Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

Abstract

Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.

Assisted technology in Parkinson's disease gait: what's up?

“…42 Some studies used VR to interact three-dimensional virtual environment. 4,25,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] We also found studies using Robotic-assisted gait training for PD. 24,29,[59][60][61][62] We analyzed several types of AP and categorized them into commercial and non-commercial devices available for research, rehabilitation, or home-based care.…”

“…42 Finally, visual, and auditory cues can be combined with treadmill training, and it has shown to be better than standard treadmill training alone. 46 This association may focus on gait and cognitive deficits to optimally address several critical aspects of fall risk and improve mobility, physical activity, cognitive function, and FOG in PD.…”

“…45 The benefit may vary according to training duration, PD patients who underwent a 12-week exercise program had better gait speed, stride length under dual-task conditions, and falls reduction compared to a 6-week VR training. 46 So far, most of the studies evidenced that VR rehabilitation may have beneficial effects on balance. In relation to gait, improvements in speed, step length, and cadence in both kinematics and clinical scale tests were observed, 49 but no significant differences were seen in walking speed in PD.…”

Mild cognitive impairment in patients with Parkinson’s disease: An updated mini-review and future outlook

“…Moreover, develop cognitive training programs through other equipment as a medium. For example, some researchers applied virtual reality technology ( Pelosin et al, 2021 ) to enhance the sense of reality and used mobile applications ( Yu et al, 2022 ) to improve the accessibility of cognitive training. Last, the prospective and longitudinal designed studies were also urgent to evaluate the long-term effects of cognitive training.…”

Efficacy of Dual‐Task Training in Patients with Parkinson's Disease: A Systematic Review with Meta‐Analysis

“…The effectiveness of DTT depends on the patient's ability to perform motor tasks automatically and the cognitive (executive) ability to combine different types of tasks 24 . DTT can be used to implement the classical approaches of rehabilitation, 25 using virtual reality or robotic devices that require the patient's full attention to complete the motor activity 26,27 . DTT has been shown to improve gait and balance disorders in stroke 28 or multiple sclerosis 29 patients, albeit with inconclusive evidence.…”