Effects of Stepping Training With Reduced Visual Cues in a Virtual Environment in Chronic Stroke Patients: A Randomized Controlled Trial
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: BACKGROUND After stroke, the ability to place the foot properly in standing and during stepping could be affected. It is not clear if targeted foot placement (stepping) training with reduced on-line visual cues would lead to better foot placement ability. Objective: This study aimed to determine if a virtual reality targeted stepping training with reduced on-line visual cues about the foot or target would be superior to the same training with full visual cues for persons with chronic stroke. OBJECTIVE This study aimed to determine if a virtual reality targeted stepping training with reduced on-line visual cues about the foot or target would be superior to the same training with full visual cues for persons with chronic stroke. METHODS Persons with chronic stroke were randomly assigned to either a control (CON) or an experimental group (EXP) to receive stepping training. The training included targeted foot placement in sitting and standing in a total immersive virtual reality environment. The images of the feet and target were presented in all the trials for CON, but partly or completely removed for EXP during training. The outcome measures included walking speed and gait symmetry ratio during preferred speed level walking, error distance and variation during targeted stepping, and toe clearance and landing distance during obstacle crossing stepping. A motion analysis system was used to record the task performance. RESULTS Each group had 19 participants. For preferred speed walking, there were no significant between- or within-group differences. For targeted stepping, EXP significantly reduced the unaffected limb error distance in poste-test (p=0.013), but not CON (p=0.238). For obstacle crossing stepping, when the unaffected limb led, EXP significantly reLess on-line visual cues during stepping training in a total immersive VR environment resulted in better training effects. This type of training may be considered to be included in stroke rehabilitation. The design of VR training programs for stroke rehabilitation may need to carefully consider the amount of visual cues providCliniclTrials.ed.duced the affected side landing distance in poste-test (p=0.001), but not CON (p=0.409). CONCLUSIONS Less on-line visual cues during stepping training in a total immersive VR environment resulted in better training effects. This type of training may be considered to be included in stroke rehabilitation. The design of VR training programs for stroke rehabilitation may need to carefully consider the amount of visual cues provided. CLINICALTRIAL ClinicalTrials.gov Protocol Registration: trial number NCT04436237
DOI: 10.5535/arm.260003
Authors: Pei-Yun Lee, Meng-Ru Tsai, Hsien-Chang Wang, Chih-Hung Chen, Hui-Yu Tseng, Sang-I Lin
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $153
OpenAlex ID: W4410332458