Visual perturbation training to reduce visual dependency in Parkinson's disease: A randomized controlled trial.

Visual perturbation training significantly decreased visual dependency compared to treadmill-only controls.

• Group x time interaction effect was significant at p < 0.001
• 25 early-to-mid-stage people with Parkinson's disease (age 50-67 years) without regular freezing of gait were enrolled
• Participants were randomly assigned to a visual perturbation group or treadmill training-only control group
• Both groups trained 2 times per week for 6 weeks

Visual perturbation training improved temporal gait characteristics including step time, stride time, and cadence compared to controls.

• Step time improvement: group x time interaction p = 0.012
• Stride time improvement: group x time interaction p = 0.021
• Cadence improvement: group x time interaction p = 0.018
• No significant effects were found for step width, step length, or gait speed

No significant effects of visual perturbation training were found for step width, step length, gait speed, or self-reported (near) falls.

• Secondary outcomes included steady-state spatiotemporal gait parameters: gait speed, step time/length/width/frequency, and cadence
• Self-reported near falls were also assessed as a secondary outcome
• Despite improvements in temporal parameters, spatial parameters and fall rates were not significantly affected

Improvements in visual dependency were negatively correlated with disease progression.

• The correlation between visual dependency improvement and disease progression was statistically significant at p = 0.004
• This indicates that participants in earlier disease stages appeared to benefit most from visual perturbation training
• The authors note that additional research is needed to confirm this relationship

Visual perturbation training was delivered via a virtual reality environment applying rotations and translations during self-paced treadmill walking.

• Perturbations were applied as rotations around the sagittal axis and medio-lateral translations of the virtual reality environment
• Training was self-paced treadmill walking with these virtual reality perturbations
• The intervention ran for 6 weeks at 2 sessions per week
• The study was pre-registered at ClinicalTrials.gov (NCT05690308) on 09/01/2023

Decreased gait automaticity and increased visual dependency are recognized as important contributors to falls in people with Parkinson's disease.

• The study targeted visual dependency as the primary outcome based on its role in falls
• The study population was restricted to early-to-mid-stage Parkinson's disease patients aged 50-67 years
• Participants without regular freezing of gait were specifically enrolled