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The effect of real and virtual visual cues on walking in Parkinson’s disease

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Abstract

Patients with Parkinson’s disease (PwPD) have a slow, shuffling gait, marked by sporadic freezing of gait (FoG) during which effective stepping ceases temporarily. As these gait problems are not commonly improved by medical and surgical treatments, alternative approaches to manage these problems have been adopted. The aim of this study was to evaluate the effect of real and virtual visual cues on walking in PD. We assessed 26 mid-stage PwPD, on and off medication, on a laboratory-based walking task which simulated real world challenges by incorporating FoG triggers and using appropriate placebo conditions. Cueing interventions were presented via virtual reality glasses (VRG rhythmic, visual flow and static placebo cues), and as transverse lines (TL) on the walkway. Objective measures of gait (task completion time; velocity, cadence, stride length; FoG frequency) and self-rated fear of falling (FoF) were recorded. Cueing intervention affected task completion time only off medication. Whereas placebo VRG cues provided no improvement in walking, visual flow VRG cues marginally reduced the task completion time. TL on the floor elicited more substantial improvements in gait with reduced cadence, increased stride length and reduced FoG frequency. VRG rhythmic cueing impaired overall walking. Notably, a final no-intervention condition yielded quicker task completion, greater walking velocity, increased stride length and less frequent FoG. Although the VRG produced modest improvements only in the visual flow condition, their flexibility is an advantage. These results endorse the use of TL and justify further testing and customisation of VRG cues for individual PwPD.

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Abbreviations

FoF:

Fear of falling

FoG:

Freezing of gait

H&Y:

Hoehn and Yahr

PD:

Parkinson’s disease

PwPD:

Patient/people with Parkinson’s disease

QoL:

Quality of life

TL:

Transverse lines

VRG:

Virtual reality glasses

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Acknowledgments

We are grateful to our participants, to Professor Nick Tyler and the staff of the PAMELA (Pedestrian Accessibility and Movement Environment Laboratory) at UCL Centre for Transport Studies, to Oxford Computer Consulting and ParkAid for providing the virtual reality glasses. This work was funded by the UK Parkinson’s Disease Society.

Conflict of interest

Dr. Reynold Greenlaw is an employee of Oxford Computer Consultants Ltd., which is a shareholder in ParkAid (www.parkaid.net), which developed and markets the Virtual Reality Glasses, used as a cueing device in this study, under the tradename INDIGO.

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Authors and Affiliations

  1. Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen’s Square, London, WC1N 3BG, UK

    H. J. Griffin, P. Limousin, K. Bhatia, N. P. Quinn & M. Jahanshahi

  2. Research Department of Cognitive, Perceptual and Brain Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK

    H. J. Griffin

  3. Oxford Computer Consultants Ltd, 23-38 Hythe Bridge Street, Oxford, OX1 2EP, UK

    R. Greenlaw

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  1. H. J. Griffin
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  2. R. Greenlaw
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  3. P. Limousin
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  4. K. Bhatia
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  5. N. P. Quinn
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  6. M. Jahanshahi
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Correspondence to M. Jahanshahi.

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Griffin, H.J., Greenlaw, R., Limousin, P. et al. The effect of real and virtual visual cues on walking in Parkinson’s disease. J Neurol 258, 991–1000 (2011). https://doi.org/10.1007/s00415-010-5866-z

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  • DOI: https://doi.org/10.1007/s00415-010-5866-z

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