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Virtual Reality: A Practical Use in PD by Tom Riess I am 47 years old and have had PD for approximately 12 years. Like many other PD people I have a great deal of difficulty with dyskinesia (uncontrolled movement) as a consequence of taking PD medications for many years. On the other side of the equation I have frequent OFF periods during the day when I am completely unable to walk (akinesia or freezing). Ever since I have had problems with akinesia I have observed that I am very sensitive to what is called visual cue phenomenon. This means that even when I am totally unmedicated and unable to walk I have no difficulty walking up or down stairs or stepping over obstacles placed at my feet. Gradually I discovered that placing a row of playing cards or dimes or any other similar objects at my feet allowed me to walk, run and change direction at will. About a year ago I learned of a product in development called Virtual Vision glasses. This product is intended for entertainment purposes and looks like ski glasses. Built into the brow piece of the glasses is a tiny television screen and an optical system which will project a television image into space for one eye. The other eye sees the real world. The two images are perceived as one creating the effect of projecting the image onto the real world without hiding reality. It occurred to me that using such a device I might be able to superimpose my visual cues onto the real world and thereby overcome my akinesia. I contacted the company and they were eager to help. I was subsequently directed to a virtual reality research lab affiliated with the University of Washington in Seattle called the Human Interface Technology lab. Over the last several months I have worked on this project both in the lab in Seattle as well as at home. I can report that I am now able to walk while unmedicated if I am wearing the glasses. We are currently in the process of re-engineering the glasses to make them more suitable for this application and refining the cueing images. They may also be useful for PD people who can walk but suddenly freeze up and for those who exhibit shuffling (festinating) gait. Subjects Needed for Testing We are current looking for additional subjects to test the equipment. Subjects may eventually need to go to the lab in Seattle; although initially they could try the equipment in the San Francisco Bay Area. If you are interested, you should test yourself for sensitivity to visual cues. The way to do this is to first wait until you are in the OFF state. If in the OFF state you are akinetic, i.e., unable to take a first step, then have someone place a small object such as a book or a pack of playing cards on the floor directly in front of your feet. If you find that looking at the object facilitates your talking a step you are probably sensitive to visual cue phenomenon. If you have problems with freezing or with little stutter steps, then in addition to the first object set directly at your feet, position 7 or 8 additional objects in a row at approximately 2 foot intervals. While looking at the objects try walking by stepping over the objects. If you notice significant improvement, you are probably sensitive to visual cue phenomenon. If you are a candidate for this project please contact me. Tom Riess, 176 Morningside Dr., San Anselmo, CA 94960 My telephone is (415) 457-8961. This appeared in the recent newsletter of YPSN of CA. Since then Tom participated in a meeting in San Diego on Virtual Reality in Medicine. He was the hit of the show. The main reason was the applied use of VR to make something better. Almost all the other exhibits were ideas looking for future applications. One exhibitor was showing stereotactic surgery using 3D imaging and frameless surgery. This would be applicable to the Pallidotomy, Thalamotomy and Fetal Tissue Transplant surgeries. There have been other interesting observations made by Tom in his playing with VR glasses. One very interesting observation is that when in the state of strong dyskinesia, putting on the glasses removed the dyskinesia. This is something he cannot explain. I should add the Tom is a doctor, a podiatrist by education, who has had to give up his profession because of PD. If any of you are interested in learning more, please contact Tom at the above address. Regards, Alan Bonander ([log in to unmask])