Training Persons with Parkinson Disease using an Advanced CAVE Virtual Reality System
Authors: Foreman K Bo , Wilson Christopher , Dibble Leland E , Merryweather Andrew S 
Published: June 2021

INTRODUCTIONPersons with Parkinson Disease (PPD) suffer from movement and coordination deficits that contribute to an increased incidence of falls. While some types of rehabilitation, like treadmill training or strength training, have been shown to improve balance and mobility in PPD,1 this type of training is often performed in the confines of a clinic and do not reflect terrains and obstacles encountered in everyday life. To address this, we created a virtual reality (VR) environment that includes obstacles and terrains reported to be challenging by PPD in which the difficulty can be modified in response to the user's performance.2 We hypothesized that PPD would demonstrate improvements in balance and mobility following six weeks of training using the VR system.METHODSParticipants over the age of 40 years with idiopathic PD were recruited. Once consented, participants were pre‐tested using the Functional Gait Assessment (FGA) and the 6‐minute walk test (6MWT). Also, laboratory measures were collected in a motion capture lab that included stepping over small and large obstacles. Spatiotemporal variables were measured for the lead foot while stepping over each obstacle during over ground walking trials. Following the pre‐test, participants completed a 6‐week, 3x/week, VR training program. Each training session consisted of 30 minutes of walking on a speed matching treadmill while simultaneously navigating over obstacles spaced 15–25 feet apart. The obstacle's heights were increased based on 80% success rate from the previous session. Following training, participants performed a post‐test and 4wk retention test (not reported) that were identical to the pre‐test.RESULTSRecruitment resulted in 10 participants [3M, 7F; Age: 69.5 (5.1) years; Hoehn and Yahr: 2.3 (0.42)] with idiopathic PD. A repeated measures ANOVA was conducted for each variable to determine if any significant changes occurred. Post‐hoc paired t‐tests were then used to determine specific differences between the pre‐test to post‐test and the pre‐test to retention test (not reported). Significance was defined when p < 0.05. The results indicate that significant differences occurred for large box negotiation [toe clearance: pre =0.11 (0.05), post = 0.2 (0.10) m; max hip flexion: pre = 57.3 (7.3), post = 71.3 (3.8) deg; and max ankle dorsiflexion: pre = 10.1 (6.1), post = 13.9 (5.5) deg)] and small box negotiation [max knee flexion: pre = 82.1 (8.9), post = 95.6 (12.3) deg] only. Furthermore, significant differences were also observed for clinical balance measures [FGA: pre = 23.8 (2.2), post = 26.6 (1.1)].CONCLUSIONThese findings indicate that the VR training impacted obstacle negotiation and improved balance. These results support the use of VR as a training tool to improve gait and balance in PPD in a virtual environment.Support or Funding InformationThis study was funded in part by NSF‐1162617 and NHS‐S10RR026565This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.