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Virtual Training for Brain Activation in PD Patients

November 07, 2017

A recent study compared the effects of two forms of exercise in patients with Parkinson disease (PD)—treadmill training with virtual reality and treadmill training alone—to investigate impact on brain activity.

Authors Inbal Maidan, PhD, and coauthors conducted a randomized controlled trial. Patients were assigned to either treadmill training (TT) alone or to the treadmill training with virtual reality (TT + VR), which targeted motor and cognitive aspects of safe ambulation. A previously validated fMRI imagery paradigm assessed changes in neural activation pre-training and post-training (Neurology. 2017;89[17]:1804-1810).

There were 17 participants in the TT group (mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) and 17 participants in the TT + VR group (mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men), all of whom trained for 6 weeks. In the TT + VR group, participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed.

Baseline brain activation patterns were similar in both groups before training interventions. After training, participants in the TT + VR group had lower brain activation than the TT group in Brodmann area 10 and the inferior frontal, while the TT group had lower activation than TT + VR in the cerebellum and middle temporal gyrus. Changes in fall frequency and brain activation were correlated in the TT + VR group.

Based on these observations, authors concluded that the interventions were able to modify brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training seemed to decrease patients’ reliance on frontal regions, “which apparently resulted in improved function, perhaps reflecting increased brain efficiency.”—Amanda Del Signore

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