Objective/Rationale:
Virtual Reality (VR) allows for training in complex environments, while motivating subjects to perform numerous repetitions of the training tasks under well-controlled conditions. The purpose of this study is to evaluate the potential of training with a VR system to improve gait and walking stability. We hypothesis that training with VR will improve the gait of patients with Parkinson's disease, reduce fall risk, and have greater effects on cognition and attention then gait training with external cues alone.
Project Description:
Twenty-five patients with mild to moderate PD will be recruited for this study. Clinical variables as well as gait and cognition will be evaluated before training. During the 18 training sessions (3 per week), subjects will walk on a treadmill with a harness while receiving visual and auditory feedback provided by a VR simulation projected through special glasses. The participants will be instructed to negotiate through different virtual targets and objects presented by the simulation. At the end of the training, subjects will be re-evaluated on aspects trained as well as while walking over ground. Follow-up evaluation will be performed at 3 months after training.
Relevance to Diagnosis/Treatment of Parkinson’s Disease:
Gait disturbances are common among patients with PD and often lead to falls, functional dependence, and diminished quality of life. In addition, PD pathology also impacts cognition which further exacerbates poor performance of mobility and walking, especially during complex or "dual task" gait activities. In PD, this has been associated with falls, and exacerbated functional dependence. We reason that treatment of gait and fall risk in PD should incorporate motor as well as cognitive training, like dual tasking. Thus, we anticipate demonstrating that training with VR is an efficacious and well-suited approach to gait training and fall risk reduction in patients with PD.
Anticipated Outcome:
We expect to show that VR-based training is a viable option for enhancing gait and mobility in patients with Parkinson's disease and that this approach has added value compared to treadmill training alone. In addition, we hope to demonstrate that the effects of the VR-based training carry over into real-world home and community activities, even six weeks after training is completed. More generally, we anticipate that this study will help transform VR-based paradigms into a therapeutic option for patients with Parkinson's disease.
Final Outcome
Gait disturbances among patients with Parkinson's disease often lead to immobility, falls, and diminished quality of life. Deficits in cognitive function further exacerbate fall risk, especially when patients walk while performing another task or navigating through complex environments.
Virtual reality (VR) provides multi-sensory feedback to enhance motor leaning through problem solving, while promoting the performance of multiple repetitions of movement. We developed an approach that combines treadmill training with a VR to implicitly teach obstacle avoidance and dual tasking abilities, while training gait.
In response to 6 weeks of VR training, patients with PD increased their over-ground gait speed and stride length, demonstrated increased endurance, and better navigated around obstacles. Walking while performing another task also was improved. This effect was not seen in previous studies of treadmill training, lending support to the idea that VR has unique benefits.
Patients also reported enhanced quality of life and fewer falls and near falls. In addition, 4-6 weeks after the completion of the intervention, mobility continued to improve. Motor learning and behavioral changes can apparently be achieved using VR, even in the presence of neurodegeneration. Future work should strive to better understand how beneficial neuroplasticity can be optimally generated in patients with PD.