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

• Published in: IEEE journal of biomedical and health informatics 2015-11, Vol.19 (6), p.1855-1861
• Main Authors: Killane, Isabelle, Fearon, Conor, Newman, Louise, McDonnell, Conor, Waechter, Saskia M., Sons, Kristian, Lynch, Timothy, Reilly, Richard B.
• Format: Article
• Language: English
• Subjects: Aged; Assistive devices; Biomedical Engineering; Cognitive tasks; Fog; Gait; Gait - physiology; Gait Disorders, Neurologic - physiopathology; Gait Disorders, Neurologic - rehabilitation; Humans; Intervention; Legged locomotion; Middle Aged; Motors; Parkinson Disease - physiopathology; Parkinson Disease - rehabilitation; Parkinson's disease; Patients; Task analysis; Task Performance and Analysis; Tasks; Training; Virtual reality; Virtual Reality Exposure Therapy - methods
• ISSN: 2168-2194; 2168-2208
• DOI: 10.1109/JBHI.2015.2479625

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.