Inbal Maidan, Freek Nieuwhof, Hagar Bernad-Elazari, Bastiaan R Bloem, Nir Giladi, Jeffrey M Hausdorff, Jurgen A H R Claassen, Anat Mirelman
Overview
A randomized control trial conducted on patients with Parkinson’s Disease (PD) found that treadmill training combined with virtual reality that addressed cognitive and motor aspects of safe ambulation led to fewer falls than treadmill training alone.
Purpose:
The purpose of this study was to test whether prefrontal activation differed between the 2 types of training and whether this contributed to differences in falls following the intervention in PD patients.
Methods:
Sixty-four patients with PD were randomly assigned to either treadmill training (n = 34, average age 73.011.1 years, 64% men, average disease duration 9.71.0 years) or treadmill training with virtual reality (n = 30, average age 71.011.3 years, 71% men, average disease duration 8.91.1 years). Using a functional near-infrared spectroscopy system, prefrontal activation during usual, dual-task, and obstacle negotiation walking was assessed before and after 6 weeks of training.
Results:
Prefrontal activation may be an essential indication of walking performance in PD. There could be an increase in prefrontal activation due to reduced movement automaticity caused by basal ganglia dysfunction.
Treadmill training with and without VR reduced prefrontal activation during walking (P < .001), with specific interactions related to training arm (P = .01), lateralization (P = .05), and walking condition (P = .001). During dual-task walking and obstacle negotiation prefrontal activation increased in the group that trained on a treadmill alone, while in the group training on V-Time combined with the treadmill the prefrontal activation decreased.
Conclusions:
Two types of training can alter prefrontal activation during normal and more challenging walking conditions. Cognitive exercise added to a treadmill exercise program appears to modify its effects on prefrontal activation and on falls, extending our understanding of the plasticity of the brain in PD.
The V-TIME academic research project that has led to many of these papers is implemented commercially by GaitBetter.