Role of Virtual Reality in Improving Balance in Patients With Myelopathy

July 7, 2018 updated by: Dhritiman Chakrabarti, National Institute of Mental Health and Neuro Sciences, India
Balance of the body is achieved by the coordination of three major systems, visual, vestibular and proprioceptive sensation and by the reflexive control of the limbs. In myelopathy, factors like balance and posture, range of motion, muscle strength, coordinated motor control, muscle tone and proprioception are affected. Balance and gait rehabilitation is an important goal in myelopathy. Virtual reality (VR) is a computer based technology that is used for task oriented biofeedback therapy in rehabilitation. This study was envisioned to observe the utility of VR in rehabilitation for improving balance in patients of myelopathy.

Study Overview

Status

Completed

Intervention / Treatment

Detailed Description

Balance of the body is achieved by the coordination of three major systems, visual, vestibular and proprioceptive sensation and by the reflexive control of the limbs. Static balance which determines the ability to maintain postural stability during sitting or standing is important to perform daily functional activities. Dynamic balance on the other hand is the ability to respond and adjust to a moving floor or any external stimuli or perturbation and is a requirement for successful gait performance.

In myelopathy, factors like balance and posture, range of motion, muscle strength, coordinated motor control, muscle tone and proprioception are affected. Lack of normal postural synergy and sensory motor integration of lower limbs and trunks and spatial information that regulate upright position and sitting balance leads to balance dysfunction in the population. Hence patient develops compensatory strategies. But ambulation involves the intricate coordination of leg movements, regulating upright posture and balance and adaptation to environmental changes. Hence balance and gait rehabilitation is an important goal in myelopathy.

Virtual reality (VR) is a computer based technology that is used for task oriented biofeedback therapy in rehabilitation. It constructs a virtual environment resembling a situation in the real world and provides multimodal sensory cues. VR ranges from non immersive to semi immersive to fully immersive, depending on the degree to which the user is isolated from the physical surroundings when interacting with the virtual environment.

In virtual reality training, participants perform functional stretching of their extremities, learn postural control of the trunk and practice weight shifting. As the level of difficulty and speed are increased for various tasks, the movement of the body's center of gravity beyond the base of support increases thus increasing the proprioceptive sensations to the joints and improves the subject's ability to adjust balance. Hence it encourages dynamic motions and functional mobility. The VR environment can be controlled and manipulated in advance to fine tune the exercises and meet individual needs. It is interactive as well as enjoyable.

Studies indicate that spinal reflex circuitry exhibits activity dependent plasticity (the capacity of the nervous system to modify its organization). Intensive task specific training is one of the most effective ways to promote neuroplasticity and develop more normalized movement patterns. VR uses this principle of neuroplasticity to promote motor relearning. Literature supports the use of VR as an effective rehabilitative tool in individuals with stroke, spinal cord injury, cerebral palsy, multiple sclerosis and other neurological disorders.

There are few studies on balance rehabilitation in myelopathy from this part of the world. Due to absence of any guidelines, identifying the most suitable type of VR system, defining the most appropriate treatment dosing, timing and intensity of training for the therapeutic application is a challenge. This study was envisioned to observe the utility of VR in rehabilitation for improving balance in patients of myelopathy.

Study Type

Interventional

Enrollment (Actual)

33

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Karnataka
      • Bangalore, Karnataka, India, 560029
        • National Institute of Mental Heath and Neurosciences

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Patients with myelopathy with neurological level of injury below C4.
  2. Both traumatic and non-traumatic myelopathy.
  3. Duration of illness less than 6 months.

Exclusion Criteria:

  1. Severe orthopedic or medical impairment that interfered with sitting.
  2. Upper limb muscle power <3/5.
  3. Cognitive or visual impairment.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Group

Instrument to be used:

Software Neuro@home (semi immersive virtual reality system for neurological rehabilitation) was used. In each of the sessions, an avatar on screen that representing the patient was regulated by the patient to perform a virtual task that focused on the training of a specific body part.

Programme schedule:

Each session of virtual reality therapy lasted for thirty minutes. Day 0 included an orientation to the machine with five minutes of gaming. This was followed by virtual reality therapy for five days a week at the same time of the day for three consecutive weeks.

As described in Experimental arm description.
No Intervention: Control Group
Virtual reality sessions were not provided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Berg Balance Scale (BBS)
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Scale is used to measure balance during functional activities. It is a 14 item scale. A 5 point scale is used for each item (0-4). "0" indicates the lowest level of function and "4" the highest level of function. Total Score = 56. Total score is obtained by adding the individual scores.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Change in Tinetti performance oriented mobility assessment (POMA)
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Balance section of Tinetti Performance Oriented Mobility Assessment (Tinetti Performance Oriented Mobility Assessment has two subscales, Balance and Gait section.) Balance section has 9 items. Each item can be scored in a 3 point ordinal scale (0-2). "0" indicates the lowest level of function and "2" the highest level of function. Total Score = 16. Total score is obtained by adding the individual scores.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Change in Functional reach test (forward and lateral)
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Functional reach score. It is used to measure postural stability and dynamic balance in sitting position. It has three subsections. Right lateral reach, left lateral reach and forward lateral reach. The value of each is obtained by measuring the distance in centimeter. The total score is obtained by adding the scores of the three subsections. Lower value indicates the lower level of function and higher value the higher level of function.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Difference in Berg Balance Scale (BBS) between groups
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Scale is used to measure balance during functional activities. It is a 14 item scale. A 5 point scale is used for each item (0-4). "0" indicates the lowest level of function and "4" the highest level of function. Total Score = 56. Total score is obtained by adding the individual scores.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Difference in Tinetti performance oriented mobility assessment (POMA) between groups
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Balance section of Tinetti Performance Oriented Mobility Assessment (Tinetti Performance Oriented Mobility Assessment has two subscales, Balance and Gait section.) Balance section has 9 items. Each item can be scored in a 3 point ordinal scale (0-2). "0" indicates the lowest level of function and "2" the highest level of function. Total Score = 16. Total score is obtained by adding the individual scores.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Difference in Functional reach test (forward and lateral) between groups
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Functional reach score. It is used to measure postural stability and dynamic balance in sitting position. It has three subsections. Right lateral reach, left lateral reach and forward lateral reach. The value of each is obtained by measuring the distance in centimeter. The total score is obtained by adding the scores of the three subsections. Lower value indicates the lower level of function and higher value the higher level of function.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Difference in Hospital anxiety and depression scale (HADS) between groups
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Hospital anxiety and depression scale. It is a self-assessment scale used to detect anxiety and depression of patients under investigation and treatment in a hospital setting. There are 7 items for anxiety and 7 items for depression. A 4 point scale (0-3) is used for each. "0" indicates a negative response and "3" the highest positive response. The total score is the sum of the anxiety and depression scores. 0-7= non case, 8-10= borderline case, 11+= case.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Difference in Spinal cord independence measurement scale (SCIM) between groups
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
This scale assesses the independence of a spinal cord injury patient in key areas of self-care, respiration and mobility. There are 4 items in 'Self-care', 4 items in 'Respiration and Sphincter management', and 9 items in 'Mobility'. Score of each section is obtained by adding the individual item scores. Total score is 100 obtained from adding the scores of the 3 sections.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.
Difference in Walking Index for Spinal Cord Injury II (WISCI II) between groups
Time Frame: At admission and at discharge from hospital or 24 weeks, whichever is earlier.
The Walking Index for Spinal Cord Injury. It corporates the extent and nature of assistance requires for walking in spinal cord injury patients. It is an ordinal scale consisting of 21 levels from "0" being unable to walk with all possible support to "20" being "able to walk with no assistive device, brace or support". The score corresponding to the person's ambulatory status is taken.
At admission and at discharge from hospital or 24 weeks, whichever is earlier.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2018

Primary Completion (Actual)

May 30, 2018

Study Completion (Actual)

May 30, 2018

Study Registration Dates

First Submitted

June 20, 2018

First Submitted That Met QC Criteria

July 7, 2018

First Posted (Actual)

July 19, 2018

Study Record Updates

Last Update Posted (Actual)

July 19, 2018

Last Update Submitted That Met QC Criteria

July 7, 2018

Last Verified

July 1, 2018

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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