The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial.
Rocco Salvatore Calabrò, Antonino Naro, Margherita Russo and 7 others
PMID 28592282WHAT IT FOUND
In 24 stroke survivors, adding a virtual avatar game to robot-assisted gait training was linked to greater mobility gains and brain activation than simple feedback.
Both groups received body-weight support, leg guidance and foot-lifting straps, so VR alone cannot be credited.
Key findings
01RMI improved more in the avatar VR group than in the no-avatar robot-training group, and POMA improved only in the avatar VR group.
02The avatar VR group showed more evident brain activation changes across the gait cycle than the no-avatar robot-training group.
03Mobility and balance improvements were correlated with specific EEG patterns in central and frontal areas.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was a pilot with 24 patients, although the sample-size section said 50 would be needed to detect the planned effect. The primary outcome was the proportion of patients achieving a 20% improvement, but the results report mean RMI and POMA changes and EEG patterns instead of that proportion. All patients received robot-assisted gait training with body-weight support, leg guidance force and foot-lifting straps, so the effect of the virtual avatar alone cannot be separated from the robot training and feedback. The control group received a smile display rather than an avatar, so the two groups did not have the same visual feedback. The VR display was 2D and the authors note that this gives a limited sense of presence. EEG outcomes are brain activity measures, and the paper reports correlations with walking scores in a small sample. Assessments were done before and after the 8-week training period, so the paper does not show whether gains lasted after treatment.
The easy way to misread this
Do not conclude that VR alone improves walking. Both groups received robot-assisted gait training with body-weight support, leg guidance and foot-lifting straps, and the avatar group also had the game. The study was a small pilot, and the paper reports mean score changes rather than the planned proportion of patients reaching a 20% improvement.