A trip to the physical therapist could soon feel a bit more like a trip to the arcade, thanks to a new multidisciplinary study being conducted at USC.

James Finley, PhD, and Beth Fisher, PhD, MS, of the USC Division of Biokinesiology and Physical Therapy and Marientina Gotsis, MFA, of the USC School of Cinematic Arts recently received a two-year, $450,000 grant from the National Institutes of Health to develop and test a virtual reality-based program for walking rehabilitation in patients with Parkinson’s disease.

Symptoms such as stiffness, shaking and balance problems can cause people with the degenerative brain disorder to have difficulty walking. While traditional physical therapies have centered around strength training, stretching and movement practice, it was discovered recently that these strategies may not lead to long-term motor learning by themselves.

“From a motor learning perspective, we now know that learning and long-term retention are optimized when the patients have a focus on the movement’s effect on the environment such as ‘step over the obstacle’ rather than on performing the movement itself — ‘flex your hip’,” Fisher explained.

The proposed VR-based system would get individuals with Parkinson’s disease back on their feet, practicing the actual walking skills necessary to navigate their communities — with seemingly real-world feedback — under the watchful eye of a physical therapist.

“We will be designing a system that will allow patients to experience and practice challenging tasks like negotiating obstacles, walking through crowds, doing turns and walking over thresholds to represent the challenges they would experience in the physical world,” Finley said.

A typical treatment session would involve a patient wearing a VR headset and walking on a standard or omni-directional treadmill or over the ground to improve their walking ability in a way that feels more like playing a video game.

“With motor rehabilitation, one of the things patients need is lots of repetition,” Finley explained. “One of the advantages of doing something like a game is it helps increase motivation to undergo the amount of practice necessary for skill learning.”

During the study’s first phase, the researchers will be designing prototypes of a low-cost, portable gait-training system that can be set up and easily used in the physical therapy office.

“Clinicians have a very limited time with their patients so any hurdles or barriers that are introduced by technology can limit the actual use of that technology in the clinic,” Finley said.

The researchers then will recruit clinicians and their patients to use the system, offering feedback to improve the experience for both the user and the supervising physical therapist.

Into the virtual world

Gotsis and her team of researchers at the USC Creative Media and Behavioral Health Center will design and assess the VR experience — paying close attention to the tiniest of nuances, including sound and haptic feedback — to ensure the most lifelike simulations.

“We would like to create a pleasurable, safe and challenging walking virtual reality experience,” Gotsis said. “We will know from participant input if the experience is enjoyable, and our collaborators will help us understand whether the experience is challenging enough to promote neuroplasticity.”

Patients will have the choice of different environments, including a cityscape with high rises, a seaside pier with a Ferris wheel, a path in a park or a visit to Trader Joe’s. To be most effective, users should choose environments that reflect the challenges they most often face in the real world, Finley said.

The study’s second phase will involve assessing the treatment strategy’s effectiveness on actual patients. Using the developed environments, patients with Parkinson’s will complete a set of progressive training sessions so that researchers can determine the program’s efficacy.

“Nobody knows best”

The study brings together expertise from a variety of academic disciplines.

Finley has devoted himself to research on how locomotion is controlled and adapted in both healthy and injured neuromuscular systems. He is an assistant professor at the USC Division of Biokinesiology and Physical Therapy and the director of the Locomotor Control Laboratory, and holds joint appointments in engineering and neuroscience.

Fisher is an expert in neuroplasticity and skill acquisition in non-disabled populations as well as individuals who have had stroke, traumatic brain injury and Parkinson’s. She is the director of the Neuroplasticity and Imaging Laboratory and has joint appointments at the USC Division of Biokinesiology and Physical Therapy as well as the Keck School of Medicine of USC’s neurology department.

Gotsis has been working with VR for 20 years, 10 of which have focused on using interactive entertainment to promote health, happiness and rehabilitation. She is the director and co-founder of the USC Creative Media and Behavioral Health Center, a research unit that bridges expertise from the USC School of Cinematic Arts and the Keck School of Medicine.

“When it comes to imagining the future of health care, we cannot afford to leave it all to the imagination of a single expert group,” said Gotsis, referring to the power of multidisciplinary approaches to solve some of society’s most vexing problems. “Nobody knows best. We’re all stakeholders in creating new therapies whether they use virtual reality or paper clips and glue.”

Research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (award number R21HD088342).

— John Hobbs