Clinical Experience Using a 5-Week Treadmill Training Program With Virtual Reality to Enhance Gait in an Ambulatory Physical Therapy Service

Current literature sees safe gait as a complex task, dependent on motor and cognitive resources. The use of virtual reality (VR) in gait training offers a multi-factorial approach, exhibiting positive effects on mobility, balance, and fall risk in elderly and individuals with neurological disorders. This form of training has been described as a viable research tool, however, it has not been applied routinely in clinical practice. Recently, the authors took this method forward to provide an adjunct training method provided by physical therapists in an ambulatory clinical setting. The objective of this paper is to describe initial clinical experience applying a 5-week VR clinical service to improve gait and mobility in subjects with a history of falls, poor mobility or postural instability. The clinical records of the first 60 patients who completed the VR gait training program were examined. Training was provided 3 times per week for 5 weeks, each session lasting approximately 1-hour and consisting of walking on a treadmill while negotiating virtual obstacles. Main outcome measures were compared across time and included the Timed Up &Go (TUG), 2 minute walk test (2MWT) and the Four Square Step Test (FSST). After 5 weeks of training, time to complete the TUG decreased by 10.3% (p<0.001), the distance walked during the 2MWT increased by 9.5% (p<0.001), and performance on the FSST improved by 13% (p=0.041).

Treadmill training with VR seem to be an effective and practical tool that can be applied in an outpatient physical therapy clinic. It appears that this training leads to improvements in gait, mobility and postural control. It may, perhaps, also augment cognitive and functional aspects.