Han Seung-Hyeon, Jang Hyeon Ju, Lee Jong Weon, Cheong Jin Woong, Kim Young Dae, Nam Hyo Suk, Kim Deog Young
Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Neurol. 2025 Jul 21;16:1603233. doi: 10.3389/fneur.2025.1603233. eCollection 2025.
INTRODUCTION: Stroke is a leading cause of long-term disability worldwide. Chronic stroke survivors experience gait and balance impairments, limiting mobility and increasing fall risk. Treadmill training improves walking speed and endurance but lacks real-world adaptability. Virtual reality (VR)-based treadmill training offers immersive, task-specific practice, potentially improving functional mobility in real environments. This randomized controlled trial, using a prospective, open, blinded end-point (PROBE) design, aimed to evaluate the effects of VR-based treadmill gait training on gait performance, functional mobility, balance, and gait symmetry compared with conventional physical therapy in individuals with chronic stroke. METHODS: Thirty chronic stroke patients were randomly assigned to virtual reality treadmill training (VTT) or conventional therapy (CT) groups. Both groups received 30 min of conventional therapy twice weekly for 6 weeks. The VTT group received an additional 30 min of VR-based treadmill training per session using the C-Mill VR+ system, including obstacle negotiation and velocity modulation. The 10-meter walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG) test, Dynamic Gait Index (DGI), Performance-Oriented Mobility Assessment (POMA), Berg Balance Scale (BBS), asymmetry of spatiotemporal gait parameters, and center of pressure (CoP) sway velocity were assessed pre- and post-intervention. RESULTS: Walking speed during the 10MWT and the 6MWT significantly increased in the VTT group compared to the CT group, and asymmetric index values for stance and swing duration decreased ( < 0.05). TUG test time, DGI values, and the POMA gait component were significantly improved in the VTT group compared to the CT group ( < 0.05). BBS scores and CoP sway velocity for eyes open and tandem stance conditions also significantly improved ( < 0.05). CONCLUSION: This study demonstrated that VR-based treadmill gait training effectively improved gait performance, functional mobility, balance, and gait symmetry in chronic stroke patients. Thus, simulating diverse virtual walking environments in a controlled setting can improve functional benefits in individuals with chronic stroke and potentially reduce fall risk in real-world community and home environments. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT06557681?term=NCT06557681&rank=1, Identifier: NCT06557681.
引言：中风是全球长期残疾的主要原因。慢性中风幸存者存在步态和平衡障碍，限制了行动能力并增加了跌倒风险。跑步机训练可提高步行速度和耐力，但缺乏现实世界的适应性。基于虚拟现实（VR）的跑步机训练提供沉浸式、特定任务的练习，有可能改善在真实环境中的功能移动性。这项随机对照试验采用前瞻性、开放性、盲终点（PROBE）设计，旨在评估与传统物理治疗相比，基于VR的跑步机步态训练对慢性中风患者步态表现、功能移动性、平衡和步态对称性的影响。 方法：30名慢性中风患者被随机分配到虚拟现实跑步机训练（VTT）组或传统治疗（CT）组。两组均每周接受两次30分钟的传统治疗，共6周。VTT组每次使用C-Mill VR+系统额外进行30分钟的基于VR的跑步机训练，包括障碍物通过和速度调节。在干预前后评估10米步行测试（10MWT）、6分钟步行测试（6MWT）、起立行走测试（TUG）、动态步态指数（DGI）、功能性移动评估（POMA）、伯格平衡量表（BBS）、时空步态参数的不对称性以及压力中心（CoP）摆动速度。 结果：与CT组相比，VTT组在10MWT和6MWT期间的步行速度显著提高，站立和摆动持续时间的不对称指数值降低（P<0.05）。与CT组相比，VTT组的TUG测试时间、DGI值和POMA步态分量显著改善（P<0.05）。睁眼和串联站立条件下的BBS评分和CoP摆动速度也显著改善（P<0.05）。 结论：本研究表明，基于VR的跑步机步态训练可有效改善慢性中风患者的步态表现、功能移动性、平衡和步态对称性。因此，在受控环境中模拟多样化的虚拟步行环境可改善慢性中风患者的功能益处，并有可能降低在现实社区和家庭环境中的跌倒风险。 临床试验注册：https://clinicaltrials.gov/study/NCT06557681?term=NCT06557681&rank=1，标识符：NCT06557681。
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