Validating a Seated Virtual Reality Threat Paradigm for Inducing Anxiety and Freezing of Gait in Parkinson’s Disease

2021 ◽  
pp. 1-12
Author(s):  
Dione Y. L. Quek ◽  
Kristin Economou ◽  
Hamish MacDougall ◽  
Simon J.G. Lewis ◽  
Kaylena A. Ehgoetz Martens

Background: Although prior research has established that freezing of gait (FOG) in Parkinson’s disease (PD) is associated with anxiety, only one study to date has directly manipulated anxiety levels to induce FOG. Objective: The current study aimed to replicate these previous findings and evaluate whether a seated version of a ‘threat’ virtual reality (VR) paradigm could induce anxiety and provoke FOG. Methods: Twenty-four PD patients with FOG were assessed across various threat conditions in both a walking VR paradigm (Experiment 1) and a seated VR paradigm (Experiment 2). Both paradigms manipulated the height (i.e., elevated vs ground) and width (wide vs narrow) of the planks participants were instructed to walk across. Results: Across both experiments, the Elevated + Narrow condition provoked significantly greater number of freezing episodes compared to all other conditions. Higher levels of self-reported anxiety were reported during the Elevated+Narrow condition compared to all other conditions in Experiment 1, and compared to the Ground condition in Experiment 2. Conclusion: These findings confirm that anxiety contributes to FOG and validates the use of a seated VR threat paradigm for provoking anxiety-related freezing. This enables future studies to combine this paradigm with functional MRI to explore the neural correlates underlying the role of anxiety in FOG.

2018 ◽  
Vol 89 (6) ◽  
pp. A10.3-A11 ◽  
Author(s):  
Elie Matar ◽  
James M Shine ◽  
Moran Gilat ◽  
Kaylena Ehgoetz-Martens ◽  
Phillip B Ward ◽  
...  

IntroductionFreezing of gait (FOG) in Parkinson’s disease (PD) is a disabling symptom of advanced PD and is frequently triggered upon passing through narrow spaces such as doorways.1 Despite being common, the mechanisms underlying this phenomenon are poorly understood. We have previously shown that increased footstep latency in a virtual reality (VR) environment is a surrogate measure of FOG.2 In this study we aimed to model doorway freezing utilising the VR paradigm in conjunction with functional magnetic resonance imaging (fMRI) to determine the neural correlates of this phenomenon.MethodsIn our study, nineteen patients who routinely experience FOG performed a previously validated VR gait paradigm3 where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their ‘ON’ and ‘OFF’ medication states. Task performance in conjunction with blood oxygenation level dependent signal changes were compared within each patient.ResultsWe were able to reproduce the finding that patients in the OFF state demonstrated significantly longer ‘footstep’ latencies as they passed through a doorway in the VR environment compared to the ON state. As seen clinically with FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. fMRI analysis revealed that doorway-provoked footstep delay was associated with selective hypoactivation in the pre-supplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses showed that this delay was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN.ConclusionThese findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the ‘hyperdirect’ pathway in the generation of this phenomenon.References. Giladi N, Treves TA, Simon ES, Shabtai H, Orlov Y, Kandinov B, Paleacu D, Korczyn AD. Freezing of gait in patients with advanced Parkinson’s disease. J Neural Transm (Vienna)2001;108:53–61.. Matar E, Shine JM, Naismith SL, Lewis SJ.Virtual realitywalking and dopamine: opening new doorways to understanding freezing of gait in Parkinson’s disease. J Neurol Sci 2014;344:182–5.. Shine JM, Matar E, Bolitho SJ, Dilda V, Morris TR, Naismith SL, Moore ST, Lewis SJ. Modelling freezing of gait in Parkinson’s disease with a virtual reality paradigm. Gait Posture2013;38:104–8.


2020 ◽  
pp. 1-12
Author(s):  
Kristin Economou ◽  
Dione Quek ◽  
Hamish MacDougall ◽  
Simon J.G. Lewis ◽  
Kaylena A. Ehgoetz Martens

Background: Freezing of gait (FOG) in Parkinson’s disease (PD) has been shown to be more frequent in stressful situations, implicating anxiety. Heart rate (HR) has been shown to increase prior to a FOG episode supporting the notion that elevated stress levels may trigger FOG. However, no studies to date have investigated whether elevated HR precedes all subtypes of FOG or only those episodes that are driven by anxiety. Objective: The present study sought to investigate whether 1) HR increases prior to FOG episodes in nonspecific environments (Experiment 1), and if 2) HR increases prior to FOG when provoked in high but not low threat environments using a virtual reality paradigm (Experiment 2). Methods: In Experiment 1, 10 of 19 participants with PD and FOG (PD + FOG) experienced FOG during a series of walking trials. In Experiment 2, 12 of 23 participants with PD + FOG experienced FOG while walking across an elevated and ground level narrow plank in virtual reality. HR was collected throughout the duration of both experiments, while FOG was quantified by experts using video review and tagging. Results: HR significantly increased 2–3 seconds prior to a FOG episode during Experiment 1. In Experiment 2, HR significantly increased 4–6 seconds prior to a FOG episode, specifically while navigating the elevated plank. However, there were no significant increases in HR prior to FOG episodes when participants navigated the ground plank. Conclusion: This study extends previous work further demonstrating that increases in HR prior to FOG episodes appear linked to elevated anxiety levels.


2020 ◽  
Vol 11 ◽  
Author(s):  
J. Sebastian Marquez ◽  
S. M. Shafiul Hasan ◽  
Masudur R. Siddiquee ◽  
Corneliu C. Luca ◽  
Virendra R. Mishra ◽  
...  

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e66718 ◽  
Author(s):  
Moran Gilat ◽  
James M. Shine ◽  
Samuel J. Bolitho ◽  
Elie Matar ◽  
Yvo P. T. Kamsma ◽  
...  

2021 ◽  
Vol 5 (3) ◽  
pp. 23
Author(s):  
Jens Carsten Möller ◽  
Daniel Zutter ◽  
Robert Riener

This narrative review provides a brief overview of the current literature on technology-based interventions for the neurorehabilitation of persons with Parkinson’s disease (PD). The role of brain–computer interfaces, exergaming/virtual-reality-based exercises, robot-assisted therapies and wearables is discussed. It is expected that technology-based neurorehabilitation will gain importance in the management of PD patients, although it is often not clear yet whether this approach is superior to conventional therapies. High-intensity technology-based neurorehabilitation may hold promise with respect to neuroprotective or neurorestorative actions in PD. Overall, more research is required in order to obtain more data on the feasibility, efficacy and safety of technology-based neurorehabilitation in persons with PD.


2020 ◽  
Author(s):  
Marit Ruitenberg ◽  
Nelleke van Wouwe ◽  
Scotty Wylie ◽  
Elger Abrahamse

Parkinson’s disease (PD) is a neurological disorder associated primarily with overt motor symptoms. Several studies show that PD is additionally accompanied by impairments in covert cognitive processes controlling motor functioning (e.g., action planning, adaptation, inhibition), and that dopaminergic medication may modulate such action control. In this review we aim to leverage findings from studies in this domain to elucidate the role of dopamine (DA) in action control. A qualitative review of studies that investigated the effects of medication status (on vs. off) on action control in PD suggests a component-specific role for DA in action control, although the expression of medication effects depends on characteristics of both the patients and experimental tasks used to measure action control. We discuss these results in the light of findings from other research lines examining the role of DA in action control (e.g., animal research, pharmacology), and recommend that future studies use multi-method, within-subject approaches to model DA effects on action control across different components as well as underlying striatal pathways (ventral vs. dorsal).


2017 ◽  
Vol 24 (2) ◽  
Author(s):  
Vanessa Carla Bezerra Fontoura ◽  
João Gabriel Figuêredo de Macêdo ◽  
Liliane Pereira da Silva ◽  
Ivson Bezerra da Silva ◽  
Maria das Graças Wanderley de Sales Coriolano ◽  
...  

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 740
Author(s):  
Mahmood Saleh Alzubaidi ◽  
Uzair Shah ◽  
Haider Dhia Zubaydi ◽  
Khalid Dolaat ◽  
Alaa A. Abd-Alrazaq ◽  
...  

Background: Parkinson’s Disease (PD) is a chronic neurodegenerative disorder that has been ranked second after Alzheimer’s disease worldwide. Early diagnosis of PD is crucial to combat against PD to allow patients to deal with it properly. However, there is no medical test(s) available to diagnose PD conclusively. Therefore, computer-aided diagnosis (CAD) systems offered a better solution to make the necessary data-driven decisions and assist the physician. Numerous studies were conducted to propose CAD to diagnose PD in the early stages. No comprehensive reviews have been conducted to summarize the role of AI tools to combat PD. Objective: The study aimed to explore and summarize the applications of neural networks to diagnose PD. Methods: PRISMA Extension for Scoping Reviews (PRISMA-ScR) was followed to conduct this scoping review. To identify the relevant studies, both medical databases (e.g., PubMed) and technical databases (IEEE) were searched. Three reviewers carried out the study selection and extracted the data from the included studies independently. Then, the narrative approach was adopted to synthesis the extracted data. Results: Out of 1061 studies, 91 studies satisfied the eligibility criteria in this review. About half of the included studies have implemented artificial neural networks to diagnose PD. Numerous studies included focused on the freezing of gait (FoG). Biomedical voice and signal datasets were the most commonly used data types to develop and validate these models. However, MRI- and CT-scan images were also utilized in the included studies. Conclusion: Neural networks play an integral and substantial role in combating PD. Many possible applications of neural networks were identified in this review, however, most of them are limited up to research purposes.


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