Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke

Abstract

SAGE PublicationsLlorens Rodríguez, R.; Gil Gómez, JA.; Alcañiz Raya, ML.; Colomer Font, C.; Noe, E. (2015). Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clinical Rehabilitation. 29(3):261-268. doi:10.1177/0269215514543333. Objective: To study the clinical effectiveness and the usability of a virtual reality based intervention compared to conventional physical therapy in the balance recovery of individuals with chronic stroke. Design: Randomized controlled trial Setting: Outpatient neurorehabilitation unit Participants: Twenty individuals with chronic stroke. Interventions: Participants were randomly assigned to either an experimental group or a control group. The intervention consisted of 20 one-hour sessions, 5 sessions per week. The experimental group combined thirty minutes with the virtual reality-based intervention with thirty minutes of conventional training. The control group underwent one hour conventional therapy. Main measures: Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-Meter Walking Test. Subjective data were collected from a feedback questionnaire at the end of the trial. Results: The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p<0.05) and in the 10-Meter Walking Test (p<0.05). Post-hoc analyses showed greater improvement in the experimental group, also in the Brunel Balance Assessment (χ2=2.5, p<0.01). The feedback score was 55. 7±3.4 (range: 15-65). Conclusions: The training of the stepping strategy through VR interventions that satisfy the motor learning principles can enhance the balance recovery in individuals with chronic stroke. Subjective data also revealed positive results regarding presence, comfort, and enjoyment. Design: Randomized controlled trial Setting: Outpatient neurorehabilitation unitParticipants: Twenty individuals with chronic stroke. Interventions:The intervention consisted of twenty one-hour sessions, five sessions per week. The experimental group combined thirty minutes with the virtual realitybased intervention with thirty minutes of conventional training. The control group underwent one hour conventional therapy. Main measures:Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-Meter Walking Test. Subjective data of the virtual reality based-intervention were collected from a feedback questionnaire at the end of the trial. Results:The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p<0.05) and in the 10-Meter Walking Test (p<0.05). Post-hoc analyses showed greater improvement in the experimental g...

Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study

“…Since VR training is characterised by individualised, high intensity training in a variety of virtual environments with a high amount of real-time feedback [13][14][15] it might be valuable in stroke rehabilitation. This is confirmed by recent studies [12,[15][16][17][18]. However, almost all studies on the effect of VR on balance and/or gait ability were conducted in the chronic phase after brain injury [9,12,16,17,[19][20][21][22][23].…”

“…This is confirmed by recent studies [12,[15][16][17][18]. However, almost all studies on the effect of VR on balance and/or gait ability were conducted in the chronic phase after brain injury [9,12,16,17,[19][20][21][22][23]. Because of the potential relevant characteristics of VR for motor learning and neuroplasticity [14], VR may be of even more added value during the earlier rehabilitation phase.…”

Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review

“…[41][42][43][44][45][47][48][49][50][51][52][53][54][55][56] Hand searching did not identify any additional papers. The flow of studies through the review is shown in Figure 1.…”

“…The majority of the studies reported that the outcome assessors were blinded. Seven studies reported withdrawals 45,[47][48][49][50][51]56 and provided the reasons for these dropouts. All trials were analysed on a per protocol basis.…”

The Study of Action Observation Therapy in Neurological Diseases: A Few Technical Considerations

“…For instance, a VR program may consist of a box moving from one side to the other; the patient performs an action and observes the displacement of the boxes on the screen). These VR approaches have demonstrated their usefulness in several neurological disorders [43,[47][48][49], with stroke being the subject of the largest number of studies. In fact, a recent Cochrane meta-analysis concluded that VR leads to an improvement in upper limb function and recommended its use as a complementary therapy to the usual therapy for improving the activity of daily living function [50].…”