JMIR Publications

ABSTRACT

Background:

Complex movement pathologies that are biopsychosocial in nature (e.g., back pain) require a multi-dimensional approach to effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic targets to be interacted with. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments.

Objective:

Compare lumbar kinematics (i.e., excursion and velocity) across our previous, and newly developed virtual reality tools in a healthy control cohort.

Methods:

Thirty-one healthy participants (16 male/15 female) took part in three gamified virtual reality therapies (i.e., Reachality, Fishality, and Dodgeality), while whole-body three-dimensional kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task, and between the four anthropometrically-defined intended target impact locations using separate two-way repeated measures analysis of variance models.

Results:

There was an interaction between game and impact height for each outcome (all p < 0.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to Dodgeality for the two higher impact heights, but greater during Reachality relative to Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality relative to Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality relative to Fishality and for Fishality relative to Dodgeality.

Conclusions:

Lumbar flexion velocity was reduced during Fishality relative to Dodgeality, and resembled velocity demands more similar to a self-paced reaching task (i.e. Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar with Reachality than Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with LBP and a high fear of movement.