Title: Effects of virtual reality training on gait biomechanics of individuals post-stroke

Authors: Mirelman A, Patritti BL, Bonato P, & Deutsch JE

PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/20189810

PubMed ID: 20189810

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 1 h 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 posttraining (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.

This article was interesting to me for two reasons. First, this research adds to the body of literature supporting the motivating characteristics of VR interfaces. In this study, both groups used the same device; however only one group used the device while playing a game with a VR interface. This group showed significant increases in gait biomechanics at the ankle. The second reason I found this article interesting was the device they used for ankle strength training. This robotic ankle is currently being tested in our lab for ankle strenghtening with children with cerebral palsy. I'm excited to see what population this device and the VR interface can help next.