Objective: To determine whether mass market virtual reality (VR) devices can be used to detect the motor manifestations of Parkinson’s disease and their response to levodopa supplementation.

Background: Parkinson’s disease is a disorder which causes rest tremor, bradykinesia, rigidity, and postural instability. These symptoms can be ameliorated by providing dopamine exogenously. In general, clinicians monitor patients using a rating scale such as the UPDRS. However, this paradigm of care is limited by its low frequency of assessment and issues with inter- and intra- rater reliability. The development of technologies to assist with clinical assessments is essential to improving care. Mass market VR devices with their ability to measure movement and generate testing environments may be able to provide objectivity and increase monitoring frequency.

Method: Individuals with levodopa responsive PD without other complicating conditions were selected. Participants were evaluated in their off state using the UPDRS motor scale and participated in a virtual reality game which simulated many of the same clinical tests. During the virtual reality portion, hand positioning was recorded. Participants then took their home PD medications. After an hour, participants were reassessed by the same clinician and performed the VR game a second time. Collected data was cleaned to reduce contribution of adventitial movements. Rest tremor signal was compared between on and off states, as well as to clinician metrics.

Results: A total of 7 of a planned 20 patients have been assessed. Rest tremor severity prior to levodopa administration was less severe than after levodopa administration (p~0.0016). There was a moderately high correlation (r=0.66) between physician measures of tremor severity and device generated measures. Additionally, patient perception surveys noted most individuals were willing to incorporate similar devices into their care.

Conclusion: Initial evidence supports that mass market VR devices can detect responsiveness to levodopa and that the features detected correlate with validated physician metrics. Additionally, when utilized in a risk averse paradigm and with appropriate guidance, VR devices are well accepted and essentially side-effect free. If further evidence is supportive, then we foresee these devices reducing barriers to care and improving how we diagnose and manage PD, especially in settings with limited access to specialty care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-virtual-reality-devices-for-the-monitoring-of-parkinsons-disease/