Stroke
Conditions
Keywords
virtual reality, stationary cycling
Brief summary
The purpose of this study is to evaluate whether an intervention based on immersive virtual reality combined with stationary cycling, in addition to neurological physiotherapy, improves gait in individuals with stroke. The study will also assess the effects of this intervention on balance, coordination, motor function, muscle tone, and participants' and therapists' satisfaction. The main questions this study aims to answer are: * Does immersive virtual reality combined with stationary cycling improve gait compared with neurological physiotherapy alone? * Does this combined intervention improve balance, coordination, motor function, and muscle tone in individuals with stroke? * How do participants and therapists perceive the use of immersive virtual reality combined with stationary cycling during rehabilitation? Researchers will compare a program that combines immersive virtual reality and stationary cycling with neurological physiotherapy to a neurological physiotherapy program alone. Participants will: * Take part in two intervention periods, with a total of 16 sessions over 8 weeks (two sessions per week). * Receive intervention sessions that include immersive virtual reality combined with stationary cycling and neurological physiotherapy, or neurological physiotherapy alone, depending on the intervention period. * Complete assessments of gait, balance, and motor function at baseline, after the first intervention period, and after the second intervention period.
Interventions
OTHERNeurological Physiotherapy intervention (NP).
The Neurological Physiotherapy intervention (NP) will include 60-minute sessions structured into six therapeutic blocks: gait training; trunk control; balance, righting and stepping reactions; lower limb strengthening; stretching of the affected lower limb; and sensory stimulation of the affected foot. Each block will last approximately 5 to 15 minutes per session, depending on the individual needs of the participant.
DEVICEVirtual Reality Combined with Stationary Cycling intervention (VR-SC)
The Virtual Reality Combined with Stationary Cycling intervention (VR-SC) will include 15 to 30 minutes of immersive virtual reality using the HOLOFIT VR Fitness software combined with stationary cycling, in addition to 30 minutes of neurological physiotherapy intervention (NP). Due to the reduced time allocated to NP, each therapeutic block will last approximately 2 to 10 minutes per session, depending on the individual needs of the participant. The VR-SC intervention will be delivered in five phases with progressively increasing cycling intensity and will include three virtual reality game modes (Exploration, Cardiogoals, and Race). Exercise intensity will vary across phases based on heart rate (HR), measured using a pulse oximeter. Stationary cycling resistance will be adjusted to keep the participant's HR within a predefined percentage range of maximum heart rate (HRmax).
Sponsors
University of Cadiz
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Men and women aged 18 years or older with a medically documented diagnosis of hemorrhagic or ischemic stroke. * At least 6 months post-stroke. * Presence of hemiparesis. * Mild to moderate balance impairment, defined as a Berg Balance Scale score \< 50. * Gait impairment, defined as a Wisconsin Gait Scale score \> 20. * Preserved active movement in the lower limbs and ability to mount and remain seated on the stationary bicycle.
Exclusion criteria
* Severe cardiac conditions. * Visual or auditory impairments limiting the use of virtual reality head-mounted displays. * Medical history of epilepsy. * Severe attentional impairment or inability to cooperate with the study intervention. * Severe cognitive impairment and marked difficulties in comprehension. * Severe vestibular disorders and predisposition to dizziness or vomiting.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Qualitative Gait Assessment | The research team will conduct assessments at baseline, after the first intervention period (4 weeks after baseline), and after the second intervention period (12 weeks after baseline). | The outcome measures will include the Wisconsin Gait Scale (WGS) for qualitative gait assessment. The Wisconsin Gait Scale consists of 14 observable items that analyze gait components. Each item is scored from 1 (normal) to 3 (atypical), except for item 1 (scored from 1 to 5) and item 11 (scored from 1 to 4). Total scores range from 13.35 to 42, with higher scores indicating greater gait impairment. |
| Quantitative Gait Assessment | The research team will conduct assessments at baseline, after the first intervention period (4 weeks after baseline), and after the second intervention period (12 weeks after baseline). | The outcome measures will include the 6-Minute Walk Test (6MWT) for quantitative gait assessment. The 6-Minute Walk Test measures the total distance in meters that the participant can walk within six minutes. The test is performed on a 30-meter course marked by two cones, with a chair available for rest if needed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Balance | The research team will conduct assessments at baseline, after the first intervention period (4 weeks after baseline), and after the second intervention period (12 weeks after baseline). | The outcome measures will include the Berg Balance Scale (BBS). Scores range from 0 to 56, with lower scores indicating greater balance impairment. |
| Motor Function | The research team will conduct assessments at baseline, after the first intervention period (4 weeks after baseline), and after the second intervention period (12 weeks after baseline). | The outcome measures will include the Fulg-Meyer Lower Extremity (FM). This scale includes five domains. In this study, the motor function and coordination/speed domains of the lower extremity will be evaluated. Scores range from 0 to 34 points for the selected domains, with lower scores indicating greater motor function and coordination impairment. |
| Spasticity | The research team will conduct assessments at baseline, after the first intervention period (4 weeks after baseline), and after the second intervention period (12 weeks after baseline). | The outcome measures will include the Modified Ashworth Scale (MAS). The Modified Ashworth Scale measures resistance to passive muscle stretching on a 0 to 4 scale, where 0 indicates no increase in muscle tone and 4 indicates higher spasticity in flexion or extension. Spasticity assessment will focus on the hip adductors, hamstrings and triceps surae of the lower limb, as well as the pectoralis major, biceps brachii, and finger flexors of the upper limb. |
Outcome results
None listed