Exploring the feasibility of technological visuo-cognitive training in Parkinson’s: Study protocol for a pilot randomised controlled trial

Abstract

Visual and cognitive dysfunction are common in Parkinson’s disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes intervention complex in people with Parkinson’s (PwP). Non-pharmacological interventions for visuo-cognitive deficits are possible with modern technology, such as combined mobile applications and stroboscopic glasses, but evidence for their effectiveness in PwP is lacking. We aim to investigate whether technological visuo-cognitive training (TVT) can improve visuo-cognitive function in PwP. We will use a parallel group randomised controlled trial to evaluate the feasibility and acceptability of TVT versus standard care in PwP. Forty PwP who meet our inclusion criteria will be randomly assigned to one of two visuo-cognitive training interventions. Both interventions will be carried out by a qualified physiotherapist in participants own homes (1-hour sessions, twice a week, for 4 weeks). Outcome measures will be assessed on anti-parkinsonian medication at baseline and at the end of the 4-week intervention. Feasibility of the TVT intervention will be assessed in relation to safety and acceptability of the technological intervention, compliance and adherence to the intervention and usability of equipment in participants homes. Additionally, semi structured interviews will be conducted to explore participants’ experience of the technology. Exploratory efficacy outcomes will include change in visual attention measured using the Trail Making Test as well as changes in balance, gait, quality of life, fear of falling and levels of activity. This pilot study will focus on the feasibility and acceptability of TVT in PwP and provide preliminary data to support the design of a larger, multi-centre randomised controlled trial. This trial is registered at isrctn.com (ISRCTN46164906).

The inhibitory effect of a recent distractor: singleton vs. multiple distractors

“…Impairments in inhibitory control have been reported across a series of different neurodevelopmental conditions: ADHD (Maron et al, 2022), dyslexia (Wilcockson et al 2019 ), neurodegenerative: Alzheimer’s disease (Boxer et al 2012 ; Crawford et al 2005b ; Crawford et al 2019 ; Heuer et al 2013 ; Kaufman et al 2012 ; Molitor et al 2015 ; Wilcockson, Mardanbegi, Xia, et al, 2019, Opwonya et al 2022 for review), and other clinical diseases and disorders: Parkinson’s disease (Waldthaler et al 2021 for review; Das et al 2022 ). Given that the distractors affect the efficiency of goal-directed saccades, it would therefore be adaptive to mitigate their influence on gaze control.…”

The integration of technology into a home-based visuo-cognitive training intervention for people with Parkinson’s: Is the future digital?

“…Participants in this pilot study were recruited from a cross-over subset of a larger single-centre pilot randomised controlled trial exploring the feasibility and effectiveness of TVT compared with standard care, in people with PD [ 10 ]. The main trial started off as a crossover intervention.…”

“…The overarching trial is described in more detail elsewhere [ 10 ], but Fig 1 provides a brief description of the study using the Template for Intervention Description and Replication (TIDieR) framework [ 33 ]. In brief, each visuo-cognitive training intervention (i.e., TVT or standard care) consisted of two 45–60 minute training sessions per week for 4 weeks undertaken in participants’ homes.…”

“…TVT could increase the challenge of standard balance and gait exercises (via progressive intermittent visual occlusion with stroboscopic glasses) and deliver a personalised training programme (via mobile applications) that can address visual, sensorimotor and cognitive skills in a home environment [ 12 , 13 ]. (For full information on the TVT intervention described in this study, please see our previously published study protocol [ 10 ]).…”

Adherence to Non-Pharmacological Interventions in Parkinson’s Disease: A Rapid Evidence Assessment of the Literature

“…Non-motor symptoms, including cognitive impairment and apathy were also raised as potential barriers to adherence [14,33,36,[40][41][42]. Cognitive deficits in areas such as attention, memory, and executive dysfunction can influence the ability to follow instructions and actively participate in exercise and rehabilitation programs.…”