Objective: To describe the development, safety, and efficacy of the Cleveland Clinic-Virtual Home Environment (CC-VHE) in provoking freezing of gait (FOG) in Parkinson’s disease (PD).

Background: Falls occur in nearly 80% of PD patients and represent the greatest motor-related contributor to health care costs and the primary reason for transition to dependent care settings. Precursors to falls in PD are FOG episodes and postural instability and gait dysfunction (PIGD). Despite their prevalence in the daily lives of PD patients, provoking FOG episodes and PIGD in a clinical or laboratory environment is challenging and inconsistent. Thus, the mechanism(s) underlying FOG and PIGD remain unknown which has greatly hampered treatment.

Method: The CC-VHE was developed to reliably provoke FOG using a virtual reality (VR) platform and multiple types of environmentally realistic triggers. The CC-VHE couples a VR headset with an omnidirectional treadmill to replicate real-world activities that trigger FOG and PIGD. Three modules were developed based on pathophysiological FOG models: physical, dual-task, and anxiety (Figure 1).

Results: The paradigm was tested in 15 individuals with PD and DBS. Clinician-identified FOG episodes were confirmed with biomechanical gait metrics captured from lower extremity IMUs. In total 179 FOG episodes lasting a total of 1055 seconds were experienced in the 11 individuals who completed the protocol; all three modules were successful in trigger FOG events with the dual-task module producing the longest duration of FOG. No adverse events occurred despite the individuals being in the OFF DBS state.

Conclusion: The CC-VHE paradigm offers a safe and reliable and standardized approach to elicit FOG in individuals with PD. With the creation of this paradigm, numerous opportunities exist to systematically investigate the impact of medication, DBS parameters, and behavioral interventions. Recently, we completed a project in which the CC-VHE kinematic data was time synchronized with neural data, EEG and STN LFP recordings with the Medtronic Percept system, to investigate the neural signatures underlying FOG.

Figure 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-cleveland-clinic-virtual-home-environment-cc-vhe-a-reliable-way-to-trigger-freezing-of-gait-in-parkinsons-disease/