Virtual reality: more than just a game by Adam Booth


“The GRAIL: gait lab of the future. Immersive and interactive virtual reality environments with real-time analysis of walking may be the next step forward in rehabilitation”. Credits: Motekforce Link


We may be within reach of a revolution in rehabilitation. It can be considered the culmination of advances in computing, engineering and medicine. It is virtual reality and it is more than just a game. With advancements in technology the potential of virtual reality to advance rehabilitation may be limited only by imagination. For many patients, rehabilitation for lifelong disability, or after injury, is a repetitive necessity that reminds them of their limitation. With virtual reality it is possible to provide patients with experiences that would not be conceivable in current rehabilitation; walking on a rickety rope bridge between cliff tops, skiing down a mountain, or simply walking down a bustling New York street in a safe, controlled environment. The expansion of virtual reality and the exploration of ‘exergaming’ – where movement controls the actions of the game – may be of particular benefit to children undertaking a long rehabilitation journey.


Some of these children that may benefit the most are those with cerebral palsy. Cerebral palsy is the most common cause of childhood physical disability. Caused by brain injury during pregnancy, or shortly after birth, it impacts the control of muscles and movement. Brain injuries are complex and may result in a range of developmental problems. However, almost all children have difficulty learning to walk. We often consider walking to be a simple action we do not even need to think about. In reality, walking is a complex movement, requiring precise co-ordination of muscles, learned and perfected over years in early childhood. This complexity is evident when anything disrupts the normal walking pattern, even as small as a sprained muscle or stone in your shoe.


While there is no cure for cerebral palsy, the condition may deteriorate without treatment, indeed correct treatment may improve walking ability. Due to the complexity of brain injury and walking, one of the major problems for doctors is to establish the correct treatment plan. This may include surgery or targeted physiotherapy. One tool that doctors may use to help them in this is Clinical Gait Analysis. This is a way of measuring how a person walks. It works using motion capture, similar to that used in films and animation. Small reflective markers are attached at specific points on the body and special infra-red camera tracks the movements of the body in a precise manor. This can give the angles and forces at joints in the body that help identify exactly where the problem lies.


The GRAIL is an advanced rehabilitation tool that allows for walking on a force sensing treadmill to provide a comprehensive analysis of gait. This information is integrated in real-time with an immersive virtual reality screen. One common problem in cerebral palsy is an inability to extend the knee and hip during walking, causing children to walk in a slight crouch. In recent studies it has been shown that children can significantly improve hip and knee motion with feedback. At the VU medical center, Amsterdam, research is progressing to see if children can improve other key aspects of walking, such as step length and ankle power generation. Children visualise themselves as a puppet and personalised feedback on how to improve their walking is given, with rewards and scores to encourage them. Unexpectedly children show good adaptability in a number of key aspects of walking. This leads to the question why they do not walk this way in everyday life; with further analysis this could help to unravel the complexities of walking. It also offers an opportunity for an engaging form of targeted physiotherapy; with feedback children may be able to improve walking ability with benefits to everyday life. Further research is needed to prove this, but with ever advancing technology, virtual reality is shifting rehabilitation as we have known it.