Virtual reality obstacle crossing: adaptation, retention and transfer to the physical world

Virtual reality (VR) paradigms are increasingly being used in movement and exercise sciences with the aim to enhance motor function and stimulate motor adaptation in healthy and pathological conditions. Locomotor training based in VR may be promising for motor skill learning, with transfer of VR skills to the physical world in turn required to benefit functional activities of daily life. This PhD project aims to examine locomotor adaptations to repeated VR obstacle crossing in healthy young adults as well as transfers to the untrained limb and the physical world, and retention potential of the learned skills. For these reasons, the current thesis comprises three studies using controlled VR obstacle crossing interventions during treadmill walking. In the first and second studies we investigated adaptation to crossing unexpectedly appearing virtual obstacles, with and without feedback about crossing performance, and its transfer to the untrained leg. In the third study we investigated transfer of virtual obstacle crossing to physical obstacles of similar size to the virtual ones, that appeared at the same time point within the gait cycle. We also investigated whether the learned skills can be retained in each of the environments over one week. In all studies participants were asked to walk on a treadmill while wearing a VR headset that represented their body as an avatar via real-time synchronised optical motion capture. Participants had to cross virtual and/or physical obstacles with and without feedback about their crossing performance. If applicable, feedback was provided based on motion capture immediately after virtual obstacle crossing. Toe clearance, margin of stability, and lower extremity joint angles in the sagittal plane were calculated for the crossing legs to analyse adaptation, transfer, and retention of obstacle crossing performance. The main outcomes of the first and second studies were that crossing multiple virtual obstacles increased participants’ dynamic stability and led to a nonlinear adaptation of toe clearance that was enhanced by visual feedback about crossing performance. However, independent of the use of feedback, no transfer to the untrained leg was detected. Moreover, despite significant and rapid adaptive changes in locomotor kinematics with repeated VR obstacle crossing, results of the third study revealed limited transfer of learned skills from virtual to physical obstacles. Lastly, despite full retention over one week in the virtual environment we found only partial retention when crossing a physical obstacle while walking on the treadmill. In summary, the findings of this PhD project confirmed that repeated VR obstacle perturbations can effectively stimulate locomotor skill adaptations. However, these are not transferable to the untrained limb irrespective of enhanced awareness and feedback. Moreover, the current data provide evidence that, despite significant adaptive changes in locomotion kinematics with repeated practice of obstacle crossing under VR conditions, transfer to and retention in the physical environment is limited. It may be that perception-action coupling in the virtual environment, and thus sensorimotor coordination, differs from the physical world, potentially inhibiting retained transfer between those two conditions. Accordingly, VR-based locomotor skill training paradigms need to be considered carefully if they are to replace training in the physical world