Biomechanical evaluation of virtual reality-based turning on a self-paced linear treadmill

Abstract

Background: Patients with brain injuries such as Parkinson's disease or stroke exhibit abnormal gait characteristics especially during gait transitions such as step initiation and turning. Since such transitions could precipitate falls and resultant injuries, evaluation and rehabilitation of non-steady state gait in those patients are important. Whereas body weight supported treadmill training (BWSTT) provides a safe and controlled environment for gait training, it is unable to adequately train for gait transitions since the typical linear treadmill does not allow for changes in walking direction and natural fluctuations in speed. Research question: This paper verifies if the suggested virtual reality (VR) based walking interface combined with the unidirectional treadmill can stimulate the user to initiate turning gait. Methods: To validate whether initiation of turning was successfully achieved with the proposed walking system, we developed the VR-based walking interface combined with the self-paced treadmill and compared kinematics, kinetics, and muscle activation levels during the VR-based turning and overground (OG) turning as well as between straight walking and turning within conditions. Results: Despite walking on a linear treadmill, subjects showed significant increases in head rotation, pelvic rotation, right hip abduction, left hip adduction, foot progression, medial-lateral ground reaction forces, right medial hamstring activation level, and changes in step width during the VR turn compared to straight walking. Significance: The developed VR-based turning interface can provide a safe and controlled environment for assessment of turning in healthy controls and may have a potential for assessment and training in patients with neurological disorders.