Objective: To investigate whether treadmill training with virtual reality is beneficial both for Parkinson’s disease patients with and without freezing of gait (FOG) to address postural instability, falls and FOG.

Background: People with Parkinson’s disease and freezing of gait (FOG+) have more postural instability, cognitive impairment, falls and loss of retention of learning compared to FOG-. The V-TIME randomized, controlled study showed positive effects of virtual reality treadmill training (TT+VR) on falls, over and above that of usual treadmill training (TT)[1], however, it is not yet clear if postural control and fall rates improve in FOG- and in FOG+.

Methods: Seventy-five FOG+ and 46 FOG- were randomly assigned to 6 weeks of TT+VR or TT. Participants were assessed at baseline and after the intervention (post, 1 month and 6 months). The primary outcome for the present analysis was the Mini-Best test, capturing postural and dynamic stability. Fall risk was assessed via diaries. Secondary outcomes comprised the new freezing of gait questionnaire (NFOG-Q) and the Trail Making Test (TMT-B).

Results: Age (p=0.295; FOG+: 70.5±6.0; FOG-: 71.7±6.3 yrs), UPDRS-III (p=0.072; FOG+: 31.4±12.6; FOG-: 27.0±13.5) and fall rates (p= 0.371; FOG+: 26.6±66; FOG-: 16.2±53 falls per 6 months) were similar in FOG+ and FOG- at baseline. In response to the interventions, both FOG+ and FOG- had a higher reduction of falls (p<0.001) after TT+VR compared to TT. Mini-Best scores improved in both FOG+ and FOG- after training (p=0.001), irrespective of study arm. Improvements were retained at 1-month, but not at 6-months in both groups. The same pattern of results was apparent for the TMT-B (p=0.001). NFOG-Q scores did not change after both training modes.

Conclusions: TT+VR was able to reduce falling more than TT in FOG+ and FOG-. Similar to FOG-, FOG+ improved postural and dynamic instability after both training modes and retained these effects for 1 month after the cessation of the intervention. Freezing scores were not helped by training and deteriorated with time. These findings point to a similar learning potential between patients with and without FOG regarding postural control and cognition. However, long-term retention was impaired in both groups. These results highlight the potential of treadmill-based rehabilitation to address gait, balance and fall risk even in FOG+, but not freezing.

References: [1] A. Mirelman, L. Rochester, I. Maidan et al., Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial 2016, p1170.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effects-of-treadmill-training-augmented-by-virtual-reality-on-postural-control-and-freezing-of-gait-in-parkinsons-disease/