title: An Immersive Virtual Reality Platform to Enhance Walking Ability of Children with Acquired Brain Injuries.
abstract: BACKGROUND
  Acquired brain injury (ABI) may result in lifelong impairment of physical, cognitive, and psychosocial functions. Several rehabilitative treatments are often needed to support walking recovery, thus participants' engagement becomes a crucial aspect, especially when patients are children. In the last few years, traditional physiotherapy (PT) has been flanked by innovative technologies for rehabilitation in the fields of robotics and Virtual Reality (VR). Preliminary results have shown interesting perspectives in the use of a VR system, the GRAIL (Gait Real-time Analysis Interactive Lab), in improving walking abilities in a small group of children with ABI, although further insights are needed about its use as rehabilitative tool in the pediatric population.
  
  
  OBJECTIVE
  To evaluate the efficacy of a rehabilitation treatment on a GRAIL system for the improvement of walking abilities, in a group of children suffering from ABI.
  
  
  METHODS
  12 children with ABI (study group - SG; mean age = 12.1 ± 3.8 years old) underwent a 10-session treatment with the GRAIL, an instrumented multi-sensor platform based on immersive VR for gait training and rehabilitation in engaging VR environments. Before (T0) and at the end of the treatment (T1), the participants were assessed by means of functional scales (Gross Motor Function Measure (GMFM), Functional Assessment Questionnaire (FAQ), 6-Minute Walk Test (6minWT) and the 3D-Gait Analysis, over ground (OGA) and on GRAIL (GGA).
  
  
  RESULTS
  All the participants completed the rehabilitative treatment. The functional evaluations showed an improvement in Gross Motor abilities (GMFM-88, p = 0.008), especially in standing (GMFM-D, p = 0.007) and walking (GMFM-E, p = 0.005), an increase of the endurance (6minWT, p = 0.002), and enhanced autonomy in daily life activities (FAQ, p = 0.025). OGA identified a significant decrease of the Gillette Gait Index for the impaired side and a general increase of symmetry. GGA showed improvements in spatiotemporal parameters and joints range of motion that moved towards normality and symmetry recovery.
  
  
  CONCLUSIONS
  A 10-session treatment with GRAIL on children with ABI led to improvements in their walking abilities and enhanced their engagement during the training. This is desirable when long life impairments are faced and children's motor functions have to be regained and it supports the leading role that VR might have in the rehabilitation field.
authors.affiliation: Emilia Biffi, Scientific Institute E. Medea, Via Don luigi Monza 20, 23842 Bosisio Parini (Lecco), Italy, E-mail: emilia.biffi@bp.lnf.it.
authors.forename: Emilia
authors.initials: E
authors.lastname: Biffi
authors.forename: Elena
authors.initials: E
authors.lastname: Beretta
authors.forename: Ambra
authors.initials: A
authors.lastname: Cesareo
authors.forename: Cristina
authors.initials: C
authors.lastname: Maghini
authors.forename: Anna C
authors.initials: AC
authors.lastname: Turconi
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Reni
authors.forename: Sandra
authors.initials: S
authors.lastname: Strazzer
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001930:Brain Injuries / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D014584:User-Computer Interface; D016138:Walking / Q000502:physiology*
keywords: GRAIL; gait rehabilitation; hemiplegia; pediatric