title: Effects of virtual reality training on gait biomechanics of individuals post-stroke. Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness. Balance performance with a cognitive task: a dual-task testing paradigm. Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Virtual Walking Training Program Using a Real-world Video Recording for Patients with Chronic Stroke: A Pilot Study Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Use of Virtual Reality to Enhance Balance and Ambulation in Chronic Stroke: A Double-Blind, Randomized Controlled Study
abstract: OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Falls occur mainly while walking or performing concurrent tasks . We determined whether a music-based multitask exercise program improves gait and balance and reduces fall risk  in elderly individuals . METHODS We conducted a 12-month r and omized controlled trial involving 134 community-dwelling individuals older than 65 years , who are at increased risk of falling . They were r and omly assigned to an intervention group ( n = 66 ) or a delayed intervention control group scheduled to start the program 6 months later ( n = 68 ) . The intervention was a 6-month multitask exercise program performed to the rhythm of piano music .  Change in gait variability under dual-task condition from baseline to 6 months was the primary end point . Secondary outcomes included changes in balance , functional performances , and fall risk . RESULTS At 6 months , there was a reduction in stride length variability ( adjusted mean difference , -1.4 % ; P < .002 ) under dual-task condition in the intervention group , compared with the delayed intervention control group . Balance and functional tests improved compared with the control group . There were fewer falls in the intervention group ( incidence rate ratio , 0.46 ; 95 % confidence interval , 0.27 - 0.79 ) and a lower risk of falling ( relative risk , 0.61 ; 95 % confidence interval , 0.39 - 0.96 ) . Similar changes occurred in the delayed intervention control group during the second 6-month period with intervention . The benefit of the intervention on gait variability persisted 6 months later . CONCLUSION In community-dwelling older people at increased risk of falling , a 6-month music-based multitask exercise program improved gait under dual-task condition , improved balance , and reduced both the rate of falls and the risk of falling . Trial Registration clinical trials.gov Identifier : NCT01107288 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 r and omly 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-st and 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-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and 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-st and transfers and the involvement of paretic limb in level walking more than the traditional one did Using r and omized control trial methodology , we evaluated the effectiveness of a 5-week cognitive-motor dual-tasking training program developed to improve performance of a group of people with dual-tasking difficulties arising from acquired brain injury . Training involved twice-daily practice on exercises involving walking being combined with tasks which increased in cognitive dem and over the course of the intervention . A treatment group ( n = 10 ) was compared with a control group ( n = 9 ) . The primary outcome measure was a task requiring participants to walk and carry out a spoken sentence verification task simultaneously . Secondary outcome measures were measures of dual-tasking involving either two motor tasks or two cognitive tasks . A question naire measure relating to activities of daily living requiring dual-tasking was also completed . Compliance with the training program was good . We found evidence of improvement in performance on the primary outcome measure , but little evidence of generalization to other measures . There was some evidence that participants believed that their dual-tasking performance in everyday life was improved after the intervention . The study was limited in terms of sample size , was not blinded and did not control fully for therapist contact time , but has produced valuable data relating to effect sizes associated with this form of intervention . ( JINS , 2009 , 15 , 112 - 120 . ) PURPOSE Athletic performance dem and s simultaneous use of cognitive and postural control capabilities . Decrements to both systems have been observed following concussion . This study evaluated a dual-task methodology to establish the tenability of using this testing model in concussed athletes . METHODS Nonconcussed subjects were assessed over 2 d. Subjects were introduced to the task-switching cognitive assessment test and a NeuroCom Smart Balance Master postural control assessment protocol on day 1 . In the following session , subjects were evaluated on  postural control and cognitive function tests independently ( single task ) , and then concurrently ( dual task ) . RESULTS Significant improvements were seen in three of the four balance conditions and in three of the four reaction times when the cognitive and balance task were performed simultaneously ( P<0.05 ) . No significant balance by cognitive task interaction was revealed ( P>0.05 ) ; however , significant differences existed in reaction time based on stimulus position and increasing balance dem and s ( P<0.05 ) . CONCLUSION Combining the cognitive and balance assessment s result ed in healthy subjects showing improved performance when compared with individual task performance . The dual-task methodology brought about systematic changes to reaction time in relation to increasing balance dem and s. The ability of this protocol to detect changes in postural control or cognitive function following concussive injury requires further study Stroke is one of the most serious healthcare problems and a major cause of impairment of cognition and physical functions . Virtual rehabilitation approaches to postural control have been used for enhancing functional recovery that may lead to a decrease in the risk of falling . In the present study , we investigated the effects of virtual reality balance training ( VRBT ) with a balance board game system on balance of chronic stroke patients . Participants were r and omly assigned to 2 groups : VRBT group ( 11 subjects including 3 women , 65.26 years old ) and control group ( 11 subjects including 5 women , 63.13 years old ) . Both groups participated in a st and ard rehabilitation program ( physical and occupational therapy ) for 60 min a day , 5 times a week for 6 weeks . In addition , the VRBT group participated in VRBT for 30 min a day , 3 times a week for 6 weeks . Static balance ( postural sway velocity with eyes open or closed ) was evaluated with the posturography . Dynamic balance was evaluated with the Berg Balance Scale ( BBS ) and Timed Up and Go test ( TUG ) that measures balance and mobility in dynamic balance . There was greater improvement on BBS ( 4.00 vs. 2.81 scores ) and TUG ( -1.33 vs. -0.52 sec ) in the VRBT group compared with the control group ( P < 0.05 ) , but not on static balance in both groups . In conclusion , we demonstrate a significant improvement in dynamic balance in chronic stroke patients with VRBT . VRBT is feasible and suitable for chronic stroke patients with balance deficit in clinical setting This is a single blind r and omized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke . Twenty subjects with stroke were assigned r and omly to either the control group ( n=9 ) or the experimental group ( n=11 ) . Subjects in the control group received the treadmill training . Subjects in the experimental group underwent the virtual reality-based treadmill training .  Walking speed , community walking time , walking ability question naire ( WAQ ) , and activities-specific balance confidence ( ABC ) scale were evaluated . Subjects in the experimental group improved significantly in walking speed , community walking time , and WAQ score at posttraining and 1-month follow-up periods . Their ABC score also significantly increased at posttraining but did not maintain at follow-up period . Regarding the between-group comparisons , the experimental group improved significantly more than control group in walking speed ( P=0.03 ) and community walking time ( P=0.04 ) at posttraining period and in WAQ score ( P=0.03 ) at follow-up period . Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke Objective The purpose of this study was to investigate the effectiveness of the virtual walking training program using a real-world video recording on walking balance and spatiotemporal gait parameters in patients with chronic stroke . Design Fourteen patients with chronic stroke were r and omly assigned to either the experimental group ( n = 7 ) or the control group ( n = 7 ) . The subjects in both groups underwent a st and ard rehabilitation program ; in addition , the experimental group participated in the virtual walking training program using a real-world video recording for 30 mins a day , three times a week , for 6 wks , and the control group participated in treadmill gait training for 30 mins a day , three times a week , for 6 wks . Walking balance was measured using the Berg Balance Scale ( BBS ) and the Timed Up and Go test . Gait performance was measured using an electrical walkway system . Results In walking balance , greater improvement on the Berg Balance Scale ( experimental group : 4.14 vs. control group : 1.85 ) and the Timed Up and Go test ( −2.25 vs. −0.94 ) was observed in the experimental group compared with the control group ( P < ; 0.05 ) . In the spatiotemporal gait parameters , greater improvement on velocity ( 25.40 vs. 9.74 ) and cadence ( 26.71 vs. 11.11 ) was observed in the experimental group compared with the control group ( P < ; 0.05 ) . Conclusions This study demonstrated the positive effects of the virtual walking training program using a real-world video recording on gait performance . These findings suggest that the virtual walking training program using a real-world video recording may be a valid approach to enhance gait performance in patients with chronic stroke OBJECTIVE To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects ( a minimum gait velocity , 58cm/s ) . INTERVENTIONS Participants were r and omized into a  control group ( n=12 ) or experimental group ( n=13 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group underwent a 4-week ball exercise program . MAIN OUTCOME MEASURES Gait performance was measured under single task ( preferred walking ) and tray-carrying task . Gait parameters of interest were walking speed , cadence , stride time , stride length , and temporal symmetry index . RESULTS The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions . In the control group , there were no significant changes over the 4-week period for all selected measures . There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions . CONCLUSIONS The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke Kim JH , Jang SH , Kim CS , Jung JH , You JH : Use of virtual reality to enhance balance and ambulation in chronic stroke : A double-blind , r and omized controlled study . Objective : To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke . Design : Twenty-four adults with hemiparetic stroke were r and omly assigned to either an experimental group ( n = 12 ) or a control group . Both groups underwent conventional physical therapy , 40 mins a day , 4 days a week for 4 wks . The experimental group received an additional 30 mins of virtual reality therapy each session . Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests . Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale , and spatiotemporal parameters were obtained using GAITRite . Analysis of variance and correlation statistics were performed at P < 0.05 . Results : In the balance test , the experimental group had improved Berg Balance Scale scores , balance and dynamic balance angles ( ability to control weight shifting ) compared with the controls ( P < 0.05 ) . In the gait performance test , the experimental group showed significant improvements in velocity , Modified Motor Assessment Scale scores , cadence , step time , step length , and stride length ( P < 0.05 ) . Improvement in dynamic balance angles was correlated with velocity and cadence ( P < 0.01 ) . Conclusions : This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy
target: Cognitive motor interference is effective for improving gait and balance function for stroke in the short term .
  However , only little evidence supports assumptions regarding CMI 's long-term benefits
background: BACKGROUND AND PURPOSE An increasing interest in the potential benefits of cognitive motor interference ( CMI ) for stroke has recently been observed , but the efficacy of CMI for gait and balance is controversial .
  A systematic review and meta- analysis of r and omized controlled trials was performed to estimate the effect of CMI on gait and balance in patients with stroke .