[WHITE PAPER] Virtual and augmented reality based balance and gait training – Full Text PDF

The use of virtual and augmented reality for rehabilitation has become increasingly popular and has received much attention in scientific publications (over 1,000 papers). This white paper aims to summarize the scientific background and efficacy of using virtual and augmented reality for balance and gait training. For many patients with movement disorders, balance and gait training is an important aspect of their rehabilitation process and physical therapy treatment. Indications for such training include, among others, stroke, Parkinson’s disease, multiple sclerosis, cerebral palsy, vestibular disorders, neuromuscular diseases, low back pain, and various orthopedic complaints, such as total hip or knee replacement. Current clinical practice for balance training include exercises, such as standing on one leg, wobble board exercises and standing with eyes closed. Gait is often trained with a treadmill or using an obstacle course. Cognitive elements can be added by asking the patient to simultaneously perform a cognitive task, such as counting down by sevens. Although conventional physical therapy has proven to be effective in improving balance and gait,1,2 there are certain limitations that may compromise treatment effects. Motor learning research has revealed some important concepts to optimize rehabilitation: an external focus of attention, implicit learning, variable practice, training intensity, task specificity, and feedback on performance.3 Complying with these motor learning principles using conventional methods is quite challenging. For example, there are only a limited number of exercises, making it difficult to tailor training intensity and provide sufficient variation. Moreover, performance measures are not available and thus the patient usually receives little or no feedback. Also, increasing task specificity by simulating everyday tasks, such as walking on a crowded street, can be difficult and time consuming. Virtual and augmented reality could provide the tools needed to overcome these challenges in conventional therapy. The difference between virtual and augmented reality is that virtual reality offers a virtual world that is separate from the real world, while augmented reality offers virtual elements as an overlay to the real world (for example virtual stepping stones projected on the floor). In the first part of this paper we will explain the different motor learning principles, and how virtual and augmented reality based exercise could help to incorporate these principles into clinical practice. In the second part we will summarize the scientific evidence regarding the efficacy of virtual reality based balance and gait training for clinical rehabilitation.

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