ABSTRACT
The Gait Deviation Index (GDI) is a multivariate measure of overall gait pathology based on 15 gait features derived from three-dimensional (3D) kinematic data. GDI aims at providing a comprehensive, easy to interpret, and clinically meaningful metric of overall gait function. It has been used as an outcome measure to study gait in several conditions: cerebral palsy (CP), post-stroke hemiparetic gait, Duchenne muscular dystrophy, and Parkinson's disease, among others. Nevertheless, its use in population with Spinal Cord Injury (SCI) has not been studied yet. The aim of the present study was to investigate the applicability of the GDI to SCI through the assessment of the relationship of the GDI with the Walking Index for Spinal Cord Injury (WISCI) II. 3D gait kinematics of 34 patients with incomplete SCI (iSCI) was obtained. Besides, 3D gait kinematics of a sample of 50 healthy volunteers (HV) was also gathered with Codamotion motion capture system. A total of 302 (iSCI) and 446 (HV) strides were collected. GDI was calculated for each stride and grouped for each WISCI II level. HV data were analyzed as an additional set. Normal distribution for each group was assessed with Kolmogorov-Smirnov tests. Afterward, ANOVA tests were performed between each pair of WISCI II levels to identify differences among groups (p < 0.05). The results showed that the GDI was normally distributed across all WISCI II levels in both iSCI and HV groups. Furthermore, our results showed an increasing relationship between the GDI values and WISCI II levels in subjects with iSCI, but only discriminative in WISCI II levels 13, 19, and 20. The index successfully distinguished HV group from all the individuals with iSCI. Findings of this study indicated that the GDI is not an appropriate multivariate walking metric to represent the deviation of gait pattern in adult population with iSCI from a normal gait profile when it is compared with the levels of walking impairment described by the WISCI II. Future work should aim at defining and validating an overall gait index derived from 3D kinematic gait variables appropriate for SCI, additionally taking into account other walking ability outcome measures.
ABSTRACT
Introducción. La realidad virtual permite al usuario interactuar con elementos dentro de un escenario simulado. Recientemente, estamos asistiendo a la introducción de dispositivos basados en realidad virtual como una de las novedades más relevantes en la neurorrehabilitación. Objetivo. Revisar las aplicaciones clínicas de los desarrollos basados en realidad virtual para el tratamiento neurorrehabilitador de los procesos discapacitantes de origen neurológico más habituales en sus aspectos motores. Desarrollo. Se revisaron las bases de datos Medline, Physiotherapy Evidence Database, Ovid y la Biblioteca Cochrane hasta abril de 2009. Se completó con una búsqueda en la web a través de Google. Todavía no se ha podido identificar ningúnensayo clínico sobre su eficacia. La información recogida se basa en la descripción de los distintos prototipos efectuada por los respectivos grupos que han participado en su desarrollo. En la mayor parte de los casos, se trata de experiencias clínicas con un número reducido de pacientes, que se han encaminado más bien a comprobar el buen funcionamiento y validez del dispositivo que a demostrar su eficacia clínica. Aunque la mayoría de las aplicaciones clínicas se refieren a pacientes con ictus, también se han encontrado aplicaciones para pacientes con lesión medular, esclerosis múltiple, enfermedad de Parkinson o alteraciones del equilibrio. Conclusiones. La realidad virtual se presenta como una herramienta novedosa y de gran proyección en la neurorrehabilitación. Son necesarios estudios futuros que avalen su eficacia clínica frente a las técnicas tradicionales (AU)
Introduction. Virtual reality allows the user to interact with elements within a simulated scene. In recent times we have been witness to the introduction of virtual reality-based devices as one of the most significant novelties in neurorehabilitation. Aim. To review the clinical applications of the developments based on virtual reality for the neurorehabilitation treatment of the motor aspects of the most frequent disabling processes with a neurological origin. Development. A review was carried out of the Medline, Physiotherapy Evidence Database, Ovid and Cochrane Library databases up until April 2009. This was completed with a web search using Google. No clinical trial conducted on its effectiveness has been found to date. The information that was collected is based on the description of the various prototypes produced by the different groups involved in their development. In most cases they are clinical trials conducted with a small number of patients, which have focused more on testing the validity of the device and checking whether it works correctly than on attempting to prove its clinical effectiveness. Although most of the clinical applications refer to patients with stroke, there were also several applications for patients with spinal cord injuries, multiple sclerosis, Parkinsons disease or balance disorders. Conclusions. Virtual reality is a novel tool with a promising future in neurorehabilitation. Further studies are needed to demonstrate its clinical effectiveness as compared to the traditional techniques (AU)
