The effect of virtual reality-based treadmill gait training on functional mobility and balance in chronic stroke patients: A randomized controlled trial

Seung-Hyeon Han¹Hyeon Ju Jang¹Jong Weon Lee^1,2Jin Woong Cheong³Young Dae Kim⁴HYO SUK NAM⁴Deog Young Kim^1,2*

• ¹Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea, Seoul, Republic of Korea
• ²Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea, Seoul, Republic of Korea
• ³Department of Physical Therapy, Severance Rehabilitation Hospital, Seoul, Republic of Korea, Seoul, Republic of Korea
• ⁴Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea, Seoul, Republic of Korea

Stroke is a leading cause of long-term disability worldwide. Chronic stroke survivors experience gait and balance impairments, limiting mobility and increasing fall risk. Treadmill training improves walking speed and endurance but lacks real-world adaptability. Virtual reality (VR)-based treadmill training offers immersive, task-specific practice, potentially improving functional mobility in real environments. This randomized controlled trial, using a prospective, open, blinded end-point (PROBE) design, aimed to evaluate the effects of VR-based treadmill gait training on gait performance, functional mobility, balance, and gait symmetry compared with conventional physical therapy in individuals with chronic stroke.Methods: Thirty chronic stroke patients were randomly assigned to virtual reality treadmill training (VTT) or conventional therapy (CT) groups. Both groups received 30 minutes of conventional therapy twice weekly for 6 weeks. The VTT group received an additional 30 minutes of VR-based treadmill training per session using the C-Mill VR+ system, including obstacle negotiation and velocity modulation. The 10-meter walk test (10MWT), 6-minute walk test (6MWT), Timed Up and Go (TUG) test, Dynamic Gait Index (DGI), Performance-Oriented Mobility Assessment (POMA), Berg Balance Scale (BBS), asymmetry of spatiotemporal gait parameters, and center of pressure (CoP) sway velocity were assessed pre-and post-intervention.Results: Walking speed during the 10MWT and the 6MWT significantly increased in the VTT group compared to the CT group, and asymmetric index values for stance and swing duration decreased (p < 0.05). TUG test time, DGI values, and the POMA gait component were significantly improved in the VTT group compared to the CT group (p < 0.05). BBS scores and CoP sway velocity for eyes open and tandem stance conditions also significantly improved (p < 0.05).This study demonstrated that VR-based treadmill gait training effectively improved gait performance, functional mobility, balance, and gait symmetry in chronic stroke patients. Thus, simulating diverse virtual walking environments in a controlled setting can improve functional benefits in individuals with chronic stroke and potentially reduce fall risk in real-world community and home environments.