Use of Virtual Reality

for Gait Training in

Patients Post-Stroke
Group 11: Megan Premo, Ashley Pasterkiewicz,
Jordan Wohlfert, Conner Steffke, and Megan Brow
 Virtual Reality
•The use of technology to create a realistic,
simulated environment which the individual feels
they are a part of.
•Can potentially provide increased enjoyment for
completing therapeutic exercises, resulting in
increased compliance with home exercise
programs.
•Could be something as accessible as a
Wii/Kinect or an entire projector setup.
 Purpose
• The purpose of this study is
to determine if individuals post-
stroke show more improvement
after receiving Virtual Reality (VR)
gait training compared to those
receiving Treatment as Usual (TAU)
gait training.
 Justification
• 75% of people with strokes end up having at least one gait deviation. (1)
• Every year over 795,000 people in the United States have a stroke. (2)
• Stroke costs the United States an estimated $34 billion each year (2)
• Includes the cost of health care services and missed days of work. (2)
• Current lack of research in VR for patients' post-stroke with low number of cases in
those studies.
• "Future studies should consider large, longitudinal randomized controlled trials to
determine the true potential of VR therapies in various clinical populations." (3)
• "To potentially limit any bias in future studies, it may be useful for future studies to adopt a
double-blinded protocol for the evaluation of the effectiveness of the use of VR." (3)
 Rationale
• "Lower extremity muscle weakness in stroke patients can lead to
functional restoration, asymmetrical posture, and physical imbalance." (1)
• "It also causes difficulty in walking ability by reducing functional low
extremity movement." (1)
• "For people with stroke, paralysis, and muscle weakness in the lower
limbs can lead to balance mobility disorders." (4)
 Hypothesis

• We hypothesize that the post-stroke VR group will have a more

significant improvement in gait velocity compared to the post-stroke
TAU group.
 Participation Criteria
Inclusion Criteria Exclusion Criteria
• First-time stroke • Receptive aphasia
• Hemi-ischemic stroke affecting dominant • Stroke occurred less than 2 years ago
side
• Unable to ambulate at least 10 meters or
• Similar compensation turn themselves around
• Lived independently prior to stroke
• ADLs and IADLs
• 40-70 years old
 Experimental Design
Mixed Repeated Measure ANOVA Independent Variables
• Treatment
• Duration: 3 months Levels of Treatment IV:
• Frequency: 15 minute treatment sessions TIW 1. VR Group: Virtual Reality
• Treatment provided Month 1 & 2 2. TAU Group: Treatment as Usual
• Participants receive no face-to-face treatment from • Time (4 measures)
weeks 8-12 (third month) then return for
measurements at the end of Month 3 Dependent Variables
• Measurement of Dependent Variable at the end of • Gait Velocity (m/s) during 10 Meter
Month 1, 2, and 3 Walk Test (10 MWT)
• Timed Up & Go (TUG)

Pre-Treatment Month 1 Month 2 Month 3

VR Group (n=30)

TAU Group (n=30)

 Treatments
VR on Wii
• Skiing with balancing on
Wii Fit Board (3 min)
• Bowling (3 min)
• Soccer (3 min)
• Dance (3 min)
• With 1-minute rest break
in between
• Total of 15 mins
TAU
• Transverse Abdominis
squeeze (3 second hold X 10 )
• Double and single leg stance
on airex (15 seconds X 2 per
leg)
• Toe taps to 6-inch step (X 10
per leg)
• 5-minute walk with gait belt
• Total of 15 minutes
 TUG 10 MWT

Click to add text

(4)
 Test and Measures
Justification
• Gait velocity is valid, reliable, and has high
sensitivity (true positive rate) when
evaluating an individual's functional status.(7)
• The TUG test and 10MWT measures an
individual's gait velocity which plays a role in
functional capacity.
Reliability of TUG test
& 10 MWT
• The TUG test is reliable and valid. It is
an easy to use clinical tool when
assessing advanced functional mobility
post stroke.(8)
• "The 10MWT was performed in a
median of 19s with the dynamic start
and 18.4s with the static start (P=0.092).
The correlation between the results of
the two methods was between 0.98 and
0.99. The inter- and intra-rater
reliabilities were between 0.95 and 0.99
for both methods."(9)
 Discussion
• We would record the assistive device subjects use at baseline and compare it to the
device they are using (if any) at the end of the study.
• There would be analysis of missed session by each group
• We would use a questionnaire to determine if participants enjoyed the use of VR in their
program.
• With these side notes, even if the TAU group and VR group have similar results, we could
conclude possible benefits in enjoyment, interest, and attendance in VR therapy.
• More beneficial treatment will be offered to the opposite group.
• Limitations:
• All of the participants did not have the same side hemisphere stroke but, we chose to use
strokes affecting dominant side because those would be more difficult to recover from.
• We were not able to compensate individuals for participating in our study due to lack of
funds.
 References
(1) Park J, Chung Y. The effects of robot-assisted gait training using virtual reality and auditory
stimulation on balance and gait abilities in persons with stroke. NeuroRehabilitation.
2018;43(2):227-235. doi:10.3233/nre-172415.
(2) Stroke. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/facts.htm. Published
September 6, 2017. Accessed October 9, 2018.
(3) Teo W-P, Muthalib M, Yamin S, et al. Does a Combination of Virtual Reality, Neuromodulation
and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? – A Narrative Review
of the Literature. Frontiers in Human Neuroscience. 2016;10. doi:10.3389/fnhum.2016.00284.
(4) In T, Lee K, Song C. Virtual Reality Reflection Therapy Improves Balance and Gait in Patients with
Chronic Stroke: Randomized Controlled Trials. Medical Science Monitor. 2016;22:4046-4053.
doi:10.12659/msm.898157.
(5) Park D-S, Lee D-G, Lee K, Lee G. Effects of Virtual Reality Training using Xbox Kinect on
Motor Function in Stroke Survivors: A Preliminary Study. Journal of Stroke and Cerebrovascular
Diseases. 2017;26(10):2313-2319. doi:10.1016/j.jstrokecerebrovasdis.2017.05.019.
(6) Parab A, Patil A. Immediate Effect of Virtual Reality on Balance, Gait and Posture in Stroke Patients -
An Experimental Study. Indian Journal of Physiotherapy & Occupational Therapy. 2018;12(1):118-