Abstract
BackgroundFreezing of gait and falls represent a major burden in patients with advanced forms of Parkinson’s disease (PD). These axial motor signs are not fully alleviated by drug treatment or deep-brain stimulation. Recently, virtual reality has emerged as a rehabilitation option for these patients. In this pilot study, we aim to determine the feasibility and acceptability of rehabilitation with a customised videogame to treat gait and balance disorders in PD patients, and assess its effects on these disabling motor signs.MethodsWe developed a customised videogame displayed on a screen using the Kinect system. To play, the patient had to perform large amplitude and fast movements of all four limbs, pelvis and trunk, in response to visual and auditory cueing, to displace an avatar to collect coins and avoid obstacles to gain points. We tested ten patients with advanced forms of PD (median disease duration = 16.5 years) suffering from freezing of gait and/or falls (Hoehn&Yahr score ≥ 3) resistant to antiparkinsonian treatment and deep brain stimulation. Patients performed 18 training sessions during a 6–9 week period. We measured the feasibility and acceptability of our rehabilitation programme and its effects on parkinsonian disability, gait and balance disorders (with clinical scales and kinematics recordings), positive and negative affects, and quality of life, after the 9th and 18th training sessions and 3 months later.ResultsAll patients completed the 18 training sessions with high feasibility, acceptability and satisfaction scores. After training, the freezing-of-gait questionnaire, gait-and-balance scale and axial score significantly decreased by 39, 38 and 41%, respectively, and the activity-balance confidence scale increased by 35%. Kinematic gait parameters also significantly improved with increased step length and gait velocity and decreased double-stance time. Three months after the final session, no significant change persisted except decreased axial score and increased step length and velocity.ConclusionsThis study suggests that rehabilitation with a customised videogame to treat gait and balance disorders is feasible, well accepted, and effective in parkinsonian patients. These data serve as preliminary evidence for further larger and controlled studies to propose this customised videogame rehabilitation programme at home.Trial registrationClinicalTrials.gov NCT02469350.
Highlights
Freezing of gait and falls represent a major burden in patients with advanced forms of Parkinson’s disease (PD)
Clinical gait and balance disorders, parkinsonian disability and quality of life After the 18th session, when compared to baseline, the freezing of gait questionnaire (FOG-Q), gait and balance scale (GABS)-B, and axial scores significantly decreased by 39, 38 and 41%, respectively (p = 0.005, 0.02 and 0.009, respectively, Fig. 5) and Activity Balance Confidence (ABC) scale significantly increased by 35% (p = 0.03, Fig. 5)
We found no changes in the clinical scores, except a persistent significant decrease of 35% in the axial score compared to baseline (p = 0.005, Fig. 5), and eight of ten patients reported recurrent falls again
Summary
Freezing of gait and falls represent a major burden in patients with advanced forms of Parkinson’s disease (PD) These axial motor signs are not fully alleviated by drug treatment or deep-brain stimulation. Parkinson’s disease (PD) is the second most common neurodegenerative disorder resulting mainly from the loss of dopaminergic midbrain neurons This disease is characterised by akinesia, with motor slowness, decreased amplitude of automatic movements and movement initiation failure, rigidity and tremor [1], and is improved by dopamine replacement therapy [2]. In advanced and severe forms, freezing of gait (FOG) and postural instability with falls occur in about 50–75% of patients [4] These signs worsen with time and become unresponsive to drug treatment or deep-brain stimulation [5], leading to increased mortality and morbidity, poor life quality and high healthcare costs [6]
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