Clinical experience using a 5-week treadmill training program with virtual reality to enhance gait in an ambulatory physical therapy service.
BACKGROUND
Current literature views safe gait as a complex task, relying on motor and cognitive resources. The use of virtual reality (VR) in gait training offers a multifactorial approach, showing positive effects on mobility, balance, and fall risk in elderly people and individuals with neurological disorders. This form of training has been described as a viable research tool; however, it has not been applied routinely in clinical practice. Recently, VR was used to develop an adjunct training method for use by physical therapists in an ambulatory clinical setting.


OBJECTIVE
The aim of this article is to describe the initial clinical experience of applying a 5-week VR clinical service to improve gait and mobility in people with a history of falls, poor mobility, or postural instability.


METHODS
A retrospective data analysis was conducted.


METHODS
The clinical records of the first 60 patients who completed the VR gait training program were examined. Training was provided 3 times per week for 5 weeks, with each session lasting approximately 1 hour and consisting of walking on a treadmill while negotiating virtual obstacles. Main outcome measures were compared across time and included the Timed "Up & Go" Test (TUG), the Two-Minute Walk Test (2MWT), and the Four Square Step Test (FSST).


RESULTS
After 5 weeks of training, time to complete the TUG decreased by 10.3%, the distance walked during the 2MWT increased by 9.5%, and performance on the FSST improved by 13%.


CONCLUSIONS
Limitations of the study include the use of a retrospective analysis with no control group and the lack of objective cognitive assessment.


CONCLUSIONS
Treadmill training with VR appears to be an effective and practical tool that can be applied in an outpatient physical therapy clinic. This training apparently leads to improvements in gait, mobility, and postural control. It, perhaps, also may augment cognitive and functional aspects.
S.R. Shema, BPT, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Shirley Roth
SR
Shema
M. Brozgol, BPT, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center.
Marina
M
Brozgol
M. Dorfman, MScPT, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center.
Moran
M
Dorfman
I. Maidan, MScPT, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center.
Inbal
I
Maidan
L. Sharaby-Yeshayahu, BPT, Department of Physical Therapy, Tel Aviv Sourasky Medical Center.
Lior
L
Sharaby-Yeshayahu
H. Malik-Kozuch, BPT, Department of Physical Therapy, Tel Aviv Sourasky Medical Center.
Hila
H
Malik-Kozuch
O. Wachsler Yannai, MScPT, Department of Physical Therapy, Tel Aviv Sourasky Medical Center.
Orly
O
Wachsler Yannai
N. Giladi, MD, Movement Disorders Unit, Department of Neurology, and Department of Physical Therapy, Tel Aviv Sourasky Medical Center, and Sagol School of Neuroscience and Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nir
N
Giladi
J.M. Hausdorff, PhD, Movement Disorders Unit, Department of Neurology, and Department of Physical Therapy, Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience; and Harvard Medical School, Boston, Massachusetts.
Jeffrey M
JM
Hausdorff
A. Mirelman, PT, PhD, Laboratory for Gait Analysis & Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel, and School of Health Related Professions, Ben Gurion University, Beer Sheba, Israel. anatmi@tasmc.health.gov.il.
Anat
A
Mirelman
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D010043:Outcome and Process Assessment, Health Care; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D063367:Virtual Reality Exposure Therapy