Does virtual reality gait training improve participation in patients after stroke?

Rationale:

Many patients after stroke experience limitations in walking and physical functioning in daily life,

mainly because of difficulties with performing dual tasks and walking on unlevel surfaces, walking up-

or downhill and walking on stairs. These limitations in walking provoke a reduced activity and

participation level. While using virtual reality training patients can be challenged more when compared

to other forms of gait training, for example by adding visual input and feedback, perturbations and dual

tasks during walking. It has been demonstrated that virtual reality training improves functional outcome

measures in people after stroke. However, there is a lack of measuring follow-up and research on the

effect of virtual reality training on activity and participation level is missing. Therefore, it is unclear

whether the effects of virtual training are translated in improved daily life activity and participation in

the home environment.

Objectives:

The primary objective of this study is to investigate the effect of virtual reality training, given between 2

weeks and 6 months after stroke, on participation and subjective physical functioning in independently

living patients. Secondary research questions are: What is the effect of virtual gait training on walking

ability in patients between 2 weeks and 6 months after stroke? What is the difference in intensity

between virtual treadmill training and conventional functional gait training? Does gait training on a

treadmill in a virtual environment lead to improved quality of life?

Study design:


A randomized controlled trial will be conducted to compare virtual gait training (experimental group)

with functional gait training (control group).



Study population:

Patients with stroke between 2 weeks and 6 months after stroke who are living independently.

Participants are experiencing constraints with walking and are minimally able to walk without manual

support (FAC 3).

Intervention:


Patients in the experimental group will receive virtual gait training on the Gait Real-time Analysis

Interactive Lab (GRAIL). Training in the control group will take place on a conventional treadmill for

half of the training. The other half of a training session functional gait exercises are performed.

Participants will train 2 times per week for 6 weeks.

Outcome measures:

The primary outcome measure is participation assessed with the Utrecht Scale for Evaluation of

Rehabilitation Participation (USER-P). Secondary outcome measures are: subjective physical

functioning (SIS-16), functional gait ability (TUG, 6 minutes walking test), fatigue (FSS), anxiety and

depression (HADS), falls efficacy (FES-I), quality of life (SS-QOL) and daily life activity level measured

with an accelerometer.

The objective of the study is to investigate the effect of virtual reality training, given between 2 weeks and 6 months after stroke, on participation and subjective physical functioning in independently living patients.

Baseline, after the 6-week training intervention and after 3 months of follow-up

The intervention group (28 persons) receives 2 virtual reality training sessions of 30 minutes per week for 6 weeks. The virtual reality training is performed on the Gait Real-time Analysis Interactive Lab (GRAIL). The GRAIL comprises a dual-belt treadmill with force platform, a motion-capture system (Vicon) and speed-matched virtual environments projected on a 180 degrees semi-cylindrical screen. Participants can practice walking ability in combination with extra cognitive tasks or tasks using the upper extremity within the virtual environment of the GRAIL.



Patients assigned to the control group (28 persons) receive functional gait training of 30 minutes 2 times per week for 6 weeks. The functional gait training will take place on a conventional treadmill for half of the training. The other half of a training session functional gait exercises are performed.