Goh Lina, Allen Natalie E, Ahmadpour Naseem, Ehgoetz Martens Kaylena A, Song Jooeun, Clemson Lindy, Lewis Simon J G, MacDougall Hamish G, Canning Colleen G
Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Sydney School of Architecture, Design and Planning, The University of Sydney, Camperdown, Australia.
JMIR Form Res. 2021 Nov 3;5(11):e28315. doi: 10.2196/28315.
Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait.
The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety.
The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180° videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale.
The recruitment rate was 24% (10/42), and the retention rate was 90% (9/10). Adherence to the intervention was high, with participants completing a mean of 84% (SD 49%) for the prescribed video viewing and a mean of 100% (SD 56%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety.
Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease.
尽管进行了最佳的药物和手术干预，但帕金森病患者仍经常出现冻结步态。通过视频自我建模进行动作观察，并结合身体练习，有可能作为一种非侵入性干预措施来减少冻结步态。
本研究的目的是确定通过虚拟现实头戴式显示器（HMD）进行的基于家庭的个性化视频自我建模干预措施在减少帕金森病患者冻结步态方面的可行性和可接受性。次要目的是研究这种干预措施对冻结步态、运动能力和焦虑的潜在影响。
该研究是一项单组前后混合方法的试点试验，招募了10名患有帕金森病且有冻结步态的参与者。一名物理治疗师在参与者家中对其进行评估，以确定特定个体的冻结触发因素，并制定个性化的运动策略来克服冻结步态。制作了参与者成功执行其运动策略的180°视频。参与者使用虚拟现实HMD观看他们的视频，然后在为期6周的干预期内在自己家中对其策略进行身体练习。主要结局指标包括干预措施的可行性和可接受性。次要结局指标包括冻结步态的身体测试和问卷，包括定时起立行走测试、10米步行测试、目标达成量表和帕金森焦虑量表。
招募率为24%（10/42），保留率为90%（9/10）。对干预措施的依从性很高，参与者规定视频观看的完成率平均为84%（标准差49%），规定身体练习的完成率平均为100%（标准差56%）。一名参与者使用虚拟现实HMD一周，由于晕动病逐渐加重，其余干预使用平板设备完成。在干预或评估期间未发生其他不良事件。大多数参与者发现使用HMD观看他们的视频有趣且令人愉快，并会选择在未来使用这种干预措施来管理他们的冻结步态。从访谈数据中构建了五个主题：看到自己时的反思、我使用虚拟现实系统的体验、虚拟现实系统在支持我学习方面的作用、对如何管理我的冻结步态有更深入的理解以及干预对我日常活动的影响。总体而言，从基线到干预后，冻结步态、运动能力或焦虑指标的变化很小，尽管参与者之间存在很大差异。该干预措施显示出对高焦虑水平参与者降低焦虑的潜力。
使用沉浸式虚拟现实HMD进行视频自我建模并结合个性化运动策略的身体练习，是解决帕金森病患者冻结步态的一种可行且可接受的方法。
