Walking-Related Everyday Life Tasks of Children with Gait Disorders: A Non-Inferiority Study Comparing a Virtual Reality Setup with a Physical Setup (Preprint)

Abstract

A frequent rehabilitation goal for children with gait disorders is to practice daily-life walking activities. Unfortunately, these activities are often difficult to practice in a conventional therapeutic setting. Virtual reality (VR) presented through head-mounted displays (HMD) could be a promising approach in neurorehabilitation to train such activities in a safe environment. First, however, we need to understand how similarly children perform such tasks in a virtual environment compared to the physical world.

This study aimed to compare spatiotemporal parameters of children with gait disorders when performing walking-related everyday life tasks in a physical and a virtual environment presented through an HMD.

In this cross-sectional study, the participants had to step over a bar, cross a gap, balance over a beam, and circumvent stationary obstructions under real physical and virtual conditions wearing a VR HMD. Various spatiotemporal parameters were measured using a Vicon motion capture system. For the primary outcomes, the differences between the VR and physical setup were compared using non-inferiority analysis with margins a priori defined by a clinical expert panel. Additionally, the participants responded to a standardized questionnaire with a visual analog scale, and the therapists scored the participants’ movement ability, movement execution, and the meaningful use of a VR HMD to train the mastering of obstacles on a 5-point Likert scale.

We recruited 20 participants (mean age 12.0 years, range 6.6-17.8 years) with various diagnoses (e.g., Cerebral palsy, Myelomeningocele, Brain Tumor, Stroke, etc.) affecting their walking ability. For all tasks, mastering virtual obstacles was non-inferior to mastering physical obstacles, except for the maximal step height of the trailing foot in the overstepping task, which yielded inconclusive results. Most participants did not feel restricted in moving around while wearing a VR HMD (median 10/10) and felt physically in the virtual scenario (median 8.5/10). The participants had fun in both conditions, and the therapists rated the participants’ movement execution as positive (median 4/5). However, their view regarding the engagement and the meaningfulness of using VR to train mastering obstacles was ambivalent (median 3/5).

Children with gait disorders perform everyday walking tasks like overstepping, crossing, balancing, or circumventing similarly in a physical compared to a VR environment making VR an appropriate therapeutic tool. In the long run, the feasibility of using HMDs in a clinical therapy setting, patient motivation over a more extended period, the effectiveness of such VR interventions, and identifying potential responders to such interventions require further investigations.

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