Virtual Reality for Hemiplegic Patients in Transforming Gait Recovery: An Experimental Study

Introduction: Stroke-induced gait disability is the most common neurological condition that leads to long-term disability. Therefore, it is essential to address the factors contributing to this disability factors to improve overall quality of life of stroke survivors. Despite extensive literature, hemiplegic gait rehabilitation remains a significant challenge for practicing physiotherapists. A comprehensive treatment plan customised for various deviations in temporal and spatial variables is crucial. Aim: To examine the add-on effect of Virtual Reality Training (VRT) combined with weight-bearing exercises on spatial parameters of gait, such as step width and step length, and temporal variables, including Center of Gravity (COG) sway velocity, reaction time, movement velocity and Limits of Stability (LOS). Materials and Methods: This experimental study was conducted at Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, Maharashtra, India. A six-week, pre-post experimental study was carried out on 30 ambulatory hemiplegic patients aged 25 to 60 years, with an episodes of a stroke at least 12 weeks, with spasticity of Modified Ashworth Scale (MAS) <2, Postural Assessment Scale for Stroke (PASS) score less than 30, and normal cognition were included in the study. Patients with any contractures, peripheral artery diseases, history of cardiac failures or epilepsy, or any neurological surgeries were excluded. The study duration was from June 2024 to August 2024. Spatial and temporal variables of gait assessed by the Neurocom Balance Master, were primary outcome measures. Statistical analysis was done using IBM Statistical Package for the Social Sciences (SPSS) software version 27.0, with paired and unpaired t-tests used to test the statistically significant difference. Results: After a six-week intervention, a reduction in movement velocity during a heel strike from 1.2°/sec to 0.9°/second (p-value=0.02) was found, suggesting improved reciprocal control of agonist-antagonist muscle coordination. Other parameters for COG sway velocity, step width, and step length improved from 0.15 sec to 0.8 sec (p-value=0.04), from 25.8 cm to 15.2 cm (p-value=0.04), and from 29.7 cm to 32.5 cm (p-value=0.03), respectively. Measures of LOS in anteroposterior sway were reduced from 5° /second to 3.3° /second (p-value=0.02). Conclusion: The findings suggest that VRT combined with weight-bearing exercises can effectively adjunct traditional rehabilitation methods, aiding spatial and temporal variable gait issues in hemiplegic patients. Authors recommend adding VRT combined with weight-bearing exercises to manage post-stroke circumduction gait problems first-line.