Virtual Reality and PD
Abstract of remarks by Dr. Tom Riess
Target Monthly, April / May 1994
Editor's note: Dr. Tom Riess is a podiatrist. His twelve years with PD has
forced him to end his medical practice. Tom is also the support group leader
for the San Anselmo Young Support Group.
As many of you know, for the past two or three years I have been studying the
effects of visual cues on Parkinson's disease. During the past year I have
worked with the Human Interface Technology Lab in Seattle and their virtual
vision glasses. The purpose of this work was to investigate the possibility
of therapeutic applications for visual cues and to gain a better
understanding of PD. Visual cues have been well documented in the literature
as a means of overcoming akinesia. In akinetic subjects who exhibit visual
cue sensitivity an object placed at the feet will enable them to take a step,
a line of objects will enable them to walk.
The intent of this project was to determine whether people could respond to
artificial visual cues, "virtual cues," and if so make them portable and
available on demand. Based on an admittedly small sample of PD patients I
feel the answer is YES. Current hardware consists of two or three
prototypes, some based on video images, (virtual vision glasses), and others
based on real objects which I have constructed. They are all bulky, awkward
and not what I would call socially acceptable. They exhibit varying degrees
of effectiveness. The point I want to make is that almost all the parameters
and requirements for effective visual cueing have been defined. What remains
is primarily an engineering problem and acquiring the necessary funding to
get it done and into the hands of the people who need it. During the week of
June 14, there will be a short summary of this work on a television program
called "Next Step" which is broadcast nationally on the Discovery network.
Whom Can This Help
Studies as to the therapeutic impact to my knowledge have not been done. It
is not known what proportion of those people with PD having gait problems
exhibit sensitivity to visual cue phenomenon. However, based on my limited
clinical testing of ten to twelve people, a written survey of approximately
thirty others and my understanding of the fundamental principles at work
here, it seems apparent that the great majority of gait-impaired PD subjects
exhibit this phenomenon. Specifically for the PD subject, who is in the OFF
state, visual cues can:
Eliminate small steps seen in PD subjects (festination)
Eliminate freezing such as in doorways and other similar
environments
Overcome the inability to initiate ambulation (akinesia)
Greatly increase arm swing, reduce stooped posture, remove masked facial
expression and return to normal our mental acuity (when associated with
akinesia).
How Do Visual Cues Work?
To anyone familiar with PD the above claims might seem difficult to believe.
However, an understanding of the basic model for walking should provide a
rationale for understanding these effects. Please see the section called
Science Corner for the article titled "How Visual Cues Work."
In conclusion, I would like to emphasize that the use of virtual visual cues
is not in any sense a cure for PD. I believe it has great potential to Ease
the Burden to those who specifically could gain from this technology. I also
must point out that the necessary hardware to apply virtual cues is currently
not available. I am hopeful that this will change in the near future.
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Note: Tom can be seen on the Discovery Cable TV channel on a progeam called
"NEXT STEP." The program will be shown on Tuesday, June 14. The air time
in the San Francisco area is 9:30 PM. I think most people with PD will find
the program segment very interesting. Tom will also be seen on a one hour
PBS special this fall. Exact time / day is not known. They just finished
tapeing yesterday.
As for hte Science Corner and the article titled "How Visual Cues Work," I
will put it online in maybe two segment next week.
I might also mention, that APDA will be making a big aenouncement next week
on Tuesday, June 14. It will hit the news, you can be sure. For all you
with PD, IT IS NOT A CURE.
Regards,
Alan ([log in to unmask])
