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Virtual reality-treadmill training to improve gait in people with multiple sclerosis
S4
Abstracts / Gait & Posture 42S (2015) S1–S27
O5 Virtual reality-treadmill training to improve gait in people with multiple sclerosis Agnese Peruzzi 1,2,∗ , Andrea Cereatti 1,2 , Roberto Zarbo 3 , Anat Mirelman 4 , Ugo Della Croce 1,2 1
Information Engineering Unit, PolComIng Department, University of Sassari, Sassari, Italy 2 Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy 3 Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy 4 Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel Introduction: Gait impairments are common in persons with multiple sclerosis (PwMS). Typically, their gait is characterized by a greater joint kinematics variability, reduced stride length and gait speed, compared to healthy controls [1]. Such features worsen with a concurrent cognitive task (dual task) [2]. Treadmill training (TT) increases gait speed and endurance in PwMS [3], while virtual reality (VR) allows to simultaneously train cognitive and motor aspects. This study aims at investigating additional benefits of a rehabilitation program based on the combined use of TT and VR (TT-VR) compared to a TT intervention on PwMS [4]. This research is ongoing and a comparison between the two training approaches will be made when a sufficient statistical power is reached (p = 0.8). Methods: Twenty-four PwMS were recruited at the Neurology Unit at Sassari University Hospital and assigned to the TT (12 m, 7 f; 42 ± 4 y.o., EDSS: 3.8 ± 1.0) or TT-VR (12 m, 6 f; 42 ± 4 y.o., EDSS: 4.1 ± 1.0) group. The training was delivered in three 45-min sessions/week, for six weeks. Subjects in the TT-VR group walked on the treadmill while exposed to the VR. They had to pass vir-
tual obstacles and to perform cognitive concurrent tasks. A gait analysis was carried out in single and dual task, before (pre-) and after the training (post-). Selected kinematic and kinetic parameters were estimated using an optoelectronic system (Vicon B10), two force platforms (AMTI) and the Vicon Plug-in Gait marker set. For each condition, five trials were evaluated. For each participant, the percent change of each parameter between pre- and post- was calculated. Mean and standard deviation were computed over participants and the Wilcoxon test was used to assess if any gait change occurred after the intervention. Results: Percent changes of selected kinematic and kinetic parameters between pre- and post-interventions are reported in Fig. 1. Discussion: All subjects improved the gait spatio-temporal parameters in single task. The intensive training increased the peak ankle and hip power, facilitating the forward progression, enabling a longer stride, and, hence, a higher gait speed. Subjects in the TT-VR group, who increased also the knee and hip ROMs in single task, retained all these gains in dual task, probably because they specifically practice how to share their attention during walking. Interestingly, subjects in the TT group improved the gait spatio-temporal parameters and the peak ankle power in dual task, probably, as a consequence of the general improvement of the gait quality. This aspect will be further explored in future work. Acknowledgments: This research has been founded by the Italian Foundation of Multiple Sclerosis (FISM2013/R/10).
References [1] [2] [3] [4]
Socie MJ, Sosnoff JJ. Mult Scler Int 2013;2013:645197. Hamilton F, et al. Mult Scler 2009;15(10):1215–27. Swinnen E, et al. Mult Scler Int 2012;2012:240274. Peruzzi A, et al. Gait Posture 2013;37(2013):S7–8.
http://dx.doi.org/10.1016/j.gaitpost.2015.07.019 O6 Application of a markerless gait analysis methodology in children with cerebral palsy: Preliminary results Andrea Castelli 1,2,∗ , Gabriele Paolini 1,2 , Andrea Cereatti 1,2 , Matilde Bertoli 1,2 , Ugo Della Croce 1,2 1 Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy 2 Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
Fig. 1.
Introduction: Instrumented clinical gait analysis is commonly performed by reconstructing the 3D position of skin markers by means of an optoelectronic system. Although accurate and reliable, such systems are expensive and require a dedicated space and technical expertise, making their use difficult in small facilities and ambulatory settings [1]. In those clinical applications for which a sagittal kinematic analysis is sufficient, single camera markerless (ML) methods can represent an effective alternative [1] to 3D optoelectronic systems. A ML approach is desirable when a totally non-invasive approach is sought, as when children are tested, since they often do not easily tolerate skin markers. In this study, we present a monolateral, single camera ML methodology [2]. The method is applied on three children affected by cerebral palsy and validated against a widely accepted clinical marker-based gait analysis protocol (gold standard – GS) [3]. Methods: Three children with cerebral palsy (2 m, 1 f, 5 ≤ age ≤ 10) walked along a walkway at self-paced speed (3 trials)
Abstracts / Gait & Posture 42S (2015) S1–S27
O5 Virtual reality-treadmill training to improve gait in people with multiple sclerosis Agnese Peruzzi 1,2,∗ , Andrea Cereatti 1,2 , Roberto Zarbo 3 , Anat Mirelman 4 , Ugo Della Croce 1,2 1
Information Engineering Unit, PolComIng Department, University of Sassari, Sassari, Italy 2 Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy 3 Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy 4 Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel Introduction: Gait impairments are common in persons with multiple sclerosis (PwMS). Typically, their gait is characterized by a greater joint kinematics variability, reduced stride length and gait speed, compared to healthy controls [1]. Such features worsen with a concurrent cognitive task (dual task) [2]. Treadmill training (TT) increases gait speed and endurance in PwMS [3], while virtual reality (VR) allows to simultaneously train cognitive and motor aspects. This study aims at investigating additional benefits of a rehabilitation program based on the combined use of TT and VR (TT-VR) compared to a TT intervention on PwMS [4]. This research is ongoing and a comparison between the two training approaches will be made when a sufficient statistical power is reached (p = 0.8). Methods: Twenty-four PwMS were recruited at the Neurology Unit at Sassari University Hospital and assigned to the TT (12 m, 7 f; 42 ± 4 y.o., EDSS: 3.8 ± 1.0) or TT-VR (12 m, 6 f; 42 ± 4 y.o., EDSS: 4.1 ± 1.0) group. The training was delivered in three 45-min sessions/week, for six weeks. Subjects in the TT-VR group walked on the treadmill while exposed to the VR. They had to pass vir-
tual obstacles and to perform cognitive concurrent tasks. A gait analysis was carried out in single and dual task, before (pre-) and after the training (post-). Selected kinematic and kinetic parameters were estimated using an optoelectronic system (Vicon B10), two force platforms (AMTI) and the Vicon Plug-in Gait marker set. For each condition, five trials were evaluated. For each participant, the percent change of each parameter between pre- and post- was calculated. Mean and standard deviation were computed over participants and the Wilcoxon test was used to assess if any gait change occurred after the intervention. Results: Percent changes of selected kinematic and kinetic parameters between pre- and post-interventions are reported in Fig. 1. Discussion: All subjects improved the gait spatio-temporal parameters in single task. The intensive training increased the peak ankle and hip power, facilitating the forward progression, enabling a longer stride, and, hence, a higher gait speed. Subjects in the TT-VR group, who increased also the knee and hip ROMs in single task, retained all these gains in dual task, probably because they specifically practice how to share their attention during walking. Interestingly, subjects in the TT group improved the gait spatio-temporal parameters and the peak ankle power in dual task, probably, as a consequence of the general improvement of the gait quality. This aspect will be further explored in future work. Acknowledgments: This research has been founded by the Italian Foundation of Multiple Sclerosis (FISM2013/R/10).
References [1] [2] [3] [4]
Socie MJ, Sosnoff JJ. Mult Scler Int 2013;2013:645197. Hamilton F, et al. Mult Scler 2009;15(10):1215–27. Swinnen E, et al. Mult Scler Int 2012;2012:240274. Peruzzi A, et al. Gait Posture 2013;37(2013):S7–8.
http://dx.doi.org/10.1016/j.gaitpost.2015.07.019 O6 Application of a markerless gait analysis methodology in children with cerebral palsy: Preliminary results Andrea Castelli 1,2,∗ , Gabriele Paolini 1,2 , Andrea Cereatti 1,2 , Matilde Bertoli 1,2 , Ugo Della Croce 1,2 1 Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy 2 Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
Fig. 1.
Introduction: Instrumented clinical gait analysis is commonly performed by reconstructing the 3D position of skin markers by means of an optoelectronic system. Although accurate and reliable, such systems are expensive and require a dedicated space and technical expertise, making their use difficult in small facilities and ambulatory settings [1]. In those clinical applications for which a sagittal kinematic analysis is sufficient, single camera markerless (ML) methods can represent an effective alternative [1] to 3D optoelectronic systems. A ML approach is desirable when a totally non-invasive approach is sought, as when children are tested, since they often do not easily tolerate skin markers. In this study, we present a monolateral, single camera ML methodology [2]. The method is applied on three children affected by cerebral palsy and validated against a widely accepted clinical marker-based gait analysis protocol (gold standard – GS) [3]. Methods: Three children with cerebral palsy (2 m, 1 f, 5 ≤ age ≤ 10) walked along a walkway at self-paced speed (3 trials)