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Visual perturbation training to reduce visual dependency in Parkinson’s disease : a randomized controlled trial

Remco J. Baggen, Anke Van Bladel (UGent) , Maarten R. Prins, Jennifer Stappers, Joke Spildooren, Miet De Letter (UGent) , Katie Bouche (UGent) , Dirk Cambier (UGent) , Leen Maes (UGent) and Patrick Santens (UGent)
(2026) PLOS ONE. 21(3).
Author
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Project
Abstract
Introduction Decreased gait automaticity and increased visual dependency are important contributors to falls in people with Parkinson’s disease. The aim of this study was to assess if visual perturbation training during treadmill walking decreases visual dependency in people with Parkinson’s disease. Materials and methods For this randomized controlled trial 25 early-to-mid-stage people with Parkinson’s disease (age 50-67y) without regular freezing of gait were randomly assigned to a visual perturbation group or treadmill training-only control group. Both groups trained 2 times per week for 6 weeks. Visual perturbation training consisted of self-paced treadmill walking with perturbations applied as rotations around the sagittal axis and medio-lateral translations of the virtual reality environment. The primary outcome was visual dependency. Secondary outcomes included steady-state spatiotemporal gait parameters (gait speed, step time/length/width/frequency, and cadence), as well as self-reported (near) falls. Results Group x time interaction effects revealed that visual perturbation training significantly decreased visual dependency (p<0.001) and improved temporal gait characteristics such as step time (p=0.012), stride time (p=0.021) and cadence (p=0.018) compared to treadmill-only controls. However, no significant effects were found for step width, step length, gait speed, and (near) falls. Improvements in visual dependency were negatively correlated to disease progression (p=0.004). Discussion: Visual perturbation training decreases visual dependency and improves temporal gait parameters in people with Parkinson’s disease. Participants in earlier disease stages appear to benefit most from visual perturbation training but additional research is needed
Keywords
IMPROVING MOTOR-PERFORMANCE, VIRTUAL-REALITY, GAIT, BALANCE, AUTOMATICITY, PEOPLE, FALLS, SPEED

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MLA
Baggen, Remco J., et al. “Visual Perturbation Training to Reduce Visual Dependency in Parkinson’s Disease : A Randomized Controlled Trial.” PLOS ONE, edited by Anne E. Martin, vol. 21, no. 3, 2026, doi:10.1371/journal.pone.0343223.
APA
Baggen, R. J., Van Bladel, A., Prins, M. R., Stappers, J., Spildooren, J., De Letter, M., … Santens, P. (2026). Visual perturbation training to reduce visual dependency in Parkinson’s disease : a randomized controlled trial. PLOS ONE, 21(3). https://doi.org/10.1371/journal.pone.0343223
Chicago author-date
Baggen, Remco J., Anke Van Bladel, Maarten R. Prins, Jennifer Stappers, Joke Spildooren, Miet De Letter, Katie Bouche, Dirk Cambier, Leen Maes, and Patrick Santens. 2026. “Visual Perturbation Training to Reduce Visual Dependency in Parkinson’s Disease : A Randomized Controlled Trial.” Edited by Anne E. Martin. PLOS ONE 21 (3). https://doi.org/10.1371/journal.pone.0343223.
Chicago author-date (all authors)
Baggen, Remco J., Anke Van Bladel, Maarten R. Prins, Jennifer Stappers, Joke Spildooren, Miet De Letter, Katie Bouche, Dirk Cambier, Leen Maes, and Patrick Santens. 2026. “Visual Perturbation Training to Reduce Visual Dependency in Parkinson’s Disease : A Randomized Controlled Trial.” Ed by. Anne E. Martin. PLOS ONE 21 (3). doi:10.1371/journal.pone.0343223.
Vancouver
1.
Baggen RJ, Van Bladel A, Prins MR, Stappers J, Spildooren J, De Letter M, et al. Visual perturbation training to reduce visual dependency in Parkinson’s disease : a randomized controlled trial. Martin AE, editor. PLOS ONE. 2026;21(3).
IEEE
[1]
R. J. Baggen et al., “Visual perturbation training to reduce visual dependency in Parkinson’s disease : a randomized controlled trial,” PLOS ONE, vol. 21, no. 3, 2026.
@article{01KK1B19Z6APE88G4RJG580CQM,
  abstract     = {{Introduction
Decreased gait automaticity and increased visual dependency are important contributors to falls in people with Parkinson’s disease. The aim of this study was to assess
if visual perturbation training during treadmill walking decreases visual dependency in
people with Parkinson’s disease.
Materials and methods
For this randomized controlled trial 25 early-to-mid-stage people with Parkinson’s
disease (age 50-67y) without regular freezing of gait were randomly assigned to a
visual perturbation group or treadmill training-only control group. Both groups trained
2 times per week for 6 weeks. Visual perturbation training consisted of self-paced
treadmill walking with perturbations applied as rotations around the sagittal axis and
medio-lateral translations of the virtual reality environment. The primary outcome was
visual dependency. Secondary outcomes included steady-state spatiotemporal gait
parameters (gait speed, step time/length/width/frequency, and cadence), as well as
self-reported (near) falls.
Results
Group x time interaction effects revealed that visual perturbation training significantly
decreased visual dependency (p<0.001) and improved temporal gait characteristics such as step time (p=0.012), stride time (p=0.021) and cadence (p=0.018)  compared to treadmill-only controls. However, no significant effects were found for
step width, step length, gait speed, and (near) falls. Improvements in visual dependency were negatively correlated to disease progression (p=0.004). Discussion:
Visual perturbation training decreases visual dependency and improves temporal gait
parameters in people with Parkinson’s disease. Participants in earlier disease stages
appear to benefit most from visual perturbation training but additional research is
needed}},
  articleno    = {{e0343223}},
  author       = {{Baggen, Remco J. and Van Bladel, Anke and Prins, Maarten R. and Stappers, Jennifer and Spildooren, Joke and De Letter, Miet and Bouche, Katie and Cambier, Dirk and Maes, Leen and Santens, Patrick}},
  editor       = {{Martin, Anne E.}},
  issn         = {{1932-6203}},
  journal      = {{PLOS ONE}},
  keywords     = {{IMPROVING MOTOR-PERFORMANCE,VIRTUAL-REALITY,GAIT,BALANCE,AUTOMATICITY,PEOPLE,FALLS,SPEED}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{18}},
  title        = {{Visual perturbation training to reduce visual dependency in Parkinson’s disease : a randomized controlled trial}},
  url          = {{http://doi.org/10.1371/journal.pone.0343223}},
  volume       = {{21}},
  year         = {{2026}},
}
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