Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis Effect of virtual reality training on walking distance and physical fitness in individuals with Parkinson's disease. Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. Clinical usefulness of the virtual reality-based postural control training on the gait ability in patients with stroke Home-based virtual reality balance training and conventional balance training in Parkinson's disease: A randomized controlled trial. Immersive Virtual Reality to Improve Walking Abilities in Cerebral Palsy: A Pilot Study Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke Virtual reality exercise intradialysis to improve physical function: A feasibility randomized trial Cognitive training on stroke patients via virtual reality-based serious games V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? A multimodal training modulates short-afferent inhibition and improves complex walking in a cohort of faller older adults with an increased prevalence of Parkinson's disease. Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson’s disease Gait improvement in patients with cerebral palsy by visual and auditory feedback Virtual reality-based cognitive-motor training for middle-aged adults at high Alzheimer's disease risk: A randomized controlled trial Operating Room Performance Improves after Proficiency-Based Virtual Reality Cataract Surgery Training. Virtual Reality Exercise Improves Mobility After Stroke: An Inpatient Randomized Controlled Trial The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial Additional Virtual Reality Training Using Xbox Kinect in Stroke Survivors with Hemiplegia Asymmetric training using virtual reality reflection equipment and the enhancement of upper limb function in stroke patients: a randomized controlled trial.
This is a single blind r and omized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke . Twenty subjects with stroke were assigned r and omly to either the control group ( n=9 ) or the experimental group ( n=11 ) . Subjects in the control group received the treadmill training . Subjects in the experimental group underwent the virtual reality-based treadmill training .  Walking speed , community walking time , walking ability question naire ( WAQ ) , and activities-specific balance confidence ( ABC ) scale were evaluated . Subjects in the experimental group improved significantly in walking speed , community walking time , and WAQ score at posttraining and 1-month follow-up periods . Their ABC score also significantly increased at posttraining but did not maintain at follow-up period . Regarding the between-group comparisons , the experimental group improved significantly more than control group in walking speed ( P=0.03 ) and community walking time ( P=0.04 ) at posttraining period and in WAQ score ( P=0.03 ) at follow-up period . Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke Objective : To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke . Design : R and omized controlled trial . Setting : Outpatient neurorehabilitation unit . Participants : A total of 20 individuals with chronic stroke . Interventions : The intervention consisted of 20 one-hour sessions , five sessions per week . The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training . The control group underwent one hour conventional therapy . Main measures : Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale , the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment , the Brunel Balance Assessment , and the 10-m Walking Test . Subjective data of the virtual reality-based intervention were collected from the experimental group , with a feedback question naire at the end of the trial . Results : The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale ( p < 0.05 ) and in the 10-m Walking Test ( p < 0.05 ) . Post-hoc analyses showed greater improvement in the experimental group : 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale , –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test , and also in the number of participants who increased level in the Brunel Balance Assessment ( χ2 = 2.5 , p < 0.01 ) . Conclusions : Virtual reality interventions can be an effective re source to enhance the improvement of balance in individuals with chronic stroke Abstract Aim : In this single blind r and omized controlled trial , we examined the effect of a virtual reality-based training on gait of people with multiple sclerosis . Methods : Twenty-five individuals with multiple sclerosis with mild to moderate disability were r and omly assigned to either the control group ( n = 11 ) or the experimental group ( n = 14 ) . The subjects in the control group received treadmill training . Subjects in the experimental group received virtual reality based treadmill training .  Clinical measures and gait parameters were evaluated . Result : Subjects in both the groups significantly improved the walking endurance and speed , cadence and stride length , lower limb joint ranges of motion and powers , during single and dual task gait . Moreover , subjects in the experimental group also improved balance , as indicated by the results of the clinical motor tests ( p < 0.05 ) . Between-group comparisons revealed that the experimental group improved significantly more than control group in hip range of motion and hip generated power at terminal stance at post-training . Conclusion : Our results support the perceived benefits of training programs that incorporate virtual reality to improve gait measures in individuals with multiple sclerosis . Implication of rehabilitation Gait deficits are common in multiple sclerosis ( 85 % ) and worsen during dual task activities . Intensive and progressive treadmill training , with and without virtual reality , is effective on dual task gait in persons with multiple sclerosis . Virtual reality-based treadmill training requiring obstacle negotiation increases the range of motion and the power generated at the hip , consequently allowing longer stride length and , consequently , higher gait speed OBJECTIVE To evaluate the effects of gait training with virtual reality ( VR ) on walking distance and physical fitness in individuals with Parkinson 's Disease ( PD ) . METHODS Thirty-seven individuals with PD participated in this prospect i ve , r and omized , controlled clinical trial . They were r and omly allocated to a control group su bmi tted to conventional training ( n = 12 ) , a treadmill group su bmi tted to gait training on a treadmill ( n = 13 ) and a VR group su bmi tted to gait training using the XboxTM ( n = 12 ) . Clinical measures , gait variables and the Six-Minute Walk Test ( 6MWT ) were evaluated : pre-intervention , after one intervention session , post-intervention and follow up ( 30 days after intervention ) . RESULTS The VR and treadmill groups travelled longer distances on the 6MWT and had faster gait speed in comparison to the control group . The VR and treadmill groups demonstrated an increase in pre-6MWT HR . The VR group had more intense HR after the first session and throughout training , but these gains were not maintained at the follow-up . CONCLUSION The present findings demonstrate that gait training with a VR program is as effective as treadmill training with regard to gains in walking distance and improvements in temporal gait variables in individuals with PD Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy ( CP ) .  Virtual reality-based rehabilitation therapy is effective in motivating children with CP . This study investigated the effects of treadmill training with virtual reality on gait , balance , muscular strength , and gross motor function in children with CP . Eighteen children with spastic CP were r and omly divided into the virtual reality treadmill training ( VRTT ) group ( 9 subjects , mean age , 10.2 years ) and treadmill training ( TT ) group ( 9 subjects , mean age , 9.4 years ) . The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks . Muscle strength was assessed using a digitalized manual muscle tester . Gross motor function was assessed using the Gross Motor Functional Measure ( GMFM ) . Balance was assessed using the Pediatric Balance Scale ( PBS ) . Gait speed was assessed using the 10-meter walk test ( 10MWT ) , and gait endurance was assessed using the 2-minute walk test ( 2MWT ) . After training , gait and balance was improved in the VRTT compared to the TT group ( P < 0.05 ) . Muscular strength was significantly greater in the VRTT group than the TT group , except for right hamstring strength . The improvements in GMFM ( st and ing ) and PBS scores were greater in the VRTT group than the TT group ( P < 0.05 ) . Furthermore , the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group ( P < 0.05 ) . In conclusion , VRTT programs are effective for improving gait , balance , muscular strength , and gross motor function in children with CP This study is a single blind r and omized controlled trial to determine the effect of virtual reality-based postural control training on the gait ability in patients with chronic stroke . Sixteen subjects were r and omly assigned to either experimental group ( VR , n= 8) or control group ( CPT , n= 8) . Subjects in both groups received conventional physical therapy for 60 min per day , five days per week during a period of four weeks . Subjects in the VR group received additional augmented reality-based training for 30 min per day , three days per week during a period of four weeks . The subjects were evaluated one week before and after participating in a four week training and follow-up at one month post-training . Data derived from the gait analyses included spatiotemporal gait parameters , 10 meters walking test ( 10 mWT ) . In the gait parameters , subjects in the VR group showed significant improvement , except for cadence at post-training and follow-up within the experimental group . However , no obvious significant improvement was observed within the control group . In between group comparisons , the experimental group ( VR group ) showed significantly greater improvement only in stride length compared with the control group ( P < 0.05 ) , however , no significant difference was observed in other gait parameters . In conclusion , we demonstrate significant improvement in gait ability in chronic stroke patients who received virtual reality based postural control training . These findings suggest that virtual reality ( VR ) postural control training using real-time information may be a useful approach for enhancement of gait ability in patients with chronic stroke BACKGROUND / PURPOSE Virtual reality has the advantage to provide rich sensory feedbacks for training balance function . This study tested if the home-based virtual reality balance training is more effective than the conventional home balance training in improving balance , walking , and quality of life in patients with Parkinson 's disease ( PD ) . METHODS Twenty-three patients with idiopathic PD were recruited and underwent twelve 50-minute training sessions during the 6-week training period . The experimental group ( n = 11 ) was trained with a custom-made virtual reality balance training system , and the control group ( n = 12 ) was trained by a licensed physical therapist . Outcomes were measured at Week 0 ( pretest ) , Week 6 ( posttest ) , and Week 8 ( follow-up ) . The primary outcome was the Berg Balance Scale . The secondary outcomes included the Dynamic Gait Index , timed Up- and -Go test , Parkinson 's Disease Question naire , and the motor score of the Unified Parkinson 's Disease Rating Scale . RESULTS The experimental and control groups were comparable at pretest . After training , both groups performed better in the Berg Balance Scale , Dynamic Gait Index , timed Up- and -Go test , and Parkinson 's Disease Question naire at posttest and follow-up than at pretest . However , no significant differences were found between these two groups at posttest and follow-up . CONCLUSION This study did not find any difference between the effects of the home-based virtual reality balance training and conventional home balance training . The two training options were equally effective in improving balance , walking , and quality of life among community-dwelling patients with PD Immersive virtual reality ( IVR ) offers new possibilities to perform treatments in an ecological and interactive environment with multimodal online feedbacks . Sixteen school-aged children ( mean age 11 ± 2.4 years ) with Bilateral CP — diplegia , attending mainstream schools were recruited for a pilot study in a pre – post treatment experimental design . The intervention was focused on walking competences and endurance and performed by the Gait Real-time Analysis Interactive Lab ( GRAIL ) , an innovative treadmill platform based on IVR . The participants underwent eighteen therapy sessions in 4 weeks . Functional evaluations , instrumental measures including GAIT analysis and parental question naire were utilized to assess the treatment effects . Walking pattern ( stride length left and right side , respectively p = 0.001 and 0.003 ; walking speed p = 0.001 ) , endurance ( 6MWT , p = 0.026 ) , gross motor abilities ( GMFM-88 , p = 0.041 ) and most kinematic and kinetic parameters significantly improved after the intervention . The changes were mainly predicted by age and cognitive abilities . The effect could have been due to the possibility of IVR to foster integration of motor/perceptual competences beyond the training of the walking ability , giving a chance of improvement also to older and already treated children Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone OBJECTIVE The main objective of this investigation was to assess feasibility of conducting a future RCT with an intradialysis non-immersive virtual reality exercise intervention . The secondary aim was to explore the impact of either conventional or VR exercise on physical function . DESIGN Feasibility r and omized trial . PARTICIPANTS Eighteen subjects who participated in a 16-week intradialysis combined exercise program .  INTERVENTIONS The program lasted four additional weeks of either combined exercise or virtual reality exercise . MAIN OUTCOME MEASURES Physical function was measured through several reliable tests ( sit-to-st and -to-sit tests 10 and 60 , gait speed , one-leg heel-rise tests , and 6-minute walk test ) at baseline , after 16 weeks of intradialysis combined exercise and by the end of four additional weeks of exercise .  Adherence to the exercise programs was registered . RESULTS There was a significant time effect , so that physical function improved in both groups . By the end of the 20 weeks , function improved as measured through the sit-to-st and -to-sit tests 10 and 60 , gait speed , one-leg heel-rise left leg , and the 6-minute walk test . Changes that did not occur due to error in the test were seen after 20 weeks were achieved in the sit-to-st and -to-sit test 60 , gait speed , one-leg heel-rise test for the left leg , and 6-minute walking test . CONCLUSION Virtual reality was a feasible intervention . Both interventions improved physical function . Adherence was not significantly different between groups Abstract Purpose : Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages . In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation , a cognitive training program using virtual reality was applied to stroke patients . Methods : A virtual reality-based serious games application for cognitive training was developed , with attention and memory tasks consisting of daily life activities . Twenty stroke patients were r and omly assigned to two conditions : exposure to the intervention , and waiting list control . Results : The results showed significant improvements in attention and memory functions in the intervention group , but not in the controls . Conclusions : Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation . Implication s for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention . Training of daily-life activities using a virtual reality application .  Accessibility to training contents Background Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits . Indeed , everyday walking in complex environments utilizes executive function , dual tasking , planning and scanning , all while walking forward . Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction . The proposed r and omized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk . Methods / Design Three hundred older adults with a history of falls will be recruited to participate in this study . This will include older adults ( n=100 ) , patients with mild cognitive impairment ( n=100 ) , and patients with Parkinson ’s disease ( n=100 ) . These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits . Subjects will be r and omly assigned to the intervention group ( treadmill training with virtual reality ) or to the active-control group ( treadmill training without virtual reality ) . Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks . Assessment s will take place before , after , and 1 month and 6 months after the completion of the training . A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence ( i.e. , the number of falls , multiple falls and falls rate ) . In addition , we will measure gait under usual and dual task conditions , balance , community mobility , health related quality of life , user satisfaction and cognitive function . Discussion This r and omized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality  reduces fall risk , improves mobility and enhances cognitive function in a diverse group of older adults . In addition , the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit . Trial Registration BACKGROUND Gait and cognitive disturbances are common in Parkinson 's disease ( PD ) . These deficits exacerbate fall risk and difficulties with mobility , especially during complex or dual-task walking . Traditional gait training generally fails to fully address these complex gait activities . Virtual reality ( VR ) incorporates principles of motor learning while delivering engaging and challenging training in complex environments . We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD . METHODS Twenty patients received 18 sessions ( 3 per week ) of progressive intensive treadmill training with virtual obstacles ( TT + VR ) . Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles . Cognitive function and functional performance were also assessed . RESULTS Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years . Posttraining , gait speed significantly improved during usual walking , during dual task , and while negotiating overground obstacles . Dual-task gait variability decreased ( ie , improved ) and Trail Making Test times ( parts A and B ) improved . Gains in functional performance measures and retention effects , 1 month later , were also observed . CONCLUSIONS To our knowledge , this is the first time that TT + VR has been used for gait training in PD . The results indicate that TT + VR is viable in PD and may significantly improve physical performance , gait during complex challenging conditions , and even certain aspects of cognitive function . These findings have important implication s for underst and ing motor learning in the presence of PD and for treating fall risk in PD , aging , and others who share a heightened risk of falls BACKGROUND Falls are frequent in Parkinson 's disease and ageing . Impairments in the cholinergic-mediated attentional supervision of gait may contribute to increased fall risk , especially when obstacles challenge gait . Interventions combining motor-cognitive approaches have been shown to improve motor performance , cognitive skills and falls number . Here , we hypothesized that an intervention simulating an attention-dem and ing walking condition could impact not only complex gait performance and fall risk but also short-latency afferent inhibition ( SAI ) , as a marker of cholinergic activity . METHODS Thirty-nine participants at falls risk ( 24 Parkinson 's disease subjects and 15 older adults ) were recruited in a r and omized controlled trial . Participants were assigned to treadmill training or treadmill training with non-immersive virtual reality intervention and trained 3 times a week for 6 weeks . SAI , a transcranial magnetic stimulation paradigm , was used to assess cholinergic activity . Gait kinematics was measured during usual walking and while negotiating physical obstacles . Transcranial magnetic stimulation and gait assessment s were performed pre , post , and 6 months post intervention . RESULTS Treadmill training combined with non-immersive virtual reality induced an increase in inhibition of the SAI protocol on cortical excitability , improved obstacle negotiation performance and induced a reduction of the number of falls compared to treadmill training . Furthermore , the more SAI increased after training , the more the obstacle negotiation performance improved and fall rate decreased Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did . VR treadmill training also improved balance skill during sit-to-st and transfers and the involvement of paretic limb in level walking more than the traditional one did Background Virtual reality ( VR ) has recently been explored as a tool for neurorehabilitation to enable individuals with Parkinson ’s disease ( PD ) to practice challenging skills in a safe environment . Current technological advances have enabled the use of affordable , fully immersive head-mounted displays ( HMDs ) for potential therapeutic applications . However , while previous studies have used HMDs in individuals with PD , these were only used for short bouts of walking . Clinical applications of VR for gait training would likely involve an extended exposure to the virtual environment , which has the potential to cause individuals with PD to experience simulator-related adverse effects due to their age or pathology . Thus , our objective was to evaluate the safety of using an HMD for longer bouts of walking in fully immersive VR for older adults and individuals with PD . Methods Thirty-three participants ( 11 healthy young , 11 healthy older adults , and 11 individuals with PD ) were recruited for this study . Participants walked for 20 min while viewing a virtual city scene through an HMD ( Oculus Rift DK2 ) . Safety was evaluated using the mini-BESTest , measures of center of pressure ( CoP ) excursion , and question naires addressing symptoms of simulator sickness ( SSQ ) and measures of stress and arousal . Results Most participants successfully completed all trials without any discomfort . There were no significant changes for any of our groups in symptoms of simulator sickness or measures of static and dynamic balance after exposure to the virtual environment . Surprisingly , measures of stress decreased in all groups while the PD group also increased the level of arousal after exposure . Conclusions Older adults and individuals with PD were able to successfully use immersive VR during walking without adverse effects . This provides systematic evidence supporting the safety of immersive VR for gait training in these population Visual and auditory feedback cues have been shown to improve gait and balance in patients with movement disorders , such as Parkinson 's disease and multiple sclerosis . Subsequently , closed-loop virtual reality was used to enhance the gait improvement effect of such cues . Objectives : To study the effects of gait training with visual and auditory feedback cues on the walking abilities of patients with gait disorders due to cerebral palsy . Methods : Visual and auditory feedback cues were generated by a wearable accelerometry-driven device . Ten r and omly selected patients with gait disorders due to cerebral palsy trained with visual feedback cues while ten such patients trained with auditory feedback cues . Baseline performance ( walking speed and stride length along a 10 m straight track ) was measured before device use . Following 20min training with the device , performance without the device was measured again and compared to the baseline performance . Results : For patients training with visual feedback , the average improvement in walking speed was 21.70%+/−36.06 % and in stride length 8.72%±9.47 % . For patients training with auditory feedback , average improvement in walking speed was 25.43%±28.65 % and in stride length 13.58%±13.10 % . Conclusion : Visual and auditory feedback cues can improve gait parameters in patients with gait disorders due to cerebral palsy Introduction Ubiquity of Alzheimer 's disease ( AD ) coupled with relatively ineffectual pharmacologic treatments has spurred interest in nonpharmacologic lifestyle interventions for prevention or risk reduction . However , evidence of neuroplasticity notwithst and ing , there are few scientifically rigorous , ecologically relevant brain training studies focused on building cognitive reserve in middle age to protect against cognitive decline . This pilot study will examine the ability of virtual reality ( VR ) cognitive training to improve cognition and cerebral blood flow ( CBF ) in middle-aged individuals at high AD risk due to parental history . Methods The design is an assessor-blind , parallel group , r and omized controlled trial of VR cognitive-motor training in middle-aged adults with AD family history . The experimental group will be trained with adaptive “ real-world ” VR tasks targeting sustained and selective attention , working memory , covert rule deduction , and planning , while walking on a treadmill . One active control group will perform the VR tasks without treadmill walking ; another will walk on a treadmill while watching scientific documentaries ( nonspecific cognitive stimulation ) . A passive ( waitlist ) control group will not receive training . Training sessions will be 45 minutes , twice/week for 12 weeks . Primary outcomes are global cognition and CBF ( from arterial spin labeling [ ASL ] ) at baseline , immediately after training ( training gain ) , and 3 months post-training ( maintenance gain ) . We aim to recruit 125 participants , including 20 passive controls and 35 in the other groups . Discussion Current pharmacologic therapies are for symptomatic AD patients , whereas nonpharmacologic training is administrable before symptom onset . Emerging evidence suggests that cognitive training improves cognitive function . However , a more ecologically valid cognitive-motor VR setting that better mimics complex daily activities may augment transfer of trained skills . VR training has benefited clinical cohorts , but benefit in asymptomatic high-risk individuals is unknown . If effective , this trial may help define a prophylactic regimen for AD , adaptable for home-based application in high-risk individuals PURPOSE To investigate the effect of virtual reality proficiency-based training on actual cataract surgery performance . The secondary purpose of the study was to define which surgeons benefit from virtual reality training . DESIGN Multicenter masked clinical trial . PARTICIPANTS Eighteen cataract surgeons with different levels of experience . METHODS Cataract surgical training on a virtual reality simulator ( EyeSi ) until a proficiency-based test was passed . MAIN OUTCOME MEASURES Technical performance in the operating room ( OR ) assessed by 3 independent , masked raters using a previously vali date d task-specific assessment tool for cataract surgery ( Objective Structured Assessment of Cataract Surgical Skill ) . Three surgeries before and 3 surgeries after the virtual reality training were video-recorded , anonymized , and presented to the raters in r and om order . RESULTS Novices ( non-independently operating surgeons ) and surgeons having performed fewer than 75 independent cataract surgeries showed significant improvements in the OR-32 % and 38 % , respectively-after virtual reality training ( P = 0.008 and P = 0.018 ) . More experienced cataract surgeons did not benefit from simulator training . The reliability of the assessment s was high with a generalizability coefficient of 0.92 and 0.86 before and after the virtual reality training , respectively . CONCLUSIONS Clinical ly relevant cataract surgical skills can be improved by proficiency-based training on a virtual reality simulator . Novices as well as surgeons with an intermediate level of experience showed improvement in OR performance score Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 [ Purpose ] This study investigates whether cognition , balance and dual task performance in institutionalized older adults improves by a virtual reality dual task training . [ Subjects and Methods ] R and omized controlled trial ; Twenty institutionalized older adults with mild cognitive impairment ( 13 female , 7 male ; average age , 87.2 ± 5.96 years ) were r and omized to the intervention ( i.e. Virtual reality dual-task training using the BioRescue ) or control group ( no additional training ) . The intervention group took part in a 6-week training program while the elderly in the control group maintained their daily activities . Balance was measured with the Instrumented Timed Up- and -Go Test with and without a cognitive task . The Observed Emotion Rating Scale and Intrinsic Motivation Inventory were administered to evaluate the emotions and motivation regarding the exergaming program . [ Results ] The intervention group improved significantly on the total Timed Up- and -Go duration and the turn-to-sit duration during single-task walking in comparison to the control group who received no additional training . Participants found the virtual reality dual task training  pleasant and useful for their concentration , memory and balance . Pleasure and alertness were the two emotions which were mostly seen during the intervention . [ Conclusion ] The BioRescue is a pleasant and interesting treatment method , well suited for institutionalized older adults in need of lifelong physical therapy Objective The aim of this study was to investigate the effects of additional virtual reality training using Xbox Kinect on upper extremity function , including range of motion , motor function , and gross manual dexterity , in stroke survivors with hemiplegia . Design This study is a r and omized controlled trial . Forty participants were r and omly allocated to either the experimental or control groups ; the experimental group ( n = 20 ) underwent virtual reality training using Xbox Kinect and conventional occupational therapy , and the control group ( n = 20 ) underwent conventional occupational therapy alone . The mean time since the onset of stroke was 7.22 mos in the experimental group and 8.47 mos in the control group . At baseline and after 6 wks of intervention , range of motion of the upper extremity was measured , and the Fugl-Meyer Assessment and the Box and Block Test were performed . Results After intervention , significant improvements from baseline values in range of motion of the upper extremity , Fugl-Meyer Assessment scores , and Box and Block Test scores were observed in the experimental and control groups ( P < 0.05 ) . At follow-up , there were significant differences between the two groups in range of motion ( except for the wrist ) , Fugl-Meyer Assessment scores , and Box and Block Test scores ( P < 0.05 ) . Conclusions The hemiplegic stroke survivors who received additional virtual reality training using Xbox Kinect showed significantly improved function of the upper extremity . However , the effects of the virtual reality training using Xbox Kinect may have been a result of the greater total intervention time in the training group compared with the control group . Thus , the potential efficacy of Xbox Kinect in the rehabilitation of post-stroke survivors needs to be investigated in greater depth BACKGROUND Asymmetric movements with both h and s contributed to the improvement of spatially coupled motion . Thus , the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients . METHODS Twenty-four stroke patients were r and omly allocated to an experimental group ( n=12 ) or a control group ( n=12 ) . Both groups participated in conventional physical therapy for 2 × 30 min/d , 5 d/wk , for 4 weeks . The experimental group also participated in an asymmetric training program using virtual reality reflection equipment , and the control group participated in a symmetric training program . Both asymmetric and symmetric programs were conducted for 30 min/d , 5 d/wk , for 4 weeks . To compare upper limb function before and after intervention , the Fugl-Meyer Assessment ( FMA ) , the Box and Block Test ( BBT ) , grip strength , range of motion ( ROM ) , and spasticity were assessed . RESULTS Both groups showed significant increases in upper limb function , excepting spasticity , after intervention ( P<.05 , 1-way repeated- measures analysis of variance [ ANOVA ] ) . A significant group-time interaction was demonstrated only for shoulder/elbow/wrist items of FMA , BBT , grip strength , and ROM of wrist flexion , extension , and ulnar deviation ( P<.05 , 2-way repeated- measures ANOVA ) . CONCLUSIONS This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients . We consider that an additional study based on a program using virtual reflection , which is more functional than performing simple tasks , and consisting of tasks relevant to the activities of daily living be conducted
CONCLUSIONS : This review provided evidence that walking training associated with virtual reality-based training was effective in increasing walking speed after stroke , and result ed in better results than non-virtual reality interventions
OBJECTIVE : To systematic ally review the available evidence on the efficacy of walking training associated with virtual reality-based training in patients with stroke .
The specific questions were : Is walking training associated with virtual reality-based training effective in increasing walking speed after stroke ?
Is this type of intervention more effective in increasing walking speed , than non-virtual reality-based walking interventions ?