None listed
Conditions
Brief summary
Freezing of gait commonly affects people with Parkinson’s disease and is known to impair mobility, increase falls risks, and reduce quality of life. The pathophysiology behind freezing of gait remains poorly understood but there is growing evidence to suggest a complex relationship between motor and non-motor factors such as cognition, mood, and environment. Pharmacological treatment is commonly offered as an intervention for freezing of gait. However, freezing of gait may persist despite optimal pharmacological intervention, especially with increased disease duration and severity. Non-pharmacological and non-surgical interventions for freezing of gait such as action observation show promise as an effective intervention to reduce freezing of gait. To date, the approach that has been tested involves: (i) the person with FOG watching video clips of an actor (without Parkinson’s disease) performing generic movement strategies to reduce freezing of gait in a clinical setting, followed by (ii) physically practising the movement strategies. The intervention that is proposed in this study is a 180 degree video self-modelling intervention using an immersive virtual reality headset, whereby the person with Parkinson’s disease observes videos of his/her own best movement strategies for preventing or overcoming freezing of gait, performed in his/her own home environment. The personalised movement strategies will be based on assessment of the individual’s motor, cognitive, emotional and environmental FOG triggers and exploration of appropriate and acceptable movement strategies for the person by a trained physiotherapist. Participants will watch their videos repeatedly (while seated), with physical practice performed separately in the context of everyday tasks. This pilot study aims to determine the feasibility and acceptability of a video self-modelling intervention using an immersive virtual reality headset for managing freezing of gait in people with Parkinson’s disease. In addition, it will evaluate the impact of the intervention on freezing of gait and on movement strategies used during freezing of gait testing. The project will provide the proof-of-concept evidence required to secure large grant funding for a randomised controlled trial to evaluate the effectiveness of the intervention.
Interventions
Participants will receive up to 8 home visits over 6 weeks. It is estimated that participants will receive 1-2 home visits per week, with each visit lasting approximately an hour.
In home visits 1-2, the participant will identify situations in the home where freezing of gait (FOG) is “troublesome”. Managing FOG in these situations will form participant-directed goals. A trained physiotherapist will then assess each participant’s motor, cognitive, emotional and environmental triggers of FOG in
Participants will receive up to 8 home visits over 6 weeks. It is estimated that participants will receive 1-2 home visits per week, with each visit lasting approximately an hour. In home visits 1-2, the participant will identify situations in the home where freezing of gait (FOG) is “troublesome”. Managing FOG in these situations will form participant-directed goals. A trained physiotherapist will then assess each participant’s motor, cognitive, emotional and environmental triggers of FOG in these situations. The identification of FOG triggers and development of suitable movement strategies will be guided by the participant’s responses on the Characterising Freezing of Gait Questionnaire. The physiotherapist and the participant will work collaboratively to determine the best movement strategy to overcome FOG in each situation where FOG was triggered. The movement strategy may be supported by self-prompting (e.g. counting) or external auditory cues (e.g. metronome), or visual cues (e.g. tape on the ground). The participant will be filmed in his/her own home using a 180 degree camera performing his/her best movement strategy to overcome FOG in one of the situations previously identified. The video will be edited to show the participant’s best performance repeated 3 times (approximately 1 min in duration). At home visits 3-4, the physiotherapist will deliver a virtual reality (VR) headset with the uploaded personal video of each participant. The physiotherapist will teach the participant how to operate the VR headset. The participant will view his/her own best movement strategy in his/her own home repetitively in a seated position. The participant will be asked to view the video x2/day (approximately 5 mins in duration per viewing). Each participant will also be asked to physically practise his/her best movement strategy in his/her home (approximately 10 mins in duration) x1/day after one of the daily viewings. The twice-daily viewing and once-daily physical practice will be performed 5 days/week. At home visits 5-6, the physiotherapist will assess participants’ progress with their first movement strategy. The physiotherapist will then film the participant performing a second movement strategy to overcome FOG. It is anticipated that the second video may be the same task in a different environment, same task with increased complexity, or a different task altogether. The second video will be edited to show the participant’s best performance 3 times. The physiotherapist will deliver the second video and participants will view the second video using the VR headset x2/day and perform physical practice x1/day, 4 days/week. In addition, the participant will continue to view the first video of the first movement strategy using the VR headset x2/day and perform physical practice x1/day, 1 day/week. A detailed intervention protocol will be developed and monitored to ensure fidelity in the delivery of the intervention. Assessment of adherence to the intervention will be based on the number and duration of home visits. Participants will be also be asked to record his/her video viewings and physical practice using a logbook. Baseline measures will be completed within one week prior to the start of the intervention (week 1). The 6 weeks intervention will be delivered between week 2 to 7. Post-intervention measures will completed within one week of intervention completion (week 8).
Sponsors
The University of Sydney
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Diagnosis of idiopathic Parkinson’s disease Presence of freezing of gait (score of more than or equal to 1 on Question 2 and score of more than or equal to 2 on Question 4 of the New Freezing of Gait Questionnaire) Stable dopaminergic medication regimen for at least 4 weeks prior to commencement of study Able to walk at least 10 metres independently with or without a walking aid Lives in the greater Sydney metropolitan area
Exclusion criteria
Medical conditions which would preclude or interfere with study safety and conduct (e.g., unstable cardiovascular disease, neurological condition other than Parkinson's disease) Cognitive impairment (Mini Mental State Examination Assessment <24) Less than 6 months post deep brain stimulation surgery Significant head tremor or motion sickness limiting ability to use a virtual reality headset
Outcome results
None listed