Gait patterns during overground and virtual omnidirectional treadmill walking.

BACKGROUND: Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults. METHODS: Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture. RESULTS: Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail. CONCLUSION: Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.

Development of the Troop Readiness Evaluation With Augmented Reality Return-to-Duty (Troop READY) Platform to Aid in the Detection and Treatment of Military Mild Traumatic Brain Injury.

INTRODUCTION: Mild traumatic brain injury (mTBI) is prevalent in service members (SMs); however, there is a lack of consensus on the appropriate approach to return to duty (RTD). Head-mounted augmented reality technology, such as the HoloLens 2, can create immersive, salient environments to more effectively evaluate relevant military task performance. The Troop Readiness Evaluation with Augmented Reality Return-to-Duty (READY) platform was developed to objectively quantify cognitive and motor performance during military-specific activities to create a comprehensive approach to aid in mTBI detection and facilitate appropriate RTD. The aim of this project was to detail the technical development of the Troop READY platform, the outcomes, and its potential role in the aiding detection and RTD decision-making post mTBI. The secondary aim included evaluating the safety, feasibility, and SM usability of the Troop READY platform. MATERIALS AND METHODS: The Troop READY platform comprises three assessment modules of progressing complexity: (1) Static and Dynamic Mobility, (2) Rifle Qualification Test, and (3) Small Unit Operations Capacity-Room Breach/Clearing Exercise. The modules were completed by 137 active duty SMs. Safety was assessed through monitoring of adverse events. Feasibility was assessed using the self-directed module completion rate. Usability was measured using the Systems Usability Scale. RESULTS: No adverse events occurred. Completion rates of the three modules ranged from 98 to 100%. In terms of usability, the mean Systems Usability Scale score of all participants was 83.92 (13.95), placing the Troop READY platform in the good-to-excellent category. Objective motor and cognitive outcomes were generated for each module. CONCLUSION: The Troop READY platform delivers self-directed, salient assessment modules to quantify single-task, dual-task, and unit-based performance in SMs. The resultant data provide insight into SM performance through objective outcomes and identify specific areas of executive or motor function that may be slow to recover following mTBI.

Digitizing a Therapeutic: Development of an Augmented Reality Dual-Task Training Platform for Parkinson's Disease.

Augmented reality (AR) may be a useful tool for the delivery of dual-task training. This manuscript details the development of the Dual-task Augmented Reality Treatment (DART) platform for individuals with Parkinson's disease (PD) and reports initial feasibility, usability, and efficacy of the DART platform in provoking dual-task interference in individuals with PD. The DART platform utilizes the head-mounted Microsoft HoloLens2 AR device to deliver concurrent motor and cognitive tasks. Biomechanical metrics of gait and cognitive responses are automatically computed and provided to the supervising clinician. To assess feasibility, individuals with PD (N = 48) completed a bout of single-task and dual-task walking using the DART platform. Usability was assessed by the System Usability Scale (SUS). Dual-task interference was assessed by comparing single-task walking and walking during an obstacle course while performing a cognitive task. Average gait velocity decreased from 1.06 to 0.82 m/s from single- to dual-task conditions. Mean SUS scores were 81.3 (11.3), which placed the DART in the "good" to "excellent" category. To our knowledge, the DART platform is the first to use a head-mounted AR system to deliver a dual-task paradigm and simultaneously provide biomechanical data that characterize cognitive and motor performance. Individuals with PD were able to successfully use the DART platform with satisfaction, and dual-task interference was provoked. The DART platform should be investigated as a platform to treat dual-task declines associated with PD.

The Immersive Cleveland Clinic Virtual Reality Shopping Platform for the Assessment of Instrumental Activities of Daily Living.

A decline in the performance of instrumental activities of daily living (IADLs) has been proposed as a prodromal marker of neurological disease. Existing clinical and performance-based IADL assessments are not feasible for integration into clinical medicine. Virtual reality (VR) is a powerful yet underutilized tool that could advance the diagnosis and treatment of neurological disease. An impediment to the adoption and scaling of VR in clinical neurology is VR-related sickness resulting from sensory inconsistencies between the visual and vestibular systems (i.e., locomotion problem). The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform attempts to solve the locomotion problem by coupling an omnidirectional treadmill with high-resolution VR content, enabling the user to physically navigate a virtual grocery store to simulate shopping. The CC-VRS consists of Basic and Complex shopping experiences; both require walking 150 m and retrieving five items. The Complex experience has additional scenarios that increase the cognitive and motor demands of the task to better represent the continuum of activities associated with real-world shopping. The CC-VRS platform provides objective and quantitative biomechanical and cognitive outcomes related to the user's IADL performance. Initial data indicate that the CC-VRS results in minimal VR-sickness and is feasible and tolerable for older adults and patients with Parkinson's disease (PD). The considerations underlying the development, design, and hardware and software technology are reviewed, and initial models of integration into primary care and neurology are provided.