November 28, 2017
Source: American Friends of Tel Aviv University
A new
study suggests that a therapy that combines virtual reality and treadmill
exercise dramatically lowers the incidence of falling among Parkinson's
patients by changing the brain's behavior and promoting beneficial brain
plasticity, even in patients with neurodegenerative disease.
Therapy effective even in later stages of the disease, researchers say
A new Tel Aviv University study suggests that a therapy that
combines Virtual Reality and treadmill exercise dramatically lowers the
incidence of falling among Parkinson's patients by changing the brain's
behavior and promoting beneficial brain plasticity, even in patients with
neurodegenerative disease.
Patients with Parkinson's disease experience gradual neuronal
loss, leading to cognitive and motor impairments that damage their ability to
walk and cause debilitating, often fatal, falls. The new study shows that fall
rates are reduced in response to treadmill training with Virtual Reality. The
number of neurons activated in the pre-frontal cortex is also reduced in
response to the same combination. This reduction likely reflects enhancements
in motor control and greater automaticity of cognitively demanding tasks.
The research underlines the importance of combining cognitive
rehabilitation with the motor rehabilitation of Parkinson's disease patients.
The study was conducted by Prof. Jeff Hausdorff of TAU's Sackler
School of Medicine and Tel Aviv Medical Center along with colleagues Dr. Inbal
Maidan of Tel Aviv Medical Center and Dr. Anat Mirelman and Prof. Nir Giladi,
both of TAU's Sackler School of Medicine and Tel Aviv Medical Center. The
findings were recently published in the journal Neurology.
"In previous research, we showed that patients with
Parkinson's disease use cognitive function, which is reflected in activation of
the pre-frontal cortex of the brain, to compensate for impaired motor
function," Prof. Hausdorff says. "We also showed that a specific form
of exercise targeting the cognitive control of gait -- combined treadmill
training with a Virtual Reality representation of obstacles in a path -- leads
to a significantly lower fall rate in Parkinson's patients.
"The Virtual Reality gait program, in which patients must
avoid obstacles, enhances the patient's cognitive performance and thus reduces
the requirement for prefrontal brain activity," Prof. Hausdorff continues.
Seventeen subjects in two groups, one which combined treadmill
training with Virtual Reality and one which used treadmill training alone,
underwent a six-week intervention, exercising three times a week for about an
hour each time. The Virtual Reality group played a "game" in which
they viewed their feet walking in a city or park environment. Through the game,
they implicitly learned how to deal with obstacles in the virtual environment,
how to plan ahead and how to do two things at once -- that is, address
cognitive challenges related to safe ambulation.
The other group just walked on a treadmill without the VR
components or cognitive challenges. Before and after the subjects participated
in the exercise programs, the researchers used functional MRI imagery to
evaluate the patients' brain activation patterns.
"The study's findings reinforce the hypothesis that
training improves motor and cognitive performance through improved
neuroplasticity -- more so than that seen with treadmill training alone,"
Prof. Hausdorff explains. "Interestingly, the benefits of treadmill
training with VR were specifically seen during walking conditions that require
cognitive input (i.e., obstacle negotiation and dual tasking), conditions
associated with falls in everyday environments. In these conditions, fewer
neurons were needed after training with VR, while no change was seen in the
group that trained by walking on a treadmill without VR."
Previous research conducted on mouse models of Parkinson's
disease suggested the importance of task-specific exercises on the brain.
However, the new TAU study is the first to show such findings in people with
Parkinson's disease.
"Exercise that focuses on motor components promotes
plasticity in brain areas associated with sensory-motor integration and
coordination," Prof. Hausdorff says. "But exercise incorporating
cognitive components also stimulates changes in brain regions related to
cognition. It may therefore have a greater impact on compensatory brain
function and the cognitive functions related to safe ambulation (i.e., walking
without falling)."
"The takeaway here is that even relatively late in the
disease, when 60-80 percent of dopaminergic neurons have died, there is still
an opportunity to promote plasticity in the brain," Prof. Hausdorff
concludes. "Moreover, to induce specific brain changes, exercise should be
personalized and targeted to a specific clinical problem."
Story Source:
Materials provided
by American Friends of Tel Aviv
University. Note: Content may be edited for style and
length.
Journal Reference:
1.
Inbal Maidan, Keren Rosenberg-Katz, Yael Jacob, Nir Giladi,
Jeffrey M. Hausdorff, Anat Mirelman. Disparate effects of training on
brain activation in Parkinson disease. Neurology, 2017; 89
(17): 1804 DOI: 10.1212/WNL.0000000000004576
https://www.sciencedaily.com/releases/2017/11/171128120150.htm
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