Role of Virtual Reality in Improving Balance in Patients With Myelopathy
Role of Virtual Reality in Improving Balance in Patients With Myelopathy
Balance of the body is achieved by the coordination of three major systems, visual,
 vestibular and proprioceptive sensation and by the reflexive control of the limbs. In
 myelopathy, factors like balance and posture, range of motion, muscle strength, coordinated
 motor control, muscle tone and proprioception are affected. Balance and gait rehabilitation
 is an important goal in myelopathy. Virtual reality (VR) is a computer based technology that
 is used for task oriented biofeedback therapy in rehabilitation. This study was envisioned to
 observe the utility of VR in rehabilitation for improving balance in patients of myelopathy.
Balance of the body is achieved by the coordination of three major systems, visual,
 vestibular and proprioceptive sensation and by the reflexive control of the limbs. Static
 balance which determines the ability to maintain postural stability during sitting or
 standing is important to perform daily functional activities. Dynamic balance on the other
 hand is the ability to respond and adjust to a moving floor or any external stimuli or
 perturbation and is a requirement for successful gait performance.

 In myelopathy, factors like balance and posture, range of motion, muscle strength,
 coordinated motor control, muscle tone and proprioception are affected. Lack of normal
 postural synergy and sensory motor integration of lower limbs and trunks and spatial
 information that regulate upright position and sitting balance leads to balance dysfunction
 in the population. Hence patient develops compensatory strategies. But ambulation involves
 the intricate coordination of leg movements, regulating upright posture and balance and
 adaptation to environmental changes. Hence balance and gait rehabilitation is an important
 goal in myelopathy.

 Virtual reality (VR) is a computer based technology that is used for task oriented
 biofeedback therapy in rehabilitation. It constructs a virtual environment resembling a
 situation in the real world and provides multimodal sensory cues. VR ranges from non
 immersive to semi immersive to fully immersive, depending on the degree to which the user is
 isolated from the physical surroundings when interacting with the virtual environment.

 In virtual reality training, participants perform functional stretching of their extremities,
 learn postural control of the trunk and practice weight shifting. As the level of difficulty
 and speed are increased for various tasks, the movement of the body's center of gravity
 beyond the base of support increases thus increasing the proprioceptive sensations to the
 joints and improves the subject's ability to adjust balance. Hence it encourages dynamic
 motions and functional mobility. The VR environment can be controlled and manipulated in
 advance to fine tune the exercises and meet individual needs. It is interactive as well as
 enjoyable.

 Studies indicate that spinal reflex circuitry exhibits activity dependent plasticity (the
 capacity of the nervous system to modify its organization). Intensive task specific training
 is one of the most effective ways to promote neuroplasticity and develop more normalized
 movement patterns. VR uses this principle of neuroplasticity to promote motor relearning.
 Literature supports the use of VR as an effective rehabilitative tool in individuals with
 stroke, spinal cord injury, cerebral palsy, multiple sclerosis and other neurological
 disorders.

 There are few studies on balance rehabilitation in myelopathy from this part of the world.
 Due to absence of any guidelines, identifying the most suitable type of VR system, defining
 the most appropriate treatment dosing, timing and intensity of training for the therapeutic
 application is a challenge. This study was envisioned to observe the utility of VR in
 rehabilitation for improving balance in patients of myelopathy.
Inclusion Criteria:

 1. Patients with myelopathy with neurological level of injury below C4.

 2. Both traumatic and non-traumatic myelopathy.

 3. Duration of illness less than 6 months.

 Exclusion Criteria:

 1. Severe orthopedic or medical impairment that interfered with sitting.

 2. Upper limb muscle power <3/5.

 3. Cognitive or visual impairment.