Overview of Medstar and GaitBetter

Semi Immersive Virtual Reality in Combination with High Intensity Gait Training

A Proposal from Medstar National Rehabilitation Hospital, Washington DC, in conjunction with GaitBetter

The primary goal of this study is to determine whether semi-immersive virtual reality–supported gait training improves attainment and maintenance of high-intensity gait training intensity and dosage targets compared with standard gait training in neurorehabilitation. Thus, improving overall outcomes including functional mobility, quality of life, and discharge disposition from inpatient rehabilitation.

Clinical research is the foundation of progress in physical therapy and neurorehabilitation. It bridges the gap between scientific theory and real-world patient care, ensuring that interventions are not only innovative, but effective, safe, and scalable.

This will be a quasi-experimental design with a single arm, comparing to previously conducted studies of HIT at Medstar NRH.

Target Population – The expectation is to recruit approximately 50 patients per year, to include inpatient stroke, TBI (Traumatic Brain Injury), and pediatrics.

This research will build on a previous limited study conducted by the team at NYU Langone – both in terms of number of participants and breadth of study.

Embedding semi-immersive VR within HIGT has the potential to transform clinical delivery in several ways:

– Improved Fidelity to Intensity and Dosage
Real-time interactive environments promote sustained effort, increasing time in heart rate zone and total stepping volume without altering the core evidence-based intervention.

– Enhanced Patient Engagement
Goal-directed tasks and enriched sensory environments improve motivation, particularly in pediatric and TBI populations, allowing patients to tolerate higher workloads for longer durations.

– Integrated Cognitive–Motor Training
Semi-immersive VR allows incorporation of attention, executive function, visuospatial navigation, and dual-task demands – aligning with real-world mobility needs.

– Scalable and Sustainable Workflow Integration
Because over 1,000 patients per year already participate in structured HIGT, integration of the Gait Better System does not require rebuilding clinical infrastructure it enhances an already established, high-volume program.

Meaningful change in the field of physical therapy requires more than isolated clinical success. To generate national and global impact, rigorous research must be conducted to evaluate, refine, and disseminate best practices beyond a single institution. Implementation without scientific validation limits scalability; conversely, research embedded within high-volume clinical care accelerates translation and external adoption.

For this reason, the proposal is intentionally designed to have dual impact, with a structured, prospective clinical research study to evaluate:

– Fidelity to heart rate and stepping dosage targets

– Functional mobility outcomes

– Cognitive–motor integration measures

– Length of stay and discharge disposition

– Implementation feasibility and scalability