Abstract
Studying freezing of gait (FOG) in the lab has proven problematic. This has primarily been due to the difficulty in designing experimental setups that maintain high levels of ecological validity whilst also permitting sufficient levels of experimental control. To help overcome these challenges, we have developed a virtual reality (VR) environment with virtual doorways, a situation known to illicit FOG in real life. To examine the validity of this VR environment, an experiment was conducted, and the results were compared to a previous “real-world” experiment. A group of healthy controls (N = 10) and a group of idiopathic Parkinson disease (PD) patients without any FOG episodes (N = 6) and with a history of freezing (PD-f, N = 4) walked under three different virtual conditions (no door, narrow doorway (100% of shoulder width) and standard doorway (125% of shoulder width)). The results were similar to those obtained in the real-world setting. Virtual doorways reduced step length and velocity while increasing general gait variability. The PD-f group always walked slower, with a smaller step length, and showed the largest increases in gait variability. The narrow doorway induced FOG in 66% of the trials, while the standard doorway caused FOG in 29% of the trials. Our results closely mirrored those obtained with real doors. In short, this methodology provides a safe, personalized yet adequately controlled means to examine FOG in Parkinson's patients, along with possible interventions.
Highlights
IntroductionParkinson’s disease (PD) is a degenerative disease that is characterized, in part, by the loss of dopamine-generating cells in the basal ganglia [1]. is lack of dopamine can cause bradykinesia (movement slowness), hypokinesia (reduced movement amplitude), akinesia (problems initiating movement), tremor, rigidity, and postural instability [2,3,4]
Parkinson’s disease (PD) is a degenerative disease that is characterized, in part, by the loss of dopamine-generating cells in the basal ganglia [1]. is lack of dopamine can cause bradykinesia, hypokinesia, akinesia, tremor, rigidity, and postural instability [2,3,4]
Interactive virtual reality (VR) environment that was used to manipulate the visual context within which participants control their walking along a virtual hallway
Summary
Parkinson’s disease (PD) is a degenerative disease that is characterized, in part, by the loss of dopamine-generating cells in the basal ganglia [1]. is lack of dopamine can cause bradykinesia (movement slowness), hypokinesia (reduced movement amplitude), akinesia (problems initiating movement), tremor, rigidity, and postural instability [2,3,4]. The causes of FOG episodes are multifaceted, they often occur in response to certain environmental triggers (e.g., doorways) that may or may not require some kind of gait adaptation (e.g., turning or slowing down [6,7,8,9,10]). We aim to show how immersive, interactive virtual reality (VR) technology can offer a new methodological framework for studying FOG in people with Parkinson’s. We will examine how well this technology can allow us to manipulate the visual context to induce changes in gait characteristics in PD patients who have and have not experienced FOG episodes. The use of an immersive, interactive VR environment can allow us to determine the extent to which different visual scenes (e.g., doorways) can induce FOG and impact gait performance
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