Effects of semi-immersive virtual reality and manipulation of optic flow speed on gait biomechanics in people post-stroke

Authors

  • Emma De Keersmaecker Rehabilitation Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Brussels, Belgium; Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Ghent, Belgium
  • Anke Van Bladel Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Ghent, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
  • Silvia Zaccardi Rehabilitation Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Brussels, Belgium; Department of Electronics and Informatics, Engineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
  • Nina Lefeber Rehabilitation Research Group, Vrije Universiteit Brussel, Brussels, Belgium
  • Carlos Rodriguez-Guerrero Department of Mechanical Engineering, KU Leuven, Heverlee Leuven, Belgium
  • Eric Kerckhofs Rehabilitation Research Group, Vrije Universiteit Brussel, Brussels, Belgium
  • Bart Jansen Brussels Human Robotic Research Center (BruBotics), Brussels, Belgium; Department of Electronics and Informatics, Engineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium; Imec, Leuven, Belgium
  • Eva Swinnen Rehabilitation Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Brussels, Belgium; Brussels Human Robotic Research Center (BruBotics), Brussels, Belgium; Alliance research group REBI (Rehabilitation technology for people with a brain injury), Vrije Universiteit Brussel & Ghent University, Brussels, Ghent, Belgium

DOI:

https://doi.org/10.2340/jrm.v56.12384

Keywords:

virtual reality, stroke, gait biomechanics, optic flow

Abstract

Objectives: To investigate how people post-stroke and healthy people experience the addition of semi-immersive virtual reality (VR) and optic flow speed manipulation while walking on a treadmill, and if optic flow speed manipulation could be used in rehabilitation to elicit changes in post-stroke gait biomechanics.

Methods: Sixteen people post-stroke and 16 healthy controls walked on a self-paced treadmill. After 2 habituation trials (without and with VR), participants walked 3 more trials under the following conditions of optic flow: matched, slow, and fast. Primary outcome measures were spatiotemporal gait parameters and lower limb kinematics. Secondary outcomes (simulator sickness and enjoyment) were assessed with the Simulator Sickness Questionnaire (SSQ) and visual analogue scales (VAS).

Results: VR did not influence the gait biomechanics, and optic flow manipulation had a limited effect. Both groups significantly increased their walking speed with the slow optic flow and decreased their speed with the fast optic flow. For the other gait parameters, only small changes were found. Only people post-stroke had a significant increase on the SSQ and the enjoyment-VAS.

Conclusion: Adding semi-immersive VR did not influence the gait pattern, was well tolerated, and enjoyable. Both groups altered their gait parameters when the optic flow speed was adjusted during the protocol. Incorporating such manipulations into treadmill training is feasible, but further research about the type of manipulation and level of immersion is needed.

Downloads

Download data is not yet available.

References

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics - 2017 update: a report from the American Heart Association. Circulation 2017; 135: e146-e603.

https://doi.org/10.1161/CIR.0000000000000491

Dobkin BH. Clinical practice. Rehabilitation after stroke. N Engl J Med 2005; 352: 1677-1684.

https://doi.org/10.1056/NEJMcp043511

Beyaert C, Vasa R, Frykberg GE. Gait post-stroke: pathophysiology and rehabilitation strategies. Neurophysiol Clin 2015; 45: 335-355.

https://doi.org/10.1016/j.neucli.2015.09.005

Kang HK, Kim Y, Chung Y, Hwang S. Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials. Clin Rehabil 2012; 26: 246-255.

https://doi.org/10.1177/0269215511419383

Keshner EA, Lamontagne A. The untapped potential of virtual reality in rehabilitation of balance and gait in neurological disorders. Front Virtual Real 2021;2: 641650.

https://doi.org/10.3389/frvir.2021.641650

Prokop T, Schubert M, Berger W. Visual influence on human locomotion - modulation to changes in optic flow. Exp Brain Res 1997; 114: 63-70.

https://doi.org/10.1007/PL00005624

Adamovich SV, Fluet GG, Tunik E, Merians AS. Sensorimotor training in virtual reality: a review. Neurorehabil 2009; 25: 29-44.

https://doi.org/10.3233/NRE-2009-0497

Lamontagne A, Fung J, McFadyen BJ, Faubert J. Modulation of walking speed by changing optic flow in persons with stroke. J Neuroeng Rehabil 2007; 4: 22.

https://doi.org/10.1186/1743-0003-4-22

Katsavelis D, Mukherjee M, Decker L, Stergiou N. The effect of virtual reality on gait variability. Nonlinear Dynamics Psychol Life Sci 2010; 143: 239-256.

Mohler BJ, Thompson WB, Creem-Regehr SH, Pick HL Jr, Warren WH Jr. Visual flow influences gait transition speed and preferred walking speed. Exp Brain Res 2007; 181: 221-228.

https://doi.org/10.1007/s00221-007-0917-0

O'Connor SM, Donelan JM. Fast visual prediction and slow optimization of preferred walking speed. J Neurophysiol 2012; 107: 2549-2559.

https://doi.org/10.1152/jn.00866.2011

Powell WA, Hand S, Stevens B, Simmonds M. Optic flow in a virtual environment: Sustained influence on speed of locomotion. Cyberpsychol Behavior 2006; 9: 710.

https://doi.org/10.1037/e695432011-117

Salinas MM, Wilken JM, Dingwell JB. How humans use visual optic flow to regulate stepping during walking. Gait Posture 2017; 57: 15-20.

https://doi.org/10.1016/j.gaitpost.2017.05.002

Konczak J. Effects of optic flow on the kinematics of human gait - a comparison of young and older adults. J Mot Behav 1994; 26: 225-236.

https://doi.org/10.1080/00222895.1994.9941678

Chou YH, Wagenaar RC, Saltzman E, Giphart JE, Young D, Davidsdottir R, et al. Effects of optic flow speed and lateral flow asymmetry on locomotion in younger and older adults: a virtual reality study. J Gerontol B Psychol Sci Soc Sci 2009; 64: 222-231.

https://doi.org/10.1093/geronb/gbp003

Osaba MY, Martelli D, Prado A, Agrawal SK, Lalwani AK. Age-related differences in gait adaptations during overground walking with and without visual perturbations using a virtual reality headset. Sci Rep 2020; 10: 15376.

https://doi.org/10.1038/s41598-020-72408-6

Schubert M, Prokop T, Brocke F, Berger W. Visual kinesthesia and locomotion in Parkinson's disease. Mov Disord 2005; 20: 141-150.

https://doi.org/10.1002/mds.20281

Lim H. Effect of the modulation of optic flow speed on gait parameters in children with hemiplegic cerebral palsy. J Phys Ther Sci 2014; 26: 145-148.

https://doi.org/10.1589/jpts.26.145

Kang HK, Kim Y, Chung Y, Hwang S. Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials. Clin Rehabil 2012; 26: 246-255.

https://doi.org/10.1177/0269215511419383

Caldas OI, Sanchez N, Mauledoux M, Avilés OF, Rodriguez-Guerrero C. Leading presence-based strategies to manipulate user experience in virtual reality environments. Virtual Reality 2022; 26: 1507-1518.

https://doi.org/10.1007/s10055-022-00645-3

Vinas-Diz S, Sobrido-Prieto M. Virtual reality for therapeutic purposes in stroke: a systematic review. Neurologia 2016; 31: 255-277.

https://doi.org/10.1016/j.nrleng.2015.06.007

Rose T, Nam CS, Chen KB. Immersion of virtual reality for rehabilitation - review. Appl Ergon 2018; 69: 153-161.

https://doi.org/10.1016/j.apergo.2018.01.009

Tieri G, Morone G, Paolucci S, Iosa M. Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies. Expert Rev Med Devices 2018; 15: 107-117.

https://doi.org/10.1080/17434440.2018.1425613

De Keersmaecker E, Van Bladel A, Zaccardi S, Lefeber N, Rodriguez-Guerrero C, Kerckhofs E, et al. Virtual reality-enhanced walking in people post-stroke: effect of optic flow speed and level of immersion on the gait biomechanics. J Neuroeng Rehabil 2023; 20: 124.

https://doi.org/10.1186/s12984-023-01254-0

Meyer C, Killeen T, Easthope CS, Curt A, Bolliger M, Linnebank M, et al. Familiarization with treadmill walking: how much is enough? Sci Rep 2019; 9: 5232.

https://doi.org/10.1038/s41598-019-41721-0

Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG. Simulator sickness questionnaire: an enhanced method of quantifying simulator sickness. Int J Aviat Psychol 1993; 3: 203-220.

https://doi.org/10.1207/s15327108ijap0303_3

Sloot LH, van der Krogt MM, Harlaar J. Effects of adding a virtual reality environment to different modes of treadmill walking. Gait Posture 2014; 39: 939-945.

https://doi.org/10.1016/j.gaitpost.2013.12.005

Hollman JH, Brey RH, Robb RA, Bang TJ, Kaufman KR. Spatiotemporal gait deviations in a virtual reality environment. Gait Posture 2006; 23: 441-444.

https://doi.org/10.1016/j.gaitpost.2005.05.005

Bohannon RW, Glenney SS. Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract 2014; 20: 295-300.

https://doi.org/10.1111/jep.12158

Uesaki M, Ashida H. Optic-flow selective cortical sensory regions associated with self-reported states of vection. Front Psychol 2015; 6: 775.

https://doi.org/10.3389/fpsyg.2015.00775

Downloads

Additional Files

Published

2024-01-10

How to Cite

De Keersmaecker, E., Van Bladel, A., Zaccardi, S., Lefeber, N., Rodriguez-Guerrero, C., Kerckhofs, E., Jansen, B., & Swinnen, E. (2024). Effects of semi-immersive virtual reality and manipulation of optic flow speed on gait biomechanics in people post-stroke. Journal of Rehabilitation Medicine, 56, jrm12384. https://doi.org/10.2340/jrm.v56.12384

Issue

Vol. 56 (2024)

Section

Original Report

Categories

License

Copyright (c) 2024 Emma De Keersmaecker, Anke Van Bladel, Silvia Zaccardi, Nina Lefeber, Carlos Rodriguez-Guerrero, Eric Kerckhofs, Bart Jansen, Eva Swinnen

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.

Crossref
Scopus
Google Scholar
Europe PMC

Funding data

  • Fonds Wetenschappelijk Onderzoek
    Grant numbers Emma De Keersmaecker is a Strategic Basic Research fellow funded by the Research Foundation – Flanders (FWO) (1S58419N)