Use of virtual reality (VR) technology to improve walking for people post-stroke has been studied for its clinical application since 2004. The hardware and software used to create these systems has varied but has predominantly been constituted by projected environments with users walking on treadmills. Transfer of training from the virtual environment to real-world walking has modest but positive research support. Translation of the research findings to clinical practice has been hampered by commercial availability and costs of the VR systems. Suggestions for how the work for individuals post-stroke might be applied and adapted for individuals with diabetes and other impaired ambulatory conditions include involvement of the target user groups (both practitioners and clients) early in the design and integration of activity and education into the systems.
BohannonRWAndrewsAWSmithMB. Rehabilitation goals of patients with hemiplegia. Int J Rehabil Res.1988;11: 181–83.
2.
HarrisJEEngJJ. Goal priorities identified through client-centered measurement in individuals with chronic stroke. Physiother Can.2004;56: 171–76.
3.
WandelAJørgensenHSNakayamaHRaaschouHOOlsenTS. Prediction of walking function in stroke patients with initial lower extremity paralysis: The Copenhagen Stroke Study. Arch Phys Med Rehabil.2000;81 (6): 736–8.
4.
OlneySJRichardsC. Hemiparetic gait following stroke. Part 1: Charecteristics. Gait Posture.1996;4: 136–48.
5.
LordSEMcPhersonKMcNaughtonHKRochesterLWeatherallM. Community ambulation after stroke: How important and obtainable is it and what measures appear predictive?Arch Phys Med Rehabil.2004;85 (2): 234–9.
6.
MichaelKMAllenJKMackoRF. Reduced ambulatory activity after stroke: The role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil.2005;86 (8): 1552–6.
7.
JanssenHBernhardtJCollierJMSenaESMcElduffPAttiaJPollackMHowellsDWNilssonMCalfordMBSprattNJ. An enriched environment improves sensorimotor function post-ischemic stroke. Neurorehabil Neural Repair.2010;24 (9): 802–13.
8.
BayonaNABitenskyJSalterKTeasellR. The role of task-specific training in rehabilitation therapies. Top Stroke Rehabil.2005;12 (3): 58–65.
9.
FrenchBThomasLHLeathleyMJSuttonCJMcAdamJForsterALanghornePPriceCIWalkerAWatkinsCL. Repetitive task training for improving functional ability after stroke. Stroke.2009;40 (4): e98–99.
10.
EngJJTangPF. Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. Expert Rev Neurother.2007;7 (10): 1417–36.
11.
BogeyRHornbyGT. Gait training strategies utilized in poststroke rehabilitation: Are we really making a difference?Top Stroke Rehabil.2007;14 (6): 1–8.
12.
JaffeDLBrownDAPierson-CareyCDBuckleyELLewHL. Stepping over obstacles to improve walking in individuals with poststroke hemiplegia. J Rehabil Res Dev.2004;41 (3A): 283–92.
13.
DeutschJEPaserchiaCVecchioneCMirelmanALewisJABoianRBurdeaG. Improved gait and elevation speed of individuals post-stroke after lower extremity training in virtual environments. J Neurologic Physical Ther.2004;28 (4): 185–6.
14.
YouSHJangSHKimYHHallettMAhnSHKwonYHKimJHLeeMY. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: An experimenter-blind randomized study. Stroke.2005;36 (6): 1166–71.
15.
FungJRichardsCLMalouinFMcFadyenBJLamontagneA. A treadmill and motion coupled virtual reality system for gait training post-stroke. Cyberpsychol Behav.2006;9 (2): 157–62.
16.
YangYRTsaiMPChuangTYSungWHWangRY. Virtual reality-based training improves community ambulation in individuals with stroke: A randomized controlled trial. Gait Posture.2008;28 (2): 201–6.
17.
MirelmanABonatoPDeutschJE. Effects of training with a robot-virtual reality system compared with a robot alone on the gait of individuals after stroke. Stroke.2009;40 (1): 169–74.
18.
WalkerMLRinglebSIMaihaferGCWalkerRCrouchJRVan LunenBMorrisonS. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: Feasibility and effectiveness in 6 subjects. Arch Phys Med Rehabil.2010;91 (1): 115–22.
19.
DeutschJEMirelmanA. Virtual reality-based approaches to enable walking for people poststroke. Top Stroke Rehabil.2007;14 (6): 45–53.
20.
HoldenMK. Virtual environments for motor rehabilitation: Review. Cyberpsychol Behav.2005;8 (3): 187–219.
21.
SveistrupH. Motor rehabilitation using virtual reality: Review. J Neuroeng Rehabil.2004;1: 10–8.
22.
WeissPLRandDKatzNKizonyR. Video capture virtual reality as a flexible and effective rehabilitation tool. J Neuroeng Rehabil.2004;1 (1): 12.
23.
Robles-De-La-TorreG. The importance of the sense of touch in virtual and real environments. IEEE Multimedia.2006;13 (3): 24–30.
24.
BoianRFDeutschJELeeCSBurdeaGCLewisJA. Haptic effects for virtual reality-based post-stroke rehabilitation. Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. Los Angeles, CA. 2003: 247–53.
25.
PerryJGarrettMGronleyJKMulroySJ. Classification of walking handicap in the stroke population. Stroke.1995;26 (6): 982–9.
26.
Oxford Centre for Evidence-based Medicine. Levels of Evidence. Oxford: University of Oxford; 2009.
27.
SugarmanHBurstinAWeisel-EichlerABrownR. Use of the Wii Fit System for the treatment of balance problems in the elderly: A case report. Presented at: IEEE Virtual Rehabilitation International Conference, Haifa, Israel. 2009, 111–16.
28.
DeutschJERobbinsDMorrisonJBolwbyPG. Wii-based compared to standard of care balance and mobility rehabilitation for two individuals post-stroke. IEEE Virtual Rehabilitation International Conference, Haifa, Israel. 2009: 117–20.
29.
MirelmanAPatrittiBLBonatoPDeutschJE. Effects of virtual reality training on gait biomechanics of individuals post-stroke. Gait Posture.2010;31 (4): 433–7.
30.
DeutschJEMeriansASAdamovichSPoiznerHBurdeaGC. Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke. Restor Neurol Neurosci.2004;22 (3–5): 371–86.
31.
DeutschJELewisJABurdeaG. Technical and patient performance using a virtual reality-integrated telerehabilitation system: Preliminary finding. IEEE Trans Neural Syst Rehabil Eng.2007;15 (1): 30–5.
32.
GironeMBurdeaGBouzitMPopescuVDeutschJE. Orthopedic rehabilitation using the “Rutgers ankle” interface. Stud Health Technol Inform.2000;70: 89–95.
33.
GironeMBurdeaGBouzitMPopescuVDeutschJE. A Stewart platform-based system for ankle telerehabilitation. Autonomous Robots.2001;10 (2): 203–12.
34.
DeutschJELatonioJBurdeaGBoianR. Post-stroke rehabilitation with the Rutgers ankle system: A case study. Presence.2001 (10): 416–30.
35.
LangeBFlynnSRizzoA. Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation. Phys Ther Rev.2009;14 (5): 355–63.
36.
BeverlyEAWrayLA. The role of collective efficacy in exercise adherence: A qualitative study of spousal support and type 2 diabetes management. Health Educ Res.2010;25 (2): 211–23.
37.
ShinjiSShigeruMRyuseiUMitsuruMShigehiroK. Adherence to a home-based exercise program and incidence of cardiovascular disease in type 2 diabetes patients. Int J Sports Med.2007;28 (10): 877–9.
38.
GlasgowRERuggieroLEakinEGDryfoosJChobanianL. Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care.1997;20 (4): 562–7.
39.
BouléNGHaddadEKennyGPWellsGASigalRJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials. JAMA.2001;286 (10): 1218–27.
40.
ColbergSRSigalRJFernhallBRegensteinerJGBlissmerBJRubinRRChasan-TaberLAlbrightALBraunB, American College of Sports Medicine, American Diabetes Association. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement. Diabetes Care.2010;33 (12): e147–67.
41.
ClarkDO. Physical activity efficacy and effectiveness among older adults and minorities. Diabetes Care.1997;20 (7): 1176–82.
42.
ErikssonKFLindgärdeF. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmö feasibility study. Diabetologia.1991;34 (12): 891–8.
43.
OrozcoLJBuchleitnerAMGimenez-PerezGRoquéIFigulsMRichterBMauricioD. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst Rev.2008; (3): CD003054.
AlletLArmandSAminianKPatakyZGolayAde BieRAde BruinED. An exercise intervention to improve diabetic patients' gait in a real-life environment. Gait Posture.2010;32 (2): 185–90.
46.
McDermottMMAdesPGuralnikJMDyerAFerrucciLLiuKNelsonMLloyd-JonesDVan HornLGarsideDKibbeMDomanchukKSteinJHLiaoYTaoHGreenDPearceWHSchneiderJRMcPhersonDLaingSTMcCarthyWJShroffACriquiMH. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: A randomized controlled trial. JAMA.2009;301 (2): 165–74.
47.
Treat-JacobsonDBronasUGLeonAS. Efficacy of arm-ergometry versus treadmill exercise training to improve walking distance in patients with claudication. Vasc Med.2009;14 (3): 203–13.
