Parkinson’s Rehabilitation Feasible With Exergame-based Program

A cognitive-motor training program featuring a video game platform that promotes exercise is feasible for people with Parkinson’s disease to use, a new study demonstrates.

Patients using the program along with standard rehabilitation showed comparable and greater motor and cognitive improvements relative to those on standard rehabilitation alone. These preliminary results support further large-scale testing to assess the effectiveness of this type of program, the researchers noted as part of the study, “Feasibility and effects of cognitive–motor exergames on fall risk factors in typical and atypical Parkinson’s inpatients: a randomized controlled pilot study,” which was published in the European Journal of Medical Research. The work was funded by the Swiss Federal Institute of Technology in Zurich.

In Parkinson’s disease, both motor and non-motor symptoms can substantially impact quality of life and a person’s ability to function day to day. Along with medication, care for people with Parkinson’s commonly include physiotherapy and exercise training.

Increasing evidence suggests simultaneous motor and cognitive training “has great potential to improve balance, [walking] and cognition in PD [Parkinson’s disease] patients and that fall rate can be significantly reduced,” the researchers wrote.

Exergames are video games that require a player to actively move in order to play; the arcade staple Dance Dance Revolution (DDR) is a well-known example of an exergame. The games promote physical exercise and also work the brain as players must follow continual instructions to grow their score.

While some small studies have shown exergame-based inpatient rehabilitation programs are safe, feasible, and effective, most patients used exergame systems originally designed for teenagers to use recreationally.

“An exergame-based training system that has been specially developed for use in older adults could have an even better effect,” wrote a research team led by scientists in Switzerland who conducted a small clinical trial (NCT04872153) where they evaluated a cognitive motor training program based on an exergame system called the Dividat Senso.

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Feasibility of exergame-type program in Parkinson’s rehabilitation

The system resembles a classic DDR arcade game, with a large platform where the patient stands and moves to play the game and a screen that shows the game itself.

The study’s main goal was to test the feasibility of the exergame-based program, as assessed by how well patients stuck with it and whether there were problems using it. The secondary goal was to assess preliminary efficacy signs on cognitive and motor functions. Positive results would provide support for large-scale testing, the researchers noted.

The trial included 42 people with Parkinson’s or atypical parkinsonism who were prescribed rehabilitation. Participants were randomly assigned to the exergame-based program in addition to a standard rehabilitation program (21 patients) or a standard rehabilitation alone (21 patients).

All programs were conducted at the Center for Neurological Rehabilitation in Zihlschlacht, Switzerland. The standard rehabilitation program included physical and occupational therapy, and the exergame program consisted of five weekly sessions, with each session lasting around 15 minutes.

During the study, two patients in the combined approach dropped out for reasons unrelated to the rehabilitation or exergame-type program.

“There were no dropouts due to the intervention,” the researchers wrote, adding the remaining 40 participants (90% with Parkinson’s) completed the majority of scheduled therapy appointments.

The average intervention lasted nearly two weeks, ranging from about a week to nearly a month, with each tailored to a patient’s specific therapy goals.

No safety issues were reported and patients generally reported enjoying the exergame-based program. The average enjoyment rating was more than 4.5 on a 5-point scale. Most said the frequency and intensity of the program were optimal.

At the start and end of the intervention, participants took a series of motor and cognitive function tests. Across all measures, improvements from the exergame-based intervention were either comparable to or better than the standard training alone. In both groups the overall change in performance after the intervention was not statistically significant on most tests, however.

The researchers emphasized that the small study was not designed to test the exergame-based program’s effectiveness. Still, the generally positive effects on motor and cognitive functioning support testing of efficacy in larger patient groups.

“The main message of our pilot trial is that the process of integrating this novel treatment option into a clinical setting is doable and safe,” the researchers wrote. “Since there is already a positive tendency to improve physical and cognitive functions in this short period of time, it is to be expected that significantly positive effects can be achieved by extending the intervention time. Consequently, future studies should look at extending the period of intervention in the area of ​​outpatient rehabilitation or also as home training.”

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