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Virtual Reality For Rehabilitation In Parkinson’s Disease

Virtual Reality In Parkinsons Disease

Virtual Reality Rehab for Parkinsons

Symptoms of Parkinson’s disease can improve by a combination of medication and regular physiotherapy. Virtual reality technology designed rehabilitation therapy that helps to improve motor learning skills in a safe environment.

It replicates real-life situations which effectively improve functional activities of daily living.

As per Market research, VR in Healthcare Market is estimated to reach USD2.38 Billion, by 2026 at 33.18% CAGR, worldwide.

Virtual Reality For Rehabilitation Of Gait And Balance In Patients With Parkinsons

With the advent and recent popularity of VR technology, VR has been proposed as a possible rehabilitation tool in conjunction with traditional physiotherapy approaches. A recent review has illustrated that a sense of control, success, and an appropriate level of challenge are key ingredients that explain a patients immersion and enjoyment of VR systems. VR systems optimize motor learning in a safe environment, and can help improve activities of daily living by replicating real-life scenarios.

The Nintendo Wii and Xbox Kinect have been used as VR tools in addressing symptoms of Parkinson’s. The rationale behind using VR systems lies in providing augmented visual and auditory feedback to gradually challenge postural control and balance during a task. This strategy bypasses the deficient motor generation system present in people with Parkinson’s, thus improving their motor response. An area where VR training may be especially effective for addressing symptoms of Parkinson’s is fall prevention when there is poor input of visual and somatosensory systems. A possible explanation for this is due to the conditions under which VR training occurs where the visual and somatosensory systems are being altered and are unreliable, thus forcing the patient to rely on use of their vestibular system for balance.

Symptoms Of Parkinsons Disease

  • Tremor Tremor is the first sign of Parkinsons disease. Hands may tremble even when a patient is resting.
  • Bradykinesia As the disease progresses, a person experience problem with normal walking. The steps may become shorter and it may take more time than usual.
  • Stiffness in muscles Any part of body muscles becomes stiff. This stiff may lead to excessive pain and restrict movement.
  • Speech problem The patient may face problems with flawless speaking. They may hesitate a lot before taking.
  • Problem with automatic movements- There is plenty of automatic movement such as blinking, smiling or swinging of arms while walking. Patients with PD many times miss these.

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Future Research In Virtual Reality For Parkinson’s

VR is still a relatively new technology. Few studies have been done, making generalizations to populations outside of the research circumstances difficult. Further research is needed to expand the evidence for the use of VR in people with Parkinson’s. Future research should aim to examine the effectiveness of VR interventions in different disease stages of Parkinson’s to determine the usefulness of VR-based interventions in the prevention of physical decline during the early stages of Parkinson’s, and during the progression of Parkinson’s in the middle to late stages. Additionally, it should also focus on providing evidence-based recommendations regarding the frequency, duration, and content of VR interventions for groups with Parkinson’s .

Identifying And Monitoring Neurodegenerative Disease

Sensors

We also hope to use our VR platform to evaluate activities of daily living in older people who could potentially be at risk for conditions like Alzheimers disease and PD. ADLs are activities that require motor skills along with cognitive ability to complete tasks that allow individuals to live independently. Some of these activities would include house cleaning, cooking, keeping up with personal finances, administering their own medications, and being in control of their transportation.

Through our monitoring in these virtual environments, we could catch the decline in ADLs, and could likely identify these neurodegenerative diseases very early on. Early detection would prove extremely beneficial so effective treatments could be administered. Our treadmill also enables subjective quantitative assessment of ADL function. We would ultimately love to see these assessments become part of the annual examinations for geriatric patients.

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Virtual Reality Training Improves Balance For Patients With Parkinson Disease

A recent literature review found that balance training conducted via virtual reality is beneficial at improving symptoms in Parkinson disease.

Virtual reality training is increasingly being used for a variety of health care applications, such as for pain relief, in multiple sclerosis, or for ophthalmology uses.

While there is no cure for Parkinson disease , levodopa and deep brain electrical stimulation can ease motor symptoms, and physical rehabilitation is used as well. VR is increasingly seen as an adjunct to physical exercise and may change neuroplasticity in the brains of patients with PD and other neurodegenerative diseases.

A recent systematic review and meta-analysis examined the use of VR to improve balance in patients with PD. The authors conducted the study because previous reviews have found inconsistent conclusions about the efficacy of VR for this population.

Databases, including Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang, were searched to identify all relevant studies published in English or Chinese from September 15, 2010, to September 15, 2020.

Three sets of keywords were used for literature retrieval:

  • Virtual reality, VR, Kinect, Wii, Xbox
  • Parkinson, parkinsonian disorders, Parkinson, parkinsonism, Parkinson disease, PD
  • Balance, equilibrium, dynamic postural control

The authors said the choice of VR platform may be the main reason for heterogeneity.

Reference

How Cognitive Reserve Should Influence Rehabilitation Choices Using Virtual Reality In Parkinsons Disease

Teresa PaolucciAcademic Editor: Received

Abstract

1. Introduction

Parkinsons disease is a chronic progressive neurodegenerative disease, characterized by the loss of dopaminergic neurons in the pars compacta of the substantia nigra and the accumulation of alpha-synuclein aggregates in specific regions of the brain stem, spinal cord, and cerebral cortex . The estimated prevalence of PD in industrialized countries is 0.3% in the general population , with incidence rates from 11 to 19 per 100,000 people each year .

Patients with PD may also have affected cognitive functions, particularly global cognitive performance and behavioral deficits that affect aspects of social and community life . The most common cognitive symptoms are deficit of attention and executive functions , difficulties in episodic memory, verbal fluency, and visuospatial and visuoperceptual abilities .

Cognitive reserve is a theoretical construct that describes differences in individuals susceptibility to cognitive, functional, or clinical decline due to ageing or neurological disease . This concept is fundamental in neurodegenerative disorders such as PD, considering the severity of motor and cognitive disability and the functional impact on daily life . Higher levels of CR are thought to be related to delayed disease onset and higher cognitive performance , and higher CR was associated with a better performance on the MMSE, thus confirming the protective role of CR on global cognitive functioning.

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Virtual Reality Offers Benefits For Parkinsons Disease Patients

Researchers are reporting early success with a new tool to help people with Parkinsons disease improve their balance and potentially decrease falls with high-tech help: virtual reality. After practicing with a virtual reality system for six weeks, people with Parkinsons disease demonstrated improved obstacle negotiation and balance along with more confidence navigating around obstacles in their path.

For many people with Parkinsons disease, the simple act of walking through the house or neighborhood can be a treacherous undertaking. The muscle and movement problems caused by the disease decrease a persons range of motion and impair balance, often leading to falls and injuries.

To help patients manage these challenges, researchers created a virtual reality training system that gives patients a safe space to hone their muscle control and balance. Patients walk on a treadmill while stepping over virtual objects that appear before them. If they are successful in one round, the objects become larger in the next round.

The primary advantage is that they can encounter multiple obstacles and terrains while a safe environment is maintained using equipment such as a fall restraint tether, said K. Bo Foreman, PT, Ph.D., associate professor and director of the Motion Capture Core Facility at the University of Utah. Participants enjoyed the experience and thought it was fun, not just exercise. They liked training and challenging themselves without the fear of falling.

D Virtual Reality Helps Neurosurgeon Treat Parkinsons

Virtual Reality And Parkinson’s Disease Rehab

Worlds first 3D virtual reality system for neurosurgery, developed at The Ottawa Hospital, will be used to increase the accuracy of deep brain stimulation surgery for patients with Parkinsons.

A bystander only sees neurosurgeon Dr. Adam Sachs wearing large goggles, looking at the air between the two wands he moves back and forth in front of him. What Dr. Sachs sees is a three-dimensional image of a patients brain, with its electrical activity superimposed. This isnt a video game. Its the cutting-edge of deep brain stimulation and neurosurgery technology.

Wearing virtual reality goggles, Dr. Sachs can view an accurate, computer-generated 3D image of a patients brain with Parkinsons disease, created using the patients own MRIs. The patients brain activity recorded from microelectrodes can be visualized in this virtual world. With the two wands, or joysticks, he can move the three-dimensional brain around, seeing it from all angles. He can also remove layers of the brain to look inside at the exact spot where he will place a DBS electrode during deep brain stimulation surgery. He is hoping to soon use this technology in the operating room.

Neurosurgeon Dr. Adam Sachs is planning to use 3D virtual reality in his deep brain surgery for patients with Parkinsons.

Nowhere else in the world are they using virtual reality in this fashion.

Dr. Adam Sachs

Neurosurgeon Dr. Adam Sachs uses virtual reality wands to manipulate a 3D image of the brain.

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Building Realistic Virtual Environments

Eliminating nausea and immersing the patient in the virtual environment opens up countless clinical and healthcare research possibilities. Once a solution for the locomotion problem was imminent, Dr. Alberts and his team started building virtual environments that replicated conditions and situations that individuals with PD often reported were difficult.

The first virtual environment they developed was the Cleveland Clinic Virtual Grocery Store Task, in which a subject wearing a VR headset walks on the treadmill to navigate through a virtual grocery store. Importantly, subjects are able to walk down aisles as they would in a real store, doing everything from straight-line walking to making turns to turning directions as they reach for items on their shopping list .

Figure.

This is the first healthcare-related VR application that truly immerses patients in an environment that often results in freezing of gait or falls. Freezing is a debilitating symptom of PD that is difficult to treat, in part because it rarely is elicited during typical clinical visits. It is difficult to treat a symptom that you cannot see, notes Dr. Alberts.

Description Of The Intervention

Virtual reality technology is a promising new rehabilitation tool with a wide range of applications . Within the context of physiotherapy, VR technology is recommended to optimise motor learning in a safe environment, and may be a worthy alternative to conventional approaches . By offering augmented feedback about performance, enabling individualised repetitive practice of motor function and stimulating both motor and cognitive processes simultaneously, VR offers opportunities to learn new motor strategies and to relearn motor abilities that were lost as a result of injury or disease .

It is not surprising that VR technology has been proposed as a tool to engage users in longterm exercise, since it provides training in a challenging and motivating environment. A recent review defined a sense of control, challenge, and success as key components for patient immersion in and enjoyment of a VR system . Also, by replicating reallife scenarios, VR technology provides greater potential for transfer to functional activities of daily living. To date, however, it remains unclear how VR technology may be optimally used and adjusted to the specific needs of various patient populations. Highquality study is needed to determine the efficacy and added value of this new training approach.

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Ological Quality Of Sr

Detailed information on the methodological quality of included SR-MAs was provided in Table Table2.2. AMSTAR-2 score showed that one review was of moderate quality, three were low, and that of all the others were critically low. The key factors affecting the quality of the literature included item 2 , item 4 , item 7 , item 9 , item 11 , item 13 , and item 15 .

Virtual Reality Technology As A Useful Tool For Rehabilitation In Parkinson’s Disease

Virtual reality for people with stroke or Parkinsons disease: bringing ...

Review question

The purpose of this review was to determine the effectiveness of virtual reality exercise interventions for rehabilitation in Parkinsons disease . We aimed to investigate whether VR exercise resulted in greater improvements compared to 1) active control interventions, and 2) passive control interventions, on gait, balance, global motor function, activities of daily living, quality of life, cognition, exercise adherence, and the occurrence of adverse events.

Background

PD is a neurodegenerative condition that places a high burden on patient quality of life and independence. As part of a multidisciplinary approach to treatment, regular exercise is encouraged and has been shown to relieve both motor and non-motor symptoms.

VR technology, a promising new rehabilitation tool, stimulates movement by means of computer-based games in a VR environment. Both commercial VR systems, such as Nintendo Wii or Xbox Kinect, and customised VR tools specifically designed to address PD symptoms, are frequently used. VR exercise exhibits potential advantages over regular exercise by allowing for individualised skill practice in a motivating and engaging interactive environment.

Study characteristics

We conducted the literature search up until 26 November 2016. We identified 8 studies involving a total of 263 participants with PD. All trials aimed to improve either gait or balance function. Most of the studies compared VR with physiotherapy.

Key results

Quality of the evidence

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Diverse Clinical And Research Uses

Cleveland Clinics efforts with this new technology are the first of their type that Dr. Alberts is aware of in healthcare research and clinical practice. He says the efforts have three broad clinical goals.

Identifying and monitoring neurodegenerative disease. One is to use the VR platform to evaluate instrumental activities of daily living in older individuals at risk for conditions such as PD and Alzheimers disease . iADLs are activities that enable an individual to live independently. In addition to requiring motor skills, they involve more significant cognitive skills than ADLs. Examples include cooking, house cleaning, taking medications, shopping, tending to personal finances and overseeing ones own transportation outside the home.

Evaluating gait freezing to fine-tune PD therapy. A second and more near-term goal is to use the omnidirectional treadmill to evaluate freezing of gait in patients with PD with the aim of refining their deep brain stimulation programming and/or PD medication regimens.

Combining Aerobic Exercise And Virtual Reality For Cognitive

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
First Posted : May 23, 2022Last Update Posted : November 4, 2022
Condition or disease
Other: Aerobic ExerciseDevice: Virtual Reality Not Applicable
Layout table for study information

Study Type :
This study will utilize a single group, pre-post design
Masking:
Combining Aerobic Exercise and Virtual Reality for Cognitive-motor Rehabilitation in Parkinson’s Disease
Estimated Study Start Date :
Experimental: Combined Aerobic Exercise and Virtual Reality -based programIndividuals diagnosed with PD will participate in AE and VR. Other: Aerobic ExerciseParticipants will perform a 30-minute exercise protocol on a StepOne recumbent stepper Device: Virtual RealityParticipants will interact with the virtual environment and view the gaming environment on a flat-screen TV placed in front of them at a suitable distance. The participants will play four games , with the order of the games randomized in every session.
  • Gait speed 10 Meter Walk Test for comfortable and fast gait speed .
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    Fig 3 Forest Plot Of Gait Speed

    heterogeneity was very low . Pooled SMD showed that VR rehabilitation training was better in improving the quality of life of patients with PD . Perceived confidence in balance. Three studies involving 104 participants with PD reported the effects of VR technology on perceived confidence in balance. A signifi- cant heterogeneity was observed . Pooled SMD presented that VR reha- bilitation training had a significant effect on perceived confidence in balance than control group . Neuropsychiatric symptoms. Four studies involving 184 participants with PD reported the effect of VR on neuropsychiatric symptoms which were recorded by BAI, BDI and HAMD. There was a low statistical heterogeneity between studies . Pooled SMD showed that VR rehabilitation training had a significant positive effect than con- trol group . Cognitive function. Only two studies involving 68 participants with PD study provided complete data on cognitive function changes, and there was no significant difference in cognitive function between two groups . Statistical heterogeneity remained low . Adverse events. Eight studies mentioned that adverse events occurred during the intervention would be observed. However, only one trial reported

    Limitations Of Virtual Reality For Parkinson’s

    Parkinson’s Patients Walk Aided by Virtual Reality Device

    VR technology holds some limitations for people with Parkinson’s. These include the possibility of cognitive overload, cyber-sickness, or an inappropriate level and content of exercises for rehabilitation of Parkinson’s.

    Additionally, home-based VR systems used for rehabilitation may be detrimental to performance, as patients may use compensatory movements to increase game performance. Patients may begin to prioritize game scores over their quality of movement, thus reducing training effects. Future home-based VR systems designed for neurological rehabilitation should ensure that compensatory movements cannot be used to improve game performance.

    It still remains unclear how VR systems may be adjusted to the specific needs of people with Parkinson’s. Commercial VR systems for persons with neurological disorders have yet to be developed. Current systems designed for the general healthy population, such as the Xbox Kinect and Nintendo Wii, can hinder the effectiveness of such interventions and the safety for such populations.

    However, VR and physiotherapy interventions both have similar overall effects on gait, balance, and quality of life. In a recent 2016 systematic review, it was concluded that there is only low-quality evidence suggesting that VR can serve as a useful alternative to traditional physiotherapy in improving gait and balance in people with Parkinson’s.

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