An Ankle to Computer Virtual Reality System for Improving Gait and Function in a Person 9 Months Poststroke

Background and Purpose: Repetitive practice improves function and facilitates cortical plasticity after stroke. Virtual reality (VR) systems have the potential to provide motivating and safe repetitive practice with minimal supervision. The purpose of this case study is to look at the effect of a VR system, activated by surface electromyography of dorsiflexors and plantarflexors, on gait velocity, function, and kinematics. Method: The first person randomized to the treatment group of a larger study was chosen for this case. She was 51 years old and 9 months poststroke. She received treatment 3 times per week for 8 weeks. Each 60-minute session consisted of both structured lower extremity exercise and VR ankle activities. Results: After intervention, the subject demonstrated increased gait speed and decreased time to perform the modified Emory Functional Ambulation Profile. Gait kinematics demonstrated improved ankle motion and plantarflexion moments at push off. Discussion: The improved gait speed, possibly due to increased ankle plantarflexion motion and moments, resulted in a more normalized trailing limb posture. This case study suggests that ankle to computer VR systems may help stroke patients improve gait function. This VR system has potential as an adjunctive therapy or home program requiring minimal supervision.