Effect of virtual reality in hereditary spastic paraplegia: pilot randomized clinical trial

Hereditary Spastic Paraplegia (HSP) is a neurodegenerative condition characterized by weakness and spasticity in the lower limbs, requiring stabilization to improve essential movements such as walking. This study aims to investigate the benefits of Vestibular Rehabilitation (VR) with virtual reality (VRi) in individuals with HSP. A randomized pilot clinical trial was conducted, registered on the Rebec Platform (trial RBR-3JMX67), with 16 adult patients of both sexes diagnosed with HSP, allocated into two groups: Balance (BG) and Strength (SG). Participants underwent anamnesis, otorhinolaryngological and labyrinthine evaluation, followed by assessment with Lafayete dynamometer and ABC (confidence scale) and VAS (pain assessment) questionnaires at three time points: T0 (baseline), T1 (after 10 sessions), and T2 (after 20 sessions). VAS results showed no significant changes between T0 and T2, indicating no discomfort caused by rehabilitation. In the ABC questionnaire, both groups showed improvement in balance perception. Dynamometer assessment revealed a significant increase in peak force (p = 0.006) and mean force in hip abduction (p = 0.001). For the force development rate (FDR), there was a trend towards significance in BG. In dorsiflexion, both groups showed significant improvements in FDR, especially in BG (p = 0.011) and SG (p = 0.004). VRi game scores were significant for both groups, validating the effectiveness of rehabilitation. These findings confirm the benefits of vestibular rehabilitation with virtual reality in individuals with HSP, highlighting the need for further research to consolidate these results and fully explore the potential of this therapeutic approach.