Crossing Virtual Doors: A New Method to Study Gait Impairments and Freezing of Gait in Parkinson’s Disease

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.

Spinal Cord Stimulation for Freezing of Gait: From Bench to Bedside

“…Factors that trigger and relieve FoG suggest that this is a complex entity with multiple interconnected mechanisms. FoG mostly occurs during walking through narrow passages (14), situations of cognitive overload (e.g., dual tasks) (15), anxiety (16), and turning movements (17). Factors that alleviate freezing are certain visual patterns (e.g., stripes on the floor) (18), auditory cues (19), proprioceptive and haptic stimuli (20), and other compensation strategies (21).…”

Can We Use the Oculus Quest VR Headset and Controllers to Reliably Assess Balance Stability?

“…Like research a decade ago that showed how the Nintendo Wii balance board could be used to measure and train balance [ 5 ], this study shows how the Oculus Quest, a low-cost VR gaming headset can also be used to measure and train balance in older adults [ 24 ]. Previous research has shown how lab-based VR is well tolerated by more vulnerable groups, with studies showing how VR can be effectively used to cue gait in people with Parkinson’s [ 25 , 26 ], but also understand older adults’ decisions about when and how to cross a virtual road [ 27 ]. Given the power of this technology, creating VR balance games that use AI to adapt to the user’s abilities, opens a whole new vista in terms of balance rehabilitation and training possibilities [ 28 , 29 ].…”

Deep learning model for doors detection: A contribution for context-awareness recognition of patients with Parkinson’s disease

“…A pathological model of FoG suggests that with additional demands of sensory overload from visual or other stimuli leads to an overactivation of typical basal-ganglia pathways leading to an inhibition of movement and occurrence of freezing episodes (Lewis & Barker, 2009). Although FoG causes are multifaceted, they often occur in response of environment triggers, as turnings and passing through narrow spaces such as a doorway (Gómez-Jordana, Stafford, Peper, & Craig, 2018;Lewis & Barker, 2009;Pham et al, 2017).…”

“…Most common situations where FoG occurs involves a change in the visual environment that might require integration of visual and proprioceptive information leading to a sensory overload and a disruption in basal ganglia pathways (Cowie, Limousin, Peters, Hariz, & Day, 2012;Gómez-Jordana et al, 2018;Lewis & Barker, 2009). This disruption appears to be overcome using external sensory cues (visual, auditory and/or vibrotactile), which may help basal ganglia circuits to shifts to healthy spared neural motor pathways (Ehgoetz Martens et al, 2013).…”

“…However, to the best knowledge of the authors, no other study focused on door detection in the PD field, remaining an unaddressed and important challenge for the targeted scientific community. These scenarios have been so important in PD motor symptoms management, that curiously, virtual doors have been used by (Gómez-Jordana et al, 2018;Yamagami et al, 2020) to produce a new framework to assess and train patients in this specific FoG-trigger scenario. Thus, the detection of doors comprises a meaningful step in advancing the development of devices for motor assistance or rehabilitation in PD, which led us to develop a camera-based system for door detection to be integrated into a wearable biofeedback device.…”