This study aimed to assess the effects and efficacy of treadmill walking in VR under two conditions on the gait of a stroke patient with ataxic gait. Condition A involved only visual stimuli, while Condition B combined visual and auditory stimuli (e.g.Walking through the forest with birds flying from the front.).
An ABA single-case design was used with a 60-year-old male stroke patient with bilateral ataxia from thalamic and cerebellar infarctions, 132 days post-onset. The intervention used the GRAIL system, an outdoor mobility simulation platform. In phase A, the VR provided only visual information, and the treadmill was set to a 5-10 degree incline, with the walking speed adjusted to match the patient's maximum walking speed on flat ground. In phase B, the VR presented tasks under various conditions using both visual and auditory stimuli, with added tilts and lateral sways of the walking path based on the visual information. Each phase lasted two weeks.Assessments included the Scale for the Assessment and Rating of Ataxia (SARA), Timed Up and Go (TUG) test, and 10-meter walk test (10MWT), with maximum walking speed (MWS) and stride time variability (STV) analyzed via 3D gait analysis. Functional Independence Measure - Locomotion (FIM-L) was assessed by an experienced physical therapist.
The results are presented in the order of phase A → B → A'. SARA: 9.5 → 8 → 8 points, BBS: 52 → 53 → 53 points, TUG: 14.0 → 11.0 → 11.0 sec, MWS: 1.43 → 1.62 → 1.43 m/sec, STV: 7.61 → 2.51 → 3.65 %. FIM-L：6 → 7 → 7 points. Clinically significant changes were observed in MWS, STV, and FIM-L.
Treadmill walking practice in a VR environment for ataxic gait after stroke may contribute to a more stable gait and improved gait independence through the use of various visual and auditory stimuli. To further strengthen the theoretical foundation, it is necessary to increase the sample size and conduct additional studies for further validation.
Our study suggests that even if ataxic symptoms and balance impairments remain, gait ability can be improved by providing a VR environment using various visual and auditory stimuli. Particularly through the VR tasks, it is suggested that visual and auditory information during walking further facilitates the functional connection between perception and movement, leading to improvements in gait abilities such as stride adjustment on uneven surfaces and the acquisition of more practical gait patterns. This approach is expected to contribute to future interventions for ataxic gait.
virtual reality
Treadmill Walking
