# An Experimental Approach for Investigating Freezing of Gait in Parkinson’s Disease Using Virtual Reality and Neural Sensing: A Pilot Study

## TL;DR

This pilot study explores using virtual reality and neural sensing to investigate freezing of gait in Parkinson’s disease, aiming to better understand its neural mechanisms.

## Contribution

The novel contribution is the integration of immersive virtual reality with real-time neural sensing to study freezing of gait in Parkinson’s disease.

## Key findings

- The CC-VHE platform successfully elicits freezing of gait under various triggers in a controlled environment.
- Synchronous cortical, subcortical, and kinematic data were recorded and analyzed from one participant.
- The study demonstrates the feasibility of combining VR and neural sensing for investigating FOG.

## Abstract

Freezing of gait (FOG) is a disabling symptom associated with Parkinson’s disease (PD). Its understanding and effective treatment is compromised due to the difficulty in reliably triggering FOG in clinical and laboratory environments. The Cleveland Clinic-Virtual Home Environment (CC-VHE) platform was developed to address the challenges of eliciting FOG by combining an omnidirectional treadmill with immersive virtual reality (VR) environments to induce FOG under physical, emotional, and cognitive triggers. Recent developments in deep brain stimulation devices that sense neural signals from the subthalamic nucleus in real time offer the potential to understand the underlying neural mechanism(s) of FOG. This manuscript presents the coupling of the CC-VHE technology, VR paradigms, and the experimental and analytical methods for recording and analyzing synchronous cortical, subcortical, and kinematic data as an approach to begin to understand the nuanced neural pathology associated with FOG. To evaluate the utility and feasibility of coupling VR and neural sensing technology, initial data from one participant are included.