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.

Friday, February 23, 2024

Gait patterns during overground and virtual omnidirectional treadmill walking

 Does your doctor and hospital have enough functioning neurons to get this researched in stroke survivors? NO? Then aren't aren't functioning properly!

Gait patterns during overground and virtual omnidirectional treadmill walking

Abstract

Background

Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults.

Methods

Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture.

Results

Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail.

Conclusion

Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.

Background

Over the past two decades, significant advancements in virtual reality (VR) technology have resulted in multiple applications of VR related to medical education [1, 2], surgical planning [2, 3], pain management [4,5,6,7], patient education [8], and rehabilitation [9, 10]. However, the utility of VR in medicine has not been fully realized, particularly in the evaluation and treatment of neurological and motor disorders. For example, performance of complex tasks under realistic conditions may reveal subtle deficits in motor control or cognitive functioning that are typically overlooked in traditional clinical tests, thus providing additional insight into disease progression and providing a target for treatment [11,12,13,14]. Capturing gait deficits (e.g., freezing of gait in Parkinson’s disease) in a traditional clinical setting is challenging [15, 16]. Virtual reality offers a means to create immersive digital representations of everyday environments and tasks to evaluate motor function in real world contexts. Barriers to using VR for the assessment and potential treatment of neurological populations include the VR locomotion problem (i.e., navigation of a large virtual environment within the confines of a smaller physical space) and an understanding of how gait patterns are impacted while walking in a VR environment.

Sensory inconsistencies between the visual and vestibular systems while completing tasks in traditional VR setups often result in nausea or physical discomfort [17]. Typical approaches to VR navigation include: (1) continuous virtual movement with a controller joystick, (2) non-continuous virtual movement through point-and-click teleportation between locations, and (3) matching the size of the virtual space with the size of the available physical space. These approaches are problematic as they can cause motion sickness from the sensory mismatch between visual flow and vestibular information, break the user’s sense of immersion, critically limit the structure and scale of possible VR environments, and, as in cases 1) and 2), fail to provide any information about gait function [18,19,20,21].

Recent VR applications have combined traditional unidirectional treadmills with simple VR environments in which the user controls a virtual avatar during treadmill walking [22,23,24,25,26,27,28]. This approach improves immersion and reduces symptoms of motion sickness by fusing virtual and physical movement; however, it necessarily limits the complexity of gait during the VR experience as multi-directional movements and turning cannot be completed [29, 30].

The growth in VR gaming has resulted in commercial availability of omnidirectional treadmills (ODTs) [31,32,33,34,35]. Omnidirectional treadmills utilize various mechanical approaches to allow the user to move more naturally within virtual environments, including low-friction flat surfaces, concave surfaces, and systems of traditional treadmill belts. One such belt-based platform is the Infinadeck ODT (Infinadeck, Rocklin, CA), which is a large treadmill in one axis that carries several smaller treadmills in the perpendicular axis [36, 37]. The treadmill’s motion is user-paced and responds to the direction and acceleration of a VR motion tracker worn by the user [38].

Advances in technology related to the development and control of ODTs may make them a viable approach to addressing the long-standing VR locomotion problem and promote the evaluation of gait under controlled, realistic conditions. Numerous studies have compared overground and traditional treadmill walking [39,40,41,42,43], but to date few studies have systematically evaluated gait kinematics during overground versus ODT locomotion. An evaluation of speed adaptation on the Cyberith Virtualizer ODT, a low friction walking device, indicated that ODT walking is characterized by consistently slower gait speeds, increased cadence, and shorter step lengths when compared to overground forward walking in a virtual environment [44]. Similarly, one study investigating the CyberWalk ODT, a belt-based system, also reported slower speeds, increased cadence, shorter steps lengths, and higher gait variability [45]. Although previous studies have evaluated gait while following curved pathways, a gap remains in understanding how gait on an ODT is affected during turning. Considering the importance of turning and deficits in turning behavior linked to limited mobility and falls in neurological patients, it is necessary to characterize the kinematics of turning during ODT locomotion [46,47,48].

The limited evidence available suggests ODT locomotion may be impacted by the challenging gait conditions, such as turning, and feelings of instability associated with the novelty of ODT walking combined with the lack of visual perception of the physical environment when using an immersive VR headset. Other factors contributing to differences with overground walking include haptic feedback from the harness systems used with ODTs and differing shear forces between the foot and walking surface when using ODTs with concave or low-friction platforms. Taken together, it is unreasonable to assume that ODT locomotion directly imitates overground gait, and the specific mechanical approach of each ODT device likely plays a role in gait adaptation.

A necessary precursor to the implementation of VR paradigms that utilize ODTs in neurology or rehabilitation is to determine the differences in overground and ODT gait patterns. As ODTs offer a distinct advantage over unidirectional treadmills in the ability to evaluate gait under realistic VR conditions that mimic the complex demands of everyday motor control (e.g., turning and changing directions in response to stimuli), ODT locomotion must be characterized for both simple forward walking and turning tasks. This understanding will facilitate appropriate development of VR environments and interpretation of outcomes, as well as provide a necessary framework for evaluating ODT locomotion in a rehabilitation context. The aim of this project was to use kinematic outcomes to compare overground and ODT walking and turning in a VR environment in healthy young adults. We hypothesized that forward gait on the Infinadeck ODT would be characterized by slower speeds, shorter steps, and increased variability in step length, and ODT turning would be prolonged compared to overground walking.

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