Objective: To investigate the safety and efficacy of a fully immersive virtual reality (VR) paradigm to study gait modulation in subjects with Parkinson’s disease (PD).

Background: Gait difficulties in PD are a major determinant of poor quality of life leading to falls, injuries, loss of independence and increased mortality. Currently, no treatment is particularly efficient and fall prediction and prevention in PD remain elusive. Gait adaptation to environmental challenges is one of the most frequent activities of daily life and it is particularly problematic for parkinsonian patients, also inducing gait-specific problems such as freezing of gait. Few studies investigated gait modulation in PD in standardized and realistic settings.

Method: A virtual laboratory environment with one-to-one mapping was created using Unity (Unity Technologies) to closely resemble the real laboratory and displayed to subjects via a wireless head-mounted display (Vive Pro, HTC). The study protocol consisted of several walking sessions in which 8 patients had to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. To ensure standardization of obstacle presentation, the speed and trajectory of the VA were defined using the participant’s kinematics as detected online during each walking trial. We collected kinematics, ground reaction forces, and EEG data.

Results: Compared to walking in the real world, walking in VR without the VA did not lead to significant changes in the walking pattern. On the contrary, the addition of the VA induced a reduction in step length, duration and speed in the first 3 strides after the start of the VA. Deviation of the walking direction was also higher during the perturbation. Most patients showed increased braking in the first 1-2 strides of modulation, followed by a compensation of propulsive forces to regain constant speed. Preliminary EEG analysis suggests an involvement of the supplementary motor area during the whole gait modulation.

Conclusion: Our VR setup has proven to be a safe and useful tool for a reproducible and standardized study of gait modulation in PD patients. This paradigm will aid the study of the impact of different therapeutic strategies (e.g., pharmacological, rehabilitation, or neuromodulation) and of specific gait problems, such as gait freezing.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-fully-immersive-virtual-reality-environment-to-study-gait-modulation-in-parkinsons-disease/