HIGH INTENSITY VIRTUAL REALITY-SITTING BALANCE TRAINING IN SEVERE FUNCTIONAL IMPAIRMENT AFTER A BRAIN LESION: A CASE REPORT

Benini C¹, Zanotti G¹, Gatti R^1,2

¹Humanitas Research Hospital, Physiotherapy Unit, Mailand, Italy, ²Humanitas University, Mailand, Italy

Background: Poor sitting balance increases the fear of falling, fall risk and disability. Intensive and motivating balance training is required to optimize confidence and recovery in sitting ability in people with a central nervous system lesion. The potential of a Virtual Reality-based approach (VR) has been little explored in people with poor sitting balance. Only two studies analyzed VR-sitting balance training with promising results. However, only low-doses of VR (less than 50% of the rehabilitation program) were considered.

Purpose: The objective of this case report was to describe the effect of a High Intensity Virtual Reality-Sitting Balance Training (HIVR-SBT) in a subject with poor sitting balance and severe functional impairment after a brain lesion.

Methods: A 45-years-old man presented a severe left sensory-motor syndrome for anaplastic astrocytoma since two years. He completely lost sitting and standing abilities in the last 6 months. Low back pain for iatrogenic osteoporotic vertebral fracture had also a functional impact. He attended a four-consecutive weeks HIVR-SBT where VR-sitting balance training covered the 80% of the neurorehabilitation program which was composed by:

• VR-sitting balance training based on multidirectional challenging trunk movements through motion tracking technology (Virtual Reality Rehabilitation System, Khymeia), five sessions of one hour / week;
• task-oriented balance training, one session of one hour / week;
• occupational training in daily living activities, three sessions of 30-minute / week.

The following outcome measures were collected pre and post-treatment: Modified Barthel Index (MBI) for functional profile, Function In Sitting Test (FIST) for sitting performance and Numeric Pain Rating Scale (NPRS) for low back pain measured in sitting position. Minimal Detectable Change (MDC) of MBI and Minimal Clinically Important Difference (MCID) of FIST and NPRS referred to people with brain injuries or chronic stroke were considered.

Results: After four weeks of training, the subject showed improvements in functional profile and sitting performance measures, exceeding MDC and MCID respectively. MBI improved from 15 to 44 points (delta = 29 points, MDC = 4) and FIST from 6 to 39 points (delta = 33 points, MCID = 6.5). Post-treatment functional sit to stand and standing were possible with minimal assistance and single upper limb support. NRS showed a reduction of 5 points (MCID = 2.2). All training sessions in VR-setting were conducted without adverse events.

Conclusion(s): This case report illustrates the benefits of HIVR-SBT to enhance sitting balance recovery in a subject with severe functional impairment. Future researches should investigate this approach by an experimental design.

Implications: Physiotherapists can consider VR for balance rehabilitation also in subjects with severe sitting balance impairment.

Keywords: Virtual reality, High-Intensity, Sitting balance

Funding acknowledgements: No funding

Topic: Robotics & technology; Neurology

Ethics approval required: No

Institution: Humanitas Research Hospital

Ethics committee: Ethics Commitee for Human Investigation of Humanitas Research Hospital

Reason not required: Ethics approval was not required.

All authors, affiliations and abstracts have been published as submitted.