Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease?
Abstract
BACKGROUND: Gait and cognitive disturbances are common in Parkinson's disease (PD). These deficits exacerbate fall risk and difficulties with mobility, especially during complex or dual-task walking. Traditional gait training generally fails to fully address these complex gait activities. Virtual reality (VR) incorporates principles of motor learning while delivering engaging and challenging training in complex environments. We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD. METHODS: Twenty patients received 18 sessions (3 per week) of progressive intensive treadmill training with virtual obstacles (TT + VR). Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles. Cognitive function and functional performance were also assessed. RESULTS: Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years. Posttraining, gait speed significantly improved during usual walking, during dual task, and while negotiating overground obstacles. Dual-task gait variability decreased (ie, improved) and Trail Making Test times (parts A and B) improved. Gains in functional performance measures and retention effects, 1 month later, were also observed. CONCLUSIONS: To our knowledge, this is the first time that TT + VR has been used for gait training in PD. The results indicate that TT + VR is viable in PD and may significantly improve physical performance, gait during complex challenging conditions, and even certain aspects of cognitive function. These findings have important implications for understanding motor learning in the presence of PD and for treating fall risk in PD, aging, and others who share a heightened risk of falls.
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Loss of dopamine in the basal ganglia impairs cognitive (executive) functions, particularly mental flexibility and set shifting related to alterations in fronto-striatal connectivity.
“The loss of DA in the basal ganglia not only impacts automatic behavior but also impairs cognitive (executive) functions55, 56, particularly mental flexibility and set shifting related to alterations in fronto-striatal connectivity 57–59.”
From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [57]
Augmented feedback is effective for improving gait.
“and gait [16]”
The control group's effect sizes can be interpreted as small, whereas the CuPiD group's can be considered clinically moderate and comparable to other cueing and treadmill studies.
“According to the recommendations by Hass et al., the control group's effect sizes can be interpreted as small [38], whereas those of the CuPiD group can be considered as clinically moderate and as comparable to other cueing and treadmill studies [9, 16, 39].”
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- Authors
- Mirelman, A., Maidan, I., Herman, T., Deutsch, J. E., Giladi, N., & Hausdorff, J. M.
- Affiliations
- Harvard University (US)
- Tel Aviv Sourasky Medical Center (IL)
- University of Medicine and Dentistry of New Jersey (US)
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-11-24
- Volume
- 66A
- Issue
- 2
- Pages
- 234-240
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2138287676
- Cited by
- 418
- References
- 45
- Citations by year
- 2026: 29 · 2025: 22 · 2024: 20 · 2023: 24 · 2022: 20 · 2021: 34 · 2020: 29 · 2019: 42 · 2018: 37 · 2017: 25 · 2016: 26 · 2015: 23 · 2014: 27 · 2013: 34 · 2012: 15
- FWCI
- 49.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
- Keywords
- virtual reality, gait training, Parkinson's disease, motor learning, dual-task walking, fall risk, treadmill training, virtual obstacles, gait variability, cognitive function, functional performance, retention effects
- MeSH terms
- Accidental Falls, Aged, Antiparkinson Agents, Cognition Disorders, Female, Gait, Humans, Learning, Male, Middle Aged, Parkinson Disease, Task Performance and Analysis, User-Computer Interface, Randomized Controlled Trials as Topic, Walking, Physical Therapy Modalities
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