The effects of virtual reality environment simulations on balance and gait rehabilitation in persons with lower extremity amputation.

Abstract

Background: Walking rehabilitation for individuals with lower limb amputation plays a crucial role in effectively using prostheses. The development of new technologies, such as virtual environments, will enhance our ability to improve walking in this population.

Objective: To explore the potential of virtual reality in lower limb amputee rehabilitation by using immersive virtual reality environments to address gait and balance issues and evaluate outcomes in individuals with lower limb amputation.

Study design: A systematic review.

Methods: The search strategy, validated by all authors, conducted in five electronic databases (Web of Science, PubMed, Science Direct, CINAHL Complet, EBSCOhost) from inception to September 2023. To be eligible, articles were required to have a virtual reality environment as an intervention in persons with lower limb amputation with the intent of improving or evaluating their gait or balance. There was no restriction for study design or type of outcome measure.

Results: We screened 1577 documents that appeared in the search, thirty-three studies after the full-text evaluation met our inclusion criteria. Ten studies used non-immersive, eighteen used semi-immersive and three used fully immersive virtual reality simulations. Virtual reality environments have been used to test and train individuals with lower limb amputation. All RCTs had focused on non-immersive virtual environment like video games, and most participants were transtibial K3-K4 level amputees.

Conclusion: The effectiveness of non-immersive, semi-immersive, and fully immersive virtual reality simulations for improving balance in individuals with amputation needs more research, especially in combination with biofeedback and newer gaming technologies. This approach has the potential to enhance rehabilitation for lower limb amputees, but need specific outcome measures for evaluation.

Data sources: The search strategy, validated by all authors, conducted in 5 electronic databases (Web of Science, PubMed, Science Direct, CINAHL Complet, EBSCOhost) from inception to September 2023.

Study selection: To be eligible, articles were required to have a VR environment as an intervention in persons with lower limb amputation with the intent of improving or evaluating their gait or balance. There was no restriction for study design or type of outcome measure.

Result: We screened 1577 documents that appeared in the search, and 33 studies after the full-text evaluation met our inclusion criteria. Ten studies used nonimmersive, 18 used semiimmersive, and 3 used fully immersive VR simulations. Virtual reality environments have been used to test and train individuals with lower limb amputation. All randomized controlled trials had focused on nonimmersive virtual environment like video games, and most participants were transtibial K3-K4 level amputees.

Conclusions: Non-immersive VR simulations like video games can be effective for improving balance-related clinical test results in persons with amputation and may have superior benefits for older adults. Semi-immersive VR simulations can improve balance and gait symmetry. Fully immersive VR simulations in combination with subjects' biofeedback need more research to engage in walking and dynamic balance rehabilitation.