Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Virtual Reality Exercise Improves Mobility After Stroke: An Inpatient Randomized Controlled Trial Virtual reality training for stroke rehabilitation. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke Clinical usefulness of the virtual reality-based postural control training on the gait ability in patients with stroke A multimodal training modulates short-afferent inhibition and improves complex walking in a cohort of faller older adults with an increased prevalence of Parkinson's disease. The Effect of a Virtual Reality Game Intervention on Balance for Patients with Stroke: A Randomized Controlled Trial. Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES) Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients Virtual Walking Training Program Using a Real-world Video Recording for Patients with Chronic Stroke: A Pilot Study Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial Cognitive training on stroke patients via virtual reality-based serious games Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training Effect of virtual reality training on walking distance and physical fitness in individuals with Parkinson's disease. Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial
This is a single blind r and omized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke . Twenty subjects with stroke were assigned r and omly to either the control group ( n=9 ) or the experimental group ( n=11 ) . Subjects in the control group received the treadmill training . Subjects in the experimental group underwent the virtual reality-based treadmill training .  Walking speed , community walking time , walking ability question naire ( WAQ ) , and activities-specific balance confidence ( ABC ) scale were evaluated . Subjects in the experimental group improved significantly in walking speed , community walking time , and WAQ score at posttraining and 1-month follow-up periods . Their ABC score also significantly increased at posttraining but did not maintain at follow-up period . Regarding the between-group comparisons , the experimental group improved significantly more than control group in walking speed ( P=0.03 ) and community walking time ( P=0.04 ) at posttraining period and in WAQ score ( P=0.03 ) at follow-up period . Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 OBJECTIVE To evaluate the effectiveness of a 2-D virtual reality ( 2DVR ) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway ( MTR ) . METHOD A flat-screen 2DVR based training programme and a corresponding , typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a r and omised control group pre-test and post-test . RESULTS Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme .  An additional 22 subjects formed the control group . They were assessed by using a behavioural checklist of MTR skills and a newly vali date d MTR self-efficacy scale . The subjects of both training groups showed a significant improvement in their knowledge , skills and self-efficacy in using the MTR ( p<0.01 ) , whereas , the MTR skills and self-efficacy of the control group remained stable over a four-week interval . CONCLUSION Though both training programmes were effective in training the patients with stroke , they demonstrated differential improvements in MTR skills and related self-efficacy . Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke Objective : To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke . Design : R and omized controlled trial . Setting : Outpatient neurorehabilitation unit . Participants : A total of 20 individuals with chronic stroke . Interventions : The intervention consisted of 20 one-hour sessions , five sessions per week . The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training . The control group underwent one hour conventional therapy . Main measures : Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale , the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment , the Brunel Balance Assessment , and the 10-m Walking Test . Subjective data of the virtual reality-based intervention were collected from the experimental group , with a feedback question naire at the end of the trial . Results : The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale ( p < 0.05 ) and in the 10-m Walking Test ( p < 0.05 ) . Post-hoc analyses showed greater improvement in the experimental group : 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale , –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test , and also in the number of participants who increased level in the Brunel Balance Assessment ( χ2 = 2.5 , p < 0.01 ) . Conclusions : Virtual reality interventions can be an effective re source to enhance the improvement of balance in individuals with chronic stroke This study is a single blind r and omized controlled trial to determine the effect of virtual reality-based postural control training on the gait ability in patients with chronic stroke . Sixteen subjects were r and omly assigned to either experimental group ( VR , n= 8) or control group ( CPT , n= 8) . Subjects in both groups received conventional physical therapy for 60 min per day , five days per week during a period of four weeks . Subjects in the VR group received additional augmented reality-based training for 30 min per day , three days per week during a period of four weeks . The subjects were evaluated one week before and after participating in a four week training and follow-up at one month post-training . Data derived from the gait analyses included spatiotemporal gait parameters , 10 meters walking test ( 10 mWT ) . In the gait parameters , subjects in the VR group showed significant improvement , except for cadence at post-training and follow-up within the experimental group . However , no obvious significant improvement was observed within the control group . In between group comparisons , the experimental group ( VR group ) showed significantly greater improvement only in stride length compared with the control group ( P < 0.05 ) , however , no significant difference was observed in other gait parameters . In conclusion , we demonstrate significant improvement in gait ability in chronic stroke patients who received virtual reality based postural control training . These findings suggest that virtual reality ( VR ) postural control training using real-time information may be a useful approach for enhancement of gait ability in patients with chronic stroke BACKGROUND Falls are frequent in Parkinson 's disease and ageing . Impairments in the cholinergic-mediated attentional supervision of gait may contribute to increased fall risk , especially when obstacles challenge gait . Interventions combining motor-cognitive approaches have been shown to improve motor performance , cognitive skills and falls number . Here , we hypothesized that an intervention simulating an attention-dem and ing walking condition could impact not only complex gait performance and fall risk but also short-latency afferent inhibition ( SAI ) , as a marker of cholinergic activity . METHODS Thirty-nine participants at falls risk ( 24 Parkinson 's disease subjects and 15 older adults ) were recruited in a r and omized controlled trial . Participants were assigned to treadmill training or treadmill training with non-immersive virtual reality intervention and trained 3 times a week for 6 weeks . SAI , a transcranial magnetic stimulation paradigm , was used to assess cholinergic activity . Gait kinematics was measured during usual walking and while negotiating physical obstacles . Transcranial magnetic stimulation and gait assessment s were performed pre , post , and 6 months post intervention . RESULTS Treadmill training combined with non-immersive virtual reality induced an increase in inhibition of the SAI protocol on cortical excitability , improved obstacle negotiation performance and induced a reduction of the number of falls compared to treadmill training . Furthermore , the more SAI increased after training , the more the obstacle negotiation performance improved and fall rate decreased OBJECTIVE The aim of this study was to investigate the effects of virtual reality ( VR ) balance training conducted using Kinect for Xbox ® games on patients with chronic stroke . MATERIAL S AND METHODS Fifty patients with mild to moderate motor deficits were recruited and r and omly assigned to two groups : VR plus st and ard treatment group and st and ard treatment ( ST ) group . In total , 12 training sessions ( 90 minutes a session , twice a week ) were conducted in both groups , and performance was assessed at three time points ( pretest , post-test , and follow-up ) by a blinded assessor . The outcome measures were the Berg Balance Scale ( BBS ) , Functional Reach Test , and Timed Up and Go Test ( cognitive ; TUG-cog ) for balance evaluations ; Modified Barthel Index for activities of daily living ability ; Activities-specific Balance Confidence Scale for balance confidence ; and Stroke Impact Scale for quality of life . The pleasure scale and adverse events were also recorded after each training session . RESULTS Both groups exhibited significant improvement over time in the BBS ( P = 0.000 ) and TUG-cog test ( P = 0.005 ) . The VR group rated the experience as more pleasurable than the ST group during the intervention ( P = 0.027 ) . However , no significant difference was observed in other outcome measures within or between the groups . No serious adverse events were observed during the treatment in either group . CONCLUSIONS VR balance training by using Kinect for Xbox games plus the traditional method had positive effects on the balance ability of patients with chronic stroke .  The VR group experienced higher pleasure than the ST group during the intervention Objective : To compare the effectiveness of upper extremity virtual reality rehabilitation training ( VR ) to time-matched conventional training ( CT ) in the subacute phase after stroke . Methods : In this r and omized , controlled , single-blind phase III multicenter trial , 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions . Participants were r and omized to either VR or CT as an adjunct to st and ard rehabilitation and stratified according to mild to moderate or severe h and paresis , defined as ≥20 degrees wrist and 10 degrees finger extension or less , respectively . The training comprised a minimum of sixteen 60-minute sessions over 4 weeks . The primary outcome measure was the Action Research Arm Test ( ARAT ) ; secondary outcome measures were the Box and Blocks Test and Functional Independence Measure . Patients were assessed at baseline , after intervention , and at the 3-month follow-up . Results : Mean time from stroke onset for the VR group was 35 ( SD 21 ) days and for the CT group was 34 ( SD 19 ) days . There were no between-group differences for any of the outcome measures . Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention ( p = 0.714 ) and follow-up ( p = 0.777 ) assessment s. Patients in VR improved 12 ( SD 11 ) points from baseline to the postintervention assessment and 17 ( SD 13 ) points from baseline to follow-up , while patients in CT improved 13 ( SD 10 ) and 17 ( SD 13 ) points , respectively . Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis . Conclusions : Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke . VR may constitute a motivating training alternative as a supplement to st and ard rehabilitation . Clinical Trials.gov identifier : NCT02079103 . Classification of evidence : This study provides Class I evidence that for patients with upper extremity motor impairment after stroke , compared to conventional training , VR training did not lead to significant differences in upper extremity function improvement Background . After inpatient stroke rehabilitation , many people still can not participate in community activities because of limited walking ability . Objective . To compare the effectiveness of 2 conceptually different , early physical therapy ( PT ) interventions to usual care ( UC ) in improving walking 6 months after stroke . Methods . The Locomotor Experience Applied Post-Stroke ( LEAPS ) study was a single-blind , r and omized controlled trial conducted in 408 adults with disabling hemiparetic stroke . Participants were stratified at baseline ( 2 months ) by impairment in walking speed : severe ( < 0.4 m/s ) or moderate ( 0.4 to < 0.8 m/s ) . Between 2 and 6 months , they received either only UC ( n = 143 ) or UC plus 36 therapist-provided sessions of either ( 1 ) walking training on a treadmill using body-weight support and practice overground at clinics ( locomotor training program [ LTP ] , n = 139 ) or ( 2 ) impairment-based strength and balance exercise at home ( home exercise program [ HEP ] , n = 126 ) . Results . LTP participants were 18 % more likely to transition to a higher functional walking level : severe to > 0.4 m/s and moderate to > 0.8 m/s than UC participants ( 95 % confidence interval [ CI ] = 7%-29 % ) , and HEP participants were 17 % more likely to transition ( 95 % CI = 5%-29 % ) . Mean gain in walking speed in LTP participants was 0.13 m/s greater ( 95 % CI = 0.09 - 0.18 ) and in HEP participants , 0.10 m/s greater ( 95 % CI = 0.05 - 0.14 ) than in UC participants . Conclusions . Progressive PT , using either walking training on a treadmill and overground , conducted in a clinic , or strength and balance exercises conducted at home , was superior to UC in improving walking , regardless of severity of initial impairment Background Increasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation . In current clinical practice , visual feedback of movement performance is often limited to the use of mirrors or video . However , neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints . Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment . However , such data are currently presented in numerical or graphical format , which is often impractical in a clinical setting . Our hypothesis is that presenting this kinematic data using bespoke visualisation software , which is tailored for gait rehabilitation after stroke , will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients . This will result in increased patient underst and ing of their rehabilitation and will enable progress to be tracked in a more accessible way . Methods The hypothesis will be assessed using an exploratory ( phase II ) r and omised controlled trial . Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability ( Functional Ambulation Classification of 1 or more ) . Participants ( n = 45 ) will be r and omised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group . The primary outcome measure will be walking speed . Secondary measures will be Functional Ambulation Category , Timed Up and Go , Rivermead Visual Gait Assessment , Stroke Impact Scale-16 and spatiotemporal parameters associated with walking . Additional qualitative measures will be used to assess the participant ’s experience of the visual feedback provided in the study . Discussion Results from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient underst and ing of their rehabilitation . Trial registration Current Controlled Trials IS RCT Memory complaints are common after stroke , yet there have been very few studies of the outcome of memory rehabilitation in these patients . The present study evaluated the effectiveness of a new manualised , group-based memory training programme .  Forty out patients with a single-stroke history and ongoing memory complaints were enrolled . The six-week course involved education and strategy training and was evaluated using a wait-list crossover design , with three assessment s conducted 12 weeks apart . Outcome measures included : tests of antero grade memory ( Rey Auditory Verbal Learning Test : RAVLT ; Complex Figure Test ) and prospect i ve memory ( Royal Prince Alfred Prospect i ve Memory Test ) ; the Comprehensive Assessment of Prospect i ve Memory ( CAPM ) question naire and self-report of number of strategies used . Significant training-related gains were found on RAVLT learning and delayed recall and on CAPM informant report . Lower baseline scores predicted greater gains for several outcome measures .  Patients with higher IQ or level of education showed more gains in number of strategies used . Shorter time since onset was related to gains in prospect i ve memory , but no other stroke-related variables influenced outcome . Our study provides evidence that a relatively brief , group-based training intervention can improve memory functioning in chronic stroke patients and clarified some of the baseline factors that influence outcome Objective The purpose of this study was to investigate the effectiveness of the virtual walking training program using a real-world video recording on walking balance and spatiotemporal gait parameters in patients with chronic stroke . Design Fourteen patients with chronic stroke were r and omly assigned to either the experimental group ( n = 7 ) or the control group ( n = 7 ) . The subjects in both groups underwent a st and ard rehabilitation program ; in addition , the experimental group participated in the virtual walking training program using a real-world video recording for 30 mins a day , three times a week , for 6 wks , and the control group participated in treadmill gait training for 30 mins a day , three times a week , for 6 wks . Walking balance was measured using the Berg Balance Scale ( BBS ) and the Timed Up and Go test . Gait performance was measured using an electrical walkway system . Results In walking balance , greater improvement on the Berg Balance Scale ( experimental group : 4.14 vs. control group : 1.85 ) and the Timed Up and Go test ( −2.25 vs. −0.94 ) was observed in the experimental group compared with the control group ( P < ; 0.05 ) . In the spatiotemporal gait parameters , greater improvement on velocity ( 25.40 vs. 9.74 ) and cadence ( 26.71 vs. 11.11 ) was observed in the experimental group compared with the control group ( P < ; 0.05 ) . Conclusions This study demonstrated the positive effects of the virtual walking training program using a real-world video recording on gait performance . These findings suggest that the virtual walking training program using a real-world video recording may be a valid approach to enhance gait performance in patients with chronic stroke Objectives : To investigate the effect of virtual reality ( VR ) rehabilitation on upper extremity motor performance of patients with early stroke . Design : Pilot r and omized controlled trial . Setting : Rehabilitation wards . Participants : Twenty three adults with stroke ( mean age ( SD ) = 58.35 ( 13.45 ) years and mean time since stroke ( SD ) = 16.30 ( 7.44 ) days ) . Interventions : Participants were r and omly assigned to VR group ( n=11 ) or control group ( n=12 ) . VR group received nine 30 minutes upper extremity VR therapy in st and ing ( five weekdays in two weeks ) plus conventional therapy , which included physical and occupational therapy . Control group received only conventional therapy , which was comparable to total training time received by VR group ( mean training hours (SD):VR = 17.07 ( 2.86 ) ; control = 15.50 ( 2.79 ) ) . Main outcome measures : The main outcome measure was the Fugl-Meyer Assessment ( FMA ) . Secondary outcomes included Action Research Arm Test , Motor Activity Log and Functional Independence Measure . Results were taken at baseline , post intervention and 1-month post intervention . Participants ’ feedback and adverse effects were recorded . Results : All participants improved in FMA scores ( mean change ( SD ) = 11.65 ( 8.56 ) , P<.001 ) . These effects were sustained at one month after intervention ( mean ( SD ) change from baseline = 18.67 ( 13.26 ) , P<.001 ) . All other outcome measures showed similar patterns . There were no significant differences in improvement between both groups . Majority of the participants found VR training  useful and enjoyable , with no serious adverse effects reported . Conclusion : Although additional VR training was not superior to conventional therapy alone , this study demonstrates the feasibility of VR training in early stroke Abstract Purpose : Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages . In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation , a cognitive training program using virtual reality was applied to stroke patients . Methods : A virtual reality-based serious games application for cognitive training was developed , with attention and memory tasks consisting of daily life activities . Twenty stroke patients were r and omly assigned to two conditions : exposure to the intervention , and waiting list control . Results : The results showed significant improvements in attention and memory functions in the intervention group , but not in the controls . Conclusions : Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation . Implication s for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention . Training of daily-life activities using a virtual reality application .  Accessibility to training contents Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did . VR treadmill training also improved balance skill during sit-to-st and transfers and the involvement of paretic limb in level walking more than the traditional one did OBJECTIVE To evaluate the effects of gait training with virtual reality ( VR ) on walking distance and physical fitness in individuals with Parkinson 's Disease ( PD ) . METHODS Thirty-seven individuals with PD participated in this prospect i ve , r and omized , controlled clinical trial . They were r and omly allocated to a control group su bmi tted to conventional training ( n = 12 ) , a treadmill group su bmi tted to gait training on a treadmill ( n = 13 ) and a VR group su bmi tted to gait training using the XboxTM ( n = 12 ) . Clinical measures , gait variables and the Six-Minute Walk Test ( 6MWT ) were evaluated : pre-intervention , after one intervention session , post-intervention and follow up ( 30 days after intervention ) . RESULTS The VR and treadmill groups travelled longer distances on the 6MWT and had faster gait speed in comparison to the control group . The VR and treadmill groups demonstrated an increase in pre-6MWT HR . The VR group had more intense HR after the first session and throughout training , but these gains were not maintained at the follow-up . CONCLUSION The present findings demonstrate that gait training with a VR program is as effective as treadmill training with regard to gains in walking distance and improvements in temporal gait variables in individuals with PD Purpose : Treadmill training with body weight support ( TTBWS ) for relearning walking ability after brain damage is an approach under current investigation . Efficiency of this method beyond traditional training is lacking evidence , especially in patients needing walking assistance after stroke . The objective of this study was to investigate change in walking and transfer abilities , comparing TTBWS with traditional walking training . Methods : A single-blinded , r and omized controlled trial was conducted . Sixty patients referred for multi-disciplinary primary rehabilitation were assigned into one of two intervention groups , one received 30 sessions of TTBWS plus traditional training , the other traditional training alone . Daily training was 1 hr . Outcome measures were Functional Ambulation Categories ( FAC ) , Walking , Functional Independence Measure ( FIM ) ; shorter transfer and stairs , 10 m and 6-min walk tests . Results : Substantial improvements in walking and transfer were shown within both groups after 5 and 11 weeks of intervention . Overall no statistical significant differences were found between the groups , but 12 of 17 physical measures tended to show improvements in favour of the treadmill approach . Conclusions : Both training strategies provided significant improvements in the tested activities , suggesting that similar outcomes can be obtained in the two modalities by systematic , intensive and goal directed training . Implication s for Rehabilitation Treadmill training with body weight support ( TTBWS ) and traditional gait training were found to be equally effective in improving walking and transfer in patients dependent on walking assistance after stroke . However , most outcome measures showed a tendency of improvement in favour of the treadmill group . Both training modalities were systematic , goal -directed and intensive , and the time used for training was the same . The choice between the two equally effective training alternatives should be based on the patients ’ preference , and availability of equipment and re sources
CONCLUSIONS : This review provided evidence that walking training associated with virtual reality-based training was effective in increasing walking speed after stroke , and result ed in better results than non-virtual reality interventions
OBJECTIVE : To systematic ally review the available evidence on the efficacy of walking training associated with virtual reality-based training in patients with stroke .
The specific questions were : Is walking training associated with virtual reality-based training effective in increasing walking speed after stroke ?
Is this type of intervention more effective in increasing walking speed , than non-virtual reality-based walking interventions ?