 |
 |
 |
 |
 |
At-home training with virtual reality cues for improvement of gait in patients with Parkinson’s disease
Alberto J. Espay, MD;1 Yoram Baram, PhD;2 Noël Burton, MA;1 Maureen Gartner, RN, MEd;1 Helard A. Miranda, MD;1 Andrew P. Duker, MD;1 Fredy J. Revilla, MD1 1: The Neuroscience Institute, Department of Neurology, Movement Disorders Center, University of Cincinnati, Cincinnati, Ohio, USA; 2: Department of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel
Abstract
Background: Shuffling and freezing of gait impair function in Parkinson’s disease (PD). Open-loop devices providing fixed-velocity visual or auditory cues can improve gait but may cause confusion or exacerbate freezing of gait in PD.
Objective: To evaluate the effects of at-home training with a closed-loop, accelerometer-driven, wearable visual-and-auditory virtual cueing system on gait velocity, stride length, and cadence in PD patients with off-state gait impairment.
Methods: Thirteen PD patients with off-state gait freezing were studied. Gait velocity, stride length, and cadence were measured in the practically-defined off state using a validated electronic gait analysis system in five conditions at baseline and after 2 weeks of daily 30-minute at-home use of a virtual cueing device. Patients underwent standard motor assessment and completed a self-administered Freezing of Gait Questionnaire (FOGQ; range 0-24, lower is better).
Results: Device use improved walking velocity by 17.0% (from 61.6 ± 18.6 to 72.1 ± 26.4 cm/sec; p = 0.0243) and stride length by 13.6% (from 73.9 ± 15.9 to 84.0 ± 18.5 cm; p = 0.046) after 14 days. Cadence was not changed. Testing after device removal for residual effect, walking velocity increased by 19.4% (from 63.8 ± 18.7 to 76.2 ± 21.5 cm/sec; p = 0.001) and stride length by 18.4% (from 75.0 ± 15.4 to 88.8 ± 17.7 cm; p = 0.001), with nearly 70% of the patients improving by at least 20% in either walking velocity, stride length, or both. The FOGQ improved from 14.2 ±1.9 to 12.4 ± 2.5 (p = 0.019).
Conclusions: Gait velocity and stride length were improved in PD patients after training with a visual-and-auditory virtual cueing system, with a marked residual effect. Devices utilizing closed-loop visual feedback system are desirable non-pharmacologic interventions to improve walking in PD.
|
|
