Virtual reality enhanced rehabilitation for a service member with bilateral lower extremity amputations: A case study

Abstract

To review the outcomes of rehabilitation for a service member with bilateral lower extremity amputations. A 25 yearold marine suffered a right knee disarticulation and a left transtibial amputation during military service. For two years, the patient underwent a comprehensive rehabilitation program at Walter Reed Army Medical Center. During the course of his rehabilitation, this patient took part in conventional physical therapy and at 16.5 months post-injury added clinical sessions in the Computer Assisted Rehabilitation Environment (CAREN) Laboratory to his therapy regimen for approximately six months. Gait analyses were conducted at three different points in his rehabilitation program: 5.5, 18, and 23.5 months post-injury.Temporal spatial parameters of self-selected velocities, cadence, and step length increased while his stance support time and step width decreased, becoming closer to asymptomatic populations. During the CAREN clinical sessions, the patient showed an increase in overall speed in the Road with Overhead Targets application. With the Boat application, the patient was able to improve the application time at increased levels of difficulty. The use of virtual reality as an adjunct to conventional rehabilitation for individuals with amputations provides a novel approach for maximizing function.

Gait Characteristics of Children with Spastic Cerebral Palsy during Inclined Treadmill Walking under a Virtual Reality Environment

“…The CAREN system is employed in this study due to the following concerns: (1) the CAREN system can perform 3D movement for a full body in real time, which provides immediate feedback to both the therapist and patient [17]; (2) the CAREN system can conduct inclined walking experiment and collect kinematic and kinetic information simultaneously; (3) the virtual environment is reproducible and as close to a natural environment as possible [18, 19]; (4) the CAREN system is proved to be an effective tool for rehabilitation (such as gait training [17, 20], prosthetic adjustment [21], balance training [22, 23], and cognitive rehabilitation [24]) and biomechanics research [25–27].…”

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.…”

Leg Laterality Differences in Persons with Bilateral Transtibial Amputation

“…In the United States alone, the number of persons with bilateral transtibial amputation 1 has been estimated to be 11,400. 5,6 With advances in rehabilitation therapy and technology, independent ambulation can often be achieved, enabling patients to walk with little or no crutch support. Without a sound leg to provide balance, proprioception, and stability, prosthetic fitting and gait training are more problematic than in persons with unilateral amputation.…”