Visual perturbation training may be superior to treadmill training for reduction of fall risk in Parkinson’s disease

1. Six weeks of visual perturbation training reduced visual dependency and improved temporal gait characteristics to a greater extent than treadmill training alone in people with early-stage Parkinson’s disease.

Evidence Rating Level: 1 (Excellent)

Visual dependency is defined as a “reduced ability to disregard visual cues in complex or conflicting visual environments”. Decreased gait automaticity and increased visual dependency may increase the risk of falls in people with Parkinson’s disease (PwPD). However, there is a lack of research on rehabilitation training to decrease visual dependency and its effects on gait and fall risk in PD. This study thus assessed if visual perturbation training during treadmill walking decreases visual dependency in PwPD and improves spatiotemporal gait characteristics. This randomized controlled trial included adults aged 50-67 years with early-to-mid-stage idiopathic PD in Belgium. Participants were randomly assigned 1:1 to the visual perturbation group or the treadmill training-only control group. Both groups trained twice/week for six weeks. Visual perturbation training consisted of self-paced treadmill walking with perturbations applied as tilting (rotations around the sagittal axis) and horizon shifts (medio-lateral translations) of a virtual reality environment. The primary outcome was visual dependency. Secondary outcomes included steady-state spatiotemporal gait parameters (gait speed, step time/length/width/frequency, and cadence), and self-reported (near) falls. In total, 25 participants completed the study, with 11 in the VPT group (mean [SD] age, 60.00 [4.93], 12 male [86%]) and 14 in the control group (mean [SD] age, 61.36 [4.82], 8 male [73%]). Compared to the treadmill-only control group, the visual perturbation training group had decreased visual dependency (interaction p < 0.001) and improved temporal gait characteristics such as step time (p = 0.012), stride time (p = 0.021) and cadence (p = 0.018). No significant effects were found for step width, step length, gait speed, and (near) falls. Overall, this study found that VPT reduced visual dependency and improved temporal gait characteristics to a greater extent than treadmill training alone in people with early-stage PD. These findings highlight the potential of VPT as a rehabilitation approach to reduce fall risk in PwPD.

Click here to read this study in PLOS One

Image: PD

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