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      A Fully-Immersive Virtual Reality Setup to Study Gait Modulation

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          Abstract

          Objective: Gait adaptation to environmental challenges is fundamental for independent and safe community ambulation. The possibility of precisely studying gait modulation using standardized protocols of gait analysis closely resembling everyday life scenarios is still an unmet need.

          Methods: We have developed a fully-immersive virtual reality (VR) environment where subjects have to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. We collected kinematic data of 12 healthy young subjects walking in real world (RW) and in the VR environment, both with (VR/A+) and without (VR/A-) the VA perturbation. The VR environment closely resembled the RW scenario of the gait laboratory. To ensure standardization of the obstacle presentation the starting time speed and trajectory of the VA were defined using the kinematics of the participant as detected online during each walking trial.

          Results: We did not observe kinematic differences between walking in RW and VR/A-, suggesting that our VR environment per se might not induce significant changes in the locomotor pattern. When facing the VA all subjects consistently reduced stride length and velocity while increasing stride duration. Trunk inclination and mediolateral trajectory deviation also facilitated avoidance of the obstacle.

          Conclusions: This proof-of-concept study shows that our VR/A+ paradigm effectively induced a timely gait modulation in a standardized immersive and realistic scenario. This protocol could be a powerful research tool to study gait modulation and its derangements in relation to aging and clinical conditions.

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          Most cited references66

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          World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

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            Simulator Sickness Questionnaire: An Enhanced Method for Quantifying Simulator Sickness

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              A multifactorial intervention to reduce the risk of falling among elderly people living in the community.

              Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.
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                Author and article information

                Contributors
                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                23 March 2022
                2022
                : 16
                : 783452
                Affiliations
                [1] 1Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg , Würzburg, Germany
                [2] 2Human-Computer Interaction, Julius Maximilian University of Würzburg , Würzburg, Germany
                [3] 3Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa , Genova, Italy
                [4] 4Parkinson Institute Milan, ASST Pini-CTO , Milano, Italy
                Author notes

                Edited by: Kiros Karamanidis, London South Bank University, United Kingdom

                Reviewed by: Omar Janeh, University of Technology, Iraq, Iraq; Christopher McCrum, Maastricht University, Netherlands

                *Correspondence: Chiara Palmisano Palmisano_C@ 123456ukw.de

                Specialty section: This article was submitted to Motor Neuroscience, a section of the journal Frontiers in Human Neuroscience

                Article
                10.3389/fnhum.2022.783452
                8983870
                35399359
                e288852c-fbf0-4025-a433-961dae1f61b2
                Copyright © 2022 Palmisano, Kullmann, Hanafi, Verrecchia, Latoschik, Canessa, Fischbach and Isaias.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 September 2021
                : 03 February 2022
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 66, Pages: 10, Words: 7114
                Funding
                Funded by: Deutsche Forschungsgemeinschaft, doi 10.13039/501100001659;
                Funded by: Fondazione Grigioni per il Morbo di Parkinson, doi 10.13039/501100008591;
                Funded by: Deutscher Akademischer Austauschdienst, doi 10.13039/501100001655;
                Categories
                Human Neuroscience
                Original Research

                Neurosciences
                gait modulation,virtual reality,obstacle avoidance,gait analysis,kinematics
                Neurosciences
                gait modulation, virtual reality, obstacle avoidance, gait analysis, kinematics

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