Abstract
Evidence for exercise based computer games (exergaming) as a rehabilitation tool for people with Parkinson’s disease (PD) is only now emerging and is yet to be synthesised. To this end, we conducted a systematic review of the exergaming literature to establish what is known about the safety, feasibility and effectiveness of exergaming for rehabilitation of motor symptoms experienced by people with PD. Seven electronic databases were searched for key terms surrounding exergaming and PD. Data were extracted by two reviewers independently. From an initial yield of 1217 articles, seven were included in the review. Six studies used commercial games with the Nintendo Wii fit platform. The scientific quality of reporting was generally good, however the overall methodological design of studies was weak, with only one randomised controlled trial being reported. Safety: Participant safety was not measured in any of the studies. Feasibility: People with PD were able to play exergames, improve their performance of gameplay and enjoyed playing. However, one study observed that people with PD had difficulty with fast and complex games. Effectiveness: Six studies showed that exergaming elicited improvements in a range of clinical balance measures or reduction in the severity of motor symptoms. Results from the only randomised controlled trial showed that exergaming was as effective as traditional balance training for people with PD to improve the UPDRS II, standing balance and cognition, with improvements in both groups retained 60 days after the training ended. In conclusion, exergaming is an emerging tool to help rehabilitate motor skills in people with PD. Although we were able to establish that exergaming is feasible in people with PD, more research is needed to establish its safety and clinical effectiveness, particularly in the home. The use of commercial games may be too difficult for some people with PD and exergames tailored specifically to the rehabilitation needs and capabilities of people with PD are required for optimal efficacy, adherence and safety.
Highlights
Exercise is emerging as an efficacious therapy to compliment the rehabilitation of problematic motor symptoms in Parkinson's disease (PD) such as gait and balance which contribute to reduced mobility and increased risk of falls [1,2]
For the purposes of this review: Safety referred to any subjective or objective measures; Feasibility referred to whether people were able to play the games, whether they improved in their gameplay and whether they enjoyed and felt motivated by the gameplay; and Effectiveness referred to whether participants improved on clinical tests of motor performance or disease severity, and whether these improvements were retained after the exergaming intervention
There were no differences between the two training groups at baseline and both groups improved by the same amount after 7 weeks on the primary or secondary measures. When data from both groups were combined, small improvements were observed in the Unified Parkinson’s Disease Rating Scale (UPDRS) II, Berg balance scale, single leg stance and Montreal Cognitive Assessment (MoCA) immediately after training
Summary
Exercise is emerging as an efficacious therapy to compliment the rehabilitation of problematic motor symptoms in Parkinson's disease (PD) such as gait and balance which contribute to reduced mobility and increased risk of falls [1,2]. Exergaming as a therapeutic tool incorporates functional, purposeful and engaging exercise in a quantifiable and reliable way [6,7,8] It has shown benefits in traumatic brain injury [9,10], Cerebral Palsy [11], stroke rehabilitation [12,13], young adults with physical and intellectual disabilities [5], and older adults [14,15]. Critical questions remain surrounding the use of exergaming for people with PD, especially in relation to the prescription of home-based exercise and the suitability of commercial games. To address these questions, we conducted a systematic review of the literature to evaluate the evidence for the safety, feasibility and effectiveness of exergaming as a rehabilitation tool in people with PD
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