Visual Perturbation Training Improves Gait in Early Parkinson’s Disease: Study
Belgium: Six weeks of visual perturbation training significantly reduced visual dependency and improved temporal gait characteristics in people with early-stage Parkinson’s disease compared with treadmill training alone. Visual dependency refers to a reduced ability to ignore visual cues in complex or conflicting visual environments.
The findings were published in PLOS One by Remco J. Baggen from the Department of Rehabilitation Sciences at Ghent University, Belgium, and the Department of Human Movement Sciences at Vrije Universiteit Amsterdam, the Netherlands, along with colleagues.
Gait disturbances and increased reliance on visual information are common in people with Parkinson's disease and contribute significantly to balance problems and falls. As the disease progresses, automatic control of walking often declines, causing patients to depend more on visual cues to guide movement. This increased reliance can make walking difficult in visually complex environments.
To evaluate whether targeted training could reduce this dependency, researchers conducted a randomized controlled trial involving 25 individuals with early- to mid-stage Parkinson’s disease aged 50 to 67 years. Participants who did not experience frequent freezing of gait were randomly assigned to either a visual perturbation training group or a treadmill training–only control group.
Both groups completed supervised exercise sessions twice weekly for six weeks. Participants in the intervention group performed self-paced treadmill walking while exposed to visual perturbations in a virtual reality environment. These perturbations included rotational movements around the sagittal axis and side-to-side shifts of the visual scene, designed to challenge the participants’ reliance on visual input during walking.
The primary outcome of the study was visual dependency. Secondary outcomes included spatiotemporal gait parameters such as gait speed, step time, stride time, cadence, step length, and step width, along with self-reported falls and near-falls.
The researchers reported the following findings:
- Visual perturbation training significantly reduced visual dependency compared with treadmill training alone.
- Participants in the intervention group showed improvements in temporal gait parameters, including step time, stride time, and cadence.
- No significant changes were observed in gait speed, step length, or step width.
- The intervention did not significantly affect the number of reported falls or near-falls.
- Greater improvements in visual dependency were observed among participants in earlier stages of Parkinson’s disease.
According to the investigators, the findings suggest that individuals with Parkinson’s disease retain the capacity to adapt sensory reliance and improve aspects of gait control. By decreasing excessive visual dependence and enhancing temporal gait features, visual perturbation training may help target mechanisms associated with fall risk.
The researchers concluded that visual perturbation training may serve as a promising rehabilitation strategy for individuals with early to mid-stage Parkinson’s disease. They noted that further studies are needed to assess its long-term benefits, evaluate its potential effects on vestibular function, and identify which patient groups are most likely to benefit from this intervention.
Reference:
Baggen RJ, Van Bladel A, Prins MR, Stappers J, Spildooren J, De Letter M, et al. (2026) Visual perturbation training to reduce visual dependency in Parkinson’s disease: A randomized controlled trial. PLoS One 21(3): e0343223. https://doi.org/10.1371/journal.pone.0343223
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