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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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Objective: The aim of the study was to evaluate the feasibility of virtual reality (VR) software built using the core concepts of hand-arm bimanual intensive training (HABIT) for improving upper extremity motor function in children with cerebral palsy (CP). Methods: Eight children with CP participated in a 10-day, 40-hour HABIT program. Half of the time custom VR software, HABIT-VR was used. The children's motor skills were assessed pre-and postintervention with the Assisting Hand Assessment, Box and Blocks Test, and Nine-Hole Peg Test. Results: The children had significant and clinically relevant changes in the Assisting Hand Assessment and Box and Blocks Test; however, Nine-Hole Peg Test scores did not change with intervention. Conclusion: These data suggest that combining traditional HABIT strategies with HABIT-VR games improve upper extremity function and gross motor skills but not fine motor skills. (Pediatr Phys Ther 2023;35:85-91

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