Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease?

Overview 

Parkinson’s disease (PD) is characterized by cognitive and gait disturbances. The deficits exacerbate fall risks and difficulty with mobility, especially during complex or dual-task walking. Traditional gait training does not adequately address these complex gait activities. While delivering engaging and challenging training in complex environments, virtual reality (VR) incorporates principles of motor learning. Our hypothesis was that virtual reality for gait training could be applied to address the multifaceted deficits associated with fall risk in PD.

Methods:

We trained twenty patients with treadmill training and virtual obstacles over the course of three weeks (TT + VR). Gait was measured under usual walking and dual-task conditions as well as when negotiating physical obstacles. Also assessed was cognitive function and functional performance.

Results:

Among the patients, the mean age was 67.1 * 6.5 years and the mean disease duration was 9.8 ± 5.6 years. Following training, gait speed was significantly higher while walking normally, performing dual tasks, and negotiating over-ground obstacles. Trail Making Test (parts A and B) times (parts A and B) improved as well as dual-task gait variability decreased. Gains in functional performance measures and retention effects were also observed one month later.

Conclusions:

It is the first time that TT + VR has been used to train gait in Parkinson’s disease. There is evidence that TT + virtual reality for gait training may significantly improve physical performance, gait during complex challenging conditions, and even certain aspects of cognitive function in PD. The findings are important for understanding motor learning in the presence of PD and for treating fall risk in PD, aging, and others who experience an increased risk of falling.