Training the brain with virtual reality treadmill training to enhance mobility and reduce falls in elderly with Parkinson's Disease.

In this trial, which is part of the Seventh Framework program V-TIME, neural correlates of plasticity of the V-TIME fall prevention intervention are investigated.

Previous work showed that a shift in functional connectivity from the posterior to the anterior putamen can be seen in PD patients (Helmich et al. 2010). Thus, PD patients probably use their anterior putamen for both cognitive and simple motor tasks. In healthy persons, cognitive tasks mostly rely on the anterior putamen whereas simple motor tasks mostly rely on the posterior putamen. We hypothesize that a bottleneck in the anterior putamen causes reduced dual task performance in PD patients. Through the VR training, we expect to see compensation for this bottleneck in other brain regions. Thus, we hypothesise that treadmill training with VR will cause a partial shift of cognitive control from the anterior putamen towards other brain regions such as the anterior cingulated cortex, the nucleus caudatus and the prefrontal cortex.

Pre assessment (all outcome measures), intermediate assessments after 4 weeks (physical and mental functioning) and 6 weeks (physical and mental functioning and fNIRS) of training, post assessment (all outcome measures), 1 and 6 month follow up assessments (all outcome measures besides (f)MRI and fNIRS).

At RUNMC (Nijmegen) 50 patients with PD will be randomized into one of these two groups:

1. Treadmill Training with Virtual Reality (TT+VR) for 12 weeks, three times per week;

2. Active control comparison of Treadmill Training alone (TT), 12 weeks, three times per week.



At TASMC (Tel Aviv) 40 patients with PD will be randomized into one of these two groups:

1. Treadmill Training with Virtual Reality (TT+VR) for 6 weeks, three times per week;

2. Active control comparison of Treadmill Training alone (TT), 6 weeks, three times per week.