Dual Motor-Cognitive Virtual Reality Training Impacts Dual-Task Performance in Freezing of Gait

Abstract

Freezing of gait (FOG), an episodic gait disturbance characterized by the inability to generate effective stepping, occurs in more than half of Parkinson's disease patients. It is associated with both executive dysfunction and attention and becomes most evident during dual tasking (performing two tasks simultaneously). This study examined the effect of dual motor-cognitive virtual reality training on dual-task performance in FOG. Twenty community dwelling participants with Parkinson's disease (13 with FOG, 7 without FOG) participated in a pre-assessment, eight 20-minute intervention sessions, and a post-assessment. The intervention consisted of a virtual reality maze (DFKI, Germany) through which participants navigated by stepping-in-place on a balance board (Nintendo, Japan) under time pressure. This was combined with a cognitive task (Stroop test), which repeatedly divided participants' attention. The primary outcome measures were pre- and post-intervention differences in motor (stepping time, symmetry, rhythmicity) and cognitive (accuracy, reaction time) performance during single- and dual-tasks. Both assessments consisted of 1) a single cognitive task 2) a single motor task, and 3) a dual motor-cognitive task. Following the intervention, there was significant improvement in dual-task cognitive and motor parameters (stepping time and rhythmicity), dual-task effect for those with FOG and a noteworthy improvement in FOG episodes. These improvements were less significant for those without FOG. This is the first study to show benefit of a dual motor-cognitive approach on dual-task performance in FOG. Advances in such virtual reality interventions for home use could substantially improve the quality of life for patients who experience FOG.

Frontal theta and beta oscillations during lower-limb movement in Parkinson’s disease

“…9,10 Previous studies have observed that reduced gait initiation time and lower-body symptoms may be related to physiological alterations in both motor and cognitive systems. [11][12][13] A recent study completed in more than one hundred PD patients proposed that gait, rather than cognition, predicts decline in cognitive domains early in PD, 14 suggesting gait might be a clinical biomarker for PD cognitive decline in early stages of the disease.…”

Characteristics, Usability, and Users Experience of a System Combining Cognitive and Physical Therapy in a Virtual Environment: Positive Bike

“…Interestingly, successful locomotion requires the ability of performing simultaneously a cognitive task that can cause an interference in gait performance, especially in older adults. Several works showed the efficacy of this paradigm [ 17 , 18 , 19 , 20 ]. The age-related decrease in attentional and executive functioning would impair the ability of managing the concurrent execution of different motor and cognitive activities, normally occurring in everyday life [ 21 , 22 ].…”

Motor preparation rather than decision-making differentiates Parkinson’s disease patients with and without freezing of gait

“…This paroxysmal symptom affects over half of people with Parkinson's disease (PD) over time (Giladi and Nieuwboer, 2008) and is closely associated with falls and admissions to nursing homes (Bloem et al, 2004). The pathophysiology of FOG remains poorly understood but freezing is closely associated with deficits in motor parameters, such as stride time, gait symmetry and rhythmicity (Killane et al, 2015) and cognitive impairment, especially, executive dysfunction (Maruyama andYanagisawa, 2006, Amboni et al, 2008). Executive function is impaired in PD with FOG (FOG+) compared to those without FOG (FOG-).…”