Effect of Spatial Disorientation in a Virtual Environment on Gait and Vital Features in Patients with Dementia: Pilot Single-Blind Randomized Control Trial

Chimezie O Amaefule, Stefan Lüdtke, Thomas Kirste, Stefan J Teipel, Chimezie O Amaefule, Stefan Lüdtke, Thomas Kirste, Stefan J Teipel

Abstract

Background: Orientation deficits are among the most devastating consequences of early dementia. Digital navigation devices could overcome these deficits if adaptable to the user's needs (ie, provide situation-aware, proactive navigation assistance). To fulfill this task, systems need to automatically detect spatial disorientation from sensors in real time. Ideally, this would require field studies consisting of real-world navigation. However, such field studies can be challenging and are not guaranteed to cover sufficient instances of disorientation due to the large variability of real-world settings and a lack of control over the environment.

Objective: Extending a foregoing field study, we aim to evaluate the feasibility of using a sophisticated virtual reality (VR) setup, which allows a more controlled observation of disorientation states and accompanying behavioral and physiological parameters in cognitively healthy older people and people with dementia.

Methods: In this feasibility study, we described the experimental design and pilot outcomes of an ongoing study aimed at investigating the effect of disorientation on gait and selected physiological features in a virtual laboratory. We transferred a real-world navigation task to a treadmill-based virtual system for gait analysis. Disorientation was induced by deliberately manipulating landmarks in the VR projection. Associated responses in motion behavior and physiological parameters were recorded by sensors. Primary outcomes were variations in motion and physiological parameters, frequency of disorientation, and questionnaire-derived usability estimates (immersion and perceived control of the gait system) for our population of interest. At this time, the included participants were 9 cognitively healthy older participants [5/9 women, 4/9 men; mean age 70 years, SD 4.40; Mini-Mental State Examination (MMSE) mean 29, SD 0.70) and 4 participants with dementia (2/4 women, 2/4 men; mean age 78 years, SD 2.30 years; MMSE mean 20.50, SD 7.54). Recruitment is ongoing, with the aim of including 30 cognitively healthy older participants and 20 participants with dementia.

Results: All 13 participants completed the experiment. Patients' route was adapted by shortening it relative to the original route. Average instances of disorientation were 21.40, 36.50, and 37.50 for the cognitively healthy older control, cognitively healthy older experimental participants, and participants with dementia, respectively. Questionnaire outcomes indicated that participants experienced adequate usability and immersion; 4.30 for presence, 3.73 for involvement, and 3.85 for realism of 7 possible points, indicating a good overall ability to cope with the experiment. Variations were also observed in motion and physiological parameters during instances of disorientation.

Conclusions: This study presents the first feasibility outcomes of a study investigating the viability of using a sophisticated VR setup, based on an earlier real-world navigation study, to study spatial disorientation among cognitively healthy older people and people with dementia. Preliminary outcomes give confidence to the notion that our setup can be used to assess motion and physiological markers of disorientation, even in people with cognitive decline.

Trial registration: ClinicalTrials.gov; https://ichgcp.net/clinical-trials-registry/NCT04134806.

Keywords: activity recognition; dementia; older adults; spatial disorientation; virtual reality; wayfinding; wearable sensors.

Conflict of interest statement

Conflicts of Interest: None declared.

©Chimezie O Amaefule, Stefan Lüdtke, Thomas Kirste, Stefan J Teipel. Originally published in JMIR Serious Games (http://games.jmir.org), 08.10.2020.

Figures

Figure 1
Figure 1
(A) The GRAIL system, consisting of a dual-belt treadmill, 180° projection surface, and optical motion capturing system (figure sourced from Motek Medical); (B) plantar figures.
Figure 2
Figure 2
(A) The OpenStreetMap (OSM)–generated virtual environment containing some notable landmarks from (B) the real world.
Figure 3
Figure 3
Map of the routes of (A) cognitively healthy older participants and (B) patients with dementia. Red crosses denote locations where the environment is changed in the experimental run. The environment is unchanged for the patients with dementia; however, the route is shortened (image: Google Maps).
Figure 4
Figure 4
Example of changes in the environment to induce disorientation. (A) Original environment shown in the guided walk (note the red landmark at the far end of the road, to the right). (B) Manipulated environment used in the experimental run; in this case, the landmark is moved to a different intersection.
Figure 5
Figure 5
Sample of motion and physiological data showing variations in walking speed, accelerometry, heart rate, and skin conductance of participants occurring during instances of disorientation (green bars in the first row) from the unguided walk for (A) an older control participant (environment not manipulated), (B) an older experimental participant (environment was manipulated), and (C) a patient with dementia (environment not manipulated).

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