Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial.

Marialuisa Gandolfi,Leopold Saltuari,Andreas Waldner,Elena Stirbu,Nicola Smania,Aristide Roberto Gravina,Monica Trevisan,Christian Geroin,Nicola Valè,Daniela Primon,Silvia Bonadiman,Laura Bloccari,Paolo Boldrini,Sara Regazzo,Eleonora Dimitrova,Christian Bosello,Alessandro Picelli,Luca Peron,Alberto Carreño Garcia,Alessia Menel,Michèle Tinazzi

doi:10.1155/2017/7962826

Abstract

Introduction Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes. Home-based virtual reality (VR) balance training has been shown to reduce postural instability in patients with Parkinson's disease (PD). The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training (SIBT). Methods In this multicenter study, 76 PD patients (modified Hoehn and Yahr stages 2.5–3) were randomly assigned to receive either in-home VR telerehabilitation (n = 38) or in-clinic SIBT (n = 38) in 21 sessions of 50 minutes each, 3 days/week for 7 consecutive weeks. VR telerehabilitation consisted of graded exergames using the Nintendo Wii Fit system; SIBT included exercises to improve postural stability. Patients were evaluated before treatment, after treatment, and at 1-month follow-up. Results Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group (p = 0.04) and significant Time × Group interactions in the Dynamic Gait Index (p = 0.04) for the in-clinic group. Both groups showed differences in all outcome measures over time, except for fall frequency. Cost comparison yielded between-group differences in treatment and equipment costs. Conclusions VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver.

Highlights

Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes
Up to 75% of people with Parkinson’s disease (PD) have impaired postural control, which can often lead to postural instability and an increased risk of falls as a consequence [1]
While postural instability in PD may involve dysfunctions in several subsystems [2, 3], it is the impaired multimodal integration of sensory feedback from the visual, proprioceptive, and vestibular systems that can predominantly contribute to deficits in gait and balance [4, 5] as seen in other neurological conditions [6, 7]

Summary

Introduction

Up to 75% of people with Parkinson’s disease (PD) have impaired postural control, which can often lead to postural instability and an increased risk of falls as a consequence [1]. The highly popular Nintendo Wii Fit and balance board is a VR fitness application that holds potential for use as an adjunct to sensory integration balance training (SIBT), one of the most effective ways to improve postural stability in PD [11]. The primary aim of this study was to compare improvements in postural stability after inhome VR-based balance training with the Nintendo Wii Fit system (TeleWii) and after in-clinic SIBT in PD patients. The secondary aim was to compare pre- and posttreatment differences in perceived balance confidence, mobility-related function, quality of life, fall frequency, and the difference in the costs of the two rehabilitation programs.

Methods

Outcomes

Discussion