Do Patients With Parkinson’s Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality?

Overview

People with parkinson’s disease and freezing of gait (FOG+) are associated with more falls, postural instability, and cognitive impairment than people without freezing of gait (FOG−). 

Purpose:

The goal of this study is to conduct a secondary analysis of the V-TIME study, a randomized, controlled research study showing a greater reduction in falls after virtual reality treadmill training (TT + VR) as compared with usual treadmill walking (TT) in a mixed population of fallers. During treadmill interventions, we examined whether FOG+ and FOG- gained similar gains.

Methods: 

A total of 77 FOG+ and 44 FOG− were randomly assigned to TT + VR or TT. A six-month follow-up was conducted as well as pre- and post-training assessments. Mini Balance Evaluation System Test (Mini-BEST) was used to assess postural stability. Fall records were kept. The New Freezing of Gait Questionnaire (NFOG-Q) and Trail Making Test (TMT-B) were also used. 

Findings: 

Mini-BEST scores and the TMT-B improved in both groups after training (P = .001), irrespective of study arm and FOG subgroup. However, gains were not sustained at 6 months. In both FOG+ and FOG-, falls were reduced after TT + VR compared with TT (P = .008). In the FOG+ group, scores on the NFOG-Q didn’t change after both modes of training.

Conclusions: 

While controlling for disease severity differences, treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG- patients. Even in those with FOG, TT + VR reduced falls more than TT alone. Although postural instability, falls and FOG are related, they may be controlled by different mechanisms, as training did not help FOG.