Materials and methodsIntroduction

Virtual reality-based telerehabilitation program for balance recovery. A pilot study in hemiparetic

individuals with acquired brain injury

The use of virtual reality (VR) in neurorehabilitation hasbeen proposed to promote motor learning throughintensive, repetitive and task-oriented exercises [1].Different studies have reported potential benefits ofapplying this technology in the current physical therapyprotocols [2]. Preliminary studies have shown the potentialbenefits of VR-based interventions that train the ankle andhip [3] and the stepping strategy [4] to improve balanceafter an acquired brain injury (ABI). The objectives of thepresent study were to evaluate the clinical effectivenessand usability of a VR telerehabilitation program in therehabilitation of balance of hemiparetic individuals withABI.

Roberto Lloréns1,2, Enrique Noé2, Joan Ferri2, Mariano Alcañiz1

Results

Conclusions

The results of the clinical scales and theposturography test support that the training withthe telerehabilitation program provided clinicalbenefits to individuals with ABI.

The high chronicity of the sample highlight theclinical improvement, suggesting that theseprograms can provide benefits, even long time afterthe injury.

Scores to the questionnaires reported that theexperience was very positive, even though thetraining was performed in their places, instead of inthe neurorehabilitation unit.

1. Krakauer, JW (2006), Motor learning: its relevance to stroke recovery and neurorehabilitation, Curr Opin Neurol, 19, 1, pp. 84-90.2. Laver, K, George, S, Thomas, S, Deutsch, JE and Crotty, M (2012), Cochrane review: virtual reality for stroke rehabilitation, Eur J Phys

Rehabil Med, 48, 3, pp. 523-530.3. Gil-Gomez, JA, Llorens, R, Alcaniz, M and Colomer, C (2011), Effectiveness of a Wii balance board-based system (eBaViR) for balance

rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury, J Neuroeng Rehabil, 8, 30.4. Llorens, R, Alcaniz, M, Colomer, C and Navarro, MD (2012), Balance recovery through virtual stepping exercises using Kinect skeleton

tracking: a follow-up study with chronic stroke patients, Stud Health Technol Inform, 181, 108-112.

Intervention

8 individuals with chronic stroke (7 males and 1 female) with a mean age of39.00±15.46 years old participated in the study. Participants presented a stroke(n=5) or a traumatic brain injury (n=3) with a right (n=3) or left (n=5)hemiparesis.

1Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.2Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain

MeasureBefore thetreatment

After thetreatment

Significance

BBS 47.62±3.81 51.62±2.20 p<0.01POMA - Balance 14.75±1.98 15.88±0.35POMA - Gait 9.12±1.73 10.88±1.13 p<0.01LOS 83.25±6.18 84.38±7.21RWS – Anterior-posterior 81.00±11.44 88.38±6.91 p<0.05RWS – Medial-lateral 86.75±14.67 90.75±9.82

Participants

The intervention consisted of twenty 45-minute sessions with the steppingexercise, 3 to 5 times a week. The program was monitored by the clinical teamfrom the neurorehabilitation unit.

Participants were assessed before and after the treatment with the BergBalance Scale (BBS) and the Tinetti Performance-Oriented Mobility Assessment(POMA), and also a posturography test. To assess the limits of stability (LOS)and the rhythmic weight shift (RWS). In addition, the subjective experiences ofthe participants after the program were registered by two questionnaires: theSystem Usability Scale (SUS) and the Intrinsic Motivatory Inventory (IMI).

The VR-based exercise represented the participants’ feet in an emptyscenario with a central circle that represented the center of the VE. Differentitems rose from the floor around the circle.

The objective of the exercise was to step on the rising items with the nearestfoot while maintaining the other foot within the boundaries of the circle,and to recruit the extended foot afterwards.

MeasureAfter the

treatmentSUS 87.19±5.58IMIInterestCompetencyTensionUsefulness

6.16±0.285.04±0.355.95±0.475.98±0.64

Participants had a significant improvement in the BBS (p<0.01), the gait subscale ofthe POMA (p<0.01), and in the posturography tests that assessed the rhythmicweight shift in the anterior-posterior axis (p<0.05).

Scores of the SUS and IMI show highsatisfaction and a good usability perception ofthe telerehabilitation system