The future of physical therapy and treating Parkinson’s disease is poised to make rapid advances through the use of virtual reality technology.  What was once monotonous and tedious therapy could soon become a fun and interactive virtual game.

A new multidisciplinary study at USC is leading the way.  James Finley and Beth Fischer of the USC Division of Biokinesiology and Physical Therapy, and Marientina Gotsis of the USC School of Cinematic arts were given a two-year grant from the National Institutes of Health.

This grant will be used to create and test a new way to rehabilitate walking in patients with Parkinson’s disease through a virtual reality program.

Could VR really solve Parkinson's?
Could VR really solve Parkinson’s?

Usually it starts with small tremors in the hand but leads to more challenging symptoms such as shaking, rigid muscles and deteriorated balance, which makes walking difficult.

Typical treatments include medication or even deep brain stimulation.  Less invasive therapy involves aerobic exercise or physical therapy focusing on balance and stretching.

Unfortunately, these traditional physical therapy treatments may not lead to long-term changes in motor learning.

“From a motor-learning perspective, we now know that learning and long-term retention are optimized when the patients have a focus on the movement’s effect on the environment such as ‘step over the obstacle’ rather than on performing the movement itself,” Fisher explained.

Real World Action

This virtual reality based rehab will actually have Parkinson’s patients practicing the real world skills that they need. Rather than isolating muscle groups via stretching or practicing static balance, patients will practice dynamic movement and interaction by virtually walking through real world scenarios. This is especially helpful because patients will get live feedback without the risk of the actual obstacles, all of course under the close supervision of a physical therapist.

“We will be designing a system that will allow patients to experience and practice challenging tasks like negotiating obstacles, walking through crowds, doing turns and walking over thresholds to represent the challenges they would experience in the physical world,” Finley said.

A common complaint with traditional physical therapy is that it’s often very tedious and unexciting. It’s a hurdle this new VR system could overcome. “With motor rehabilitation, one of the things patients need is lots of repetition,” Finley said. “One of the advantages of doing something like a game is it helps increase motivation to undergo the amount of practice necessary for skill learning.” The treatment will have patients walking on the ground or on various treadmills while wearing the VR headset. The hope is that this will feel more like an interactive game rather than rehab.

To minimize risk and increase accessibility the researchers will build affordable and portable systems that can be set up in offices during the initial stages of the research. With already hectic and crammed schedules researchers believe the ease of use is paramount to gaining traction. “Clinicians have a very limited time with their patients so any hurdles or barriers that are introduced by technology can limit the actual use of that technology in the clinic,” Finley said.

Once the system is built researchers will recruit both clinicians and patients to test the technology to get feedback and improve the system.

Developing a Progressive and Effective System

In addition, Gotis’s team at USC Creative Media and Behavioral Health Center will closely assess, analyze and tweak the VR experience. Every minute detail will be examined including sound and haptic feedback to create the most realistic experience possible.
“We would like to create a pleasurable, safe and challenging walking virtual reality experience,” Gotsis said. “We will know from participant input if the experience is enjoyable, and our collaborators will help us understand whether the experience is challenging enough to promote neuroplasticity.”

Stressing the importance of challenge and functionality is key to the success of the program beyond user entertainment. Patients will actually choose from different environments that present relevant challenges; an important factor according to Finley. They’ll have an assortment of environments such as high-rise cities, a beachside pier or even a stroll down to the grocery store.

Phase 2 of the study will hone in on the efficacy of the technology. Once the VR environments are ready actual Parkinson’s patients will go through progressive training to determine the effectiveness.

Coming Together for Research and Progress

This team of researchers truly has the intent of making a difference in Parkinson’s treatment. Their decades of international experience partnered together will push forth the care and treatment provided to patients. “When it comes to imagining the future of health care, we cannot afford to leave it all to the imagination of a single expert group,” said Gotsis. “Nobody knows best. We’re all stakeholders in creating new therapies whether they use virtual reality or paper clips and glue.”

VR is already pushing athletes and recreational exercisers to new heights, it’s only a matter of time before physical therapists take advantage. The ability to acutely progress VR environments coupled with the entertainment and engagement VR provides is promising for Parkinson’s patients.

-Raphael Konforti, MS


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