Virtual reality cues for improvement of gait in patients with multiple sclerosis

Baram, Yoram; Miller, David H.

doi:10.1212/01.wnl.0000194255.82542.6b

Cited by 116 publications

(63 citation statements)

References 20 publications

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“…Hemiparetic stoke patients who performed a task-orientated exercise program under conditions of vision and surface manipulations showed more improvement in their standing balance than a control group that performed a conventional task-oriented program [25]. Patients with balance control problems [26][27][28] and gait disturbances [29,30] have also demonstrated improvement following adaptive generalization training. We believe analogous improvements might be made in the reduction of gait ataxia in returning astronauts if they are trained to make rapid adjustments to novel physical and sensory stimuli such as that produced by variations in visual flow and support surface stability.…”

Section: Discussionmentioning

confidence: 99%

Strategies of healthy adults walking on a laterally oscillating treadmill

2009

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Abstract:We mounted a treadmill on top of a six degree-of-freedom motion base platform to investigate locomotor responses produced by healthy adults introduced to a dynamic walking surface. The experiment examined self-selected strategies employed by participants when exposed to continuous, sinusoidal lateral motion of the support surface while walking. Torso translation and step width were used to classify responses used to stabilize gait in a novel, dynamic environment. Two response categories emerged. Participants tended to either fix themselves in space (FIS), allowing the treadbelt to move laterally beneath them, or they fixed themselves to the base (FTB), moving laterally as the motion base oscillated. The degree of fixation in both extremes varied across participants. This finding suggests that normal adults have innate and varied preferences for reacquiring gait stability, some depending more heavily on vision (FIS group) and others on proprioception (FTB group).

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Section: Discussionmentioning

confidence: 99%

Strategies of healthy adults walking on a laterally oscillating treadmill

2009

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“…We sought to examine the effect of a wearable, closed-loop, visual-auditory cueing system on parkinsonian gait in the "off" state, when the magnitude of gait impairment is expected to be largest. Preliminary clinical studies [3,12] have demonstrated that the closed-loop feedback device significantly improves gait speed while in use and appears to induce a residual benefit for several days by dynamically delivering a tiled floor pattern adapted to the patient's own motion. It is believed that the optical flow provides a reassuring feedback effect, informing the patient of motion being performed and matching visual feedback from foot-tile matching to auditory feedback from clicking obtained for each step.…”

Section: Introductionmentioning

confidence: 99%

At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease

Espay¹,

Baram²,

Dwivedi³

et al. 2010

JRRD

135

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Abstract-Shuffling and freezing while walking can impair function in patients with Parkinson disease (PD). Open-loop devices that provide fixed-velocity visual or auditory cues can improve gait but may be unreliable or exacerbate freezing of gait in some patients. We examined the efficacy of a closedloop, accelerometer-driven, wearable, visual-auditory cueing device in 13 patients with PD with off-state gait impairment at baseline and after 2 weeks of twice daily (30 minute duration) at-home use. We measured gait velocity, stride length, and cadence using a validated electronic gait-analysis system. Subjects underwent standard motor assessment and completed a self-administered Freezing of Gait Questionnaire (FOGQ) (range 0-24; lower is better). After training, device use enhanced walking velocity (61.6 ± 20.1 cm/s to 72.6 ± 26.5 cm/s, p = 0.006) and stride length (74.3 ± 16.4 cm to 84.0 ± 18.5 cm, p = 0.004). Upon device removal, walking velocity (64.5 ± 21.4 cm/s to 75.4 ± 21.5 cm/s, p < 0.001) and stride length (79.0 ± 20.3 cm to 88.8 ± 17.7 cm, p = 0.003) exhibited a greater magnitude of change, suggesting immediate residual benefits. Also upon device removal, nearly 70 percent of subjects improved by at least 20 percent in either walking velocity, stride length, or both. An overall improvement in gait was measured by the FOGQ (14.2 ±1.9 to 12.4 ± 2.5, p = 0.02). Although issues related to compliance and response variability render a definitive interpretation of study outcome difficult, devices using closed-loop sensory feedback appear to be effective and desirable nonpharmacologic interventions to improve walking in selected individuals with PD.

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“…Although complete loss of sensation is rare, up to 80% of patients present with some sensory impairments, [1][2][3] and this is often the first sign of MS. Sensory loss can be a significant cause of disability, 4,5 and several studies have found that somatosensory impairments have a significant effect on gait 6,7 and balance 8,9 and lead to decreased mobility, independence, and quality of life 9,10 in people with MS.…”

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confidence: 99%

Interrater Reliability of Four Sensory Measures in People with Multiple Sclerosis

Uszynski¹,

Purtill²,

Coote³

2016

International Journal of MS Care

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Background: Sensory disturbances are a major problem for people with multiple sclerosis (MS), and up to 80% of people with MS present with various sensory deficits. To date, only one study has investigated the reliability of sensory measures in people with MS. We sought to determine the interrater reliability of the verbal analogue scale (VAS), the Erasmus MC modifications to the revised Nottingham Sensory Assessment (EmNSA), Semmes-Weinstein monofilaments (SWMs), and the neurothesiometer (NT) in people with MS.

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Virtual reality cues for improvement of gait in patients with multiple sclerosis

Abstract: Patients with multiple sclerosis showed improvement in walking abilities using virtual reality visual-feedback cues.

Cited by 116 publications

References 20 publications

Strategies of healthy adults walking on a laterally oscillating treadmill

Strategies of healthy adults walking on a laterally oscillating treadmill

At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease

Interrater Reliability of Four Sensory Measures in People with Multiple Sclerosis

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