Objective: To evaluate the effects of VR-based rehabilitation on freezing of gait and gait performance in individuals with PD and FOG.

Background: Freezing of gait (FOG) is a disabling symptom of Parkinson’s disease (PD) that is strongly associated with falls and reduced quality of life. The pathophysiology of FOG is multifactorial, involving dysfunction across motor, cognitive, sensory, and limbic circuits that disrupt neural integration required for locomotor control.¹ Increasing evidence suggests that impaired cognitive–motor integration contributes to FOG.² Virtual reality (VR)–based rehabilitation provides an interactive environment that simultaneously engages motor and cognitive processes and may help target these disrupted networks to improve gait performance in PD (Figure 1).

Method: A systematic search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted from database inception to October 2025. Eligible studies included adults with PD and explicitly defined FOG who received VR-based rehabilitation and reported FOG-related or gait outcomes. Randomized controlled trials and quasi-experimental studies were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane risk-of-bias tools. The study selection process followed PRISMA guidelines (Figure 2). Study characteristics and intervention details were extracted (Table 1).

Results: Three studies involving 73 participants with PD and FOG met the inclusion criteria, including one randomized controlled trial and two quasi-experimental pilot studies. All interventions used non-immersive VR platforms, with training programs ranging from 8 to 18 sessions over 2–9 weeks. VR-based rehabilitation was associated with improvements in gait parameters, including step length and gait speed, and reductions in FOG severity in two studies (Table 2). Risk-of-bias assessment indicated small sample sizes and moderate-to-high risk of bias in several domains.

Conclusion: VR-based rehabilitation shows potential to improve gait performance and reduce FOG in PD by engaging cognitive–motor processes involved in gait control. However, the current evidence is limited and of low certainty. Larger randomized controlled trials with standardized outcome measures are needed to establish its clinical effectiveness.

Table 1

Table 2

Figure 1

Figure 2

References: 1. Tosserams A, Fasano A, Gilat M, Factor SA, Giladi N, Lewis SJG, et al. Management of freezing of gait: mechanism-based practical recommendations. Nat Rev Neurol. 2025;21(6):327-344. doi:10.1038/s41582-025-01079-6.
2. Lewis SJG, Factor SA, Giladi N, Nieuwboer A, Nutt JG, Hallett M. Stepping up to meet the challenge of freezing of gait in Parkinson’s disease. Transl Neurodegener. 2022;11(1):23. doi:10.1186/s40035-022-00298-x.

« Back to 2026 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/virtual-reality-based-rehabilitation-for-freezing-of-gait-in-parkinsons-disease-implications-for-cognitive-motor-integration-a-systematic-review/