Effects Of Virtual Reality Training Research Articles

P100 - Effects of virtual reality training on mobility in individuals with Parkinson’s disease

The aim of the present study was to evaluate the effects of gait training with virtual reality (VR) on mobility in patients with Parkinson’s disease (PD). Thirty-seven individuals with PD were allocated to three groups (control = 12, VR = 12 and treadmill = 13) submitted to 12 twenty-minute training sessions. Evaluations involved the Timed Up and Go (TUG) test before the intervention, after one session, after all 12 sessions and 30 days after the end of the intervention. The groups submitted to VR and treadmill training took less time to execute the TUG test than the control group. Individuals with PD submitted to VR and treadmill gait training presented mobility improvements in comparison to traditional physiotherapeutic training.

Effect of Virtual Reality Training for the Enclosed Space Entry

Effect of Virtual Reality Training for the Enclosed Space Entry

Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis

Objective: To evaluate the evidence for the use of virtual reality to treat balance and gait impairments in multiple sclerosis rehabilitation. Design: Systematic review and meta-analysis of randomized controlled trials and quasi-randomized clinical trials. Methods: An electronic search was conducted using the following databases: MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Database of Systematic Reviews (CDSR) and (CINHAL). A quality assessment was performed using the PEDro scale. The data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guideline statement. It was registered in the PROSPERO database (CRD42016049360). Results: A total of 11 studies were included. The data were pooled, allowing meta-analysis of seven outcomes of interest. A total of 466 participants clinically diagnosed with multiple sclerosis were analysed. Results showed that virtual reality balance training is more effective than no intervention for postural control improvement (standard mean difference (SMD) = −0.64; 95% confidence interval (CI) = −1.05, −0.24; P = 0.002). However, significant overall effect was not showed when compared with conventional training (SMD = −0.04; 95% CI = −0.70, 0.62; P = 0.90). Inconclusive results were also observed for gait rehabilitation. Conclusion: Virtual reality training could be considered at least as effective as conventional training and more effective than no intervention to treat balance and gait impairments in multiple sclerosis rehabilitation.

Effect of early virtual reality training on the rehabilitation of stroke patients with hemiplegia

Objective To explore the effect of early virtual reality training in the rehabilitation of stroke patients with hemiplegia. Methods From June 2015 to May 2016, 60 cases of stroke patients from the Department of Rehabilitation of the First Affiliated Hospital of Wenzhou Medical University were randomly divided into observation group and control group, 30 cases in each group. The patients of control group received routine rehabilitation training program, and patients of the observation group received routine rehabilitation and virtual reality training. The two groups were trained for 6 weeks. The walking function, activities of daily living and mental status of the patient before and after training were evaluated by functional ambulation category scale (FAC) , modified Barthel index (MBI) , hospital anxiety and depression scale (HAD) . Results Before training, FAC, MBI and HAD scores had no significant difference between patients of two groups (P>0.05) . After 6 weeks of training, the scores of FAC, MBI and HAD in the two groups were better than those before training (P<0.05) ; After training, except for HAD (D) , the indexes in the observation group were better than those in the control group (P<0.05) . Conclusions Early virtual reality training can effectively improve the walking function and activities of daily living in stroke patients with hemiplegia, and relieve the patients' unhealthy psychological emotion. Key words: Stroke; Anxiety; Depression; Virtual reality training; Walking function; Activities of daily living

Effects of Virtual Reality Training With Trunk Support Trainer (TruST) on Postural Kinematics

Improving functional motor deficits in patients with neurological and musculoskeletal disorders has been a primary objective of rehabilitation. Task-oriented training in physical environments is a leading approach for rehab training utilizing tasks that are challenging, adaptable, and meaningful. Although different training paradigms can be utilized in a laboratory setting, they often require expensive training equipment and personnel, limiting the number of training sessions. Creating an effective virtual reality (VR) training environment can greatly increase the repetition, cognitive engagement, and training variability. Specifically, dynamic trunk control is required for the successful completion of everyday tasks. These tasks require coordination between the head, upper and lower trunk, and the pelvis. We have developed a novel robotic device, trunk support trainer (TruST) and a VR gaming environment, which allows training in a seated posture at and beyond an individual's point of stability failure using an assist-as-needed force tunnel strategy. The VR environment consists of challenging reaching tasks where the subject's dominant hand is used to manipulate a VR drone. We conducted a study that involved three groups: ten adult subjects trained using VR, ten adult subjects trained in a physical environment (PR), and ten without TruST assistance (control group) to investigate the changes in trunk kinematics. Our study supports the hypothesis that a single training session with TruST in both VR and PR can increase lower trunk range of motion. This approach may be useful for creating training variability and translating therapy in home settings.

Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study

Although the Kinect gaming system (Microsoft Corp, Redmond, WA) has been shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect-based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of VR training, using the Xbox Kinect-based game system, on the motor recovery of patients with chronic hemiplegic stroke. This was a randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention group or the control group. Participants in the intervention group (n = 10) received 30 minutes of conventional physical therapy plus 30 minutes of VR training using Xbox Kinect-based games, and those in the control group (n = 10) received 30 minutes of conventional physical therapy only. All interventions consisted of daily sessions for a 6-week period. All measurements using Fugl-Meyer Assessment (FMA-LE), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the 10-meter Walk Test (10mWT) were performed at baseline and at the end of the 6 weeks. The scores on the FMA-LE, BBS, TUG, and 10mWT improved significantly from baseline to post intervention in both the intervention and the control groups after training. The pre-to-post difference scores on BBS, TUG, and 10mWT for the intervention group were significantly more improved than those for the control group (P <.05). Evidence from the present study supports the use of additional VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function during stroke rehabilitation.

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

Objective: To investigate the feasibility and effectiveness of virtual reality training for improving balance and/or gait during inpatient rehabilitation of patients within 12 weeks after stroke. Methods: Sixteen patients within 12 weeks after stroke and dependent gait as categorised with a Functional Ambulation Category score of 2 or 3 were included in this longitudinal pilot study. Participants received eight 30-min sessions of virtual reality training during four weeks as part of the regular inpatient rehabilitation program. Feasibility was assessed using compliance with the training, adverse events, experiences of the participants and the physiotherapists; and effectiveness with the Berg Balance Scale, centre of pressure velocity, Functional Ambulation Category and 10-meter walking test. Results: Participants positively evaluated the intervention and enjoyed the training sessions. Also, physiotherapists observed the training as feasible and beneficial for improving balance or gait. Compliance with the training was 88% and no serious adverse events occurred. The Berg Balance Scale, anterior-posterior centre of pressure velocity, Functional Ambulation Category and 10-meter walking test showed significant improvement after four weeks of training (p<0.05). Conclusion: This study demonstrates that virtual reality training in patients early after stroke is feasible and may be effective in improving balance and/or gait ability.

Effects of virtual reality training on limb movement in children with spastic diplegia cerebral palsy

To study the effects of virtual reality (VR) training on the gross motor function of the lower limb and the fine motor function of the upper limb in children with spastic diplegia cerebral palsy. Thirty-five children with spastic diplegia cerebral palsy were randomly assigned to VR training group (n=19) and conventional training group (n=16). The conventional training group received conventional physical therapy and occupational therapy for three months. The VR training group received VR training and occupational therapy for three months. Grip and visual-motor integration subtests in Peabody Developmental Motor Scales-2 were used to evaluate the fine movement in patients before and after treatment. The D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88), Modified Ashworth Scale (MAS), and Berg Balance Scale (BBS) were used to evaluate the gross movement in patients before and after treatment. Before treatment, there were no significant differences in grip, visual-motor integration, fine motor development quotient, scores of D and E domains of GMFM-88, MAS score, or BBS score between the two groups (P>0.05). After treatment, all the indices were significantly improved in the VR training group compared with the conventional training group (P<0.05). VR training can effectively improve the gross motor function of the lower limb and the fine motor function of the upper limb in children with spastic diplegia cerebral palsy.

Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized, Controlled, Double-Blind, Clinical Trial

ABSTRACTThe authors' aim was to investigate the effects of continuous transcranial direct current stimulation (tDCS) combined with virtual reality training on static and functional balance in children with cerebral palsy (CP). Twenty children with CP (6 girls and 14 boys; M age = 7 years 6 months ± 2 years) were randomly allocated to two groups. The experimental group received active tDCS and the control group received sham stimulation during the 10 sessions of virtual reality mobility training protocols. The children were evaluated on 3 occasions (preintervention, postintervention, and 1-month follow-up). Static balance was evaluated using a force plate under 4 conditions: feet on force plate with (a) eyes open and (b) with eyes closed, and feet on foam mat with (c) eyes open and (d) with eyes closed. Functional balance was evaluated using the Pediatric Balance Scale and the Timed Up and Go Test. The analyses demonstrated statistically significant postintervention and follow-up effects favoring the experimental group over the control group with regard to the Pediatric Balance Scale, Timed Up and Go Test, and area of oscillation of the center of pressure when standing on the force plate with eyes open. The present findings suggest that tDCS can potentiate the effects of virtual reality training on static and functional balance among children with CP.

Effects of Virtual Reality Training (Exergaming) Compared to Alternative Exercise Training and Passive Control on Standing Balance and Functional Mobility in Healthy Community-Dwelling Seniors: A Meta-Analytical Review.

Balance training is considered an important means to decrease fall rates in seniors. Whether virtual reality training (VRT) might serve as an appropriate treatment strategy to improve neuromuscular fall risk parameters in comparison to alternative balance training programs (AT) is as yet unclear. To examine and classify the effects of VRT on fall-risk relevant balance performance and functional mobility compared to AT and an inactive control condition (CON) in healthy seniors. The literature search was conducted in five databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus). The following search terms were used with Boolean conjunction: (exergam* OR exer-gam* OR videogam* OR video-gam* OR video-based OR computer-based OR Wii OR Nintendo OR X-box OR Kinect OR play-station OR playstation OR virtua* realit* OR dance dance revolution) AND (sport* OR train* OR exercis* OR intervent* OR balanc* OR strength OR coordina* OR motor control OR postur* OR power OR physical* OR activit* OR health* OR fall* risk OR prevent*) AND (old* OR elder* OR senior*). Randomized and non-randomized controlled trials applying VRT as interventions focusing on improving standing balance performance (single and double leg stance with closed and open eyes, functional reach test) and functional mobility (Berg balance scale, Timed-up and go test, Tinetti test) in healthy community-dwelling seniors of at least 60years of age were screened for eligibility. Eligibility and study quality (PEDro scale) were independently assessed by two researchers. Standardized mean differences (SMDs) served as main outcomes for the comparisons of VRT versus CON and VRT versus AT on balance performance and functional mobility indices. Statistical analyses were conducted using a random effects inverse-variance model. Eighteen trials (mean PEDro score: 6±2) with 619 healthy community dwellers were included. The mean age of participants was 76±5years. Meaningful effects in favor of VRT compared to CON were found for balance performance [p<0.001, SMD: 0.77 (95% CI 0.45-1.09)] and functional mobility [p=0.004, SMD: 0.56 (95% CI 0.25-0.78)]. Small overall effects in favor of AT compared to VRT were found for standing balance performance [p=0.31, SMD: -0.35 (95% CI -1.03 to 0.32)] and functional mobility [p=0.05, SMD: -0.44 (95% CI: -0.87 to 0.00)]. Sensitivity analyses between "weaker" (n=9, PEDro ≤5) and "stronger" (n=9, PEDro ≥6) studies indicated that weaker studies showed larger effects in favor of VRT compared to CON regarding balance performance (p<0.001). Although slightly less effective than AT, VRT-based balance training is an acceptable method for improving balance performance as well as functional mobility outcomes in healthy community dwellers. VRT might serve as an attractive complementary training approach for the elderly. However, more high-quality research is needed in order to derive valid VRT recommendations compared to both AT and CON.

Effects of virtual reality training with modified constraint-induced movement therapy on upper extremity function in acute stage stroke: a preliminary study.

[Purpose] The purpose of this study was to investigate the effects of virtual reality training combined with modified constraint-induced movement therapy on upper extremity motor function recovery in acute stage stroke patients. [Subjects and Methods] Four acute stage stroke patients participated in the study. A multiple baseline single subject experimental design was utilized. Modified constraint-induced movement therapy was used according to the EXplaining PLastICITy after stroke protocol during baseline sessions. Virtual reality training with modified constraint-induced movement therapy was applied during treatment sessions. The Manual Function Test and the Box and Block Test were used to measure upper extremity function before every session. [Results] The subjects’ upper extremity function improved during the intervention period. [Conclusion] Virtual reality training combined with modified constraint-induced movement is effective for upper extremity function recovery in acute stroke patients.

Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients.

[Purpose] The purpose of this study is to investigate the effects of virtual reality training using Nintendo Wii on balance and walking for stroke patients. [Subjects and Methods] Forty stroke patients with stroke were randomly divided into two exercise program groups: virtual reality training (n=20) and treadmill (n=20). The subjects underwent their 40-minute exercise program three times a week for eight weeks. Their balance and walking were measured before and after the complete program. We measured the left/right weight-bearing and the anterior/posterior weight-bearing for balance, as well as stance phase, swing phase, and cadence for walking. [Results] For balance, both groups showed significant differences in the left/right and anterior/posterior weight-bearing, with significant post-program differences between the groups. For walking, there were significant differences in the stance phase, swing phase, and cadence of the virtual reality training group. [Conclusion] The results of this study suggest that virtual reality training providing visual feedback may enable stroke patients to directly adjust their incorrect weight center and shift visually. Virtual reality training may be appropriate for patients who need improved balance and walking ability by inducing their interest for them to perform planned exercises on a consistent basis.

Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients.

Virtual reality training is considered as an effective intervention method of stroke patients, and the virtual reality system for therapeutic rehabilitation has emphasized the cognitive factors to improve walking function. The purpose of current study was to investigate the effect of virtual reality training with cognitive load (VRTCL) on walking function of chronic stroke. Chronic stroke patients were randomly assigned to the VRTCL group (11 patients, including 5 men; mean age, 60.0 years; post-stroke duration, 273.9 days) or control group (11 patients, including 2 men; mean age, 58.6 years; post-stroke duration, 263.9 days). All subjects participated in the standard rehabilitation program that consisted of physical and occupational therapies. In addition, VRTCL group participated in the VRTCL for 4 weeks (30 min per day and five times a week), while those in the control group participated in virtual reality treadmill training. Walking function under single (walking alone) and dual task (walking with cognitive tasks) conditions was assessed using an electrical walkway system. After the 4-week intervention, under both single and dual task conditions, significant improvement on walking function was observed in VRTCL and control groups (P < 0.05). In addition, in the dual task condition, greater improvement on walking function was observed in the VRTCL group, compared with the control group (P < 0.05). These findings demonstrated the efficacy of VRTCL on the walking function under the dual task condition. Therefore, we suggest that VRTCL may be an effective method for the achievement of independent walking in chronic stroke patients.

가상현실 훈련이 노인의 하지 근활성도에 미치는 영향

PURPOSE: The objective of this study was to determine the effects of virtual reality training on muscle activation in the elderly. METHODS: The subjects were 32 healthy elderly people aged between 65 and 80, who were divided into the VR(virtual reality) training group(n=17) and the control group(n=15). The Virtual reality training group engaged in a 30-minute exercise session using Wii Fit three times a week for eight weeks. Virtual reality training group used the Ski Slalom, Table tile, Balance bubble programs. low-extremity muscle activation of the two groups were measured before and after the intervention. RESULTS: To investigate the effects of the training on lower-extremity muscle activation, biceps femoris, gastrocnemius, tibialis anterior, vastus lateralis were measured. The results revealed that the activation of gastrocnemius and tibialis anterior significantly increased(p<.05), which indicates virtual reality training is effective in improving the activation of the muscles involved in the movement of the ankle joint. CONCLUSION: Virtual reality training is effective in improving the healthy elderly's activation of the muscles involved in the movement of the ankle joint. Thus, virtual reality training can be proposed as a form of fall prevention exercise for the elderly.

Additional Virtual Reality Training Using Xbox Kinect in Stroke Survivors with Hemiplegia

The aim of this study was to investigate the effects of additional virtual reality training using Xbox Kinect on upper extremity function, including range of motion, motor function, and gross manual dexterity, in stroke survivors with hemiplegia. This study is a randomized controlled trial. Forty participants were randomly allocated to either the experimental or control groups; the experimental group (n = 20) underwent virtual reality training using Xbox Kinect and conventional occupational therapy, and the control group (n = 20) underwent conventional occupational therapy alone. The mean time since the onset of stroke was 7.22 mos in the experimental group and 8.47 mos in the control group. At baseline and after 6 wks of intervention, range of motion of the upper extremity was measured, and the Fugl-Meyer Assessment and the Box and Block Test were performed. After intervention, significant improvements from baseline values in range of motion of the upper extremity, Fugl-Meyer Assessment scores, and Box and Block Test scores were observed in the experimental and control groups (P < 0.05). At follow-up, there were significant differences between the two groups in range of motion (except for the wrist), Fugl-Meyer Assessment scores, and Box and Block Test scores (P < 0.05). The hemiplegic stroke survivors who received additional virtual reality training using Xbox Kinect showed significantly improved function of the upper extremity. However, the effects of the virtual reality training using Xbox Kinect may have been a result of the greater total intervention time in the training group compared with the control group. Thus, the potential efficacy of Xbox Kinect in the rehabilitation of post-stroke survivors needs to be investigated in greater depth.

Effects of virtual reality training on functional reaching movements in people with Parkinson’s disease: a randomized controlled pilot trial

Objective: To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson’s disease. Design: Randomized pretest–posttest control group design. Setting: A virtual reality laboratory in a university setting. Participants: Thirty-three adults with Parkinson’s disease. Interventions: The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand. Main outcome measures: Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects. Results: Compared with the control group, the virtual reality training group became faster (F = 9.08, P = 0.005) and more forceful (F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls. Conclusion: A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.

The Effect of Virtual Reality Training on Unilateral Spatial Neglect in Stroke Patients

ObjectiveTo investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients.MethodTwenty-four stroke patients (14 males and 10 females, mean age=64.7) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited. All patients were randomly assigned to either the virtual reality (VR) group (n=12) or the control group (n=12). The VR group received VR training, which stimulated the left side of their bodies. The control group received conventional neglect therapy such as visual scanning training. Both groups received therapy for 30 minutes a day, five days per week for three weeks. Outcome measurements included star cancellation test, line bisection test, Catherine Bergego scale (CBS), and the Korean version of modified Barthel index (K-MBI). These measurements were taken before and after treatment.ResultsThere were no significant differences in the baseline characteristics and initial values between the two groups. The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment. The changes in line bisection test score and the K-MBI in the VR group were not statistically significant.ConclusionThis study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients.

Effects of virtual reality training on gait biomechanics of individuals post-stroke

Objective To evaluate gait biomechanics after training with a virtual reality (VR) system and to elucidate underlying mechanisms that contributed to the observed functional improvement in gait speed and distance. Design A single blind randomized control study. Setting Gait analysis laboratory in a rehabilitation hospital and the community. Participants Fifteen men and three women with hemiparesis caused by stroke. Interventions Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation. Subjects were randomized to either a VR group ( n = 9) or non-VR group (NVR, n = 9). Training was performed three times a week for 4 weeks for approximately 1 h each visit. Main outcome measures Kinematic and kinetic gait parameters. Results Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p = 0.036). The VR group had greater change in ankle ROM post-training (19.5%) as compared to the NVR group (3.3%). Significant differences were found in knee ROM on the affected side during stance and swing, with greater change in the VR group. No significant changes were observed in kinematics or kinetics of the hip post-training. Conclusions These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis. It is likely that the effects of training included improved motor control at the ankle, which enabled the cascade of changes that produced the functional improvements seen after training.

Effect of virtual reality training on laparoscopic surgery: randomised controlled trial

Effect of virtual reality training on laparoscopic surgery: randomised controlled trial

Authors' reply: Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery (Br J Surg 2008; 95: 1088–1097)

Authors' reply: Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery (<i>Br J Surg</i> 2008; 95: 1088–1097)