A virtual reality approach to gait training in service members with lower extremity amputations

Abstract

Gait training is an essential part of the rehabilitation process for those with lower extremity (LE) amputations. For service members at Walter Reed Army Medical Center, the Computer Assisted Rehabilitation Environment (CAREN) allows virtual reality to be incorporated into gait training as an adjunct to conventional therapies. This retrospective case series examines the self-selected velocities achieved in two different virtual environments (VE) by 11 service members with LE amputations. These VEs allowed participants to progress from level walking to more challenging terrain. Over periods of four to eight weeks, all participants were found to increase their self-selected velocities; progression appears to be individual. The preliminary results obtained indicate that further investigation is warranted.

The use of the computer assisted rehabilitation environment in assessment and rehabilitation

“…Twenty-two articles used the computer-assisted rehabilitation environment system for biomechanical analysis , 15 articles used the computerassisted rehabilitation environment system for rehabilitation [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57], 4 articles were reviews [19,20,58,59] and 9 articles addressed the computerassisted rehabilitation environment system in other ways [60][61][62][63][64][65][66][67][68]. A flow chart summarizing study selection is shown in figure 1.…”

“…The computer-assisted rehabilitation environment system was used in different types of rehabilitation: neurological [43][44][45][46] vestibular [47][48][49][50], psychological [51,52], amputation [53], Cognitive [54] and visual rehabilitation [55]. We also identified two randomized controlled trial protocols: one was for the use of the computer-assisted rehabilitation environment system in improving balance and reducing falls in older adults [56] and the other was for the use of the computer-assisted rehabilitation environment system in military members with combat-related treatment-resistant posttraumatic stress disorder [57].…”

“…Although several studies concluded that virtual reality is an effective rehabilitative tool [6][7][8][9][10][11][12][13][14][15][16][17][18], only a limited number of studies have addressed the use of the computer-assisted rehabilitation environment system in different types of rehabilitation: neurological [43][44][45][46] vestibular [47][48][49][50], psychological [51,52], amputation [53], cognitive [54] and visual rehabilitation [55].…”

A systematic literature review of the use and effectiveness of the Computer Assisted Rehabilitation Environment for research and rehabilitation as it relates to the wounded warrior

“…Reports including biomechanics measurements indicate that the CAREN is a successful tool to rehabilitate and train individuals with lower extremity injuries over multi-week rehabilitation programs. Several studies [18][19][20][21][22] examined the use of the CAREN as an adjunct to conventional physical therapy for active duty persons with lower limb amputations to work on dynamic weight shifting and gait. They found improved performance over several weeks of training, though the type of improvements varied between studies.…”

“…They found improved performance over several weeks of training, though the type of improvements varied between studies. Studies by Kruger [19,20] reported increased selfselected walking velocities, decreased step width, improvements in overall stride symmetry, and ability to negotiate inclines and declines. Darter and Wilken [21] did not report the same improvements in temporal spatial parameters, but saw certain kinematic improvements (i.e.…”