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.
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.
Virtual Reality Offers Benefits For Parkinson’s Disease Patients
Researchers are reporting early success with a new tool to help people with Parkinson’s 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 Parkinson’s disease demonstrated improved obstacle negotiation and balance along with more confidence navigating around obstacles in their path.
For many people with Parkinson’s 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 person’s 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.”
Conclusion And Future Work
In this paper, we have presented an immersive VR exergame prototype and the evaluation. The prototype was found user-friendly and it was well received by the participants. The high System Usability Scale scores indicated high levels of acceptability, ease of use, learnability and confidence when using the prototype. The small number of participants in the evaluation does not allow us to make any conclusions. However, the results indicate that immersive VR exergames is a promising tool for patients with PD. The evaluation also provides valuable input that guided further improvement of the prototype. More user testing with larger number of participants and longitudinal study are necessary in order to improve the usability of the game and understand its effects on improving hand-eye coordination and finger movements.
Through this research, we have found that although there are considerable research on exergames for rehabilitation in general and for people with PD specifically, there is a lack of evidence-based design guidelines for immersive VR and research on exergames with fully immersive VR for rehabilitation purpose is limited. Future research should therefore focus on design principles for task-specific immersive VR exergames for patients with Parkinsons Disease taking into consideration the special needs of this user group.
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Why It Is Important To Do This Review
Conventional physiotherapy aims to maximise functional ability and minimise secondary complications through movement rehabilitation. It has previously been shown to have a positive impact upon gait, endurance, balance, and global motor function in people with PD . However, exercise effects decreased after followup periods without training, illustrating the importance of sustained effort . Although recent studies in PD have demonstrated that prolonged exercise for two years induced sustained benefits on both motor and cognitive outcomes , engaging patients in longterm regular exercise programmes is challenging. Both motor and nonmotor symptom burden may affect the willingness of people with PD to participate. In a recent report, longterm exercise adherence was shown to be low even with optimal input provided by trainers and coaches . Technologybased exercise interventions may improve adherence by stimulating users to exercise in a personalised, motivating, fun, and engaging manner.
Ways Virtual Reality Therapy Supports People With Parkinsons Disease
Parkinsons disease results from degenerative changes in the nervous system, leading to dysfunction of the cerebral basal ganglia.1 People with PD often experience symptoms that affect their quality of life, including tremor, slowness of movement, limb rigidity, and gait and balance problems.2 Although there is no cure, treatment options vary and include medications and surgery.2 It is common for people with PD to take a variety of these medications all at different doses and at different times of day to manage symptoms.2
In recent years, virtual reality has been tested as a therapeutic tool in neurorehabilitation research.3 VR therapy is a promising drug-free treatment for patients with Parkinsons disease and has the potential to improve their quality of life. VR provides visual, auditory, and somatosensory stimuli to assist in improving gait. Immersive VR has proven effective in cognitive therapies, pain management, and motivation of the elderly.4
Here are five ways VR therapy specifically helps people with PD:
Increases mobility, strength, and ROM
Improves gait and balance
Addresses cognitive changes
Reduces depression, anxiety, and stress
Gives back independence
Many people with PD that were treated by XRHealth were able to manage their symptoms and improve their quality of life. Joe was able to start playing his guitar after he completed his VR therapy.
Watch Joes story below.
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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.
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.
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Virtual Reality Brings Real Life Parkinsons Awareness
Canadian neuroscientist Kaylena Ehgoetz Martens has more than an academic interest in uncovering the reasons why almost half of everyone in the advanced stages of Parkinsons disease experiences terrifying moments of being unable to move.
For three years, Ehgoetz Martens worked at an exercise rehabilitation program with a woman with Parkinsons disease who experienced severe freezing of her gait. Three times a week, she helped the woman master a series of sensory-based and coordination exercises at the Movement Disorders Research and Rehabilitation Centre at Wilfrid Laurier University. At the end of their work together, the woman went from being largely wheelchair bound to walking short distances. More importantly, her less frequent falls and increased independence improved her outlook on life.
It totally changed her mood, Ehgoetz Martens says. Whenever she was able to walk unassisted, her mouth would be open, smiling from ear-to-ear. It was really important to me that we were able to change how independent and worthwhile she felt for those last few years.
The woman has since died, but she inspired the neuroscientists determination to pursue a research career focused on freezing of gait. Ehgoetz Martens pursued a PhD that demonstrated the link between anxiety and freezing.
Experiment pathways with and without visual cues and a devise to block the sight of leg movements.
Identifying And Monitoring Neurodegenerative Disease
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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D Virtual Reality Helps Neurosurgeon Treat Parkinsons
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.
James Thomas Leads A Team At Vcus Motor Control Lab Who Are Developing Immersive Games To Help Those With Trunk Control Impairments Get Moving
9/9/2021 12:00:00 AM
Youd call them games. James S. Thomas, Ph.D., a professor in the Department of Physical Therapy at Virginia Commonwealth University, and his team call them interventions for patients with movement disorders.
What began as a clinical trial at VCU to learn whether virtual reality games could relieve lower back pain has evolved to include their use as therapy for those with Parkinsons disease.
Thomas leads a team of multidisciplinary researchers at VCUs Motor Control Lab in the College of Health Professions who are developing immersive VR games to help those with trunk control impairments caused by orthopedic or neurological conditions get moving.
You feel like youre playing a game, but what’s happening behind the scenes is that we’ve developed algorithms to tailor the game experience to the individual and encourage you to move with better trunk control, Thomas recently told a small group of Parkinsons patients who gathered in a suburban park to see the labs technology in action.
We’re trying to get you to move your body in a way that will help you maintain your quality of life, and hopefully get you moving better, so that you can enjoy more of life.
The first was a simple fishing game that lets users scoop fish that leap out of water and swat at an attacking shark every few seconds. The other, a dodgeball game, shoots red balls at an avatar of the user, who has to punch the balls from the air.
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Icipants And Study Design
This study was approved by the Ethics Board Brazil Platform, number 832.502/2014 Sociedade Evangélica Beneficente, Curitiba, Paraná, Brazil and authorized by the patients in the free informed consent form.
A prospective observational cohort study was carried out. The sample comprised 16 patients with PD, from the Internal Medicine Department, Hospital das Clínicas, and from the Association of Patients with Parkinson’s Disease in the city of Curitiba, Paraná State, Brazil. The PD diagnoses were confirmed according to the criteria of the Queen Square Brain Bank, applied by the Association. The patients’ ages were between 18 and 82 years . The mean duration of the disease was 5.1 years, standard deviation of 3.2 .
The study inclusion criteria were adult patients with PD, absence of middle-ear diseases, no use of gait devices, and not previously given any rehabilitative therapies. Patients excluded from the study had otologic disorders, were unable to understand and respond to simple verbal commands, or had severe visual deficits or other impairments that would prevent them from performing the proposed procedures.
The Therapy Of The Future: Virtual Reality For Parkinsons Disease
At first glance, it is not clear how to make a connection between virtual reality and Parkinsons disease. But by looking closer, this form of technology may actually contribute to the treatment of this condition.
Around 60,000 new cases of Parkinsons disease are reported annually in the United States alone. While there is still no cure yet, doctors have been progressively exploring new ways of alleviating the symptoms of this disease. Elderly people who have been afflicted with Parkinsons experience daily torment, not only because of the disease but also because of the high cost of treatment.
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Virtual reality technology became a big hit in the consumer market. It offered a one-of-a-kind experience for users, and this also paved the way for software developers in programming a wide variety of applications associated with VR. Doctors saw this opportunity for developing alternate methods of treatment.
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Emergence Of Virtual Reality
The technology of virtual reality is already available before it came to the mass market. Companies developed ways to make consumer-grade VR equipment, mostly in the form of headsets and integration of smartphones. There are also omnidirectional treadmills and assistive controllers available to improve the virtual reality experience.
The idea of VR is to project the users senses into a virtual environment. Headsets block off any interaction with the sense of sight and sound from reality. Instead, a virtual world is projected to the eyes and ears through specialized displays and headphones that transmit lifelike visuals and sounds. Treadmills with VR integration are also used to simulate unobstructed lower body movement and controllers that track hand movements for more VR applications such as swinging a bat or shooting a ball. This aims to deliver a fully immersive experience to the users in the virtual environment.
Most VR headsets are used in video games and most of the software developers lean toward this kind of function. There are other uses for VR such as military training and education amongst many others. Medical therapy also delved in this technology, developing therapies for pain and PTSD.
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Lets make it clear, this is not an overnight take-over of conventional therapy. VR and gaming solutions have the potential to provide a similar level of care to traditional exercise-based therapy, without having to replace it. At least for the next decades, think of it as a potential complementary therapy subsidised by the NHS or private insurance: part of a medical treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. that would encourage patients to do meaningful exercise in between the supervised physiotherapy sessions. Conversely, VR-based exercise units in hospitals could train patients in daily tasks, emulating their home environment. Beyond that, the technology is simply not mature enough to match that of a human eye and brain in terms of assessment and choice of best treatment. However, with Artificial Intelligence looming on the distant horizon, this is not beyond the realms of possibilitysome day.
Tread carefully though when it comes to any products or apps that are advertised as a rehabilitation tool on the consumerConsumer is Cochranes preferred term for patients , care-givers or family members of someone with a health condition. market. In order for it to be a relevant training tool it needs to be paired with sensors in order to provide feedback.
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