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Feasibility of Virtual Reality Augmented Cycling for Health Promotion of People Poststroke

Deutsch, Judith E. PT, PhD, FAPTA; Myslinski, Mary Jane PT, EdD; Kafri, Michal PT, PhD; Ranky, Richard PhD; Sivak, Mark PhD; Mavroidis, Constantinos PhD; Lewis, Jeffrey A. MS, MBA

Journal of Neurologic Physical Therapy: September 2013 - Volume 37 - Issue 3 - p 118–124
doi: 10.1097/NPT.0b013e3182a0a078
Research Articles
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Background and Purpose: A virtual reality (VR) augmented cycling kit (VRACK) was developed to address motor control and fitness deficits of individuals with chronic stroke. In this article, we report on the safety, feasibility, and efficacy of using the VR augmented cycling kit to improve cardiorespiratory (CR) fitness of individuals in the chronic phase poststroke.

Methods: Four individuals with chronic stroke (47–65 years old and ≥3 years poststroke), with residual lower extremity impairments (Fugl-Meyer 24–26/34), who were limited community ambulators (gait speed range 0.56–1.1 m/s) participated in this study. Safety was defined as the absence of adverse events. Feasibility was measured using attendance, total exercise time, and “involvement” measured with the presence questionnaire (PQ). Efficacy of CR fitness was evaluated using a submaximal bicycle ergometer test before and after an 8-week training program.

Results: The intervention was safe and feasible with participants having 1 adverse event, 100% adherence, achieving between 90 and 125 minutes of cycling each week, and a mean PQ score of 39 (SD 3.3). There was a statistically significant (13%; P = 0.035) improvement in peak VO2, with a range of 6% to 24.5%.

Discussion and Conclusion: For these individuals, poststroke, VR augmented cycling, using their heart rate to set their avatar's speed, fostered training of sufficient duration and intensity to promote CR fitness. In addition, there was a transfer of training from the bicycle to walking endurance. VR augmented cycling may be an addition to the therapist's tools for concurrent training of mobility and health promotion of individuals poststroke.

Video Abstract available (see Video, Supplemental Digital Content 1, for more insights from the authors.

Supplemental Digital Content is Available in the Text.

Research in Virtual Environments and Rehabilitation Sciences Laboratory (J.E.D., M.J.M., M.K.), Department of Rehabilitation and Movement Sciences, Rutgers University, Camden, New Jersey; Biomedical Mechatronics Laboratory (R.R., M.S., C.M.), Northeastern University, Boston, Massachusetts; and VRehab LLC (J.E.D., J.A.L.), Jersey City, New Jersey.

Correspondence: Judith E. Deutsch, PT, PhD, FAPTA, Department of Rehabilitation and Movement Sciences, Rutgers University 65 Bergen Street, Newark, NJ 07103 (

Funded by NICHD R41 HD54261-01 Deutsch PI.

Drs Deutsch, Ranky, Sivak, and Mavroidis and Mr Lewis are inventors of the VRACK.

Parts of this manuscript were presented at the 9th International Conference for Virtual Reality and Associated Technologies (ICDVRAT), Laval, France.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Neurology Section, APTA