Effect of home-based virtual reality-augmented exercise therapy

Villiger, Michael and Liviero, Jasmin and Stoop, Rahel and Awai, Lea and Curt, Armin and Pyk, Pawel and Hohenauer, Erich and Clijsen, Ron and Eng, Kynan and Bolliger, Marc (2016) Effect of home-based virtual reality-augmented exercise therapy. In: 21st annual Congress of the European College of Sport Science, Vienna, Austria, 06.07.2016-09.07.2016.

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Introduction After injury of the adult brain or spinal cord, functional recovery is reduced as severed axons are restricted in their capacity to spontaneously regenerate, and compensatory fibre growth is limited. Key factors influencing successful rehabilitation and functional recovery include variety in training, intensive movement repetition and a motivating training environment. Technologies which can provide all of these features, independent of the patient’s location, may thus provide significant benefits for rehabilitation. We hypothesize that home-based and unsupervised virtual reality (VR)-augmented neurorehabilitation training should be feasible with incomplete spinal cord injury (iSCI) patients and improve motor functions (e.g. mobility - transfer ability, strength, balance). Methods For our study we use a prototype of a mobile lower limb VR training system (YouKicker®) combining action observation and execution using motivating training scenarios. Patients using YouKicker control virtual representations of their legs and feet designed to facilitate observation of goal-directed actions presumed to activate overlapping cortical networks. Clinically relevant movements are trained in different scenarios, as specified in design discussions with therapists. We have previously tested a stationary version of the system on iSCI patients and found significant improvements in lower limb function (Villiger et al., 2013, 2015). Ten subjects with iSCI completed a home-based training with a VR device during four weeks. Before and after training, mobility (clinical outcomes) and gait quality (kinematic outcomes) were assessed. Results Results revealed that subjects with iSCI performed significantly better in (a) functional mobility combined with balance and lower limb muscle strength and in (b) gait quality, i.e. gait parameters, foot dorsiflexion and intralimb coordination. Discussion Following iSCI training with a home-based VR training device without supervision can induce positive training effects, comparable to the stationary training device (Villiger et al., 2013, 2015), and might be used as a neurorehabilitation tool. References - Villiger M, Bohli D, Kiper D, Pyk P, Spillmann J, Meilick B, Curt A, Hepp-Reymond MC, Hotz-Boendermaker S and Eng K. (2013). Virtual reality-augmented neurorehabilitation improves motor function and reduces neuropathic pain in patients with incomplete spinal cord injury. Neurorehabil Neural Repair, 27, 675-83. - Villiger M, Grabher P, Hepp-Reymond MC, Kiper D, Curt A, Bolliger M, Hotz-Boendermaker S, Kollias S, Eng K and Freund P. (2015). Relationship between structural brainstem and brain plasticity and lower-limb training in spinal cord injury: a longitudinal pilot study. Front Hum Neurosci, 9:254.

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