Immersive Virtual Walking as Treatment for Neuropathic Pain in Spinal Cord Injury: Examining Treatment Efficacy and Cortical Mechanisms
Abstract
What is the purpose of this development project? Chronic neuropathic pain (NP) can be debilitating for persons with spinal cord injury (SCI) and does not respond to available treatments. We aim to design a study to test a promising novel treatment (immersive interactive virtual reality walking) for SCI NP. Our interactive virtual (VR) platform allows persons with SCI NP to walk through virtual worlds by controlling movement of virtual legs. VR walking is an extension of "mirror" therapies for neuropathic phantom limb pain, which provide amputees with a visual representation of their missing limb using a mirror along the body midline. These therapies are understood to work by affecting maladaptive brain changes that accompany NP. Why did we decide to pursue this project? There is urgent need to pursue promising treatment for SCI NP. Evidence from our group and others suggests that "illusory walking" offers SCI NP relief. Our interactive VR platform represents a major advancement; to date, illusory walking treatments allowed only passive viewing of a video of walking legs. However, many studies now show that the volitional and interactive properties of our VR platform are critical to ameliorating NP. Positive responses from our advisory group of persons with SCI NP support our confidence in this intervention. We will also improve on previous studies by adding brain imaging to ensure that the treatment offers benefit – and to better understand SCI NP. This is vital to have a meaningful impact on science and the lives of those with SCI NP. Our proposed study will be conducted at two research sites in the U.S. and Australia. Each institution contributes essential expertise to this project and will allow large-scale participant recruitment. What are the tasks that we plan to accomplish during the FY17 Spinal Cord Injury Research Program Clinical Research Development Award period to enable the future clinical study? Preparation for the future clinical study is guided by four essential tasks over the planning year. As part of Task 1, our technical experts will create a secure system of communication and information sharing. We will also finalize the roles of research team members at both sites for the planning period and clinical trial. As part of Task 2, researchers from the U.S. and Australia will visit each other s labs to set up equivalent VR and brain imaging capabilities at both sites. As part of Task 3, we will decide what the VR intervention will look like for the future study and do a test run of the protocol at both sites. Task 4 will involve writing a Manual of Operations that will define all procedures for the anticipated study, helping to ensure consistency across the two sites. What is the ultimate applicability of the future clinical study? The intervention is expected to have short- and long-term application within clinical care settings across early and late stages of treatment, as well as various kinds of SCI injury. Findings will also inform research regarding other possible applications of this platform. In addition, the knowledge gained from neuroimaging can help shape alternate treatments for SCI NP. What persons with SCI will it help, and how will it help them? We aim to provide a readily-accessible treatment for individuals with SCI NP. The proposed study will test the intervention among individuals with lower limb paralysis. If effective, the intervention will be extended to additional levels of SCI and motor function. What are the potential clinical applications, benefits, and risks? The VR walking intervention may provide one of the only accessible nonpharmacological treatments for an otherwise refractory condition, and it is readily adaptable for clinic/rehabilitation or self-guided home use. There is a risk that some individuals may experience nausea negative emotional reactions to the virtual images; however, this was not observed in pilot testing. What is the pr
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810720
Entities
People
- Zina Trost
Organizations
- United States Army
- University of Alabama at Birmingham