Gait Training in Virtual Reality: Short-Term Effects of Different Virtual Manipulation Techniques in Parkinson’s Disease

Abstract

It is well documented that there is a strong relationship between gait asymmetry and the freezing of gait (FOG) in Parkinson’s Disease. The purpose of this pilot study was to find a “virtual reality (VR)- based” gait manipulation strategy to improve gait symmetry by equalizing step length. Fifteen male PD patients (mean age of 67.6 years) with FOG were assessed on a GAITRite® walkway. Natural gait was compared with walking conditions during “VR-based” gait modulation tasks that aimed at equalizing gait symmetry using visual or proprioceptive signals. Compared to natural gait, VR manipulation tasks significantly increased step width and swing time variability for both body sides. Within the VR conditions, only the task with “proprioceptive-visual dissociation” by artificial backward shifting of the foot improved spatial asymmetry significantly with comparable step lengths of both sides. Specific, hypothesis-driven VR tasks represent an efficient tool to manipulate gait features as gait symmetry in PD potentially preventing FOG. This pilot study offers promising “VR-based” approaches for rehabilitative training strategies to achieve gait symmetry and prevent FOG.

An Immersive Virtual Reality Exergame for People with Parkinson’s Disease

“…In recent years with the increasing offers and decreasing price of immersive VR technology on the market, a few more studies have used immersive VR technology such as HTC vive and Oculus Rift for gait and balance training for people with PD [ 15 , 16 ].…”

Virtual reality training enhances gait poststroke: a systematic review and meta‐analysis

“…[6][7][8] Recent experimental studies have reported the beneficial influence of virtual reality (VR) training strategies to enhance gait performance poststroke. 3,[9][10][11] These studies have reported enhancements in spatiotemporal gait parameters while suggesting an enhancement in gait stability, 12 hence inferred in this study as an enhancement in gait performance. Typically, VR can be defined as an application that, in very near real-time, allows a user to navigate through, and interact with, a virtual environment.…”

“…Recent experimental studies have reported the beneficial influence of virtual reality (VR) training strategies to enhance gait performance poststroke 3,9–11 . These studies have reported enhancements in spatiotemporal gait parameters while suggesting an enhancement in gait stability, 12 hence inferred in this study as an enhancement in gait performance.…”

Can google glass™ technology improve freezing of gait in parkinsonism? A pilot study

“…Dopaminergic therapy has the best effect on gait velocity, stride length, and cadence, but this and other agents, including cholinergic (donepezil), glutamatergic, noradrenergic (methylphenidate, venlafaxine), and multi-mechanistic (amantadine) medications have variable and generally limited success. Because of the limited therapeutic options, several alternative modes of therapies have been tested in small studies to determine better treatment approaches for FOG, including the following: virtual reality [4,5], wearable assistive devices [6], robot-assisted gait training [7], and a single open-label study assessing the utility of Google Glass TM (GG) [8]. Though the first GG report utilizing external visual and auditory cues in 12 subjects with FOG demonstrated no significant change in FOG, a more stable gait pattern did emerge with auditory rather than visual cueing.…”