What you need to know
Treadmills
The treadmills discussed here often do not differ from those available to the public at gyms and other fitness stores. In the physiotherapy setting they may be used in gait analysis and rehabilitation for a wide variety of conditions and presentations.
Some models of treadmill come with in-built computer screens that can track objective measures such as distance travelled, speed, approximate calories burnt and heart rate. They may also contain more sophisticated features that allow it connect to laptops and tablets or even the internet. It is this ability that allows the utilisation of virtual reality. Playing footage of walking trails or every day situations while walking on a treadmill may help to motivate an individual to better engage in their training. Additionally, adding obstacles or dual tasks in these videos may encourage a patient to react more appropriately to these types of situations in the real world in order to prepare them for re-entry to the community.
Intended Patient Population
As mentioned before, most models of treadmill are not designed specifically to aid in the rehabilitation of neurological conditions. However, this is not true of all models.
Motek, a company from The Netherlands, have created GRAIL (Gait Real Time Analysis Lab), a treadmill designed to assist in the analysis and training of gait in orthopaedic and neurological populations. As part of GRAIL are projected screens in front of the treadmill that allow for patients to be immersed in virtual environments. For more information on GRAIL, please click here. A similar treadmill to GRAIL is also made by Motek, called CAREN (Computer Assisted Rehabilitation ENvironment) which focuses more on balance rehabilitation than gait rehabilitation through providing 3D visual, sound, and proprioceptive stimuli. More info can be found through the same link as above by clicking on the products tab.
Though a lack of focus toward specific conditions exists, evidence for the use of treadmills + VR indicate its use in the following conditions:
Evidence
Stroke
Iruthayarajah et al., 2017
SR + Meta Analysis of 20 papers
Deficits Targeted: Static and dynamic balance
Included papers featuring virtual reality + treadmill training:
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Kim, Park, & Lee, 2015
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Technology: Treadmill + VR walking video
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Deficits Targeted: Static balance
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Cho et al., 2014
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RCT PEDro: 7/10
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Technology: Treadmill + VR walking track (sunny, rainy, objects)
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Deficits Targeted: Static/dynamic balance and gait
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Cho and Lee., 2013
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RCT PEDro: 7/10
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Technology: Treadmill + real world video recording of walking
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Deficits Targeted: Static/dynamic balance and gait
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Kang et al., 2012
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RCT PEDro: 6/10
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Technology: Treadmill + speed modulated optic flow (video)
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Deficits Targeted: Dynamic balance and gait
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Jung et al., 2012
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RCT PEDro: 7/10
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Technology: Treadmill + video on a head mounted device
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Deficits Targeted: Dynamic balance
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RCT PEDro: 5/10
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Technology: Treadmill with partial weight bearing harness + video comparison of normal gait to patient gait on a head mounted device
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Deficits Targeted: Strength, static/dynamic balance
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Improving balance skills in patients who had stroke through virtual reality treadmill training.
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Yang et al., 2011
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PEDro: 7/10
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Technology: Treadmill + VR walking video
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Deficits Targeted: Static balance
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Kalron, Fonkatz, Frid, Baransi, & Achiron., 2016
RCT PEDro: 7/10
Technology: CAREN + Projected road environment
Deficits Targeted: Static and dynamic balance
Kim, Lee, Kim, & Min., 2016
RCT PEDro: 7/10
Technology: Treadmill + VR simumlated environment
Deficits Targeted: Dynamic balance and gait
Kim, Choi, Lee, & Song., 2015
RCT PEDro: 6/10
Technology: Treadmill + VR supermarket to encourage dual tasking
Deficits Targeted: Gait parameters in single and dual task environments
Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients
Cho, Kim, Lee, & Lee., 2015
RCT PEDro: 7/10
Technology: Treadmill + VR crosswalk, garden, and marketplace with additional tasks
Deficits Targeted: Gait parameters in single and dual task environments
Rodrigues-Baroni, Nascimento, Ada, & Teixeira-Salmela., 2014
SR + Meta Analysis of 7 papers
Deficits Targeted: Walking speed
Included papers featuring virtual reality + treadmill training that are not featured in other SR:
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Stepping over obstacles to improve walking in individuals with poststroke hemiplegia
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Jaffe et al., 2004
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RCT PEDro: 4/10
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Technology: Treadmill + head mounted display to show obstacles to step over
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Deficits Targeted: Gait parameters
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Yang et al., 2008
RCT PEDro: 6/10
Technology: Treadmill + images projected in front of the patients
Deficits Targeted: Dynamic balance and community walking + parameters
Multiple Sclerosis
Peruzzi et al., 2017
RCT PEDro: 5/10
Technology: Treadmill + VR walking trails involing object passing and map following
Deficits Targeted: Static/dynamic balance, gait parameters
Population: Patients with mild or moderate multiple sclerosis
Parkinson's Disease
Mirelman et al., 2016
Multi-Centre RCT PEDro 8/10
Technology: Treadmill + VR that contained obstacles, multiple pathways, and distractors. Patients feet were also video taped and played in real time alongside the VR
Deficits Targeted: Falls incidence, as well as gait parameters in a laboratory setting
Cerebral Palsy
Cho, Huang, Huang, & Chung., 2016
RCT PEDro: 6/10
Technology: Treadmill + Nintendo Wii Fit Plus jogging program
Deficits Targeted: Strength, motor function, balance and gait
Additional Reading:
Non-RCT studies exist that study the addition of VR to treadmill training. This study utilises unique technology in an extremely variable population. Therefore, its inclusion is purely for interest.
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Uses GRAIL
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Interested?
Treadmills are available from a wide variety of fitness stores, both online and in retail stores. They vary in price from several hundred dollars to several thousand depending on features. This does not factor in the additional costs of the electronics required to implement the virtual reality components discussed above. As such, giving a price estimate for the start-up cost for this intervention is not feasible. If a particular study interests you, please click the link to learn more about their setup if you wish to replicate or approximate it.
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