Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson's disease

Aram Kim, Nora Darakjian, James M Finley, Aram Kim, Nora Darakjian, James M Finley

Abstract

Background: Virtual reality (VR) has recently been explored as a tool for neurorehabilitation to enable individuals with Parkinson's disease (PD) to practice challenging skills in a safe environment. Current technological advances have enabled the use of affordable, fully immersive head-mounted displays (HMDs) for potential therapeutic applications. However, while previous studies have used HMDs in individuals with PD, these were only used for short bouts of walking. Clinical applications of VR for gait training would likely involve an extended exposure to the virtual environment, which has the potential to cause individuals with PD to experience simulator-related adverse effects due to their age or pathology. Thus, our objective was to evaluate the safety of using an HMD for longer bouts of walking in fully immersive VR for older adults and individuals with PD.

Methods: Thirty-three participants (11 healthy young, 11 healthy older adults, and 11 individuals with PD) were recruited for this study. Participants walked for 20 min while viewing a virtual city scene through an HMD (Oculus Rift DK2). Safety was evaluated using the mini-BESTest, measures of center of pressure (CoP) excursion, and questionnaires addressing symptoms of simulator sickness (SSQ) and measures of stress and arousal.

Results: Most participants successfully completed all trials without any discomfort. There were no significant changes for any of our groups in symptoms of simulator sickness or measures of static and dynamic balance after exposure to the virtual environment. Surprisingly, measures of stress decreased in all groups while the PD group also increased the level of arousal after exposure.

Conclusions: Older adults and individuals with PD were able to successfully use immersive VR during walking without adverse effects. This provides systematic evidence supporting the safety of immersive VR for gait training in these populations.

Keywords: Gait; Head-mounted display; Parkinson’s disease; Simulator sickness; Virtual reality.

Figures

Fig. 1
Fig. 1
Experimental protocol. Pre-test evaluation involved a set of clinical assessments (MDS-UPDRS for the PD group, mini-BESTest, 10 m walk test, MoCA), static postural stability measures (CoP during eyes open and closed) and questionnaires (SSQ, SAC). The test consisted of walking for a total of 20 min with breaks taken every 5 min for participants to complete a short symptom checklist and for measures of blood pressure (BP) to be monitored. Post-test evaluation involved an additional set of clinical assessments (mini-BESTest, 10 m walk test), static postural stability measures and questionnaires (SSQ, SAC, PQ)
Fig. 2
Fig. 2
Representative images of the virtual environment. The environment consisted of a cityscape including buildings, avatars and a 800 m pedestrian path. A first person views (a) up, (b) front, (c) left, and (d) right
Fig. 3
Fig. 3
Pre- (dark gray bar) and post-test (white bar) average simulator sickness questionnaire total score and sub-category scores with standard deviation. Asterisks represent statistical significance (**: p < 0.01, ***: p < 0.005). a Average total score of SSQ. b Average Nausea score. c Average Oculomotor discomfort score. d Average Disorientation score
Fig. 4
Fig. 4
CoP sway area. Pre- (black bar) and post-test (dark gray bar) during eyes open (EO) and pre- (light gray bar) and post-test (white bar) during eyes closed (EC). Vertical bars represent standard deviations. Asterisks represent statistical significance (*: p < 0.05)
Fig. 5
Fig. 5
Average presence questionnaire scores are shown with individual scores. a Average total score. b Average sub-category scores; Involvement/Control, visual fidelity, adaptation/Immersion and interface quality for HY (dark gray bar), HO (light gray bar), and PD (white bar). Vertical bars represent standard deviations. Asterisks represent statistical significance (*: p < 0.05)

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