Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy.
Mov Disord Clin Pract. 2024 Apr;11(4):337-345. doi: 10.1002/mdc3.13961. Epub 2024 Jan 4.
Motor symptoms in functional motor disorders (FMDs) refer to involuntary, but learned, altered movement patterns associated with aberrant self-focus, sense of agency, and belief/expectations. These conditions commonly lead to impaired posture control, raising the likelihood of falls and disability. Utilizing visual and cognitive tasks to manipulate attentional focus, virtual reality (VR) integrated with posturography is a promising tool for exploring postural control disorders.
To investigate whether postural control can be adapted by manipulating attentional focus in a 3D immersive VR environment.
We compared postural parameters in 17 FMDs patients and 19 age-matched healthy controls over a single session under four increasingly more complex and attention-demanding conditions: simple fixation task (1) in the real room and (2) in 3D VR room-like condition; complex fixation task in a 3D VR city-like condition (3) avoiding distractors and (4) counting them. Dual-task effect (DTE) measured the relative change in performance induced by the different attention-demanding conditions on postural parameters.
Patients reduced sway area and mediolateral center of pressure displacement velocity DTE compared to controls (all, P < 0.049), but only under condition 4. They also showed a significant reduction in the sway area DTE under condition 4 compared to condition 3 (P = 0.025).
This study provides novel preliminary evidence for the value of a 3D immersive VR environment combined with different attention-demanding conditions in adapting postural control in patients with FMDs. As supported by quantitative and objective posturographic measures, our findings may inform interventions to explore FMDs pathophysiology.
功能性运动障碍（FMDs）中的运动症状是指与异常的自我关注、主体感和信念/期望相关的、不自主但习得的、改变的运动模式。这些情况通常会导致姿势控制受损，增加跌倒和残疾的可能性。利用视觉和认知任务来改变注意力焦点，虚拟现实（VR）与姿势描记术相结合，是探索姿势控制障碍的一种很有前途的工具。
研究在 3D 沉浸式 VR 环境中通过操纵注意力焦点是否可以适应姿势控制。
我们在一次会话中比较了 17 名 FMD 患者和 19 名年龄匹配的健康对照者在四种越来越复杂和注意力要求高的情况下的姿势参数：在真实房间和 3D VR 房间状条件下进行简单固定任务（1）；在 3D VR 城市状条件下进行复杂固定任务（3）避免分心物和（4）对它们进行计数。双重任务效应（DTE）测量了不同注意力要求条件对姿势参数的相对变化引起的性能变化。
与对照组相比，患者在所有条件下（均 P < 0.049）的摆动面积和中侧位压力中心位移速度 DTE 均降低，但仅在条件 4 下如此。与条件 3 相比，他们在条件 4 下的摆动面积 DTE 也显著降低（P = 0.025）。
这项研究为 3D 沉浸式 VR 环境与不同注意力要求条件相结合在适应 FMDs 患者的姿势控制方面提供了新的初步证据。基于定量和客观的姿势描记术测量，我们的发现可能为探索 FMDs 病理生理学的干预措施提供信息。
