Objective: To prove the effects of a virtual reality (VR) EEG guided motor Neurofeedback (NFB) training protocol on stability and gait of non-demented HY I-III PD patients without previous history of falls.

Background: Up to 60% of PD patients fall. Postural Instability (PI) initiates in prodromal stages [1] and increases with the reduction on the Limits of Stability (LOS) area. NFB training has been previously reported to improve balance in unstable PD patients [2] and reduce the number of falls [3]. No studies have tested the effect of visual NFB using VR in the early stages of PD.

Method: 20 non demented PD were recruited and divided in 2 groups (11 patients in experimental group and 9 in control group), no differences sex (χ2(1)=0.2; p=0.88), age (t(18)= 1.17; p=0.258) or education years (t(17)= 1.09; p=0.289).  UPDRS III of 15,60±8,46 (SD), 705,08±461,68mg LED/day. The intervention was 8  sessions of 30-minute visual feedback using 3D VR oculus® googles (goal: reduction in the average of bilateral alpha and beta bands in 6 central EEG derivations.) Frequency reduction threshold was increased daily.  Control group did not receive any intervention. UPDRSIII, Up and Go (UG) test and Biodex® static limits of stability (LOS) and risk of falls (ROF) evaluation were performed 3 times in both groups: pre-intervention (A), after the completion of the protocol(B) and 15 days after completing the protocol (C).

Results: In experimental group there was a reduction in the UG time  (F (1,13) = 5.25, p = 0.031) between measurement A and B (μA-μB = -1.03 sc, p = 0.005), but It did not stay on C. Reduction in ROF  (F (2.20) = 4.55, p = 0.023),  between measurement A and B (μA-μB = – 0.191, p = 0.028). LOS scores improved in the experimental group (F (2.18) = 8.51, p = 0.003) between A and B (μA-μB = 6.65, p = 0.029) but also persisted in C (μA-μC = 7.45, p = 0.028). There was not any significant difference in the control group.

Conclusion: LOS improvement is independent of motor symptoms. Long-lasting effects may reflect stable changes in local brain activity by the use of VR. Improvement in UG time and ROF may produce an improvement in the quality of life but may need longer protocols. There is a need for a bigger and placebo-controlled study of VR NFB in PD stability control including different stages of the disease.

References: 1 Maetzler, et al (2012). “Impaired Trunk Stability in Individuals at High Risk for Parkinson’s Disease”. PLOS ONE, 7(3 2 Azarpaikan, A., Torbati, H. T., & Sohrabi, M. (2014). “Neurofeedback and physical balance in Parkinson’s patients”. Gait & Posture, 40(1), 177-181. 3 Rossi-Izquierdo, et al. (2013). “Vibrotactile neurofeedback balance training in patients with Parkinson’s disease: reducing the number of falls

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MDS Abstracts - https://www.mdsabstracts.org/abstract/virtual-reality-eeg-guided-motor-neurofeedback-training-has-mid-term-effects-in-parkinsons-disease-patients-limits-of-stability/