The objective of this study was to examine the effect of various forms of training interventions, with and without virtual reality, on the initiation and maintenance of active participation during robot-assisted gait training. Ten patients (5 males, mean age 12.47 years, standard deviation 1.84 years) with different neurological gait disorders and 14 healthy children (7 males, mean age 11.76 years, standard deviation 2.75 years) participated. All participants walked in the driven gait orthosis Lokomat® in 4 different randomly-assigned conditions. Biofeedback values calculated during swing phases were the primary outcome measure and secondary outcomes were derived from a questionnaire assessing the participant’s motivation. Results: Findings revealed a significant main effect for training condition in all participants (p < 0.001), for patients (p < 0.05) and for healthy controls (p < 0.01). Overall, both virtual reality-assisted therapy approaches were equally the most effective in initiating the desired active participation in all children, compared with conventional training conditions. Motivation was very high and differed between the groups only in the virtual navigation condition.
Novel virtual reality-based training conditions represent a valuable approach to enhance active participation during robot-assisted gait training in patients and healthy controls.