Effect of a virtual walking and therapeutic exercise‐based intervention on gait and balance in people with incomplete spinal cord injury

BACKGROUND: People with spinal cord injury (SCI) experience sensory and motor impairments that often require exercise-based treatments. However, these interventions are challenging due to limited active mobility. Novel rehabilitation approaches, such as those targeting the mirror neuron system, could offer additional benefits. OBJECTIVE: To assess the effect of combining virtual walking (VW) therapy with a therapeutic physical exercise (PE) program compared to PE alone on gait and balance in people with incomplete SCI. DESIGN: Single-blinded randomized controlled trial. SETTING: Exercise laboratory. PATIENTS: Thirty-eight people with chronic incomplete SCI. INTERVENTIONS: Participants were randomized to two groups: (1) experimental intervention (EI): VW combined with PE or (2) control intervention (CI): placebo VW combined with PE. Both groups performed 18 sessions over 6 weeks (3 sessions/week). MAIN OUTCOME MEASURES: Gait performance (assessed by the 10 Meter Walk Test [10MWT, primary outcome], Walking Index for SCI [WISCI], and Center of Mass [CoM] movement during the modified Timed Up and Go test) were assessed. Moreover, static balance (assessed by CoM movement in the standing position) and dynamic balance (assessed by CoM movement during turning, sitting, and getting up tasks) were also evaluated. The assessments were performed before (T1) and after (T2) the intervention and at 4- (T3) and 12-week (T4) follow-up. The assessment points were compared through a mixed factorial analysis of variance. RESULTS: The EI group reduced the time to perform 10MWT at T2 (-36.5%, p < .05), T3 (-42.6%, p < .05), and T4 (-42.1%, p < .05), the total time to execute the modified Timed Up and Go at T3 (-18.5%, p < .05) and CoM movement during standing position at T2 (-56.1%, p < .05) and T3 (-54.1%, p < .05). The EI group also improved time to standing up at T3 (-34.9%, p < .05) and smoothness at T2 (34.8%, p < .05), and time to sitting down at T3 (-43.1%, p < .05). By contrast, the CI group improved balance only at T2 (-13.0%, p < .05), without maintaining the improvement at T3 and T4, and time to standing up at T3 (-28.8%, p < .05). No significant improvement in gait was demonstrated. CONCLUSIONS: Adding a VW intervention to a PE program could improve gait and balance in people with incomplete SCI.