Immersive Virtual Reality May Improve Treadmill Gait Training

Immersive virtual reality may make treadmill exercise more engaging and effective for people with multiple sclerosis (MS) or other conditions that can make walking difficult, according to new research.

The findings were published in the Journal of NeuroEngineering and Rehabilitation, in the study “Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke.”

MS and other neurological impairments, such as stroke, can cause gait disorders or walking difficulty. Physical therapy and exercise therapy are part of standard care for gait disorders, and this often involves time spent on a treadmill.

Exercising on a treadmill, especially doing so regularly over a long period of time, can be repetitious and boring, with patients often feeling unmotivated and unlikely to continue long term. As such, researchers are looking for ways to increase people’s motivation for this type of exercise.

One potential strategy is using virtual reality, or VR, with the general goal of making treadmill exercise more fun and engaging. Prior research has indicated that VR may be a useful addition to treadmill exercise in several contexts.

In general, this kind of research has used one of two types of VR: in some studies, participants have worn a head-mounted display (HMD), which goes over the face like a pair of goggles, providing a fully immersive experience. Other studies have used a less immersive approach and had participants walk in front of a projector or television screen a few feet away.

In the new study, researchers in Germany set out to compare these two VR approaches, in terms of their usefulness for gait disorder therapy.

“For the first time, the current study provides a direct comparison of immersive, semi-immersive VR-based gait rehabilitation and conventional gait rehabilitation with patients, which is essential to reveal the advantages and disadvantages of the respective methods,” the team wrote.

Building on previous research, the scientists designed two VR systems — one immersive using a HMD, the other less immersive using a television screen. Then, they had 36 students at their institution perform walking tests three times: once with each VR system, and once with no VR system.

With both forms of virtual reality, participants walked more quickly than they did without any VR. Walking speeds also were significantly faster with the HMD setup than with the less immersive form of virtual reality.

The researchers then performed a similar experiment with participants who had neurological disorders — MS (10 participants) or stroke (four participants). Similar to the results in students, walking speed was fastest with the HMD setup, and slowest without any virtual reality system.

The finding of increased walking speed with the more immersive setup “indicates that immersive VR might improve the therapeutic outcome in gait rehabilitation,” according to the researchers.

Various participant-reported outcomes generally also favored the more immersive form of VR. For example, participants in both groups generally reported feeling “more present” in the VR world when wearing the head device. Participants in both groups also generally said that they felt more motivated to do training with the immersive virtual reality setup.

Participants generally did not experience problems with using either virtual reality system, although nausea was generally more common with the head-mounted display.

“The side effects of the immersive VR presentation were low for the vast majority of study participants,” the researchers wrote.

Overall, 89% of the students and 71% of the patients reported liking treadmill training with the head-mounted device better than the other two setups.

This study “demonstrated the feasibility and patients’ acceptance of a treadmill training with immersive VR via an HMD,” the scientists concluded. “Due to its excellent usability and low side effects, the system could serve as a valid alternative to conventional treadmill training in gait rehabilitation.”

While the results are promising, the researchers stressed that this was a small study done at a single institution, so the results should be interpreted with appropriate caution. They also noted that implementing VR-based gait therapies in clinical setting will require a lot of additional thought and consideration, such as ensuring that equipment is appropriately disinfected and determining how to accommodate VR for people with visual impairments.