THE ACUTE EFFECTS OF LOADING PRACTICE USING A SIMULATED PROSTHETIC LEG WITH VIRTUAL REALITY ON DYNAMIC BALANCE ABILITY

Y. Shigekuni¹, N. Maeda¹, M. Komiya¹, S. Tsutsumi¹, S. Kuroda¹, T. Nagao¹, Y. Urabe¹

¹Hiroshima University, Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima city, Japan

Background: In recent years, the using virtual reality (VR) has been attracting attention for conventional rehabilitation with prostheses after lower limb amputation. It has been reported that load practice withVR efficiently improves simulated prosthetic walking ability (Fukui et al., 2021). However, the mechanism by which walking ability was improved is unclear. Since dynamic balance has been shown to play a significant role in walking (Shamay et al., 2005), this study focused on the more fundamental aspect of dynamic balance.

Purpose: This study aimed to investigate the effects of loading practice using a simulated prosthetic leg combined with VR on dynamic balance ability.

Methods: Eighteen healthy males who had never worn a simulated prosthetic leg participated and were divided into three groups of six each: VR, Tablet, and Control group. Participants practiced stepping on the parallel bars for 5 minutes with a simulated prosthetic leg on their right leg. VR group watched a walking movie which was filmed subjectively on a head-mounted display, and Tablet group watched that on a tablet set up at eye level. As an index of dynamic balance ability during walking, the Timed Up and Go test (TUG) was conducted before and after the intervention. Additionally, VR and Tablet groups recorded their immersion score in the video using Visual Analog Scale.
Outcomes were confirmed using a one-way ANOVA followed by a multiple comparison test with Bonferroni method as a post hoc test to compare the rate of improvement in TUG time among the three groups. The relationship between the rate of improvement in the TUG timeand the immersion score for the 12 participants (VR and Tablet groups)was examined using Pearson's correlation analysis. Statistical significance was set up p<0.05.

Results: In VR group, TUG times before and after intervention were 11.8±2.3 s and 9.7±2.0 s, respectively (improvement rate: 17.2±5.4%). For the Tablet group, the TUG times were 10.3±2.2 and 9.4±1.8 s, respectively (improvement rate: 7.6±6.3%), and for the Control group, 13.2±3.1 and 12.2±2.8 s, respectively (improvement rate: 7.0±4.7%). The improvement rate was a significant difference between groups (F=6.52, p<0.01), and VR group were significantly higher than in other groups (p<0.05, respectively). The immersion scores of VR group (57.3±26.9 mm) and Tablet group (24.3±14.1 mm) showed a significant positive correlation with the improvement rate (r=0.72, p<0.01).

Conclusions: The results suggest that VR is effective in improving the dynamic balance during walking with simulated prosthetic leg users. The greater the amount of loading during walking, the shorter the TUG times (Nascimento et al., 2017), and visual feedback through highly immersive 3D images facilitates motor learning (Levin et al., 2015). In other words, the use of highly immersive VR videos may have increased the amount of loading on the prosthetic leg and further improved the TUG time.

Implications: Our findings suggest that introducing VR-based prosthetic leg loading practice into prosthetic rehabilitation has the potential to efficiently improve dynamic balance.

Funding acknowledgements: We have no funding acknowledgement in this study.

Keywords:
Virtual reality
Lower limb amputee
Timed Up and Go test

Topics:
Disability & rehabilitation
Musculoskeletal: lower limb
Innovative technology: robotics

Did this work require ethics approval? Yes

Institution: Hiroshima University

Committee: The Ethical Committee for Epidemiology of Hiroshima University

Ethics number: E-2398