Effectiveness of Occupational Therapy using Virtual Reality (VR) for Neurological Rehabilitation and Parkinson’s Disease BJ Woolston

Definitions Bradykinesia – Slow movement (walking). Akinesia – loss of power for voluntary movement. Dyskinesia – Impairment of voluntary movement. Virtual Reality – An interactive computer generated environment that simulates the real world. Ideopathic – relating to or denoting any disease/ condition that arises spontaneously or for which the cause is unknown.

Parkinson’s Disease One of most common age-related degenerative diseases. 555 per 100,000 in 60’s 2,949 per 100,000 over 85 For every woman with PD there are 1.5 men. Decrease in ability for voluntarily muscle control. Facial muscles

Focus What are the benefits of group OT for patients with Parkinson’s disease? What is the evidence for the effectiveness of interventions within the scope of OT practice to improve performance… and quality of life of people with Parkinson's disease? For patients with acute CVA, is VR gaming more effective than standard recreational therapy for the improvement of hand function? 1 – what is the effectiveness of OT on neurodegenerative disease? 2 – How can VR help CVA? 3 – How well does group OT work on Parkinson’s?

Group OT for Parkinson’s Focus areas General mobility Dexterity ADL’s Education Clear understanding of PD. Decreased fear Increase self assurance Attitude changes: egocentric – concerned Family members participation. Amelioration of physical appearance. Maintained Fx status for 1 yr. Arrival, welcome and soc., general mobility exercise, rest and soc., dexterity activities, functional activities, educational activities, and departure with informal soc. Control group decreased independence wit progression of PD. Rehab group perceived progression as less severe…?

Effective OT for Parkinson’s 3 areas of focus that affect outcome Strengthening of performance skills Environmental elicitation performance Integration of performance patterns 3 resulting areas of outcome Strengthening physical performance skills and occupational performance in physical activities. Providing environmental elicitation of regulated performance. Teach self-management and cognitive behavioral strategies for integrating performance patterns into daily life.

Neurodegenerative Diseases & OT Can develop new skills with task-specific training. Especially in enriched adaptive environments helping brain to compensate for loss in basal ganglia Fx. Vestibular and sensory processing rehab may reduce balance problems. Unclear if it reduces falls. Education…? Important to align knowledge about compensatory motor activity, interpersonal behavior, and environmental stimuli. i.e., partnered dancing to music

VR in Rehab Neuroplasticity makes it possible. Various uses Spinal Cord Injury CVA Phobias (acrophobia) Parkinson’s Projection of items into area Use of head set to create environment Precautions/ difficulties Motion sickness Equipment failure Schizophrenia Can provide corrective experiences that ameliorate attitudes and anxieties. Another study evaluated the use of VR with CVA patients finding that their UE motor function increased by 7.4 seconds using the WFMT (wolf motor function test) which is a series of strength, functional ability, and time.

Treatments for NCD/ Parkinson’s Group Tx Task specific training (partner dancing) Teach self-management VR supplement Medication management Perception of client Family/ support group

Conclusion Parkinson’s disease and neurodegenerative diseases decrease the ability for people to create fluid movements, thereby impairing occupational function and the desire to participate in social activities. The use of group Tx with supplemental VR can take advantage of neuroplasticity to increase Fx, social participation, safety and overall quality of life.

References Gauthier L., Dalziel S., Gauthier S., (1987). The Benefits of Group Occupational Therapy for Patients With Parkinson’s Disease. American Journal of Occupational Therapy, Volume 41, Number 6. Taken from: file:///Users/bradfordwoolston/Downloads/360.pdf Bell Boucher, Danielle M., "Investigating Immersive Augmented Reality as a Rehabilitation Tool for Parkinson disease" (2013). Electronic Thesis and Dissertation Repository. Paper 1588. Taken from: http://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=2986&context=etd What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance skills, occupational performance, and quality of life of people living with Parkinsosn’s disease? Link: http://www.aota.org/- /media/corporate/files/secure/practice/ccl/neuro/parkinsons%20cat. pdf M. H. Andreae (1996). Virtual Reality in Rehabilitation. British Medical Journal. Taken from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349678/