Effects of virtual reality training on gait biomechanics of individuals post-stroke
Received 25 March 2009; received in revised form 17 January 2010; accepted 24 January 2010. published online 02 March 2010.
Abstract
Objective
To evaluate gait biomechanics after training with a virtual reality (VR) system and to elucidate underlying mechanisms that contributed to the observed functional improvement in gait speed and distance.
Design
A single blind randomized control study.
Setting
Gait analysis laboratory in a rehabilitation hospital and the community.
Participants
Fifteen men and three women with hemiparesis caused by stroke.
Interventions
Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation. Subjects were randomized to either a VR group (n=9) or non-VR group (NVR, n=9). Training was performed three times a week for 4 weeks for approximately 1h each visit.
Main outcome measures
Kinematic and kinetic gait parameters.
Results
Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training (p=0.036). The VR group had greater change in ankle ROM post-training (19.5%) as compared to the NVR group (3.3%). Significant differences were found in knee ROM on the affected side during stance and swing, with greater change in the VR group. No significant changes were observed in kinematics or kinetics of the hip post-training.
Conclusions
These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis. It is likely that the effects of training included improved motor control at the ankle, which enabled the cascade of changes that produced the functional improvements seen after training.
aGait and Neurodynamics Laboratory, Tel Aviv Sourasky Medical Center, Israel
bRiVERS Lab, Doctoral Program in Physical Therapy, Department of Rehabilitation and Movement Science, University of Medicine and Dentistry of New Jersey, United States
cDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, United States
dThe Harvard-MIT Division of Health Sciences and Technology, United States
Corresponding author at: Gait & Neurodynamics Lab, Tel.: Aviv Medical Center, 6 Weizmann st, Tel Aviv 64239, Israel. Tel.: +972 3 6764095; fax: +972 3 5345807.
ABSTRACT