title: Virtual reality-augmented neurorehabilitation improves motor function and reduces neuropathic pain in patients with incomplete spinal cord injury.
abstract: BACKGROUND
  Neurorehabilitation interventions to improve lower limb function and neuropathic pain have had limited success in people with chronic, incomplete spinal cord injury (iSCI).
  
  
  OBJECTIVE
  We hypothesized that intense virtual reality (VR)-augmented training of observed and executed leg movements would improve limb function and neuropathic pain.
  
  
  METHODS
  Patients used a VR system with a first-person view of virtual lower limbs, controlled via movement sensors fitted to the patient's own shoes. Four tasks were used to deliver intensive training of individual muscles (tibialis anterior, quadriceps, leg ad-/abductors). The tasks engaged motivation through feedback of task success. Fourteen chronic iSCI patients were treated over 4 weeks in 16 to 20 sessions of 45 minutes. Outcome measures were 10 Meter Walking Test, Berg Balance Scale, Lower Extremity Motor Score, Spinal Cord Independence Measure, Locomotion and Neuropathic Pain Scale (NPS), obtained at the start and at 4 to 6 weeks before intervention.
  
  
  RESULTS
  In addition to positive changes reported by the patients (Patients' Global Impression of Change), measures of walking capacity, balance, and strength revealed improvements in lower limb function. Intensity and unpleasantness of neuropathic pain in half of the affected participants were reduced on the NPS test. Overall findings remained stable 12 to 16 weeks after termination of the training.
  
  
  CONCLUSIONS
  In a pretest/posttest, uncontrolled design, VR-augmented training was associated with improvements in motor function and neuropathic pain in persons with chronic iSCI, several of which reached the level of a minimal clinically important change. A controlled trial is needed to compare this intervention to active training alone or in combination.
authors.affiliation: 1University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Villiger
authors.forename: Dominik
authors.initials: D
authors.lastname: Bohli
authors.forename: Daniel
authors.initials: D
authors.lastname: Kiper
authors.forename: Pawel
authors.initials: P
authors.lastname: Pyk
authors.forename: Jeremy
authors.initials: J
authors.lastname: Spillmann
authors.forename: Bruno
authors.initials: B
authors.lastname: Meilick
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Hepp-Reymond
authors.forename: Sabina
authors.initials: S
authors.lastname: Hotz-Boendermaker
authors.forename: Kynan
authors.initials: K
authors.lastname: Eng
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013904:Thoracic Vertebrae; D063367:Virtual Reality Exposure Therapy; D016138:Walking / Q000502:physiology*
keywords: locomotion; motor function; neuropathic pain; neurorehabilitation; spinal cord injury; virtual reality