Parkinson’s disease affects balance, gait, and quality of life. However, there are physical exercises, sports activities, and technologies that can improve or decrease the progress of PD. Virtual reality is one of the technological inventions for the reduction of PD balance impairments.
Parkinson’s disease affects balance and gait.
68% of people with PD diagnosis have at least one fall per year.
Balance improvement in PD patients can be seen when exercises are adapted individually and supervised.
Virtual reality-based balance training can improve spatial gait parameters, balance, and mobility.
Assistive technologies can help PD patients to reduce the freezing of gait
What happens when our balance skills are reduced?
One million Americans have been diagnosed with Parkinson’s disease, and approximately 50,000 new cases are diagnosed each year.
Parkinson’s disease (PD) affects balance and gait which are the cardinal signs of PD. About 68% of people who live with PD have at least one fall per year. Most patients with this diagnosis suffer recurrent falls over one year. Falls reduce the quality of life and cause injuries.
Why do PD patients fall?
Parkinson’s disease affects the basal ganglia which are essential for balance. Healthy people have automatic balance restoration - when they slip, balance is restored during postural control strategies (ankle, hip, or step).
For PD patients balance control is no longer automatic and becomes more difficult. Reduced spatial gait parameters worsen the postural control step strategy. When PD patients try not to fall they take a small step instead of a bigger stride and cannot avoid falling because of the weight shift.
Strategies to improve balance for Parkinson's disease sufferers
Balance improvement is one of the ways to increase the quality of life. Strategies to improve balance have been shown to reduce fall risk, increase walking velocity, improve standing balance activities, and help transition from sitting to standing.
Sensorimotor training programs improve balance when adapted individually instead of in group training. Minimally supervised programs must be implemented in the early PD disease stage to reduce the risk of falls.
Combination training works best to reduce fall risk. The combination of balance exercises, strength exercises, gait training, tai chi, and functional training can increase balance control. One study showed that highly challenging, and progressive exercises reduce the risk of falls and improve balance.
The training consisted of 6 interacting systems that contributed to balance control:
|Biomechanical constraints||Calf raises.||Calf stretch.||Standing hip abduction.||Push-ups or planks.|
|Stability limits||Functional reach forward.||Functional reach lateral.|
|Anticipatory postural adjustments||Step ups (forward and lateral).||Sit to stand or squats.||Lunges.||Single limb stance with reaching.|
|Postural adjustments||Standing on foam.||Perturbations on stable and unstable surfaces.||Ball toss.||Standing hip abduction and flexion.|
|Sensory integration||Modified CTSIB conditions.||Squats on foam.||Standing on incline.|
|Stability in gait||Gait at varying speeds with auditory cueing.||Gait with dual-task conditions.||Gait with head turns, starts, stops, and quick turns.||Walking backward.|
Technological Innovations for people with Parkinson’s disease
As well as balance control, finding ways to improve motor learning and retention are essential. PD patients have reduced motor learning abilities because of the deterioration of the brain's basal ganglia and frontoparietal and temporal lobes.
Virtual reality (VR) is one of the ways to improve the retention of motor skills. VR is a variety of tools or technologies which affect multiple sensory channels and can offer augmented or immediate feedback on motor performance.
VR has the potential to maximize motor learning with a variety of practices that focus on attention, learning by action, observation, and problem-solving. Moreover, the progression of difficulty can be modified in line with feedback on performance and results.
A systematic review revealed that virtual reality-based balance training improved balance and mobility compared to traditional balance training. There was no significant effect on walking speed for people with PD.
VR-based balance training can improve spatial gait parameters because it stimulates change in support balance and gait initiation strategies.
Exercise for gait improvement
Gait impairments affect the quality of life and patients feel discomfort when walking in public. Symptoms common in PD patients:
- Uneven stride.
- Freezing of gait.
- Shortened stride.
- Reduced step length.
During the rehabilitation period, PD patients are given aerobic exercises on a treadmill to improve the cardiorespiratory system and gait parameters. It is common for family members and physiotherapists to encourage a PD person to take bigger steps.
To evaluate and collect data for gait kinematics, kinetics, and spatial-temporal parameters, sophisticated movement analysis systems are used in 3D motion laboratories. However, this system is high-cost and requires a specialized person to perform it.
Accessory and device technologies for ‘freezing of gait’
Freezing of gait is also a major motor symptom of Parkinson’s disease, often presenting during the advanced stages of PD. It is described as ‘a brief episode of involuntary absence of locomotion’.
For patients, this feels like the sensation of being stuck in one place, especially when trying to initiate a step, or when navigating through or turning around obstacles. For this reason, many devices are designed to help patients to handle freezing gait.
Many technology companies are designing wearable tech for PD patients. These instruments aim to be portable and easily accessed once they come to market.
A recent market feedback study indicated a wearable prototype device Parkibit that could be connected to a mobile app. Movement feedback information would be transmitted from sensors worn on the ankle. The device would then utilize vibration and spoken feedback to mimic the vocal support of a physiotherapist. However, this is currently only a prototype version and may be commercialized in the future.
Another wearable device is Agilitas which clips onto the belt of the patient is out in the market already. Created by Parkinson's disease specialists and neuropsychiatricians, it can automatically detect a person’s freezing. The device instructs to step on, step over or follow a laser dot to break the freeze. Moreover, it automatically detects freezing episodes.
There are wearables available such as Walk With Path that can be strapped to shoes. The straps have integrated laser beams which help to reduce the freezing of gait.
Devices for canes, walkers, or walking poles
There is a device NextStride available that customizes visual and auditory cues to help people with Parkinson's overcome the freezing of gait. The apparatus works with acoustic and visual stimulation to activate the brain motor cortex, re-establishing the neurological path between the brain and body, and allowing the patient to resume walking. This simple-to-use accessory can be attached to a cane, walker, or walking pole to reduce the duration and frequency of freezing episodes.
Rollz Motion Rhythm - a walker developed specifically for people living with neurological diseases is available on the market. The walker contains integrated stimuli to help users take the first step, make subsequent steps, or maintain a walking rhythm. The stability of the walker helps prevent falls that could occur due to problems with balance. There is an integrated laser that can help for freezing of gait, and a metronome or repeating vibration that can help to set a walking pace. This device can also be managed using a mobile app.
Although Parkinson’s disease affects motor functions, there are a variety of assistive devices and individually adapted exercises that help patients reduce the symptoms. The emergence of innovative new technologies aims to give control back to the user. By utilizing these breakthroughs in technology, it’s possible to reduce falls, improve gait and empower an independent movement for as long as possible.