Article

Neurorehabilitation interventions to improve lower limb function and
neuropathic pain have had limited success in people with chronic, incomplete
spinal cord injury (iSCI). OBJECTIVE: We hypothesized that intense virtual
reality (VR)-augmented training of observed and executed leg movements would
improve limb function and neuropathic pain. METHODS: Patients used a VR system
with a first-person view of virtual lower limbs, controlled via movement sensors
fitted to the patient's own shoes. Four tasks were used to deliver intensive
training of individual muscles (tibialis anterior, quadriceps, leg
ad-/abductors). The tasks engaged motivation through feedback of task success.
Fourteen chronic iSCI patients were treated over 4 weeks in 16 to 20 sessions of
45 minutes. Outcome measures were 10 Meter Walking Test, Berg Balance Scale,
Lower Extremity Motor Score, Spinal Cord Independence Measure, Locomotion and
Neuropathic Pain Scale (NPS), obtained at the start and at 4 to 6 weeks before
intervention. RESULTS: In addition to positive changes reported by the patients
(Patients' Global Impression of Change), measures of walking capacity, balance,
and strength revealed improvements in lower limb function. Intensity and
unpleasantness of neuropathic pain in half of the affected participants were
reduced on the NPS test. Overall findings remained stable 12 to 16 weeks after
termination of the training. CONCLUSIONS: In a pretest/posttest, uncontrolled
design, VR-augmented training was associated with improvements in motor function
and neuropathic pain in persons with chronic iSCI, several of which reached the
level of a minimal clinically important change. A controlled trial is needed to
compare this intervention to active training alone or in combination.

Langue : ANGLAIS