The effects of virtual reality augmented robot-assisted gait training on dual-task performance and functional measures in chronic stroke: a randomized controlled single-blind trial

Abstract

BACKGROUND: Many studies have demonstrated positive effects of virtual reality (VR) and robot-assisted gait training (RAGT) on balance, gait skills, functional capacity, active participation, and motivation in stroke patients, previously. However the effects of VR augmented RAGT on dual-task performance which requires simultaneous use of motor and cognitive parameters has not been investigated. AIM: To primarily investigate the effects of virtual reality (VR) augmented robot-assisted gait training (RAGT) on dual-task performance and secondarily, functional measurements in chronic stroke patients. DESIGN: A randomized, single-blind trial. SETTING: Inpatient rehabilitation center. POPULATION: The study included 30 chronic stroke patients aged between 40-65 with the level of ≥ 3 from Functional Ambulation Classification and ≥ 24 from the Standardized Mini Mental State Examination. METHODS: Fifteen patients in the study group received VR augmented RAGT and 15 patients in the control group received only RAGT during 12 sessions (six weeks). All patients received neurodevelopmental therapy in addition to their treatments, simultaneously. To evaluate dualtask performance, motor and cognitive tasks were given in addition to the 10 Meter Walk (first motor task), and durations were recorded in seconds. Functional measures such as Functional Gait Assessment, Rivermead Mobility Index, Berg Balance Scale, Fall Activity Scale International, and the Functional Independence Measure for gait, mobility, balance, fear of falling, and independence in daily living activities were also applied, consecutively. RESULTS: The mean age of the study population was 57.93±5.91. After the treatment, single and dual-task gait speeds and cognitive dual-task performance increased in the study group (p <0.05), while no change was observed in the control group (p> 0.05). No significant difference was detected between the groups in terms of all assessments after the treatment (p>0.05). CONCLUSIONS: This study demonstrated that VR augmented RAGT improved dual-task gait speeds and dual-task performance of chronic stroke patients however there were no difference between the two groups after the treatment. Although functional improvements were determined with VR combined RAGT approach, it was not superior to RAGT only treatment. CLINICAL REHABILITATION IMPACT: The results of current study suggest the simultaneous use of VR as an adjunct therapy method to the functional training to obtain functional gains in ambulant patients with chronic stroke.