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Lohss R, Winter R, Göpfert B, Visscher RMS, Sangeux M, Zentai N, Viehweger E. Biomechanical gait parameters change with increasing virtual height in a child with spastic cerebral palsy: A case report. Clin Case Rep 2024; 12:e8548. [PMID: 38440770 PMCID: PMC10909796 DOI: 10.1002/ccr3.8548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/02/2023] [Accepted: 01/25/2024] [Indexed: 03/06/2024] Open
Abstract
Virtual height exposure coupled with motion capture is feasible to elicit changes in spatiotemporal, kinematic, and kinetic gait parameters in a child with cerebral palsy and should be considered when investigating gait in real-world-scenarios.
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Affiliation(s)
- Regine Lohss
- Laboratory for Movement AnalysisUniversity Children's Hospital BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Rebecca Winter
- Laboratory for Movement AnalysisUniversity Children's Hospital BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Beat Göpfert
- Laboratory for Movement AnalysisUniversity Children's Hospital BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Rosa M. S. Visscher
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
- Careum School of HealthKalaidos University of Applied SciencesZurichSwitzerland
| | - Morgan Sangeux
- Laboratory for Movement AnalysisUniversity Children's Hospital BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Norbert Zentai
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Elke Viehweger
- Laboratory for Movement AnalysisUniversity Children's Hospital BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
- Department of OrthopedicsUniversity Children's Hospital BaselBaselSwitzerland
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De Keersmaecker E, Van Bladel A, Zaccardi S, Lefeber N, Rodriguez-Guerrero C, Kerckhofs E, Jansen B, Swinnen E. Virtual reality-enhanced walking in people post-stroke: effect of optic flow speed and level of immersion on the gait biomechanics. J Neuroeng Rehabil 2023; 20:124. [PMID: 37749566 PMCID: PMC10518929 DOI: 10.1186/s12984-023-01254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Optic flow-the apparent visual motion experienced while moving-is absent during treadmill walking. With virtual reality (VR), optic flow can be controlled to mediate alterations in human walking. The aim of this study was to investigate (1) the effects of fully immersive VR and optic flow speed manipulation on gait biomechanics, simulator sickness, and enjoyment in people post-stroke and healthy people, and (2) the effects of the level of immersion on optic flow speed and sense of presence. METHODS Sixteen people post-stroke and 16 healthy controls performed two VR-enhanced treadmill walking sessions: the semi-immersive GRAIL session and fully immersive head-mounted display (HMD) session. Both consisted of five walking trials. After two habituation trials (without and with VR), participants walked three more trials under the following conditions: matched, slow, and fast optic flow. Primary outcome measures were spatiotemporal parameters and lower limb kinematics. Secondary outcomes (simulator sickness, enjoyment, and sense of presence) were assessed with the Simulator Sickness Questionnaire, Visual Analogue Scales, and Igroup Presence Questionnaire. RESULTS When walking with the immersive HMD, the stroke group walked with a significantly slower cadence (-3.69strides/min, p = 0.006), longer stride time (+ 0.10 s, p = 0.017) and stance time for the unaffected leg (+ 1.47%, p = 0.001) and reduced swing time for the unaffected leg (- 1.47%, p = 0.001). Both groups responded to the optic flow speed manipulation such that people accelerated with a slow optic flow and decelerated with a fast optic flow. Compared to the semi-immersive GRAIL session, manipulating the optic flow speed with the fully immersive HMD had a greater effect on gait biomechanics whilst also eliciting a higher sense of presence. CONCLUSION Adding fully immersive VR while walking on a self-paced treadmill led to a more cautious gait pattern in people post-stroke. However, walking with the HMD was well tolerated and enjoyable. People post-stroke altered their gait parameters when optic flow speed was manipulated and showed greater alterations with the fully-immersive HMD. Further work is needed to determine the most effective type of optic flow speed manipulation as well as which other principles need to be implemented to positively influence the gait pattern of people post-stroke. TRIAL REGISTRATION NUMBER The study was pre-registered at ClinicalTrials.gov (NCT04521829).
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Affiliation(s)
- Emma De Keersmaecker
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium.
- Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
| | - Anke Van Bladel
- Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Department Rehabilitation Sciences, Campus UZ Gent, Ghent, Belgium
| | - Silvia Zaccardi
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics, Engineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nina Lefeber
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Movement and Nutrition for Health and Performance, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Eric Kerckhofs
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Jansen
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics, Engineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Imec, Leuven, Belgium
| | - Eva Swinnen
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
- Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Lohss R, Odorizzi M, Sangeux M, Hasler CC, Viehweger E. Consequences of Virtual Reality Experience on Biomechanical Gait Parameters in Children with Cerebral Palsy: A Scoping Review. Dev Neurorehabil 2023; 26:377-388. [PMID: 37537745 DOI: 10.1080/17518423.2023.2242930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
Virtual reality (VR), coupled with motion tracking, can investigate walking in a controlled setting while applying various walking challenges. The purpose of this review was to summarize the evidence on consequences of VR on biomechanical gait parameters in children with cerebral palsy. MEDLINE, Embase and Web of Science were searched. Among 7.574 studies, screened by two independent reviewers, seven studies were included, analyzing treadmill (n = 6) or overground walking (n = 1) under VR. Most frequently reported were the spatiotemporal parameters walking speed, stride length, step width, stance phase, and the kinematic parameters range of knee flexion and peak ankle dorsiflexion. However, methodological approaches and reporting of the results were inconsistent among studies. This review reveals that VR can complement information gained from clinical gait analysis. However, this is still an emerging field of research and there is limited knowledge on the effect of VR on gait parameters, notably during overground walking.
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Affiliation(s)
- Regine Lohss
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Marco Odorizzi
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Morgan Sangeux
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Carol-Claudius Hasler
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
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Arnoni JLB, Lima CRG, Verdério BN, Kleiner AFR, de Campos AC, Rocha NACF. Active Videogame Training Combined with Conventional Therapy Alters Body Oscillation in Children with Cerebral Palsy: A Randomized Controlled Trial. Games Health J 2022; 11:252-261. [PMID: 35687479 DOI: 10.1089/g4h.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: Assess the effect of nonimmersive virtual reality (VR) training as complementary rehabilitation on body oscillation in children with cerebral palsy (CP) while standing on different bases of support and surfaces. Materials and Methods: Twenty-three children with unilateral CP randomly allocated to an intervention group (IG, n = 12) or control group (CG, n = 11). The IG underwent two weekly 50-minute sessions of VR training over 8 weeks, associated with conventional therapy, while the CG was submitted to two 45-minute sessions of conventional neurodevelopmental-based physiotherapy a week over the same time period. Participants were evaluated on a force platform under control conditions (CCs) (rigid surface, feet parallel); semitandem stance; flexible surface (FS) with feet parallel; and flexible surface in a semitandem (FSST) stance. The effect of the group and time factors on the center of pressure oscillation variables was analyzed by repeated-measures analysis of variance (ANOVA), with significance set at 0.05. Results: The main effect observed was for time on the FS, with a decline in the amplitude of mediolateral (ML Amp) (P = 0.01) and mediolateral root mean square (P = 0.01) after intervention. In the IG, ML Amp also declined after intervention under CCs (P = 0.02) and total velocity increased for FSST (P = 0.04). The percentage change was significant only in the IG. Conclusion: VR training as complementary rehabilitation can help improve body oscillation in children with CP and mild functional impairment. Nonimmersive VR can be considered a complementary tool for the physical rehabilitation of children with CP. This study was registered with the Brazilian Clinical Trials Registry (RBR-3zty4w).
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Affiliation(s)
- Joice Luiza Bruno Arnoni
- Neuropediatrics Section, Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | - Bruna Nayara Verdério
- Neuropediatrics Section, Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | - Ana Carolina de Campos
- Neuropediatrics Section, Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
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Yazıcı M, Livanelioğlu A, Gücüyener K, Tekin L, Sümer E, Yakut Y. Effects of robotic rehabilitation on walking and balance in pediatric patients with hemiparetic cerebral palsy. Gait Posture 2019; 70:397-402. [PMID: 30974395 DOI: 10.1016/j.gaitpost.2019.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/26/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The most prominent characteristics of hemiparetic cerebral palsy (hCP) children are structural and functional asymmetries. These children have low walking speeds, endurance and poor balance. The robotic walking devices repeat and experience symmetrical stepping at the corresponding speed and angles of the lower extremities. RESEARCH QUESTION 1: Are robotic walking devices effective in the development of walking in hCP children who can walk? RESEARCH QUESTION 2: How does the aerobic exercise experience with assisted and symmetrical movement affect the walking and local muscle, peripheral oxygenation of children with hCP? METHODS This prospective, controlled study included 24 children with hCP. All children attended to a standard physiotherapy rehabilitation (PTR) program (three days a week for 12 weeks); those in the study group (n=12) also attended to an Robotic Gait Training (RGT) program three times a week. Evaluations performed before treatment, after treatment, and at the 3rd month after treatment included assessment of balance, functionality walking and measurements for oxygenation of vastus lateralis muscle and peripheral oxygenation. RESULTS The evaluations were similar for both groups before treatment. After treatment, walking speed, endurance and peripheral O2 saturation were increased and balance abilities and functional performances improved in the RGT group as compared with the pre-treatment evaluations; these improvements in balance and functional performance were generally preserved after 3 months of treatment. An increase in 6-min walking distance and a partial increase in gross motor functions and functional muscle strength were observed in the control group; however, these abilities were not preserved after the treatment. SIGNIFICANCE RGT can provide a faster and higher effect on the development of functional muscle strength, balance, walking speed and endurance than the standard PTR program. It improves functional walking performance. RGT can be used for aerobic exercise training in children with walking hCP.
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Affiliation(s)
- Meltem Yazıcı
- Hacettepe University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey; Nuh Naci Yazgan University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kayseri, Turkey.
| | - Ayşe Livanelioğlu
- Hacettepe University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Kıvılcım Gücüyener
- Gazi University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey.
| | - Leman Tekin
- Gazi University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey.
| | - Erkan Sümer
- Hacettepe University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Yavuz Yakut
- Hasan Kalyoncu University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey.
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