A Video Self-Modelling Intervention Using Virtual Reality Plus Physical Practice For Freezing of Gait in Parkinson’s Disease: A Feasibility and Acceptability Study (Preprint)

2021 ◽  
Author(s):  
Lina Goh ◽  
Natalie E Allen ◽  
Naseem Ahmadpour ◽  
Kaylena A Ehgoetz Martens ◽  
Jooeun Song ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Outcome Measures ◽  
Freezing Of Gait ◽  
Secondary Outcome ◽  
Virtual Reality System ◽  
Physical Practice ◽  
Head Mounted Display ◽  
Movement Strategies

BACKGROUND Despite optimal medical and/or surgical intervention, freezing of gait occurs commonly in people with Parkinson’s disease, leading to reduced mobility, falls, poor quality of life and increased healthcare costs. Action observation via video self-modelling, combined with physical practice, has potential as a non-invasive intervention to reduce freezing of gait. OBJECTIVE To determine the feasibility and acceptability of a home-based, personalised video self-modelling intervention delivered via a virtual reality head mounted display to reduce freezing of gait in people with Parkinson’s disease. Secondary aims included investigating the potential effect of this intervention on freezing of gait, mobility and anxiety. METHODS A single group pre/post mixed methods pilot trial. Ten participants with Parkinson’s disease and freezing of gait were recruited. A physiotherapist assessed participants in their homes to identify person-specific triggers of freezing and developed individualised movement strategies to overcome freezing of gait. 180-degree videos of participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality head mounted display, followed by physical practice of their strategies in their own homes over a six-week intervention period. Primary outcome measures included feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, Timed Up and Go test, 10m walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. RESULTS Ten participants were recruited. The recruitment rate was 24% and retention rate was 90%. Adherence to the intervention was high, with participants completing a mean of 84% for the prescribed video viewing and a mean of 100% for the prescribed physical practice. One participant used the virtual reality head mounted display for one week and completed the rest of the intervention using a flatscreen device due to a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessments. Most participants found using the head mounted display to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from interview data: reflections when seeing myself; my experience of using the virtual reality system; the role of the virtual reality system in supporting my learning; developing a deeper understanding on how to manage my freezing of gait; and impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility or anxiety measures from baseline to post-intervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. CONCLUSIONS Video self-modelling using an immersive virtual reality head mounted display plus physical practice of personalised movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson’s disease. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR12619000139178)

scholarly journals Donepezil for mild cognitive impairment in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyoungwon Baik ◽  
Seon Myeong Kim ◽  
Jin Ho Jung ◽  
Yang Hyun Lee ◽  
Seok Jong Chung ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Treatment Group ◽  
Outcome Measures ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Control Group ◽  
Significant Difference

AbstractWe investigated the efficacy of donepezil for mild cognitive impairment in Parkinson’s disease (PD-MCI). This was a prospective, non-randomized, open-label, two-arm study. Eighty PD-MCI patients were assigned to either a treatment or control group. The treatment group received donepezil for 48 weeks. The primary outcome measures were the Korean version of Mini-Mental State Exam and Montreal Cognitive Assessment scores. Secondary outcome measures were the Clinical Dementia Rating, Unified Parkinson’s Disease Rating Scale part III, Clinical Global Impression scores. Progression of dementia was assessed at 48-week. Comprehensive neuropsychological tests and electroencephalography (EEG) were performed at baseline and after 48 weeks. The spectral power ratio of the theta to beta2 band (TB2R) in the electroencephalogram was analyzed. There was no significant difference in the primary and secondary outcome measures between the two groups. However, the treatment group showed a significant decrease in TB2R at bilateral frontotemporoparietal channels compared to the control group. Although we could not demonstrate improvements in the cognitive functions, donepezil treatment had a modulatory effect on the EEG in PD-MCI patients. EEG might be a sensitive biomarker for detecting changes in PD-MCI after donepezil treatment.

scholarly journals The Add-On Effect of Lactobacillus plantarum PS128 in Patients With Parkinson's Disease: A Pilot Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Chin-Song Lu ◽  
Hsiu-Chen Chang ◽  
Yi-Hsin Weng ◽  
Chiung-Chu Chen ◽  
Yi-Shan Kuo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Lactobacillus Plantarum ◽  
Outcome Measures ◽  
Rating Scale ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Motor Deficits ◽  
Motor Symptoms ◽  
Non Motor Symptoms

Background:Lactobacillus plantarum PS128 (PS128) is a specific probiotic, known as a psychobiotic, which has been demonstrated to alleviate motor deficits and inhibit neurodegenerative processes in Parkinson's disease (PD)-model mice. We hypothesize that it may also be beneficial to patients with PD based on the possible mechanism via the microbiome-gut-brain axis.Methods: This is an open-label, single-arm, baseline-controlled trial. The eligible participants were scheduled to take 60 billion colony-forming units of PS128 once per night for 12 weeks. Clinical assessments were conducted using the Unified Parkinson's Disease Rating Scale (UPDRS), modified Hoehn and Yahr scale, and change in patient “ON-OFF” diary recording as primary outcome measures. The non-motor symptoms questionnaire, Beck depression inventory-II, patient assessment of constipation symptom, 39-item Parkinson's Disease Questionnaire (PDQ-39), and Patient Global Impression of Change (PGI-C) were assessed as secondary outcome measures.Results: Twenty-five eligible patients (32% women) completed the study. The mean age was 61.84 ± 5.74 years (range, 52–72), mean disease duration was 10.12 ± 2.3 years (range, 5–14), and levodopa equivalent daily dosage was 1063.4 ± 209.5 mg/daily (range, 675–1,560). All patients remained on the same dosage of anti-parkinsonian and other drugs throughout the study. After 12 weeks of PS128 supplementation, the UPDRS motor scores improved significantly in both the OFF and ON states (p = 0.004 and p = 0.007, respectively). In addition, PS128 intervention significantly improved the duration of the ON period and OFF period as well as PDQ-39 values. However, no obvious effect of PS128 on non-motor symptoms of patients with PD was observed. Notably, the PGI-C scores improved in 17 patients (68%). PS128 intervention was also found to significantly reduce plasma myeloperoxidase and urine creatinine levels.Conclusion: The present study demonstrated that PS128 supplementation for 12 weeks with constant anti-parkinsonian medication improved the UPDRS motor score and quality of life of PD patients. We suggest that PS128 could serve as a therapeutic adjuvant for the treatment of PD. In the future, placebo-controlled studies are needed to further support the efficacy of PS128 supplementation.Clinical Trial Registration:https://clinicaltrials.gov/, identifier: NCT04389762.

scholarly journals Variability of Stepping during a Virtual Reality Paradigm in Parkinson’s Disease Patients with and without Freezing of Gait

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e66718 ◽  
Author(s):  
Moran Gilat ◽  
James M. Shine ◽  
Samuel J. Bolitho ◽  
Elie Matar ◽  
Yvo P. T. Kamsma ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Freezing Of Gait

Home-based exercise monitored with telehealth is feasible and acceptable compared to centre-based exercise in Parkinson’s disease: A randomised pilot study

2020 ◽  
pp. 026921552097626
Author(s):  
Allyson Flynn ◽  
Elisabeth Preston ◽  
Sarah Dennis ◽  
Colleen G Canning ◽  
Natalie E Allen
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Management Program ◽  
Self Management ◽  
Randomised Control Trial ◽  
Secondary Outcome ◽  
Mixed Response ◽  
Home Based ◽  
At Home

Objectives: To investigate the feasibility and acceptability of a home-based exercise program monitored using telehealth for people with Parkinson’s disease. Design: Pilot randomised control trial. Setting: University physiotherapy clinic, participants’ homes. Participants: Forty people with mild to moderate Parkinson’s disease, mean age 72 (6.9). Intervention: In Block 1 (5 weeks) all participants completed predominantly centre-based exercise plus a self-management program. Participants were then randomised to continue the centre-based exercise ( n = 20) or to a home-based program with telehealth ( n = 20) for Block 2 (5 weeks). The exercises targeted balance and gait. Outcomes: The primary outcomes were the feasibility and acceptability of the intervention. Secondary outcomes were balance, gait speed and freezing of gait. Results: Adherence was high in Block 1 (93%), and Block 2 (centre-based group = 93%, home-based group = 84%). In Block 2, the physiotherapist spent 6.4 hours providing telehealth to the home-based group (mean 10 (4) minutes per participant) and 32.5 hours delivering the centre-based exercise classes (98 minutes per participant). Participants reported that exercise was helpful, they could follow the home program and they would recommend exercising at home or in a group. However, exercising at home was less satisfying and there was a mixed response to the acceptability of the self-management program. There was no difference between groups in any of the secondary outcome measures (preferred walking speed mean difference −0.04 (95% CI: −0.12 to 0.05). Conclusion: Home-based exercise monitored using telehealth for people with Parkinson’s disease is feasible and acceptable.

scholarly journals Brain activation underlying turning in Parkinson’s disease patients with and without freezing of gait: a virtual reality fMRI study

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Moran Gilat ◽  
James M Shine ◽  
Courtney C Walton ◽  
Claire O’Callaghan ◽  
Julie M Hall ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Freezing Of Gait ◽  
Brain Activation ◽  
Fmri Study

025 The neural correlates of doorway freezing in parkinson’s disease

2018 ◽  
Vol 89 (6) ◽  
pp. A10.3-A11 ◽  
Author(s):  
Elie Matar ◽  
James M Shine ◽  
Moran Gilat ◽  
Kaylena Ehgoetz-Martens ◽  
Phillip B Ward ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Functional Connectivity ◽  
Freezing Of Gait ◽  
Neural Correlates ◽  
Blood Oxygenation ◽  
List Type ◽  
Oxygenation Level ◽  
Dependent Signal

IntroductionFreezing of gait (FOG) in Parkinson’s disease (PD) is a disabling symptom of advanced PD and is frequently triggered upon passing through narrow spaces such as doorways.1 Despite being common, the mechanisms underlying this phenomenon are poorly understood. We have previously shown that increased footstep latency in a virtual reality (VR) environment is a surrogate measure of FOG.2 In this study we aimed to model doorway freezing utilising the VR paradigm in conjunction with functional magnetic resonance imaging (fMRI) to determine the neural correlates of this phenomenon.MethodsIn our study, nineteen patients who routinely experience FOG performed a previously validated VR gait paradigm3 where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their ‘ON’ and ‘OFF’ medication states. Task performance in conjunction with blood oxygenation level dependent signal changes were compared within each patient.ResultsWe were able to reproduce the finding that patients in the OFF state demonstrated significantly longer ‘footstep’ latencies as they passed through a doorway in the VR environment compared to the ON state. As seen clinically with FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. fMRI analysis revealed that doorway-provoked footstep delay was associated with selective hypoactivation in the pre-supplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses showed that this delay was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN.ConclusionThese findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the ‘hyperdirect’ pathway in the generation of this phenomenon.References. Giladi N, Treves TA, Simon ES, Shabtai H, Orlov Y, Kandinov B, Paleacu D, Korczyn AD. Freezing of gait in patients with advanced Parkinson’s disease. J Neural Transm (Vienna)2001;108:53–61.. Matar E, Shine JM, Naismith SL, Lewis SJ.Virtual realitywalking and dopamine: opening new doorways to understanding freezing of gait in Parkinson’s disease. J Neurol Sci 2014;344:182–5.. Shine JM, Matar E, Bolitho SJ, Dilda V, Morris TR, Naismith SL, Moore ST, Lewis SJ. Modelling freezing of gait in Parkinson’s disease with a virtual reality paradigm. Gait Posture2013;38:104–8.

Heart Rate Changes Prior to Freezing of Gait Episodes Are Related to Anxiety

2020 ◽  
pp. 1-12
Author(s):  
Kristin Economou ◽  
Dione Quek ◽  
Hamish MacDougall ◽  
Simon J.G. Lewis ◽  
Kaylena A. Ehgoetz Martens
Keyword(s):  
Parkinson’S Disease ◽  
Heart Rate ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Freezing Of Gait ◽  
Ground Level ◽  
Video Review ◽  
Stress Levels ◽  
Anxiety Levels

Background: Freezing of gait (FOG) in Parkinson’s disease (PD) has been shown to be more frequent in stressful situations, implicating anxiety. Heart rate (HR) has been shown to increase prior to a FOG episode supporting the notion that elevated stress levels may trigger FOG. However, no studies to date have investigated whether elevated HR precedes all subtypes of FOG or only those episodes that are driven by anxiety. Objective: The present study sought to investigate whether 1) HR increases prior to FOG episodes in nonspecific environments (Experiment 1), and if 2) HR increases prior to FOG when provoked in high but not low threat environments using a virtual reality paradigm (Experiment 2). Methods: In Experiment 1, 10 of 19 participants with PD and FOG (PD + FOG) experienced FOG during a series of walking trials. In Experiment 2, 12 of 23 participants with PD + FOG experienced FOG while walking across an elevated and ground level narrow plank in virtual reality. HR was collected throughout the duration of both experiments, while FOG was quantified by experts using video review and tagging. Results: HR significantly increased 2–3 seconds prior to a FOG episode during Experiment 1. In Experiment 2, HR significantly increased 4–6 seconds prior to a FOG episode, specifically while navigating the elevated plank. However, there were no significant increases in HR prior to FOG episodes when participants navigated the ground plank. Conclusion: This study extends previous work further demonstrating that increases in HR prior to FOG episodes appear linked to elevated anxiety levels.

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