NEW TREATMENT FOR PARKINSON’S DISEASE
AUGMENTED REALITY: Part 2 of 2
Bill is a 3rd year doctor of physical therapy student at The University of Scranton and works as a student PT aide at Mackarey Physical Therapy. He is a graduate of Scranton Prep and plans to practice orthopedic and sports PT in California. He and his classmates at completed a graduate research project on the use of augmented reality for Parkinson’s disease and will present it at The American Physical Therapy Association National Combined Section Meeting in New Orleans in February 2018.
Last week in this column, we discussed a disease that affects more than 1 million people in the United States, Parkinson’s disease. This neurodegenerative disease affects the way our brain produces and uses dopamine and therefore, it affects the way people living with the disease are able to move. The hallmark signs: a resting tremor, slowness of movement, muscle rigidity, and gait and balance disturbances can all be treated through medication, rehab therapy, or in severe cases, surgical intervention. Managing these symptoms is important an important part of maintaining a high quality of life and independence in daily activities. The problem with these treatments is that they can be time consuming, expensive, and not as effective after continued use. Luckily, recent research has proven that exercise and an active lifestyle can help our brains use available dopamine more efficiently.
One of the biggest barriers to an active lifestyle for people with Parkinson’s disease is problems with balance and walking. These problems include a slow, shuffling gait and difficulty with turning or changing from one surface to another, like stepping from a hardwood floor onto a carpet. Freezing of gait can also occur, where their movement is involuntarily halted, another major fall risk. All of these symptoms are more likely to occur in environments that are crowded and unfamiliar which can lead to a more sedentary or homebound lifestyle. While medications do help manage these problems for a time, they are characterized by having on and off periods throughout the day meaning they work for a few hours, and then the symptoms return for a few hours. As previously mentioned, an active lifestyle is vital to improve quality of life and so there has to be a better way to address this problem moving forward.
A group of my fellow classmates from the University of Scranton and I, conducted a systematic review of literature to find out how people with Parkinson’s could walk more safely in their environment by using augmented reality visual cues. Past research has suggested the use of audio or visual cues for training gait in therapy sessions, but until recently, these methods were difficult to translate safely to community ambulation. It is now theorized that, by using a visual cue, the person is able to use a different part of their brain to control walking, one that bypasses the basal ganglia, or the part of the brain most affected by Parkinson’s. Using this new technology could change the way people with Parkinson’s move.
“Augmented” reality is a computer generated projection into a person’s real environment. This differs from “virtual” reality which uses a computer generated environment. An example of augmented reality you may have seen before is on Snapchat where computer generated objects like crowns or dog ears are added to regular pictures. Our research team specifically focused on the use of augmented reality visual cues to improve the speed, length of each stride, and the cadence during ambulation. It was found that these visual cues are produced from various devices including a cane or walker with a laser attachment that projects a line onto the ground in front of the user when the base of the cane comes into contact with the floor. Another option used to augment reality is a pair of glasses or goggles that shows a cue across the lens that appears to be projected into the environment, cuing the user to step. The cues varied from horizontal lines, to vertical lines that flow with the user’s movement and, in with more advanced technology; a checkerboard pattern is projected over the walking surface to facilitate normal gait.
We found 8 studies that tested these measures in the past 10 years and after analyzing their results, we found statistically significant gains in all measures, including some studies that showed less in freezing of gait. These are promising results, but more high quality studies will be needed in order to determine if these devices will consistently produce the same results over time, find which cues work best, and additional benefits to their use. Practical application simply requires the use of walkers and canes with laser projections. They are readily available and are relatively inexpensive. The glasses, however, are not as easy to obtain. Much of the available research utilized glasses that aren’t available at retail, however, there has been research done with both Google Glasses and Epson Moviero BT Smartglasses. As technological advances continue, there is great promise that augmented reality glasses become more available and less expensive. Until then, obtaining and appropriately programming the glasses will be difficult for most, unless they are involved in clinical trials.
In February, my colleagues and I will present our research at the American Physical Therapy Association’s National Combined Sections Meeting in New Orleans, LA. If you are interested about learning more about this topic or other research being done by the University of Scranton PT Department visit:
http://www.scranton.edu/academics/pcps/physicaltherapy/pt-research.shtml. “The Effect of Augmented Reality Visual Cues on Temporal-Distance Gait Parameters in Individuals with Parkinson's Disease: A Systematic Review” William Connell, Alexandra Crowley, Cassandra Fitzgerald, Samantha Marri, Dr. Renée Hakim
Visit your doctor regularly and listen to your body.
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.