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

Yang, Saiwei PhD; Hwang, Wei-Hsung MS; Tsai, Yi-Ching PhD(c); Liu, Fu-Kang MD; Hsieh, Lin-Fen MD; Chern, Jen-Suh PhD

American Journal of Physical Medicine & Rehabilitation: December 2011 - Volume 90 - Issue 12 - p 969–978
doi: 10.1097/PHM.0b013e3182389fae
Original Research Articles

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.

From the Institute of Biomedical Engineering, National Yang-Ming University, Taipei (SY, W-HH, Y-CT); Rehabilitation Medicine, Cheng-Hsin Rehabilitation Medical Center, Taipei (F-KL); Department of Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei (L-FH); and Department of Occupational Therapy, Chang Gung University, Tao-Yuan, Taiwan (J-SC).

All correspondence and requests for reprints should be addressed to: Jen-Suh Chern, PhD, Department of Occupational Therapy, Chang Gung University, No. 259, Wen-Hwa 1st Rd, Kwei-Shan Township, Taoyuan County, Taiwan 333.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supported by the National Science Council of the Republic of China through Grants NSC89-2614-B010-004-M47 and NSC90-2614-B010-002-M47.

Reported, in part, at the 4th Congress of Biomechanics, Calgary, Canada, August 4, 2002.

© 2011 Lippincott Williams & Wilkins, Inc.