, extracted data and assessed trial quality. Results: Sixteen studies involving 428 participants were included. People who received virtual reality interventions showed marked improvements in Berg Balance Scale (mean difference: 1.46, 95% confidence interval: 0.09–2.83, P<0.05, I²=0%) and Timed Up and Go Test (mean difference: –1.62, 95% confidence interval: –3.07– –0.16, P<0.05, I²=24%) compared with controls. Conclusions: This meta-analysis of randomized controlled trials supports the use of virtual reality to improve balance after stroke.
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Affiliation(s)
- Zhen Li
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiu-Guo Han
- Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Sheng
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shao-Jun Ma
- Department of Geriatrics, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Darekar A, McFadyen BJ, Lamontagne A, Fung J. Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review. J Neuroeng Rehabil 2015; 12:46. [PMID: 25957577 PMCID: PMC4425869 DOI: 10.1186/s12984-015-0035-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 04/13/2015] [Indexed: 02/04/2023] Open
Abstract
Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke. Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation. VR-based therapy thus has the potential to be a useful tool for balance and gait training for stroke rehabilitation. Utilization of motor learning principles related to task-related training may have been an important factor leading to positive results. Other principles such as repetition, feedback etc. were used in studies but were not explored explicitly and may need to be investigated to further improve the strength of results. Lastly, robust study designs with appropriate attention towards the intensity and dose-response aspects of VR training, clear study objectives and suitable outcomes would further aid in determining evidence-based efficacy for VR game-based interventions in the future.
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Affiliation(s)
- Anuja Darekar
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.
| | - Bradford J McFadyen
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) at the Quebec Rehabilitation Institute and Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.
| | - Joyce Fung
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.
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