Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training

Objective: The aim of this study was to evaluate the effects of virtual reality (VR) treadmill training on the balance skills of patients who have had a stroke. Design: A total of 14 patients with strokes were recruited and randomly assigned to receive VR treadmill or traditional treadmill training. The outcome measures that were included for the study were center of pressure (COP) sway excursion, COP maximum sway in anterior-posterior direction, COP maximum sway in medial-lateral direction, COP sway area, bilateral limb-loading symmetric index, the sway excursion values for the paretic foot (sway excursion/P), paretic limb stance time (stance time/P), number of steps of the paretic limb (number of steps/P), and contact area of the paretic foot (contact A/P) during quiet stance, sit-to-stand transfer, and level walking. Results: There were no significant improvements in COP-related measures and symmetric index during the quiet stance, either in the VR treadmill or traditional treadmill training group (P > 0.05). However, the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant (P = 0.038). Traditional treadmill training failed to improve sit-to-stand performance, whereas VR treadmill training improved symmetric index (P = 0.028) and sway excursion (P = 0.046) significantly during sit-to-stand transfer. The changes of symmetric index between groups were markedly different (P = 0.045). Finally, both groups improved significantly in stance time/P, but only VR treadmill training increased contact A/P (P = 0.034) after training during level walking. The difference between groups during level walking was not significant. Conclusions: Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance, but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did. VR treadmill training also improved balance skill during sit-to-stand transfers and the involvement of paretic limb in level walking more than the traditional one did.

[1]  Y. Pai,et al.  Control of body mass transfer as a function of speed of ascent in sit-to-stand. , 1990, Medicine and science in sports and exercise.

[2]  N. Mayo,et al.  Predicting Falls among Patients in a Rehabilitation Hospital , 1989, American journal of physical medicine & rehabilitation.

[3]  Ching-Yi Wu,et al.  Whole-Body Reaching as a Measure of Dynamic Balance in Patients with Stroke , 2006, American journal of physical medicine & rehabilitation.

[4]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[5]  N G Kim,et al.  A new rehabilitation training system for postural balance control using virtual reality technology. , 1999, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[6]  D S Nichols,et al.  Balance retraining after stroke using force platform biofeedback. , 1997, Physical therapy.

[7]  R Ortengren,et al.  Postural equilibrium in adolescent idiopathic scoliosis. , 1978, Acta orthopaedica Scandinavica.

[8]  L W Forrester,et al.  Task-Oriented Aerobic Exercise in Chronic Hemiparetic Stroke: Training Protocols and Treatment Effects , 2005, Topics in stroke rehabilitation.

[9]  R. Hamman,et al.  Training effects during repeated therapy sessions of balance training using visual feedback. , 1992, Archives of physical medicine and rehabilitation.

[10]  A. Schultz,et al.  Biomechanical analyses of rising from a chair. , 1992, Journal of biomechanics.

[11]  B. Brouwer,et al.  Use of visual feedback in retraining balance following acute stroke. , 2000, Physical therapy.

[12]  M. Y. Lee,et al.  The sit-to-stand movement in stroke patients and its correlation with falling. , 1998, Archives of physical medicine and rehabilitation.

[13]  Joseph Mizrahi,et al.  Bilateral Postural Sway in Stroke Patients: New Parameters for Assessing and Predicting Locomotor Outcome , 1991 .

[14]  S. H. Wu,et al.  Effects of a program on symmetrical posture in patients with hemiplegia: A single-subject design. , 1996, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[15]  D. V. Vander Linden,et al.  Variant and invariant characteristics of the sit-to-stand task in healthy elderly adults. , 1994, Archives of Physical Medicine and Rehabilitation.

[16]  Ronald J Ozminkowski,et al.  The burden of falling on the quality of life of adults with Medicare supplement insurance. , 2011, Journal of gerontological nursing.

[17]  S. Krafczyk,et al.  POSTURAL IMBALANCE WITH HEAD EXTENSION: IMPROVEMENT BY TRAINING AS A MODEL FOR ATAXIA THERAPY * , 1981, Annals of the New York Academy of Sciences.

[18]  A. Shumway-cook,et al.  Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. , 1988, Archives of physical medicine and rehabilitation.

[19]  A Straube,et al.  Visual stabilization of posture. Physiological stimulus characteristics and clinical aspects. , 1984, Brain : a journal of neurology.

[20]  S. Baker,et al.  Fall injuries in the elderly. , 1985, Clinics in geriatric medicine.

[21]  E. Roth,et al.  1. Epidemiologic aspects and acute management , 1994 .

[22]  S Hesse,et al.  Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial , 2004, Clinical rehabilitation.

[23]  E D Lemaire,et al.  Indicators of dynamic stability in transtibial prosthesis users. , 2010, Gait & posture.

[24]  G. Wannstedt,et al.  Use of augmented sensory feedback to achieve symmetrical standing. , 1978, Physical therapy.

[25]  S. Taback,et al.  Force Platform Feedback for Standing Balance Training After Stroke , 2005, The Cochrane database of systematic reviews.

[26]  L Nyberg,et al.  Fall prediction index for patients in stroke rehabilitation. , 1997, Stroke.

[27]  C. Winstein,et al.  Standing balance training: effect on balance and locomotion in hemiparetic adults. , 1989, Archives of physical medicine and rehabilitation.

[28]  A. Eagger.  Rehabilitation , 1960 .

[29]  G. Kwakkel,et al.  The impact of physical therapy on functional outcomes after stroke: what's the evidence? , 2004, Clinical rehabilitation.

[30]  S. Olney,et al.  Hemiparetic gait following stroke. Part I: Characteristics , 1996 .

[31]  M. Maležič,et al.  Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. , 1995, Stroke.

[32]  P. Celnik,et al.  Stroke Rehabilitation. , 2015, Physical medicine and rehabilitation clinics of North America.

[33]  R. Dickstein,et al.  Foot-ground pressure pattern of standing hemiplegic patients. Major characteristics and patterns of improvement. , 1984, Physical therapy.

[34]  Chen-Yu Lo,et al.  Dynamic Postural Control During Trunk Bending and Reaching in Healthy Adults and Stroke Patients , 2010, American journal of physical medicine & rehabilitation.