Balancing the prescription of virtual reality balance training for Parkinson disease: a critically appraised topic

Abstract

Clinical Scenario Individuals with Parkinson Disease (PD) often present with impaired balance, resulting in increased fall risk. Evidence suggests that balance can be improved with physical therapy balance training interventions applied through video game play, or ‘exergaming’. However, best practices regarding the prescription of exergaming for persons with PD are unknown. The goal of this appraisal was to identify the Nintendo Wii exergame (NWE) parameters that have been shown to improve dynamic balance in individuals with PD, specifically Hoehn and Yahr (HY) stages 1-3, and make recommendations for the prescription of NWE balance interventions for this population. Methods The literature was searched to identify randomized controlled trials (RCT) that utilized NWE as a balance intervention for individuals with PD within HY stages 1-3. The search was limited to articles published within the last 10 years that assessed dynamic balance outcomes via the Dynamic Gait Index (DGI) or Functional Gait Assessment (FGA). Participants had no other known comorbidities that would impact dynamic balance and were on a stable dopaminergic prescription. 3 RCTs were identified and included in this appraisal. Conclusion and Implications for Practice NWE may improve dynamic balance in individuals with PD, HY stages 1-3. Recommended parameters include a variety of NWE modes, performed for 45-50 min per session, at a frequency of 2-3 times a week for 6-8 weeks. Clinicians should utilize a skilled approach when prescribing NWE including ongoing assessment to determine progress and to maintain safety. Future research is needed to determine the necessary intensity of NWE to improve dynamic balance in individuals with PD.