Virtual Reality in Health and Rehabilitation

Christopher M. Hayre, Dave J. Muller, Marcia J. Scherer, Christopher M. Hayre, Dave J. Muller, Marcia J. Scherer

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000319972
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

This edited book focuses on the role and use of VR for healthcare professions in both health and rehabilitation settings. It is also offers future trends of other emerging technology within medicine and allied health professions. This text draws on expertise of leading medical practitioners and researchers who utilise such VR technologies in their practices to enhance patient/service user outcomes. Research and practical evidence is presented with a strong applied emphasis to further enhance the use VR technologies within the community, the hospital and in education environment(s). The book may also be used to influence policymakers on how healthcare delivery is offered.

Section II

Virtual Reality in Neurological Rehabilitation

2

On the Possibility of Using Virtual Reality to Improve the Mobility of People with Parkinson's Disease

Amin Amini

Brunel University London

London, UK

CONTENTS

• Introduction
• Freezing of Gait (FOG)
• Possible Treatments
• Sensory Stimulation
• The Effect of Visual Cue on PD Locomotion
• Virtual and Augmented Reality
• Discussion
• References

INTRODUCTION

Parkinson's is a neurological condition in which parts of the brain responsible for movements become incapacitated over time due to the abnormal dopamine equilibrium. Freezing of Gait (FOG) is one of the main Parkinson's disease (PD) symptoms that affects patients not only physically, but also psychologically as it prevents them from fulfilling simple tasks such as standing up or walking. Different auditory and visual cues have been proven to be very effective in improving the mobility of People with Parkinson's (PwP). Nonetheless, many of the available methods require user intervention or devices to be worn, charged, etc. to activate the cues.

PD, caused by the depletion of dopamine in the substantia nigra, is a degenerative neurological condition affecting the initiation and control of movements, particularly those related to walking (Yarnall et al. 2015, Dirkx et al. 2017). There are many physical symptoms associated with PD including akinesia, hypokinesia, and Bradykinesia (Young et al. 2016). An additional symptom is FOG, usually presenting in advanced stages of Parkinson's (Bloem et al. 2004, Okuma 2006, Pickering et al. 2007, Johnson et al. 2013). FOG is one of the most debilitating and least understood symptoms associated with Parkinson's. It is exacerbated by several factors including the need to walk through narrow spaces, turning as well as stressful situations (Okuma 2006, Beck et al. 2015).

FREEZING OF GAIT (FOG)

FOG is one of the most disabling symptoms in PD that affects its sufferers by impacting their gait performance and locomotion. FOG is an episodic phenomenon that prevents the initiation or continuation of a patient's locomotion and usually occurs in latter stages of PD where patients' muscles freeze in place as they are trying to move (Bloem et al. 2004, Okuma 2006, Donovan et al. 2011, Yarnall et al. 2015, Amini 2018).

FOG and associated incidents of falling often incapacitate PwP and, as such, can have a significant detrimental impact at both physical and psychological levels (Bloem et al. 2004). Consequently, the patient's quality of life decreases and health care and treatment expenditures increase substantially (Nutt et al. 2011). A research study conducted by the University of Rochester's Strong Memorial Hospital (University of Rochester 1999) showed that approximately 30% of PwP experience sudden, unexpected freezing episodes, thus highlighting the high level of dependency that many PwP have on physical or psychological strategies that may assist in alleviating FOG and help people start walking again.

POSSIBLE TREATMENTS

There is no proven therapy to eradicate the PD or slow down its progression. As a result, the focus of the medical therapy is on the treating or reducing the effect of its symptoms (Factor and Weiner 2007). There are different treatments available to improve PwP living standards and help deal with the symptoms including supportive therapies, medications, and surgery.

Supportive therapies focus towards pain relief using different methods including physiotherapy that relieves joint pain and muscle stiffness as well as exercises and occupational therapy that provide support for day-to-day activities of PwP and programmes that help them maintain their independence. Moreover, supportive therapies also cover dietary advice that would be beneficial to some extent for symptom relieve. Lastly, speech, and language therapy can also help PwP improving speech impairment caused by the disease or reduce the patient's swallowing difficulties (dysphagia), also related to PD (Parkinson's disease - Treatment 2016).

Medications are also beneficial in reducing the frequency or effect of PD's main symptoms including FOG and tremors. Nonetheless, there are usually possible short- and long-term side effects in these methods. The three types of the mainstream medication for PwP are (Parkinson's disease - Treatment 2016):

• Levodopa: Levodopa helps to the increase the dopamine production by the nerve cells; an agent for message transmission between brain parts and nerves responsible of controlling movement. Consequently, this would improve the patient's movement irregularities and locomotion (Factor and Weiner 2007, Galvez-Jimenez 2013).
• Dopamine agonists: These chemicals act as a substitute for the imbalanced dopamine level in the brain, which yields similar effect as levodopa. Dopamine agonists could have many side effects including hallucinations and confusion (Factor and Weiner 2007, Galvez-Jimenez 2013).
• Monoamine oxidase-B inhibitors: Monoamine oxidase-B (MOA-B) inhibitors aim at blocking the effect of an enzyme responsible of breaking down dopamine. As a result, the dopamine level would be increased. MOA-B can improve the PD symptoms and can be prescribed to be used alongside other medications such as dopamine agonists or levodopa (Factor and Weiner 2007, Galvez-Jimenez 2013).

Finally, a pulse generator can be surgically implanted into the subject's chest wall connected using wires to a specific part of the brain. This acts as a deep brain stimulation that produces a tiny electrical current that stimulates the brain in order to ease PD symptoms (Marks 2010).

SENSORY STIMULATION

Many studies suggest that auditory (Rubinstein et al. 2002a, Suteerawattananon et al. 2004, Rochester et al. 2005, Khan 2013) and visual cues (Azulay et al. 1999, 2006, Rubinstein et al. 2002, Suteerawattananon et al. 2004, Jiang and Norman 2006, Carrel 2007, Kaminsky et al. 2007, McAuley et al. 2009, Donovan et al. 2011, Dvorsky et al. 2011, Griffin et al. 2011, Lebold and Almeida 2011, Velik 2012, Velik et al. 2012) can improve PwP's gait performance, especially during FOG. Rubinstein et al. (2002) observed that in the presence of an external ‘movement trigger’ (i.e., a sensory cue), a patient's self-paced actions, such as walking, can be significantly improved, a phenomenon known as ‘kinesia paradoxica’.

THE EFFECT OF VISUAL CUE ON PD LOCOMOTION

Many previous studies have developed methods for monitoring FOG behaviours and intervening to improve motor symptoms with the use of external visual cues. Many studies utilised computer vision technologies to minimise the need for patients to wear measurement devices, which can be cumbersome and also have potential to alter a person's movement characteristics. Since the release of the Microsoft Kinect camera, several attempts have been made to use the Kinect sensor as a non-invasive approach for monitoring PD-related gait disorders. Many previous research studies have focussed on rehabilitation outcomes and experimental methods for monitoring patients' activities.

For instance, in Takač, et al. (2013), a home tracking system was developed using Microsoft Kinect sensors to help PwP who experience regular FOG. The research interconnected multiple Kinect sensors together to deliver a wider coverage of the testing environment. The model operated by collectively gathering data from multiple Kinect sensors into a central computer and storing them in a centralised database for further analysis and processing. The research employed a model based on the subject's histogram colour and height together with the known average movement delays between each camera. Nonetheless, as a Kinect camera produces a raw RGB (red, green, blue) data stream, analysing multiple Kinect colour data stream for the histogram of colour in real-time requires a very powerful processor and significant amount of computer memory. Moreover, the synchronisation between each camera feed would add extra computation for this approach.

Previous research has demonstrated that dynamic visual cues (such as laser lines projected on the floor) can deliver a profound improvement to walking characteristics in PwP (Rubinstein et al. 2002). Furthermore, strong evidence now exists suggesting that it is not only the presence of sensory information (or an external ‘goal’ for movement) that ‘drives' improvements/kinesia paradoxia, but rather the presence of continuous and dynamic sensory information. This was first demonstrated by Azulay et al. (1999) who showed that the significant benefits to gait gained when walking on visual stepping targets were lost when patients walked on the same targets under conditions when the room was illuminated by strophic lighting, thus making the visual targets appear static. Similar observations have also been made in the auditory domain (Young et al. 2016).

In Zhao et al. (2013), in order to improve PwP's gait performance, a visual cue system was implemented based on a wearable system installed on subjects' shoes. This system employed laser pointers as visual cues fitted on a pair of modified shoes using a 3D printed caddy. The system consisted of pressure sensors that detect the stance phase of gait and ...