Deans' stroke musings: Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, April 25, 2021

Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke

This will never get to your stroke hospital, with specific technical setup procedures this will never occur since your hospital doesn't even have the brains to bring in music therapy.

Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 68 (2021) Cite this article

Abstract

Background

The rehabilitation of gait disorders in patients with multiple sclerosis (MS) and stroke is often based on conventional treadmill training. Virtual reality (VR)-based treadmill training can increase motivation and improve therapy outcomes. The present study evaluated an immersive virtual reality application (using a head-mounted display, HMD) for gait rehabilitation with patients to (1) demonstrate its feasibility and acceptance and to (2) compare its short-term effects to a semi-immersive presentation (using a monitor) and a conventional treadmill training without VR to assess the usability of both systems and estimate the effects on walking speed and motivation.

Methods

In a within-subjects study design, 36 healthy participants and 14 persons with MS or stroke participated in each of the three experimental conditions (VR via HMD, VR via monitor, treadmill training without VR).

Results

For both groups, the walking speed in the HMD condition was higher than in treadmill training without VR and in the monitor condition. Healthy participants reported a higher motivation after the HMD condition as compared with the other conditions. Importantly, no side effects in the sense of simulator sickness occurred and usability ratings were high. No increases in heart rate were observed following the VR conditions. Presence ratings were higher for the HMD condition compared with the monitor condition for both user groups. Most of the healthy study participants (89%) and patients (71%) preferred the HMD-based training among the three conditions and most patients could imagine using it more frequently.

Conclusions

For the first time, the present study evaluated the usability of an immersive VR system for gait rehabilitation in a direct comparison with a semi-immersive system and a conventional training without VR with healthy participants and patients. The study demonstrated the feasibility of combining a treadmill training with immersive VR. Due to its high usability and low side effects, it might be particularly suited for patients to improve training motivation and training outcome e. g. the walking speed compared with treadmill training using no or only semi-immersive VR. Immersive VR systems still require specific technical setup procedures. This should be taken into account for specific clinical use-cases during a cost–benefit assessment.

Background

The prevalence of gait disorders resulting from neurological disorders such as multiple sclerosis (MS) and stroke is high [1,2,3] and expected to further increase in the coming years due to the demographic change [4, 5]. Most patients with MS suffer from walking impairments as their main problem [6]. Impaired walking can occur early in the course of MS [7] and 15 years after diagnosis, 40% of patients require walking aids [8]. Of the two thirds of people who survive a stroke, more than 60% suffer from impaired walking abilities after an acute infarction and require gait rehabilitation [9,10,11].

Gait disorders can result from general muscle weakness, paresthesia, cerebellar coordination problems, general fatigue or a disorder of central gait control [12]. Typical manifestations are reduced stride length or walking speed and loss of balance control [13]. The walking limitations cause severe restraints in daily life, result in an increased risk of falling [14, 15], and a reduced quality of life for those affected [16, 17]. To maintain the patient's independence as long as possible, a gait disorder must be managed early and consistently. Standard treatments are physical therapy or exercise therapy [18, 19]. An essential element of these forms of therapy is treadmill training [20, 21]. If required, it can be combined with body-weight-supported systems [22] or robotic assistance such as in active orthoses [23, 24]. Regular treadmill training can reduce motor deficits of the lower limbs and significantly improve the patients’ walking abilities [25]. In patients with stroke, it can also enhance gait symmetry, gait uniformity and walking speed [26, 27]. However, the training structure is based on regularity and repetition [20, 25, 28]. For patients with gait disorders, who may depend on lifelong training, this training structure offers limited variety and could lead to low motivation and a lack of adherence in the long term. Treadmill training can be combined with virtual reality (VR) to increase its efficacy and the patients’ motivation, as demonstrated in several studies [28,29,30,31,32,33]. For instance, a recent study complemented a robot-assisted gait training with a semi-immersive VR presentation via a monitor [29]. At the end of an eight-week training, a 20% improvement in gait and balance was demonstrated for patients with MS. Importantly, the training with VR had positive effects on the patients' attitudes and coping strategies for dealing with their disease. In a randomized controlled trial with patients with MS comparing conventional with VR-based treadmill training, both groups improved walking endurance and speed [30]. Persons with gait disorders caused by a stroke can also benefit from regular, VR-supported gait training [31, 34]. In this group of patients, the cause of an uncertain gait pattern is usually a balance impairment [35]. Targeted treadmill training in VR can help patients regain their balance and reduce their risk of falling [36]. Most previous studies with patients have used either semi-immersive or immersive VR systems [33]. Until now, no study has conducted a direct comparison of an immersive and a semi-immersive VR based treadmill training with patients with stroke and MS. For the current study, a novel VR-based treadmill training was implemented and its feasibility tested with healthy participants and patients with stroke and MS with gait disorders. The virtual scenario that was created for this study aimed at increasing motivation with an engaging storyline and gamification elements to foster the experience of relatedness, competence and autonomy [37, 38]. We followed a well-established development regime in medical-oriented human–computer systems. To ensure that the immersive VR treadmill training increases motivation and has no negative side effects, we conducted a first usability study with healthy participants prior to the current study [38]. In that study, the immersive VR treadmill training was compared with a conventional treadmill training without VR. For the current study, a semi-immersive VR treadmill training was added as a further control condition. This is essential to assess the advantages and disadvantages of an immersive and semi-immersive VR system, respectively—in particular, in light of the increased effort needed to setup an immersive system and possible side effects previously reported, such as simulator sickness [39]. Thus, all participants took part in three conditions in which they tested an immersive VR system (HMD), a semi-immersive VR system (presented via a monitor) and conventional treadmill training (electric treadmill with manual speed adjustment) without additional VR.

The aim of the study was to evaluate an immersive VR application for supervised gait rehabilitation of patients with MS or stroke, to test its feasibility and acceptance and to compare its effects to those of a semi-immersive application and to a conventional treadmill training. First, healthy people participated followed by persons with MS or stroke. For both studies, walking speed served as an indicator of the short-term effectiveness of the systems. Heart rate was assessed as additional objective measure before and after each condition. Furthermore, the usability of the system was systematically evaluated by the participants with questionnaires and rating scales and potential side effects, mood and motivation were assessed.