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Author Response

Chang-Yi Yen, Kwan-Hwa Lin, Ming-Hsia Hu, Ruey-Meei Wu, Tung-Wu Lu, Chia-Hwa Lin
DOI: 10.2522/ptj.20100050.ar Published 1 June 2011
Chang-Yi Yen
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Kwan-Hwa Lin
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Ming-Hsia Hu
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Ruey-Meei Wu
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Tung-Wu Lu
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Chia-Hwa Lin
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The commentary by Deutsch et al1 focuses on the strengths and weaknesses of virtual reality (VR)–augmented therapy in our study.2 Their invaluable suggestions about VR applications for balance and mobility training are highly appreciated. Mirelman et al3 trained people with Parkinson disease (PD) using treadmill plus VR training for about 40 minutes per session, 3 sessions per week, for 6 weeks, and we agree that our training dosage was low. However, in their study of people with stroke, Yang et al4 used treadmill plus VR training for 20 minutes per session, 3 sessions per week, over a 3-week period. Thus, in VR training in neurological rehabilitation, the session lengths and numbers and training periods vary widely.5

As mentioned in the commentary, a head-mounted display can deliver a virtual task matched with an identical real-world task. However, flatscreen VR also is recommended for older adults to prevent cybersickness and restricted movement of head.6 Because dynamic balance training on a tilting board is challenging, flatscreen VR was used in our study. The participants were satisfied with this VR setting and did not complain of dizziness during dynamic balance training.

In terms of the number of movement repetitions and exposures to the exercise, we controlled the duration instead of repetitions of exercise in both the VR-augmented balance training group and the conventional balance training group. Future studies are suggested to quantify the movement repetitions during training. Reassessing the speed threshold setting once a week for treadmill training is a good guideline for intensity adjustment.3 We have designed the assessment of maximal weight shift in 4 directions in our VR programs, but it was not sensitive enough to detect the minor changes for monitoring the difficulty of progression. In our study, the platform sensitivity and movement direction were adjusted every week by the error of performance shown on the screen and the self-perceived exertion of the participants. Deutsch et al suggested adding more cognitive training for fall-risk reduction, so that attention strategy, such as traffic auditory distraction and traffic light recognition, would be considered in future design of VR balance training with dual tasks.7,8

  • © 2011 American Physical Therapy Association

References

  1. ↵
    1. Deutsch JE,
    2. Mirelman A,
    3. Hausdorff JM
    . Invited commentary on “Effects of virtual reality–augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial.” Phys Ther. 2011;91:875–877.
    OpenUrlFREE Full Text
  2. ↵
    1. Yen C-Y,
    2. Lin K-H,
    3. Hu M-H,
    4. et al
    . Effects of virtual reality–augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial. Phys Ther. 2011;91:862–874.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Mirelman A,
    2. Maidan I,
    3. Herman T,
    4. et al
    . Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? J Gerontol A Biol Sci Med Sci. 2011;66:234–240.
    OpenUrlPubMed
  4. ↵
    1. Yang YR,
    2. Tsai MP,
    3. Chung TY,
    4. et al
    . Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Gait Posture. 2008;28:201–206.
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    1. Crosbie JH,
    2. Lennon S,
    3. Basford JR,
    4. McDonough SM
    . Virtual reality in stroke rehabilitation: still more virtual than real. Disabil Rehabil. 2007;29:1139–1146.
    OpenUrlCrossRefPubMedWeb of Science
  6. ↵
    1. Sveistrup H,
    2. Thornton M,
    3. Bryanton C,
    4. et al
    . Outcomes of intervention programs using flatscreen virtual reality. In: Proceedings of the 26th Annual International Conference of the IEEE EMBS; September 1–5, 2004; San Francisco, California.
  7. ↵
    1. Cunnington R,
    2. Iansek R,
    3. Bradshaw JL
    . Movement-related potentials in Parkinson's disease: external cues and attentional strategy. Mov Disord. 1999;14:63–68.
    OpenUrlCrossRefPubMedWeb of Science
  8. ↵
    1. Ma HI,
    2. Hwang WJ,
    3. Lin KC
    . The effects of two different auditory stimuli on functional arm movement in persons with Parkinson's disease: a dual-task paradigm. Clin Rehabil. 2009;23:229–237.
    OpenUrlAbstract/FREE Full Text
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Vol 96 Issue 12 Table of Contents
Physical Therapy: 96 (12)

Issue highlights

  • Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes
  • Physical Therapist–Led Ambulatory Rehabilitation for Patients Receiving CentriMag Short-Term Ventricular Assist Device Support: Retrospective Case Series
  • Education Research in Physical Therapy: Visions of the Possible
  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation
  • Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
  • Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation
  • Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis
  • Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease
  • Measurement Properties of Instruments for Measuring of Lymphedema: Systematic Review
  • myMoves Program: Feasibility and Acceptability Study of a Remotely Delivered Self-Management Program for Increasing Physical Activity Among Adults With Acquired Brain Injury Living in the Community
  • Application of Intervention Mapping to the Development of a Complex Physical Therapist Intervention
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Author Response
Chang-Yi Yen, Kwan-Hwa Lin, Ming-Hsia Hu, Ruey-Meei Wu, Tung-Wu Lu, Chia-Hwa Lin
Physical Therapy Jun 2011, 91 (6) 877-878; DOI: 10.2522/ptj.20100050.ar

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Author Response
Chang-Yi Yen, Kwan-Hwa Lin, Ming-Hsia Hu, Ruey-Meei Wu, Tung-Wu Lu, Chia-Hwa Lin
Physical Therapy Jun 2011, 91 (6) 877-878; DOI: 10.2522/ptj.20100050.ar
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  • Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease
  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
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