Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

Summary

Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objectives: To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. Methods: We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Results: Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). Conclusion: The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Keywords

Virtual reality exposure therapy - stroke - gait - feedback - physical therapy modalities

• References

• 1 Riva G. Applications of virtual environments in medicine. Methods Inf Med 2003; 42: 524-534.
• 2 Laver K, George S, Thomas S. et al. Cochrane review: virtual reality for stroke rehabilitation. Eur J Phys Rehabil Med 2012; 48: 1-2.
• 3 Hassid E, Rose D, Commisarow J. et al. Improved gait symmetry in hemiparetic stroke patients induced during body weight-supported treadmill stepping. J Neurol Rehab 1997; 11: 21-26.
• 4 Jaffe DL, Brown DA, Pierson-Carey CD. et al. Stepping over obstacles to improve walking in individuals with poststroke hemiplegia. J Rehabil Res Dev 2004; 41: 283-292.
• 5 Moreira MC, De Amorim Lima AM, Ferraz KM. et al. Use of virtual reality in gait recovery among post stroke patients – a systematic literature review. Disabil Rehabil Assist Technol 2013; 8: 357-362.
• 6 You SH, Jang SH, Kim YH. et al. Virtual reality- induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study. Stroke 2005; 36: 1166-1171.
• 7 Fung J, Richards CL, Malouin F. et al. A treadmill and motion coupled virtual reality system for gait training post-stroke. Cyberpsychol Behav 2006; 9: 157-162.
• 8 Dunning K, Levine P, Schmitt L. et al. An ankle to computer virtual reality system for improving gait and function in a person 9 months poststroke. Top Stroke Rehabil 2008; 15: 602-610.
• 9 Yang YR, Tsai MP, Chuang TY. et al. Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Gait Posture 2008; 28: 201-206.
• 10 Mirelman A, Bonato P, Deust JE. Effects of training with a robot-virtual reality system compared with a robot alone on the gait of individuals after stroke. Stroke 2008; 40: 169-174.
• 11 Kim JH, Jang SH, Kim CS, Jung JH, You JH. Use of virtual reality to enhance balance and ambulation in chronic stroke: A double-blind randomized controlled study. Am J Phys Med Rehabil 2009; 88: 693-701.
• 12 Mirelman A, Patritti BL, Bonato P. et al. Effects of virtual reality training on gait biomechanics of individuals post-stroke. Gait Posture 2010; 31: 433-437.
• 13 Turolla A, Dam M, Ventura L. et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil 2013; 10: 85.
• 14 Piron L, Turolla A, Agostini M. et al. Assessment and treatment of the upper limb by means of virtual reality in post-stroke patients. Stud Health Technol Inform 2009; 145: 55-62.
• 15 Kiper P, Agostini M, Luque-Moreno C, Tonin P, Turolla A. Reinforced feedback in virtual environment for rehabilitation of upper extremity dys-function after stroke: preliminary data from a randomized controlled trial. Biomed Res Int 2014; 2014: 752128.
• 16 Byrne RW, Russon AE. Learning by imitation: a hierarchical approach. Behav Brain Sci 1998; 21: 667-684.
• 17 Perry J. Gait analysis. Normal and pathological function. New York: Slack Incorporated; 1992
• 18 Tilson JK, Sullivan KJ, Cen SY, Rose DK, Koradla CH, Azen SP. et al. Meaningful gait speed improvement during the first 60 days poststroke: Minimal clinically important difference. Phys Ther 2010; 90: 196-208.
• 19 Bowden MC, Behrman AL, Neptune RR, Gregory CM, Kautz SA. Locomotor rehabilitation of individuals with chronic stroke: difference between responders and nonresponders. Arch Phys Med Rehabil 2013; 94: 856-862.
• 20 Holden M. Virtual environments for motor rehabilitation: review. Cyberpsichology Behav 2005; 8 (Suppl. 03) 187-211.
• 21 Luque-Moreno C, Ferragut-García A, RodríguezBlanco C, Heredia-Rizo AM, Oliva-Pascual-Vaca J, Kiper P. et al. A decade of progress using virtual reality for poststroke lower extremity rehabilitation: Systematic review of the intervention methods. Biomed Research Int 2015; 2015: 342529.
• 22 Albiol-Pérez S, Forcano-García M, Muñoz-Tomás MT, Manzano-Fernández P, Solsona-Hernández S, Mashat MA. et al. A novel virtual motor rehabilitation system for Guillain-Barré syndrome. Two single case studies. Methods Inf Med 2015; 54 (Suppl. 02) 127-134.
• 23 Luque-Moreno C, Oliva-Pascual-Vaca A, Kiper P, Rodriguez-Blanco C, Agostini M, Turolla A. Virtual reality to improve lower extremity function, kinematic parameters, and walking speed post-stroke: Preliminary results. Proceedings of the 2nd ICTs for improving Patient Rehabilitation Research Techniques Workshop. 8th International Conference on Pervasive Computing Technologies for Healthcare; 2014 May 20; Oldenburg, Germany.:
• 24 Burdea GC. Virtual rehabilitation – Benefits and challenges. Methods Inf Med 2003; 42 (Suppl. 05) 519-523.