Comparing Walking-Related Everyday Life Tasks of Children with Gait Disorders in a Virtual Reality Setup With a Physical Setup: Cross-Sectional Noninferiority Study.

IF 3.8 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES JMIR Serious Games Pub Date : 2024-03-18 DOI:10.2196/49550
Sophia Rhiel, Andrina Kläy, Urs Keller, Hubertus J A van Hedel, Corinne Ammann-Reiffer
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Abstract

Background: A frequent rehabilitation goal for children with gait disorders is to practice daily-life walking activities. Unfortunately, these are often difficult to practice in a conventional therapeutic setting. Virtual reality (VR) with head-mounted displays (HMDs) could be a promising approach in neurorehabilitation to train such activities in a safe environment. First, however, we must know whether obstacles in VR are indeed mastered as obstacles.

Objective: This study aimed to provide information on whether VR is feasible and motivating to induce and practice movements needed to master real obstacles in children and adolescents with gait disorders. Furthermore, this project aims to evaluate which kinds of everyday walking activities are appropriate to be practiced in VR.

Methods: In this cross-sectional study, participants stepped over a bar, crossed a gap, balanced over a beam, and circumvented stationary obstructions arranged in a course under real physical and virtual conditions wearing a VR HMD. We recorded the respective primary outcomes (step height, step length, step width, and minimal shoulder-obstacle distance) with motion capture. We then calculated the mean differences and 95% CI of the spatiotemporal parameters between the VR and physical setup and later compared them using noninferiority analysis with margins defined a priori by a clinical expert panel. Additionally, the participants responded to a standardized questionnaire while the therapists observed and evaluated their movement performance.

Results: We recruited 20 participants (mean age 12.0, range 6.6-17.8 years) with various diagnoses affecting their walking ability. At 3.77 (95% CI 1.28 to 6.26) cm, the mean difference in step height of the leading foot in the overstepping task did not exceed the predefined margin of -2 cm, thus signifying noninferiority of the VR condition compared to mastering the physical obstacles. The same was true for step length (-1.75, 95% CI -4.91 to 1.41 cm; margin -10 cm), step width (1.05, 95% CI 0.20 to -1.90 cm; margin 3 cm), and the minimal shoulder-obstacle distance (0.25, 95% CI -0.85 to 0.35 cm; margin -2 cm) in the other tasks. Only the trailing foot in the overstepping task yielded inconclusive results.

Conclusions: Children with gait disorders perform everyday walking tasks like overstepping, crossing, balancing, or circumventing similarly in physical and VR environments, suggesting that VR could be a feasible therapeutic tool to practice everyday walking tasks.

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比较步态障碍儿童在虚拟现实设置和物理设置中与步行相关的日常生活任务:横断面非劣效性研究。
背景:步态障碍儿童经常面临的康复目标是练习日常生活中的行走活动。遗憾的是,这些活动通常很难在传统的治疗环境中进行。使用头戴式显示器(HMD)的虚拟现实(VR)可能是神经康复中一种很有前景的方法,可在安全的环境中训练此类活动。不过,首先我们必须知道,VR 中的障碍是否确实被当作障碍来掌握:本研究旨在提供相关信息,说明 VR 是否可行,是否能激励步态障碍儿童和青少年诱导和练习掌握真实障碍所需的动作。此外,该项目还旨在评估哪些日常行走活动适合在 VR 中进行练习:在这项横断面研究中,参与者佩戴 VR HMD,在真实物理和虚拟条件下跨过横杆、越过缝隙、在横梁上保持平衡,并绕过布置在赛道上的固定障碍物。我们通过动作捕捉记录了各自的主要结果(步高、步长、步宽和肩与障碍物的最小距离)。然后,我们计算了 VR 设置和物理设置之间时空参数的平均差异和 95% CI,随后使用非劣效性分析对它们进行了比较,并由临床专家小组预先确定了差值。此外,参与者还回答了一份标准化问卷,同时治疗师观察并评估了他们的运动表现:我们招募了 20 名参与者(平均年龄为 12.0 岁,年龄范围为 6.6-17.8 岁),他们的行走能力受到各种诊断的影响。在跨步任务中,前脚步高的平均差异为 3.77 厘米(95% CI 为 1.28 至 6.26 厘米),没有超过预先设定的-2 厘米的差值,这表明 VR 条件与掌握物理障碍相比没有劣势。其他任务中的步长(-1.75,95% CI -4.91至1.41厘米;边距-10厘米)、步宽(1.05,95% CI 0.20至-1.90厘米;边距3厘米)和肩与障碍物的最小距离(0.25,95% CI -0.85至0.35厘米;边距-2厘米)也是如此。结论:步态障碍儿童在日常行走中的障碍距离为0.25厘米(95% CI -0.85至0.35厘米),边缘为-2厘米:步态障碍儿童在物理环境和虚拟现实环境中完成日常行走任务(如越位、跨越、平衡或绕行)的情况相似,这表明虚拟现实可以成为练习日常行走任务的一种可行的治疗工具。
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来源期刊
JMIR Serious Games
JMIR Serious Games Medicine-Rehabilitation
CiteScore
7.30
自引率
10.00%
发文量
91
审稿时长
12 weeks
期刊介绍: JMIR Serious Games (JSG, ISSN 2291-9279) is a sister journal of the Journal of Medical Internet Research (JMIR), one of the most cited journals in health informatics (Impact Factor 2016: 5.175). JSG has a projected impact factor (2016) of 3.32. JSG is a multidisciplinary journal devoted to computer/web/mobile applications that incorporate elements of gaming to solve serious problems such as health education/promotion, teaching and education, or social change.The journal also considers commentary and research in the fields of video games violence and video games addiction.
期刊最新文献
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