title: 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.
authors.affiliation: Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel. anatmi@tasmc.health.gov.il
authors.forename: Anat
authors.initials: A
authors.lastname: Mirelman
authors.forename: Inbal
authors.initials: I
authors.lastname: Maidan
authors.forename: Talia
authors.initials: T
authors.lastname: Herman
authors.forename: Judith E
authors.initials: JE
authors.lastname: Deutsch
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Hausdorff
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000188:drug therapy / Q000534:rehabilitation; D005260:Female; D005684:Gait; D006801:Humans; D007858:Learning / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D016138:Walking
chemical_list: D000978:Antiparkinson Agents