How Does Postural Control in Patients with Functional Motor Disorders Adapt to Multitasking‐Based Immersive Virtual Reality?

Abstract

BackgroundMotor symptoms in functional motor disorders (FMDs) refer to involuntary, but learned, altered movement patterns associated with aberrant self‐focus, sense of agency, and belief/expectations. These conditions commonly lead to impaired posture control, raising the likelihood of falls and disability. Utilizing visual and cognitive tasks to manipulate attentional focus, virtual reality (VR) integrated with posturography is a promising tool for exploring postural control disorders.ObjectivesTo investigate whether postural control can be adapted by manipulating attentional focus in a 3D immersive VR environment.Methodswe compared postural parameters in 17 FMDs patients and 19 age‐matched healthy controls over a single session under four increasingly more complex and attention‐demanding conditions: simple fixation task (1) in the real room and (2) in 3D VR room‐like condition; complex fixation task in a 3D VR city‐like condition (3) avoiding distractors and (4) counting them. Dual‐task effect (DTE) measured the relative change in performance induced by the different attention‐demanding conditions on postural parameters.ResultsPatients reduced sway area and mediolateral center of pressure displacement velocity DTE compared to controls (all, p <0.049), but only under condition 4. They also showed a significant reduction in the sway area DTE under condition 4 compared to condition 3 (p=0.025).ConclusionsThis study provides novel preliminary evidence for the value of a 3D immersive VR environment combined with different attention‐demanding conditions in adapting postural control in patients with FMDs. As supported by quantitative and objective posturographic measures, our findings may inform interventions to explore FMDs pathophysiology.This article is protected by copyright. All rights reserved.

Virtual reality in functional neurological disorder: a theoretical framework and research agenda for use in the real world

“… 42 Graded attentional dual tasks were also used in FMD to explore impact on postural stability. 43 Similarly, PPPD studies (which comprise the bulk of the literature) largely used VR for balance training and vestibular rehabilitation via visual directional motion and rotation cues (eg, virtual rollercoasters, moving stars, trains) with several also making use of graded levels of dual-task attentional demands. 46 47 50 The single study of functional cognitive disorder used a virtual maze to explore attentional and visuospatial learning in dissociative amnesia.…”

“…This could be expanded by incorporating stepped levels of distraction, potentially using multisensory input to explore its effect on symptom severity. This has already been explored in several aforementioned studies such as Gandolfi et al ’s study of postural stability in FMD during increasingly demanding virtual attentional dual tasks, 43 as well as several VR studies of PPPD. 46 47 50 Moreover, adaptive psychophysics could be used to identify the specific level of distraction that engenders symptom attenuation (ie, a symptom attention threshold) and this could be used as an outcome measure in therapy.…”