This study of subjects with multiple sclerosis or hemiparesis assessed the interrater and test-retest reliability of temporal-distance (TD) gait measures and examined the relationship of TD values to functional ambulation ability. Sixty-one subjects ambulated twice on a 9-m (30-ft) paper walkway and rested 15 minutes between trials. An ink footprint record and ambulation time were used to calculate velocity, cadence, step and stride lengths, stride length to lower extremity length ratio, and step- and stride-time differentials. Subjects were rated on a scale that assessed the amount of manual assistance required for ambulation. Interrater and test-retest reliability were high for all TD measures except stride-time differential for the total sample and within diagnostic categories. The TD values were highly reliable in all functional categories except one. All TD measures except stride- and step-time differential displayed a strong linear relationship to the functional ambulation category. Implications for using TD measures in clinical settings are discussed.

In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

This study compared the temporal-distance (TD) gait values of two groups of neurologically impaired subjects with published TD gait values of healthy subjects and analyzed the influence of nine clinical characteristics on TD values in the neurologically impaired subjects. Velocity, cadence, step length, stride length, and ratio of stride length to lower extremity length were recorded for 37 subjects with hemiparesis and 24 subjects with multiple sclerosis. Temporal-distance values were well below normal values, even in functionally independent subjects. Overall, the subjects with hemiparesis had lower values than the subjects with multiple sclerosis. Of the nine characteristics examined, only diagnosis, etiologic factor (for hemiparesis), type of ambulation aid, and functional category were related significantly to TD values. Our findings suggest that TD gait performance goals for patients with neurological impairment should be based on values from impaired rather than healthy subjects and that these goals should be adjusted for the individual patient's diagnosis, etiologic factor, type of ambulation aid, and functional category.