Jay Alberts, PhD
Director Cleveland Clinic Concussion Center
Vice Chair of Health Technology Enablement Cleveland Clinic Neurological Institute
Strosacker Auditorium
Fusing the virtual and real worlds to understand and treat Parkinson’s gait and postural instability. Freezing of gait (FOG) and postural instability and gait dysfunction (PIGD) are cardinal motor signs of Parkinson’s disease (PD) and are frequently reported as the most vexing symptom in people living with the disease. Despite their prevalence in the daily lives of PD patients, identifying FOG episodes and PIGD in a clinical or laboratory environment is challenging. We recently developed the Cleveland Clinic-Virtual Home Environment (CC-VHE) platform that reliably and safely triggers FOG and PIGD in PD patients. For the first time, PD patients can physically walk and navigate a virtual world that replicates scenarios that frequently trigger FOG and PIGD. In addition to gathering biomechanical data while patients are performing CC-VHE we simultaneously monitor neural activity within the subthalamic nucleus (STN) of the basal ganglia and cortex. Data from the Medtronic Percept deep brain stimulation (DBS) platform and EEG data are gathered while the patient safely navigates the virtual world. The ability to simultaneously record biomechanical and neural data provides unprecedented insight into the potential neural mechanism(s) of FOG and PIGD. The success in treating FOG and PIGD with medication or surgical intervention is substantially less than treatment of other PD cardinal motor symptoms. Dual-task training (DTT) is known to be an effective treatment for PD lower extremity dysfunction, but it is rarely used due to the time and expertise requirements. We recently developed and validated in a RCT a digital augmented reality version of DTT that overcomes clinical barriers. Results from the RCT indicate the augmented reality version of DTT improves gait speed and postural stability in PD patients. Data will be presented and discussed from the perspective of using virtual and augmented reality in the identification and treatment of PD related FOG and PIGD