JMIR Publications

ABSTRACT

Background:

Despite optimal medical and/or surgical intervention, freezing of gait occurs commonly in people with Parkinson’s disease, leading to reduced mobility, falls, poor quality of life and increased healthcare costs. Action observation via video self-modelling, combined with physical practice, has potential as a non-invasive intervention to reduce freezing of gait.

Objective:

To determine the feasibility and acceptability of a home-based, personalised video self-modelling intervention delivered via a virtual reality head mounted display to reduce freezing of gait in people with Parkinson’s disease. Secondary aims included investigating the potential effect of this intervention on freezing of gait, mobility and anxiety.

Methods:

A single group pre/post mixed methods pilot trial. Ten participants with Parkinson’s disease and freezing of gait were recruited. A physiotherapist assessed participants in their homes to identify person-specific triggers of freezing and developed individualised movement strategies to overcome freezing of gait. 180-degree videos of participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality head mounted display, followed by physical practice of their strategies in their own homes over a six-week intervention period. Primary outcome measures included feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, Timed Up and Go test, 10m walk test, Goal Attainment Scale, and Parkinson Anxiety Scale.

Results:

Ten participants were recruited. The recruitment rate was 24% and retention rate was 90%. Adherence to the intervention was high, with participants completing a mean of 84% for the prescribed video viewing and a mean of 100% for the prescribed physical practice. One participant used the virtual reality head mounted display for one week and completed the rest of the intervention using a flatscreen device due to a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessments. Most participants found using the head mounted display to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from interview data: reflections when seeing myself; my experience of using the virtual reality system; the role of the virtual reality system in supporting my learning; developing a deeper understanding on how to manage my freezing of gait; and impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility or anxiety measures from baseline to post-intervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety.

Conclusions:

Video self-modelling using an immersive virtual reality head mounted display plus physical practice of personalised movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson’s disease. Clinical Trial: Australian New Zealand Clinical Trials Registry (ANZCTR12619000139178)