Gait Training in Virtual Reality Home Environment for Stroke Patients: A Case Study

Yuya Nagashima, Daigo Ito, Ryo Ogura, Takanori Tominaga, Yumie Ono
Vol. 10 (2021) p.150-157

We developed a virtual reality (VR)-based gait training system for inpatients aiming to improve their gait performance in a simulated home environment and to reduce the risk of falls after discharge. The proposed system simulates a home environment in a head-mounted display projection, in which the user can walk freely. The system provides combined visual, auditory, and tactile feedback when the user collides with an object in the simulated environment, aiming to encourage the user to modify his or her gait pattern. We report the training effect of the proposed system in three hospitalized patients who had stroke and lower limb paralysis. Changes in the balance function (Berg Balance Scale: BBS) and mobility function (Timed Up and Go test: TUG) were evaluated in all patients, and change in the fear of falling (Modified Falls Efficacy Scale: MFES) was additionally assessed in two patients (A and B). Patients A and B performed five sessions of gait training in the VR home environment every day for 5 consecutive days. Patient A who had moderate motor paralysis (Brunnstrom stage V) and moderately impaired gait function showed a remarkable improvement in MFES score, with minor improvement in TUG score and comparable BBS score after the intervention. Patient B who had severe motor paralysis and highly impaired gait function (Brunnstrom stage IV) showed remarkable improvement in TUG and BBS scores while there was no change in MFES score. Patient C who had severe motor impairment (Brunnstrom stage III) and a history of falls during a short visit at home underwent 20 minutes of gait training daily for 3 weeks in the VR-TUG room with a corridor having varying widths. The combined conventional and VR-based intervention diminished fall events during the TUG test in the patient’s home, which remained after the same duration of conventional gait training prior to the combined intervention. These results suggest the potential of VR-based gait training in assisting patients to adapt to the environment, improve balance and gait function, and reduce the fear of falling.