Adding obstacle-avoiding virtual reality training to treadmill workouts dramatically decreases Parkinson’s patients’ falls, even in later stages of the disease, a Tel Aviv University study shows.
The research, “Disparate effects of training on brain activation in Parkinson disease,” was published in the journal Neurology.
Parkinson’s causes the gradual loss of nerve cells. This leads to cognitive and movement impairment that reduces patients’ ability to walk and increases their risk of falling.
Patients in the study had fewer falls because the virtual program caused them to use a different brain pattern than they use in treadmill training alone, researchers said.
“In previous research, we showed that patients with Parkinson’s disease use cognitive function, which is reflected in activation of the pre-frontal cortex of the brain, to compensate for impaired motor function,” Professor Jeff Hausdorff, a Tel Aviv University medical professor, said in a press release.
“We also showed that a specific form of exercise targeting the cognitive control of gait — combined treadmill training with a Virtual Reality representation of obstacles in a path — leads to a significantly lower fall rate in Parkinson’s patients,” said Hausdorff, the lead author of the study.
“The virtual reality gait program, in which patients must avoid obstacles, enhances the patients’ cognitive performance and thus reduces the requirement for prefrontal brain activity,” he added.
Seventeen patients took part in the six-week study. One group did treadmill training, and the other treadmill work plus virtual reality training.
The treadmill training for both groups was an hour long three times a week. The virtual reality training consisted of a game to play in which patients could see their feet moving around the city or in a park. The game allowed them to learn how to avoid obstacles, how to plan ahead and how to multitask.
Researchers used magnetic resonance imaging (MRI) to record patients’ brain activation patterns before and after the six weeks of training.
“The study’s findings reinforce the hypothesis that training improves motor [movement] and cognitive performance through improved neuroplasticity — more so than that seen with treadmill training alone,” Hausdorff said. Neuroplasticity is brain nerve cells’ ability to change connections and behavior in response to new information.
“Interestingly, the benefits of treadmill training with VR were specifically seen during walking conditions that require cognitive input” — negotiating obstacles and multitasking, Hausdorff said. These conditions are associated with falls, he said.
Patients who received VR training used fewer nerve cells to process information, the researchers discovered. In contrast, the team saw no change in nerve cell use among the patients who used a treadmill but did not have virtual reality training.
The difference in patients’ brain patterns during training led to fewer falls in the group with both treadmill and virtual realty components, researchers said.
“The takeaway here is that even relatively late in the disease, when 60-80 percent of dopaminergic neurons [nerve cells that use the neurotransmitter dopamine to communicate] have died, there is still an opportunity to promote plasticity in the brain,” Hausdorff said. “to induce specific brain changes, exercise should be personalized and targeted to a specific clinical [disease] problem,” he said.
Researchers said it was the first study to show how task-specific exercises affect Parkinson’s patients’ brains. The team said their findings underscore the importance of having both movement and cognitive components in Parkinson’s rehabilitation.