Thomas, a retired attorney, was a real character. Love the man or hate him, he was a man of his convictions. You always knew where he stood by the look on his face… but today, the face was a mask; the quintessential poker face. Unfortunately for Thomas, we weren’t playing cards.
Thomas had Parkinson’s disease. And, his flat affect was just one of the clinical presentations that are so common among patients with Parkinson’s disease.
In a 2016 study, virtual reality was combined with proprioceptive training to test if improving proprioceptive function could also improve motor performance.
Participants diagnosed with Parkinson’s disease were attached to a robotic sensor that detected small, precise wrist movements to make a table tilt in a virtual environment with the goal of balancing a virtual ball on a target. To increase the difficulty of the test, the responsiveness of the virtual ball was increased.
The researchers found an increase in movement precision in other, untrained motor tasks and wrist proprioceptive function.
However, more research is certainly called for in this field. There are huge questions regarding the choice of physical training methods and the exact nature and duration of exercises to be prescribed for Parkinson’s disease patients.
Why is this important?
Well, one factor that can help improve symptoms of Parkinson’s disease is being able to see what’s going on. It might seem obvious that seeing movements would make it easier to control them, but in a study by Pilgram et al. (2016), patients with Parkinson’s needed more support and took wider, slower steps when vision of their limbs was occluded. Participants without Parkinson’s took shorter steps with impaired vision, but their gait was otherwise unchanged.
Interestingly, it seems that seeing movements in a virtual reality can help the patient with Parkinson’s. As technology progresses, so do the training options for improving motor function. (However, more investigations and controlled clinical trials are necessary.)
Watch for another way VR is being used in Parkinson’s treatment:
Parkinson’s Disease and Motor Movement
Parkinson’s disease is a disabling neurodegenerative disease which is apparently on the rise. According to Statista.com (2015), the number of patients with Parkinson’s worldwide is on a trajectory to more than double over a 25 year period (from 4.1. million in 2005 to 8.7 million in 2030).
Parkinson’s disease is characterised by the decline in physical, psychological, social and neurological functions in affected patients. The disease manifests in the form of loss of gait and mobility, tremors in skeletal muscles, postural inability, and loss of balance and coordination.
Individuals with PD have movements which appear stiff and they intermittently freeze-up in the middle of a motor act, especially when doing non-automated acts such as stepping over the threshold to a doorway. Patients with Parkinson’s live on a continuum, but the end of the road is the inability to perform dual processing.
For you or me, the environment provides comprehensible clues, both visual and tactile, that help us originate movements and predict the need to make U-turns in our motor planning. This skill is damaged for the patient with PD. Many researchers believe that haptic perception (the ability to reach into a bag of – for illustration purposes — slimy worms and distinguish a lone penny nail by touch) is seriously atrophied in Parkinson’s patients.
Routinely, patients with PD manifest with odd patterns of proprioceptive integration. Individuals lose spatial awareness of where their limbs are located. If you passively move one of their limbs and do not allow them to visually assess the change, they may be unable to match the placement with the other side. They can even lose their ability to regulate grip strength, a truly frustrating and highly noticeable sign of the looming disability of PD.
Further Reading: Nursing Care for Parkinson’s Disease
Cause and Effect of Parkinson’s Disease
So, what is the root cause of these degenerative changes seen in this Parkinson’s population? Some researchers argue that these deficits are prompted by changes experienced in the diseased brain’s ability to process the barrage of incoming kinesthetic signals. The information which comes in is not “read” correctly by the brain and thus the motor action which is generated – based on that faulty information – is also faulty.
Death of dopamine-stimulated neurons in the motor cortex is responsible for the progressive debilitation seen in Parkinson’s disease patients. Since the disease is chronic and progressive, patients gradually lose their ability to perform even simple daily tasks.
There are also psychological facets to Parkinson’s disease; sufferers are likely to suffer from depression. When patients were asked about their reaction to a new diagnosis of Parkinson’s disease, only 48% stated that they were able to cope with this new reality. Over half of respondents expressed feelings like “my world has ended” or “I didn’t know who to turn to”. Although there are drugs available to alleviate specific symptoms of Parkinson’s disease, the disease usually progresses to a stage where the patient’s movements are severely restricted.
Further Reading: Nursing Care for Parkinson’s Disease
[show_more more=”Show References” less=”Hide References” align=”center” color=”#808080″]
- Clarke, CE, Patel, S, Ives, N, Rick, CE, Woolley, R, Wheatley, K & Sackley, CM 2016, ‘Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB)’, Health Technology Assessment, vol. 20, no. 63, pp. 1-96, http://eprints.nottingham.ac.uk/38008/
- Elangovan, N, Tuite, P & Konczak, J 2016, ‘Proprioceptive training as a means to enhance sensorimotor function in Parkinson’s disease’, Movement Disorders, vol. 31, S668. http://www.mdsabstracts.org/abstract/proprioceptive-training-as-a-means-to-enhance-sensorimotor-function-in-parkinsons-disease/
- Lee, A & Gilbert, RM 2016, ‘Epidemiology of Parkinson disease’, Neurologic clinics, vol. 34, no. 4, pp. 955-65, http://onlinelibrary.wiley.com/doi/10.1111/jnc.13691/full
- Olszewska, DA, Fearon, C & Lynch, T 2016, ‘Loss of visual feedback revealing motor impairment–an early symptom of Parkinson’s disease in two Irish farmers’, Journal of clinical movement disorders, vol. 3, no. 1, p. 12, https://clinicalmovementdisorders.biomedcentral.com/articles/10.1186/s40734-016-0040-0
- Pilgram, LM, Earhart, GM & Pickett, KA 2016, ‘Impact of limiting visual input on gait: Individuals with Parkinson disease, age-matched controls, and healthy young participants’, Somatosensory & motor research, vol. 33, no. 1, pp. 29-34, http://www.tandfonline.com/doi/abs/10.3109/08990220.2016.1152237
- Statistica.com 2016, Share of reactions to receiving a diagnosis of Parkinson’s disease in the United Kingdom (UK) in 2016, https://www.statista.com/statistics/547156/reaction-after-receiving-diagnosis-of-parkinsons-disease-united-kingdom-uk/
- Statistica.com, Projected worldwide increase in prevalence of Parkinson’s disease in 2005 and 2030 (in million patients). https://www.statista.com/statistics/215459/projected-worldwide-increase-in-prevalence-of-parkinsons-diseas/
- Sveinbjornsdottir, S. (2016). The clinical symptoms of Parkinson’s disease. Journal of neurochemistry, 139(S1), 318-324. http://onlinelibrary.wiley.com/doi/10.1111/jnc.13691/full
Andrea Salzman, MS, PT graduated from the University of Alabama at Birmingham with a Master’s degree in physical therapy in 1992. Over the last two decades, she has held numerous prominent leadership roles in the physical therapy field, with a heavy emphasis on academic writing and administrative functions. Between 1995 and 1998, Salzman served as the Editor-in-Chief of an American Physical Therapy Association (APTA) journal. In 2010, Salzman received one of the highest honors given to a physical therapist from the American Physical Therapy Association, the Judy Cirullo Leadership Award. Between 2012 and the present, Salzman has written 12 physical therapy courses for Care2Learn, Relias Learning and reviewed over 100 other course offerings. Currently, Salzman continues in her writing, leadership and administrative roles at Aquatic Therapy University and 10K Health.