Exploring virtual reality solutions to help patients with dystonia
Dystonia is a neurological movement disorder that causes uncontrollable muscle spasms. This is an under-researched area of medicine, and dystonia patients respond to different treatments to varying degrees. PhD student Andreas Polydorides is exploring how virtual reality (VR) might be able to help dystonia patients.
Patients who have dystonia suffer from muscle spasms they cannot control, caused by incorrect signals from the brain. The exact cause is still being explored, but it is thought to relate to parts of the brain that relate to movement and motor learning – the basal ganglia and the cerebellum. Sometimes the muscle spasms of dystonic patients can be painful, and they tend to occur in a specific part of the body, depending on the type of dystonia a person has. It is a lifelong condition that can start in either childhood or adulthood, and although it is not life limiting, there is currently no cure.
There are various treatments available to help dystonia patients, and most of these focus on lessening the symptoms associated with dystonia. This includes deep brain stimulation, where electrodes are inserted into the brain and deliver electrical pulses that block the signals that cause dystonia. Denervation is another treatment, where nerves connecting to the overactive muscles are cut. Some patients also gain some relief from medications, physiotherapy and occupational therapy. However, newer technologies such as VR have not been fully explored as a possible treatment option for dystonia patients.
VR as a way to improve movement and function
In response to this, Andreas Polydorides – who has a Master’s in biomedical engineering – is exploring the possibilities VR might hold to help people suffering from dystonia.
“Dystonia isn’t very well known, yet it’s the third most common movement disorder, at least 100,000 people suffer from it in the UK. Doing more research on this, and finding out how we can help people suffering from it, is really important.”
The work Polydorides is undertaking through his PhD is part of the PRIME-VR2 project. PRIME-VR2 is funded by the European Commission, under the Horizon 2020 initiative. A combination of academic and industrial partners are involved, along with hospitals and rehabilitation centres.
The purpose of PRIME-VR2 is to create a digital environment using VR, to use as part of rehabilitation programmes. Patients will utilise bespoke controllers, developed as part of the project, to carry out exercises in virtual reality. As well as helping people with dystonia, the project could also help stroke patients and people with musculoskeletal injuries, among many others. The concept is that VR games can help people develop the strength and movement needed to help with their specific condition. The nature of VR means that it can be tailored and personalised to each specific patient's needs.
For his research, Polydorides is focusing on people with upper limb dystonia. Currently undertaking a literature review, Polydorides is looking at all the research design and research methodologies that have been used to date with extended reality technologies. This includes any virtual environment based studies, incorporating those done with well-known consoles such as Wii. This will help with identifying research gaps and developing concrete designs and methodologies for future planned studies.
When Polydorides has all the background information from the literature review, he plans to run detailed interviews with dystonia patients. In particular, he wants to find out what their functional priorities and motivations are, before trying different ideas with VR to see what works and what doesn’t. The fact that some dystonia patients may have had recent deep brain stimulation means that a VR headset might not feel like a comfortable option for some patients, and Polydorides wants to understand all of the factors fully before creating solutions.
A particularly exciting area for VR – used together with electromyography (EMG) – could be to help capture movement data in dystonia patients. “There is a big gap in knowledge about movement data for dystonia patients,” Polydorides said. “But if you have movement data, you have the ability to characterise and compare symptoms of dystonia objectively. Allowing for personalised treatments, this could be a very powerful tool for therapists.”