Virtual reality in research and rehabilitation of gait and balance in Parkinson disease

Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait and balance impairments in people with Parkinson disease (PD) as it allows users to be engaged in an enriched and highly individualized complex environment. This Review examines the rationale and evidence for using VR in the assessment and rehabilitation of people with PD, makes recommendations for future research and discusses the use of VR in the clinic. In the assessment of people with PD, VR has been used to manipulate environments to enhance study of the behavioural and neural underpinnings of gait and balance, improving understanding of the motor–cognitive neural circuitry involved. Despite suggestions that VR can provide rehabilitation that is more effective and less labour intensive than non-VR rehabilitation, little evidence exists to date to support these claims. Nevertheless, much unrealized potential exists for the use of VR to provide personalized assessment and rehabilitation that optimizes motor learning in both the clinic and home environments and adapts to changes in individuals over time. Design of such systems will require collaboration between all stakeholders to maximize useability, engagement, safety and effectiveness. This Review examines the rationale for the use of virtual reality in research and rehabilitation of people with Parkinson disease. The authors provide a critical appraisal of the current state of the art, make recommendations for future research and outline clinical implications. Key points Virtual reality (VR) might provide unique opportunities to improve understanding of the behavioural and neural underpinnings of gait and balance in people with Parkinson disease. VR environments can be manipulated in ways that are not possible and/or safe in the real world, with the potential to improve assessment and training of multisensory motor–cognitive integration. Non-immersive VR rehabilitation improves gait and balance when compared with no intervention, but is not superior to non-VR rehabilitation of similar exercise type and dose. Future applications of VR should be tailored to deliver personalized interventions according to each person’s profile of deficits and rehabilitation needs. Future developments of VR rehabilitation interventions require collaboration between therapists, technology experts and people with Parkinson disease to ensure optimal, engaging exercise that is acceptable for long-term use. Therapists should c