Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease

 Our stroke doctors and therapists with ANY COMPETENCE AT ALL, should look at this and remark: 'This could safely improve balance in stroke survivors'. BUT NOTHING WILL OCCUR; there aren't two functioning neurons among your stroke medical 'professionals'.

Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease

• Yi-Ching Tsai,
• Wei-Li Hsu,
• Phunsuk Kantha,
• Po-Jung Chen &
• Dar-Ming Lai 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 74 (2024) Cite this article

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Abstract

Background

Degenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD.

Methods

Fourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment.

Results

After the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05).

Conclusion

This is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.

Background

Degenerative lumbar spine disease (DLD) is a common musculoskeletal disorder in older adults [1]. DLD represents a progressive degenerative condition encompassing spondylolisthesis, lumbar spinal stenosis, and disc degeneration [2]. Globally, an estimated 2.66 billion individuals are affected by DLD [3, 4]. DLD typically presents with various clinical symptoms such as lower back pain, muscle weakness, and paresthesia, which result from nerve root compression [2, 3]. Moreover, balance impairments have been identified in 40–65% of patients with DLD [5, 6] and correlate with walking difficulties and disability. Additionally, patients with DLD often score lower in balance assessments and are at increased risk of falls [7]. All these factors significantly impact the quality of life of patients with DLD [8].

Maintaining balance in daily activities requires the integration of sensory inputs from the visual, vestibular, and somatosensory systems, as well as motor outputs from the musculoskeletal system [9,10,11]. Patients with DLD display a reduced sense of body position, possibly from abnormalities in paraspinal muscle spindle afference and the processing of central sensory inputs [12]. Research indicates that impaired lumbosacral proprioception contributes to the decline in upright balance among patients with DLD [12, 13]. This altered balance control leads to an increased reliance on ankle proprioception [13]. Additionally, changes in biomechanical characteristics, such as increased sway in the center of pressure (CoP), correlate with compromised balance and suboptimal performance in daily activities [14, 15]. Restricting pelvic movement may serve as a compensatory mechanism for spinal instability and slow walking [6, 14, 16, 17]. Consequently, a thoughtfully designed exercise training program targeting improved balance recovery is imperative for enhancing the quality of life of patients with DLD [18].

The “shopping cart sign,” resembling the action of holding a shopping cart handle, indicates an expanded space in the spinal canal due to the forward flexion posture adopted by patients with DLD. This posture provides significant relief from nerve root compression and associated pain during movement [19]. Additionally, research has highlighted the advantages of incorporating trunk and core muscle group strengthening training in the rehabilitation of patients with chronic lower back pain, leading to improvements in both rehabilitation and balance [20, 21]. Hence, exercise training programs tailored to patients with DLD should integrate these essential elements.

The skateboard exercise training designed in this study, combined with supporting handrails, corresponds to the previously identified movement elements suitable for patients with DLD. Skateboarding also improves coordination and balance, for it requires synchronous engagement of the entire body with muscular and visual input [22]. Furthermore, unlike walking, skateboarding enhances balance compared to walking by promoting greater trunk and hip flexion, activating the knee extensor muscles, and shifting weight onto the supporting leg [23]. As a result, the primary benefits of skateboard training for patients with DLD include (1) engagement in exercise training in a less painful posture, and (2) a focus on single-leg weight-bearing.

Virtual Reality (VR) integrates multisensory stimuli, including visual, auditory, and somatosensory systems [24]. It also enhances participants’ motivation, engagement, and attention, so it is finding wide use in clinical applications. Furthermore, related studies have demonstrated that VR can improve pain management and enhance muscle and balance performance [23, 25,26,27,28,29].

The design of VR skateboarding training [23] not only incorporates unilateral limb training but also theoretically aligns with the activity needs of patients with DLD. We hypothesized that the balance and muscle performance of patients with DLD could be improved through this novel VR skateboarding training. Nevertheless, this novel approach to exercise training has not been applied to individuals with Degenerative Lumbar Disease (DLD). This study sought to assess the impact of exercise training on DLD patients by conducting a comparative analysis with healthy individuals of the same age group.

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