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Gait Training after Stroke on a Self-Paced Treadmill with and without Virtual Environment Scenarios. A Proof-of-Principle Study

The purpose of this proof-of-principle study was to show that virtual
reality (VR) technology could be coupled with a self-paced treadmill to further
improve walking competency in individuals with chronic stroke. Method: A
62-year-old man with a chronic right hemispheric stroke participated in a
treadmill walking programme involving first a control (CTL) protocol, then VR
training. In CTL training, he walked without time constraints while viewing still
pictures and reacting to treadmill movements similar to those that he would have
experienced later in VR training. In VR training, he experienced treadmill
movements programmed to simulate changes encountered in five virtual environments
rear-projected onto a large screen. Training difficulty in nine sessions over 3
weeks was increased by varying the time constraints, terrain surface changes, and
obstacles to avoid. Effects on walking competency were assessed using clinical
measures (5 m walk test, 6 min walk test, Berg Balance Scale, Activities-specific
Balance Confidence scale) and questionnaires (Assessment of Life Habits Scale and
personal appraisal). Results: CTL and VR training resulted in a similar
progression through the training sessions of total time walked on the treadmill.
The VR training led to an additional increase in speed as measured by walking 5
metres as fast as possible and distance walked in 6 minutes, as well as improved
balance self-efficacy and anticipatory locomotor adjustments. As reported by the
participant, these improved outcomes transferred to real-life situations.
Conclusions: Despite the limited potential for functional recovery from chronic
stroke, an individual can achieve improvements in mobility and self-efficacy
after participating in VR-coupled treadmill training, compared with treadmill
training with the same intensity and surface perturbations but without VR
immersion. A larger scale, randomized controlled trial is warranted to determine
the efficacy of VR-coupled treadmill training for mobility intervention
post-stroke.

Langue : ANGLAIS

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