Centre of pressure displacements produced in sitting during virtual reality training in younger and older adults and patients who have had a stroke

Abstract

Purpose: Poor sitting balance is common after stroke and makes leaning and reaching while sitting difficult and dangerous. Virtual reality training (VRT) uses computer hardware and software to track a person’s movements and allow him or her to interact with a virtual environment. VRT games are available to train sitting balance after stroke; however, it is unknown how challenging they are. The objectives of this study were to characterize the centre of pressure displacements generated during the performance of VRT in stroke patients (ST) and compare their performance to that of young (YA) and older adults (OA).

Materials and Methods: Eight ST participants who could stand for at least four minutes were recruited from an inpatient stroke rehabilitation unit for this cross-sectional, observational pilot study. Eight YA and eight OA were recruited from the community. Participants sat on a pressure mat and played 17 VRT game/difficulty combinations. The area, range and average velocity of centre of pressure displacement were determined for each game/difficulty.

Results: Virtually manoeuvring a motorcycle around barriers and leaning to move a ball down a maze produced the greatest displacement of the centre of pressure, particularly in the mediolateral direction. OA moved further and faster in the mediolateral direction than YA. ST’s performance was more variable.

Conclusions: Some VRT games were more likely to push participants to challenge their limits of stability. Others required less displacement but more trunk stability. These results can guide which VRT games are used for the rehabilitation of sitting balance after stroke.

Implications for rehabilitation

• Some virtual reality training games produce greater displacements of the centre of pressure in sitting than others, suggesting that careful matching between game challenge and desired therapeutic outcome is necessary when selecting games.

• Virtual reality training performed in sitting with feet on the floor challenges sitting balance in the frontal plane more so than in the sagittal plane.

• Older adults tend to lean more than younger adults while individuals with stroke move more or less than others, depending on the game.

Keywords:

• Centre of pressure
• virtual reality
• stroke
• rehabilitation
• sitting position
• postural control

Ackowledgements

The authors would like to thank all of our participants and the clinical staff on the inpatient stroke unit at Élisabeth Bruyère Hospital.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data

Data are available from the authors upon reasonable request.

Additional information

Funding

This work was supported by a grant-in-aid from the Heart and Stroke Foundation of Canada under Grant G-14–0005830, and by a generous personal donation from Tony & Elizabeth Graham.