Effects of virtual reality environments on overground walking in people with Parkinson disease and freezing of gait

Yamagami, Momona; Imsdahl, Sheri I.; Lindgren, Kyle; Bellatin, Olivia; Nhan, Nawat; Burden, Samuel A.; Pradhan, Sarita; Kelly, Valerie E.

doi:10.1080/17483107.2020.1842920

Cited by 10 publications

(12 citation statements)

References 40 publications

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“…Martelli et al (2019) already reported an increase in variability of step width (+13%) and a trend in step length variability (+24%). Also Yamagami et al (2020) have reported an increase in step length variability (+67%) in their patients, however as mentioned above in patients with Parkinson's disease. In line with this earlier research, we found an increase of 38% in step width variability, next to 40% in foot off variability.…”

Section: Discussionmentioning

confidence: 73%

“… Canessa et al (2019) reported a decrease in cadence (∼ −10%). There is another particular study which analyzed whether overground VR environments that replicate freezing-of-gait (FoG) provoking situations for people with Parkinson’s disease would exacerbate gait adaptions relevant for FoG ( Yamagami et al, 2020 ). While they have used similar motion capture techniques as in our study, they only reported a subset of spatio-temporal parameters along with step length variability.…”

Section: Discussionmentioning

confidence: 99%

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Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

Horsak

Simonlehner

Schöffer

et al. 2021

Front. Bioeng. Biotechnol.

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Virtual reality (VR) is an emerging technology offering tremendous opportunities to aid gait rehabilitation. To this date, real walking with users immersed in virtual environments with head-mounted displays (HMDs) is either possible with treadmills or room-scale (overground) VR setups. Especially for the latter, there is a growing interest in applications for interactive gait training as they could allow for more self-paced and natural walking. This study investigated if walking in an overground VR environment has relevant effects on 3D gait biomechanics. A convenience sample of 21 healthy individuals underwent standard 3D gait analysis during four randomly assigned walking conditions: the real laboratory (RLab), a virtual laboratory resembling the real world (VRLab), a small version of the VRlab (VRLab−), and a version which is twice as long as the VRlab (VRLab+). To immerse the participants in the virtual environment we used a VR-HMD, which was operated wireless and calibrated in a way that the virtual labs would match the real-world. Walking speed and a single measure of gait kinematic variability (GaitSD) served as primary outcomes next to standard spatio-temporal parameters, their coefficients of variant (CV%), kinematics, and kinetics. Briefly described, participants demonstrated a slower walking pattern (−0.09 ± 0.06 m/s) and small accompanying kinematic and kinetic changes. Participants also showed a markedly increased gait variability in lower extremity gait kinematics and spatio-temporal parameters. No differences were found between walking in VRLab+ vs. VRLab−. Most of the kinematic and kinetic differences were too small to be regarded as relevant, but increased kinematic variability (+57%) along with increased percent double support time (+4%), and increased step width variability (+38%) indicate gait adaptions toward a more conservative or cautious gait due to instability induced by the VR environment. We suggest considering these effects in the design of VR-based overground training devices. Our study lays the foundation for upcoming developments in the field of VR-assisted gait rehabilitation as it describes how VR in overground walking scenarios impacts our gait pattern. This information is of high relevance when one wants to develop purposeful rehabilitation tools.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

Horsak

Simonlehner

Schöffer

et al. 2021

Front. Bioeng. Biotechnol.

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“…51 Moreover, a systematic review found that immersive VR (VRi) presents additional clinical benefits when compared with conventional vestibular training (performance and repetition of exercises in a motivational environment, oriented tasks, multisensory stimulation, extrinsic feedback and promotion of adherence). [52][53][54][55][56][57] The VR induces neuroplastic changes in neurological affection as MS. 58 Within VRi, the modality that integrates physical activity in a virtual environment with mentioned advantages is exergame, that has proven to be effective for neurological diseases. 59 60 Moreover, despite exercising through a VR system, it is perceived as less exhausting, 61 while the subject is exposed to a large variety of environments boosting the vestibular mechanism of habituation.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial

et al. 2021

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IntroductionVestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention.Methods and analysisThis protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1.Ethics and disseminationThe study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals.Trial registration numberNCT04497025.

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“…In contrast, one study found that a prolonged VR experience lead to a reduction in most VR-related gait adjustments [19]. The study of Yamagami et al [23] is one of the few ones that assessed the effects of VR overground walking for people with Parkinson’s disease. They found similar effects, such as reduced walking speed, step length, and increased step width compared to the real-world laboratory.…”

Section: Introductionmentioning

confidence: 99%

“…They found similar effects, such as reduced walking speed, step length, and increased step width compared to the real-world laboratory. Interestingly, Martelli et al [19] and Yamagami et al [23] also reported a clear increase in variability for step width and length. In a previous study, our group examined the effects of a room-scale VR environment on healthy adults by means of standard clinical 3D full-body gait analysis [24].…”

Section: Introductionmentioning

confidence: 99%

Unraveling the effects of virtual reality overground walking on dynamic balance and postural control

Horsak

Simonlehner

Dumphart

et al. 2022

Preprint

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This study analyzed the effects of walking freely in Virtual Reality (VR) compared to walking in the real-world on dynamic balance and postural control. For this purpose nine male and twelve female healthy participants underwent standard 3D gait analysis while walking randomly in a real laboratory and in a room-scale overground VR environment resembling the real laboratory. The VR was delivered to participants by a head-mounted-display which was operated wirelessly and calibrated to the real-world. Dynamic balance was assessed with three outcomes: the Margin of Stability (MOS) in the anteroposterior (AP-MOS) and mediolateral (ML-MOS) directions at initial-contact, the relationship between the mediolateral Center of Mass (COM) position and acceleration at mid-stance with subsequent step width, and trunk kinematics during the entire gait cycle. We observed increased mediolateral (ML) trunk linear velocity variability, an increased coupling of the COM position and acceleration with subsequent step width, and a decrease in AP-MOS while walking in VR, but no change in ML-MOS when walking in VR. We conclude that walking in VR results in a less reliable optical flow, indicated by increased mediolateral trunk kinematic variability, which seems to be compensated by the participants by slightly reweighing sensorimotor input and thereby consciously tightening the coupling between the COM and foot placement to avoid a loss of balance. Our results are particularly valuable for future developers who want to use VR to support gait analysis and rehabilitation.

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Effects of virtual reality environments on overground walking in people with Parkinson disease and freezing of gait

Cited by 10 publications

References 40 publications

Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial

Unraveling the effects of virtual reality overground walking on dynamic balance and postural control

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