CHSU Discovery

Abstract:
Background and Purpose: Parkinson's disease (PD) is a neurodegenerative disorder that affects movement, balance, and gait. Virtual reality (VR) based exercises in conjunction with physical therapy can provide a safe and controlled environment for people with PD to practice motor skills in an engaging environment. The purpose of this study was to evaluate the effectiveness of multimodal VR based exercises on motor deficits, fall risk, balance, and gait related functional outcomes in PD patient who uses deep brain stimulation (DBS).

Case Description: In this case study a 76-year-old female (AB, synonym) with PD, reported to the neurorehab clinic with gait and balance impairments. AB lives in a single-story home with her husband. The patient is currently using the Four-Wheeled Walker (4WW) and exhibited initial hesitation during sit-to-stand movements. The initial evaluation identified high fall risk, motor deficits, impaired balance, and gait abnormalities. The plan of care included VR based Exercises along with traditional physical therapy. VR headset from neurorehab VR was used with specific games inbuilt such as ‘Explore’ is best utilized for Parkinson's patients when working on gait training, functional mobility and activity tolerance goals. Within this activity the patient is tasked with walking through a relaxing village and collecting coins. ‘Rhythm Therapy’ utilizes rhythmic auditory stimulation as part of exercise. ‘Fowl Play’ is a fun and engaging activity where PD patient worked on their postural stability through alternating positions as they dodge cannon balls being fired at them.

Outcomes: The patient was enrolled in 8-week rehabilitation program. Pretest values at initial evaluation indicated high fall risk as assessed through various clinical outcome measures such as FOGQ (Freezing of Gait Questionnaire) = 12/24; The activities specific balance confidence (ABC) scale = 17.5% , TUG ( time up and go) = 29.6 sec , mCTSIB = 33/120, Berg Balance Scale (BBS) =
17/56, Gait Speed= 0.20 m/s. Interestingly, the patient reported no falls just after three weeks of physical therapy integrated with VR in comparison to falling everyday prior to this therapy at the pretest evaluation. The patient provided positive feedback to VR and tolerated the exercises well with less rest breaks required. Post rehab patients’ functional outcomes improved along with confidence in balance.

Discussion: Integrating VR exercises into the rehabilitation program revolutionized the approach to address motor deficits, fall risk, balance impairments, and gait abnormalities in a Parkinson's disease patient with Deep Brain Stimulation (DBS). The compelling results unequivocally demonstrate that VR interventions are highly effective in significantly enhancing motor performance and functional independence. By providing a controlled and repetitive environment, VR enables patients to engage in intensive and focused training, promoting the formation of new neural connections and thereby inducing neuroplasticity.

Keywords: Parkinson's disease, Deep Brain Stimulation, immersive virtual reality, motor rehabilitation, fall risk, gait mechanics.