Gait training in a virtual reality (VR) environment is promising for children affected by different disorders. However, the efficacy of VR therapy is still under debate, and more research is needed to clarify its effects on clinical conditions. The combination of VR with neuroimaging methods, such as the electroencephalography (EEG), might help in answering this need. The aim of the present work was to set up and test a system for the multimodal analysis of the gait pattern during VR gait training of pediatric populations by analyzing the EEG correlates as well as the kinematic and kinetic parameters of the gait. An EEG system was integrated with the Gait Real-time Analysis Interactive Lab (GRAIL). We developed and validated, with healthy adults (n = 5) and children (n = 4, healthy or affected by cerebral palsy (CP)), the hardware and software integration of the two systems, which allowed the synchronization of the acquired signals and a reliable identification of the initial contact (IC) of each gait cycle, showing good sensitivity and critical success index values. Moreover, we tested the multimodal acquisition by successfully analyzing EEG data and kinematic and kinetic parameters of one healthy child and one child with CP. This system gives the possibility of monitoring the effect of the VR therapy and studying the neural correlates of gait.

Objective: The aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet. Design: A single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments. Setting: Intensive rehabilitation unit (IRU) at the Institute S. Anna (Italy). Participants: 63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups. Treatments: All groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group ("control") underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group). Main Outcome Measures: Absolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up. Results: Significant interaction Group*Time effects scales (F2,126 = 5.1, p-level = 0.005, ?²p = 0.25; F2,126 = 4.7, p-level = 0.007, ?²p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p's <= 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment. Conclusion: The proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.

Walking may be defined as the forward displacement of the body requiring coordination between alternate successions of the swing phase and the stance phase. In literature it is known that, looking at the relationship between external moments and relative angles at lower limb joints during human walking is a new way of analyzing the biomechanical behavior of a joint (stiffness concept). Numerous studies show that the concept of quasi-stiffness applies particularly well to major loading phases of the lower extremity joints during stance phase. This study represents the first attempt to quantify the joint quasi-stiffness during the swing phase of gait over rehabilitation sessions performed by a child with cerebral palsy with the Lokomat system. The obtained results, albeit preliminarily, demonstrate the sensitivity of this new method in evaluating the degree of resistance offered by the patient over the rehabilitation sessions.