Virtual Footprints Can Improve Walking Performance in People With Parkinson's Disease

Abstract

In Parkinson's disease (PD) self-directed movement, such as walking, is often found to be impaired while goal directed movement, such as catching a ball, stays relatively unaltered. This dichotomy is most clearly observed when sensory cueing techniques are used to deliver patterns of sound and/or light which in turn act as an external guide that improves gait performance. In this study we developed visual cues that could be presented in an immersive, interactive virtual reality (VR) environment. By controlling how the visual cues (black footprints) were presented, we created different forms of spatial and temporal information. By presenting the black footprints at a pre-specified distance apart we could recreate different step lengths (spatial cues) and by controlling when the black footprints changed color to red, we could convey information about the timing of the foot placement (temporal cues). A group of healthy controls (HC; N = 10) and a group of idiopathic PD patients (PD, N = 12) were asked to walk using visual cues that were tailored to their own gait performance [two spatial conditions (115% [N] and 130% [L] of an individual's baseline step length) and three different temporal conditions (spatial only condition [NT], 100 and 125% baseline step cadence)]. Both groups were found to be able to match their gait performance (step length and step cadence) to the information presented in all the visual cue conditions apart from the 125% step cadence conditions. In all conditions the PD group showed reduced levels of gait variability (p < 0.05) while the HC group did not decrease. For step velocity there was a significant increase in the temporal conditions, the spatial conditions and of the interaction between the two for both groups of participants (p < 0.05). The coefficient of variation of step length, cadence, and velocity were all significantly reduced for the PD group compared to the HC group. In conclusion, our results show how virtual footsteps presented in an immersive, interactive VR environment can significantly improve gait performance in participants with Parkinson's disease.

Motor Learning Deficits in Parkinson's Disease (PD) and Their Effect on Training Response in Gait and Balance: A Narrative Review

“…Increasing the amount of external information provided to individuals with PD, such as through cueing, can significantly improve acquisition, automaticity, and retention of motor tasks, even once cues are removed (67, 120). The beneficial effects of cueing on gait and motor learning (121, 122) in PD are likely largely caused by addressing cognitive factors of the disease, such as attention (71). By directing attention to the motor action being practiced and giving feedback about its correctness, cueing can facilitate feedforward learning.…”

“…The use of technology in training of gait and balance for PD has been of interest. Several studies have utilized gamification of training, technology to assist, resist or create movements or perturbation, augmented feedback and VR (119, 121, 139, 144, 155, 169, 172, 173, 179, 180, 182, 183, 189). Cueing in particular shows promise and is an important area of research (120, 145, 155, 157–162, 171, 173, 190).…”

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover

“…One of the longest studied and most documented techniques for gait rehabilitation in PD is the use of sensory cueing (20, 21). Several studies have shown improvement in electromyographic and spatiotemporal parameters of gait in PD patients undergoing gait training with auditory, visual, and tactile cues (22–27).…”

Movement Speed-Accuracy Trade-Off in Parkinson's Disease

“…Motor impairments are observed when PD patients rely on internal control processes but have preserved externally cued performances ( 48 – 51 ). The use of external sensory cues as a strategy to facilitate movement continuity has been extensively documented in the locomotor activity domain using rhythmic auditory stimulation and visual stimulation ( 52 – 57 ). Dynamic visual cues are also involved in the visual perception of one owns actions ( 58 ) in terms of optic flow.…”