Advantages of using 3D virtual reality based training in persons with Parkinson’s disease: a parallel study

Abstract

Background Parkinson’s disease (PD) is a slowly progressive neurodegenerative disease. There are mixed reports on success of physiotherapy in patients with PD. Our objective was to investigate the functional improvements, motivation aspects and clinical effectiveness when using immersive 3D virtual reality versus non-immersive 2D exergaming. Methods We designed a randomized parallel study with 97 patients, but only 20 eligible participants were randomized in 2 groups; the one using 3D Oculus Rift CV1 and the other using a laptop. Both groups participated in the 10-session 3 weeks training with a pick and place task in the virtual world requiring precise hand movement to manipulate the virtual cubes. The kinematics of the hand was traced with Leap motion controller, motivation effect was assessed with modified Intrinsic Motivation Inventory and clinical effectiveness was evaluated with Box & Blocks Test (BBT) and shortened Unified Parkinson’s disease rating scale (UPDRS) before and after the training. Mack-Skilling non-parametrical statistical test was used to identify statistically significant differences (p < 0.05) and Cohen’s U3 test to find the effect sizes. Results Participants in the 3D group demonstrated statistically significant and substantially better performance in average time of manipulation (group x time, p = 0.009), number of successfully placed cubes (group x time, p = 0.028), average tremor (group x time, p = 0.002) and UPDRS for upper limb (U3 = 0.35). The LCD and 3D groups substantially improved their BBT score with training (U3 = 0.7, U3 = 0.6, respectively). However, there were no statistically significant differences in clinical tests between the groups (group x time, p = 0.2189, p = 0.2850, respectively). In addition the LCD group significantly decreased the pressure/tension (U3 = 0.3), the 3D did not show changes (U3 = 0.5) and the differences between the groups were statistically different (p = 0.037). The 3D group demonstrated important increase in effort (U3 = 0.75) and perceived competences (U3 = 0.9). Conclusions The outcomes of the study demonstrated that the immersive 3D technology may bring increased interests/enjoyment score resulting in faster and more efficient functional performance. But the 2D technology demonstrated lower pressure/tension score providing similar clinical progress. A study with much larger sample size may also confirm the clinical effectiveness of the approaches. Trial registration The small scale randomized pilot study has been registered at ClinicalTrials.gov Identifier: NCT03515746, 4 May 2018

The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study

“…The results from their study demonstrated that the use of immersive 3D technology might increase interest and enjoyment in therapy compared to intervention with LMC, and produce faster and more efficient functional performance and reduced resting tremors as assessed by BBT, UPDRS III, and LMC. Our results are in line with Cikajlo and Potisk [57]. Fernández-González [3] conducted a randomized controlled trial using LMC and serious games compared to conventional UL rehabilitation in PD patients.…”

“…Few studies have been conducted concerning the use of technology to improve dexterity and coordination in UL rehabilitation [3,[55][56][57].…”

“…Cikajlo and Potisk [57] designed a randomized parallel study with 20 PD patients randomized into two groups-one using 3D Oculus Rift technology plus LMC and the other using a laptop plus LMC. In their study, both groups conducted a pick-and-place task in the virtual world that required precise hand movements to manipulate virtual cubes.…”

“…Our experimental protocol consisted of 30-min sessions performed three times per week across six weeks (18 sessions), compared to Cikajlo and Potisk [57], who used ten sessions during three weeks of training with 30 min per session. In our research, we followed motor learning principles that encourage the repetition of functional motor tasks in a distributed practice (same treatment time but incorporating resting periods) as a part of a guided learning program [58].…”

Virtual reality-based action observation facilitates acquisition of body-powered prosthetic control skills

“…Additionally, virtual reality (VR) is technology used to simulate an environment that users experience as being comparable to the real world [11]. Previous studies showed that VR training promotes recovery of upper limb functions in patients with stroke or Parkinson's disease [12][13][14]. Therefore, VR training may be used in acquiring bp-prosthetic control.…”