Role of Virtual Reality in Improving Balance in Patients With Myelopathy
Condition: Myelopathy; Virtual Reality
MeSH terms: Spinal Cord Diseases; Bone Marrow Diseases
Study type: Interventional

Summary: 
      Balance of the body is achieved by the coordination of three major systems, visual,
      vestibular and proprioceptive sensation and by the reflexive control of the limbs. In
      myelopathy, factors like balance and posture, range of motion, muscle strength, coordinated
      motor control, muscle tone and proprioception are affected. Balance and gait rehabilitation
      is an important goal in myelopathy. Virtual reality (VR) is a computer based technology that
      is used for task oriented biofeedback therapy in rehabilitation. This study was envisioned to
      observe the utility of VR in rehabilitation for improving balance in patients of myelopathy.
    

Detailed description: 
      Balance of the body is achieved by the coordination of three major systems, visual,
      vestibular and proprioceptive sensation and by the reflexive control of the limbs. Static
      balance which determines the ability to maintain postural stability during sitting or
      standing is important to perform daily functional activities. Dynamic balance on the other
      hand is the ability to respond and adjust to a moving floor or any external stimuli or
      perturbation and is a requirement for successful gait performance.

      In myelopathy, factors like balance and posture, range of motion, muscle strength,
      coordinated motor control, muscle tone and proprioception are affected. Lack of normal
      postural synergy and sensory motor integration of lower limbs and trunks and spatial
      information that regulate upright position and sitting balance leads to balance dysfunction
      in the population. Hence patient develops compensatory strategies. But ambulation involves
      the intricate coordination of leg movements, regulating upright posture and balance and
      adaptation to environmental changes. Hence balance and gait rehabilitation is an important
      goal in myelopathy.

      Virtual reality (VR) is a computer based technology that is used for task oriented
      biofeedback therapy in rehabilitation. It constructs a virtual environment resembling a
      situation in the real world and provides multimodal sensory cues. VR ranges from non
      immersive to semi immersive to fully immersive, depending on the degree to which the user is
      isolated from the physical surroundings when interacting with the virtual environment.

      In virtual reality training, participants perform functional stretching of their extremities,
      learn postural control of the trunk and practice weight shifting. As the level of difficulty
      and speed are increased for various tasks, the movement of the body's center of gravity
      beyond the base of support increases thus increasing the proprioceptive sensations to the
      joints and improves the subject's ability to adjust balance. Hence it encourages dynamic
      motions and functional mobility. The VR environment can be controlled and manipulated in
      advance to fine tune the exercises and meet individual needs. It is interactive as well as
      enjoyable.

      Studies indicate that spinal reflex circuitry exhibits activity dependent plasticity (the
      capacity of the nervous system to modify its organization). Intensive task specific training
      is one of the most effective ways to promote neuroplasticity and develop more normalized
      movement patterns. VR uses this principle of neuroplasticity to promote motor relearning.
      Literature supports the use of VR as an effective rehabilitative tool in individuals with
      stroke, spinal cord injury, cerebral palsy, multiple sclerosis and other neurological
      disorders.

      There are few studies on balance rehabilitation in myelopathy from this part of the world.
      Due to absence of any guidelines, identifying the most suitable type of VR system, defining
      the most appropriate treatment dosing, timing and intensity of training for the therapeutic
      application is a challenge. This study was envisioned to observe the utility of VR in
      rehabilitation for improving balance in patients of myelopathy.
    

Intervention name(s): Virtual Reality
Intervention type(s): Other
Intervention description(s): As described in Experimental arm description.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective Cohort study involving cases with use of intervention. Matched control cohort subjects were selected using pre-specified matching criteria (for matching with interventional cohort) as comparison group.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Myelopathy; Virtual Reality; Rehabilitation; Balance