Clinical Feasibility of Applying Immersive Virtual Reality During Robot-Assisted Gait Training for Individuals with Neurological Diseases: A Pilot Study

Overview

Journal Brain Sci

Publisher MDPI

Date 2024 Oct 25

PMID 39452016

Authors

Daniele Munari

Angela von Wartburg

Veronica G Garcia-Marti

Matjaz Zadravec

Zlatko Matjacic

Jan F Veneman

Affiliations

Soon will be listed here.

Abstract

Background: Immersive virtual reality has the potential to motivate and challenge patients who need and want to relearn movements in the process of neurorehabilitation.

Objective: The aim of this study was to evaluate the feasibility and user acceptance of an innovative immersive virtual reality system (head-mounted display) used in combination with robot-assisted gait training in subjects suffering from neurological diseases.

Methods: Fifteen participants suffering from cerebrovascular accident or spinal cord injury completed a single session of immersive virtual reality using a head-mounted display during a Lokomat gait session. Training parameters and safety indicators were collected, and acceptance was investigated among participants and therapists.

Results: The results suggest that an immersive virtual reality system is feasible in terms of safety and tolerance. Furthermore, the very positive overall acceptance of the system suggests that it has the potential to be included in a robot-assisted gait training session using Lokomat.

Conclusion: Overall, this study demonstrates that a fully immersive virtual reality system based on a head-mounted display is both feasible and well received by cerebrovascular accident and spinal cord injury patients and their therapists during robot-assisted gait training. This study suggests that such a virtual reality system could be a viable alternative to the screen-based training games currently used in neurorehabilitation. It may be especially suitable for enhancing patient motivation and adherence to training, particularly if the application is enjoyable and not mentally taxing.

References

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

Schiza E, Matsangidou M, Neokleous K, Pattichis C . Virtual Reality Applications for Neurological Disease: A Review. Front Robot AI. 2021; 6:100. PMC: 7806052. DOI: 10.3389/frobt.2019.00100. View

Song Y, Lee H . Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke. Brain Sci. 2021; 11(8). PMC: 8391150. DOI: 10.3390/brainsci11081032. View

Bonanno M, De Luca R, De Nunzio A, Quartarone A, Calabro R . Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review. Brain Sci. 2022; 12(12). PMC: 9775990. DOI: 10.3390/brainsci12121678. View

Calabro R, Cassio A, Mazzoli D, Andrenelli E, Bizzarini E, Campanini I . What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations. Eur J Phys Rehabil Med. 2021; 57(5):841-849. DOI: 10.23736/S1973-9087.21.06915-X. View

Martino Cinnera A, Bisirri A, Chioccia I, Leone E, Ciancarelli I, Iosa M . Exploring the Potential of Immersive Virtual Reality in the Treatment of Unilateral Spatial Neglect Due to Stroke: A Comprehensive Systematic Review. Brain Sci. 2022; 12(11). PMC: 9688364. DOI: 10.3390/brainsci12111589. View

Sullivan G, Artino Jr A . Analyzing and interpreting data from likert-type scales. J Grad Med Educ. 2014; 5(4):541-2. PMC: 3886444. DOI: 10.4300/JGME-5-4-18. View

Weber L, Nilsen D, Gillen G, Yoon J, Stein J . Immersive Virtual Reality Mirror Therapy for Upper Limb Recovery After Stroke: A Pilot Study. Am J Phys Med Rehabil. 2019; 98(9):783-788. PMC: 6697203. DOI: 10.1097/PHM.0000000000001190. View

Hussain R, Chessa M, Solari F . Mitigating Cybersickness in Virtual Reality Systems through Foveated Depth-of-Field Blur. Sensors (Basel). 2021; 21(12). PMC: 8229538. DOI: 10.3390/s21124006. View

10.

Fang C, Tsai J, Li G, Lien A, Chang Y . Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis. Biomed Res Int. 2020; 2020:2102785. PMC: 7115057. DOI: 10.1155/2020/2102785. View

11.

Zanatta F, Farhane-Medina N, Adorni R, Steca P, Giardini A, DAddario M . Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients. Health Qual Life Outcomes. 2023; 21(1):18. PMC: 9942343. DOI: 10.1186/s12955-023-02097-y. View

12.

Alwardat M, Etoom M, Al Dajah S, Schirinzi T, Di Lazzaro G, Salimei P . Effectiveness of robot-assisted gait training on motor impairments in people with Parkinson's disease: a systematic review and meta-analysis. Int J Rehabil Res. 2018; 41(4):287-296. DOI: 10.1097/MRR.0000000000000312. View

13.

Ferrero L, Quiles V, Ortiz M, Ianez E, Gil-Agudo A, Azorin J . Brain-computer interface enhanced by virtual reality training for controlling a lower limb exoskeleton. iScience. 2023; 26(5):106675. PMC: 10214472. DOI: 10.1016/j.isci.2023.106675. View

14.

Moon H, Han S . Perspective: Present and Future of Virtual Reality for Neurological Disorders. Brain Sci. 2022; 12(12). PMC: 9775006. DOI: 10.3390/brainsci12121692. View

15.

Chan K, Hui C, Suen Y, Lee E, Chang W, Chan S . Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review. Brain Sci. 2023; 13(3). PMC: 10046161. DOI: 10.3390/brainsci13030471. View

16.

Maier M, Ballester B, Verschure P . Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neurosci. 2020; 13:74. PMC: 6928101. DOI: 10.3389/fnsys.2019.00074. View

17.

Laszlo C, Munari D, Maggioni S, Knechtle D, Wolf P, De Bon D . Feasibility of an Intelligent Algorithm Based on an Assist-as-Needed Controller for a Robot-Aided Gait Trainer (Lokomat) in Neurological Disorders: A Longitudinal Pilot Study. Brain Sci. 2023; 13(4). PMC: 10136719. DOI: 10.3390/brainsci13040612. View

18.

Nedergard H, Arumugam A, Sandlund M, Brandal A, Hager C . Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis. J Neuroeng Rehabil. 2021; 18(1):64. PMC: 8052671. DOI: 10.1186/s12984-021-00857-9. View

19.

Fowler C, Ballistrea L, Mazzone K, Martin A, Kaplan H, Kip K . A virtual reality intervention for fear of movement for Veterans with chronic pain: protocol for a feasibility study. Pilot Feasibility Stud. 2020; 5:146. PMC: 6907328. DOI: 10.1186/s40814-019-0501-y. View

20.

Winter C, Kern F, Gall D, Latoschik M, Pauli P, Kathner I . Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke. J Neuroeng Rehabil. 2021; 18(1):68. PMC: 8061882. DOI: 10.1186/s12984-021-00848-w. View