Virtual reality doorway and hallway environments alter gait kinematics in people with Parkinson disease and freezing

Abstract

Background: Many people with Parkinson disease (PD) experience freezing of gait (FoG), a transient gait disturbance associated with increased fall risk and reduced quality of life. Head-mounted virtual reality (VR) systems allow overground walking and can create immersive simulations of physical environments that induce FoG.

Research question: For people with PD who experience FoG (PD+FoG), are kinematic gait changes observed in VR simulations of FoG-provoking environments?

Methods: In a cross-sectional experiment, people with PD+FoG walked at their self-selected speed in a physical laboratory and virtual laboratory, doorway, and hallway environments. Motion analysis assessed whole-body kinematics, including lower extremity joint excursions, swing phase toe clearance, trunk flexion, arm swing, sagittal plane inclination angle, and spatiotemporal characteristics. One-way repeated measures analysis of variance was conducted to examine the effects of environment on gait variables, with planned contrasts between laboratory environments and the virtual doorway and hallway.

Results: Twelve participants with PD+FoG (mean age [standard deviation]=72.8 [6.5] years, disease duration=8.8 [8.9] years, 3 females) completed the protocol. The environment had significant and widespread effects on kinematic and spatiotemporal variables. Compared to the physical laboratory, reduced joint excursions were observed in the ankle, knee, and hip when walking in the virtual doorway and in the knee and hip when walking in the virtual hallway. In both the virtual doorway and hallway compared to the physical laboratory, peak swing phase toe clearance, arm swing, and inclination angle were reduced, and walking was slower, with shorter, wider steps.

Significance: Virtual doorway and hallway environments induced kinematic changes commonly associated with FoG episodes, and these kinematic changes are consistent with forward falls that are common during FoG episodes. Combined with the flexibility of emerging VR technology, this research supports the potential of VR applications designed to improve the understanding, assessment, and treatment of FoG.

Keywords: Freezing of gait; Gait analysis; Parkinson disease; Rehabilitation; Virtual reality.