Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial. Effect of virtual reality training on walking distance and physical fitness in individuals with Parkinson's disease. Home-based virtual reality balance training and conventional balance training in Parkinson's disease: A randomized controlled trial. Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson’s disease: a single-blinded randomized controlled trial Technology-Assisted Balance and Gait Training Reduces Falls in Patients With Parkinson’s Disease Reliability of the PEDro scale for rating quality of randomized controlled trials. Virtual Reality–Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson’s Disease Use of Virtual Reality to Enhance Balance and Ambulation in Chronic Stroke: A Double-Blind, Randomized Controlled Study
BACKGROUND Balance training has been demonstrated to improve postural control in patients with Parkinson 's disease ( PD ) . The objective of this pilot r and omized clinical trial was to investigate whether a balance training program using augmented visual feedback is feasible , safe , and more effective than conventional balance training in improving postural control in patients with PD . METHODS Thirty-three patients with idiopathic PD participated in a five-week training program consisting of ten group treatment sessions of 60 min . Participants were r and omly allocated to ( 1 ) an experimental group who trained on workstations consisting of interactive balance games with explicit augmented visual feedback ( VFT ) , or ( 2 ) a control group receiving conventional training .  St and ing balance , gait , and health status were assessed at entry , at six weeks , and at twelve weeks follow-up . RESULTS Sixteen patients were allocated to the control group and seventeen to the experimental group . The program was feasible to apply and took place without adverse events . Change scores for all balance measures favored VFT , but the change in the primary outcome measure , i.e. the Functional Reach test , did not differ between groups ( t(28 ) = -0.116 , p = .908 ) . No other differences between groups were statistically significant . CONCLUSIONS VFT proved to be a feasible and safe approach to balance therapy for patients with PD . In this proof-of-concept study VFT was not superior over conventional balance training although observed trends mostly favored VFT . These trends approached clinical relevance only in few cases : increasing the training load and further optimization of VFT may strengthen this effect . TRIAL REGISTRATION Controlled Trials , IS RCT N47046299 OBJECTIVE To evaluate the effects of gait training with virtual reality ( VR ) on walking distance and physical fitness in individuals with Parkinson 's Disease ( PD ) . METHODS Thirty-seven individuals with PD participated in this prospect i ve , r and omized , controlled clinical trial . They were r and omly allocated to a control group su bmi tted to conventional training ( n = 12 ) , a treadmill group su bmi tted to gait training on a treadmill ( n = 13 ) and a VR group su bmi tted to gait training using the XboxTM ( n = 12 ) . Clinical measures , gait variables and the Six-Minute Walk Test ( 6MWT ) were evaluated : pre-intervention , after one intervention session , post-intervention and follow up ( 30 days after intervention ) . RESULTS The VR and treadmill groups travelled longer distances on the 6MWT and had faster gait speed in comparison to the control group . The VR and treadmill groups demonstrated an increase in pre-6MWT HR . The VR group had more intense HR after the first session and throughout training , but these gains were not maintained at the follow-up . CONCLUSION The present findings demonstrate that gait training with a VR program is as effective as treadmill training with regard to gains in walking distance and improvements in temporal gait variables in individuals with PD BACKGROUND / PURPOSE Virtual reality has the advantage to provide rich sensory feedbacks for training balance function . This study tested if the home-based virtual reality balance training is more effective than the conventional home balance training in improving balance , walking , and quality of life in patients with Parkinson 's disease ( PD ) . METHODS Twenty-three patients with idiopathic PD were recruited and underwent twelve 50-minute training sessions during the 6-week training period . The experimental group ( n = 11 ) was trained with a custom-made virtual reality balance training system , and the control group ( n = 12 ) was trained by a licensed physical therapist . Outcomes were measured at Week 0 ( pretest ) , Week 6 ( posttest ) , and Week 8 ( follow-up ) . The primary outcome was the Berg Balance Scale . The secondary outcomes included the Dynamic Gait Index , timed Up- and -Go test , Parkinson 's Disease Question naire , and the motor score of the Unified Parkinson 's Disease Rating Scale . RESULTS The experimental and control groups were comparable at pretest . After training , both groups performed better in the Berg Balance Scale , Dynamic Gait Index , timed Up- and -Go test , and Parkinson 's Disease Question naire at posttest and follow-up than at pretest . However , no significant differences were found between these two groups at posttest and follow-up . CONCLUSION This study did not find any difference between the effects of the home-based virtual reality balance training and conventional home balance training . The two training options were equally effective in improving balance , walking , and quality of life among community-dwelling patients with PD 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 r and omly 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 grade d 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 Background The present study examined the effects of a balance-based exergaming intervention using the Kinect sensor on postural stability and balance in people with Parkinson ’s disease ( PD ) . Methods We conducted a subject-blinded , r and omized controlled study . Twenty people with PD ( Hoehn and Yahr stages I through III ) were recruited and r and omly assigned to either a balance-based exergaming group ( N = 10 ) or a balance training group ( N = 10 ) for an 8-week balance training period . Postural stability was assessed using the limits of stability ( LOS ) and one-leg stance ( OLS ) tests . Balance was assessed using the Berg Balance Scale ( BBS ) and the timed up and go ( TUG ) test . Participants were assessed pre- and post-training . Results After training , participants in the balance-based exergaming group showed significant improvements in LOS performance , and in the eyes-closed condition of the OLS test . Both training programs led to improvements in BBS and TUG performance . Furthermore , balance-based exergaming training result ed in significantly better performance in directional control in the LOS test ( 78.9 ± 7.65 % ) compared with conventional balance training ( 70.6 ± 9.37 % ) . Conclusions Balance-based exergaming training result ed in a greater improvement in postural stability compared with conventional balance training . Our results support the therapeutic use of exergaming aided by the Kinect sensor in people with PD.Trial registration Clinical Trials.gov . Objective . To examine the effects of technology-assisted balance and gait training on reducing falls in patients with Parkinson ’s disease ( PD ) . Methods . Eligible subjects were r and omly allocated to an experimental group given  technology-assisted balance and gait training ( BAL , n = 26 ) and an active control group undertaking strengthening exercises ( CON , n = 25 ) . The training in each group lasted for 3 months . The number of fallers and fall rate were used as primary outcomes , and single-leg-stance-time , latency of postural response to perturbation , self-selected gait velocity , and stride length as secondary outcomes . Fall incidence was recorded over 15 months after the baseline assessment ( Pre ) . Other tests were performed at Pre , after 3-month intervention ( Post3 m ) , at 3 months ( Post6 m ) , and 12 months ( Post15 m ) after treatment completion . Results . Forty-five subjects who completed the 3-month training were included in the data analysis . There were fewer fallers in the BAL than in the CON group at Post3 m , Post6 m , and Post15 m ( P < .05 ) . In addition , the BAL group had lower fall rate than the CON group at Post3 m and Post6 m ( incidence rate ratio : 0.111 - 0.188 , P < .05 ) , and marginally so at Post15 m ( incidence rate ratio : 0.407 , P = .057 ) . Compared with the CON subjects , the BAL subjects demonstrated greater reduction in the postural response latency and increase in the stride length against baseline at each assessment interval ( P < .05 ) , and marginally more increases of single-leg-stance-time at Post3 m ( P = .064 ) , Post6 m ( P = .041 ) and Post15 m ( P = .087 ) . Conclusions . Our positive findings provide evidence for the clinical use of technology-assisted balance and gait training in reducing falls in people with PD BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Background . Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson ’s disease ( PD ) . However , programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established . Objective . To examine the effects of virtual reality – based exercise on obstacle crossing performance and dynamic balance in participants with PD . Methods . Thirty-six participants with a diagnosis of PD ( Hoehn and Yahr score ranging 1 to 3 ) were r and omly assigned to one of three groups . In the exercise groups , participants received virtual reality – based Wii Fit exercise ( VRWii group ) or traditional exercise ( TE group ) for 45 minutes , followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks . Participants in the control group received no structured exercise program . Primary outcomes included obstacle crossing performance ( crossing velocity , stride length , and vertical toe obstacle clearance ) and dynamic balance ( maximal excursion , movement velocity , and directional control measured by the limits-of-stability test ) . Secondary outcomes included sensory organization test ( SOT ) , Parkinson ’s Disease Question naire ( PDQ39 ) , fall efficacy scale ( FES-I ) , and timed up and go test ( TUG ) . All outcomes were assessed at baseline , after training , and at 1-month follow-up . Results . The VRWii group showed greater improvement in obstacle crossing velocity , crossing stride length , dynamic balance , SOT , TUG , FES-I , and PDQ39 than the control group . VRWii training also result ed in greater improvement in movement velocity of limits-of-stability test than TE training . Conclusions . VRWii training significantly improved obstacle crossing performance and dynamic balance , supporting implementation of VRWii training in participants with PD Kim JH , Jang SH , Kim CS , Jung JH , You JH : Use of virtual reality to enhance balance and ambulation in chronic stroke : A double-blind , r and omized controlled study . Objective : To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke . Design : Twenty-four adults with hemiparetic stroke were r and omly assigned to either an experimental group ( n = 12 ) or a control group . Both groups underwent conventional physical therapy , 40 mins a day , 4 days a week for 4 wks . The experimental group received an additional 30 mins of virtual reality therapy each session . Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests . Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale , and spatiotemporal parameters were obtained using GAITRite . Analysis of variance and correlation statistics were performed at P < 0.05 . Results : In the balance test , the experimental group had improved Berg Balance Scale scores , balance and dynamic balance angles ( ability to control weight shifting ) compared with the controls ( P < 0.05 ) . In the gait performance test , the experimental group showed significant improvements in velocity , Modified Motor Assessment Scale scores , cadence , step time , step length , and stride length ( P < 0.05 ) . Improvement in dynamic balance angles was correlated with velocity and cadence ( P < 0.01 ) . Conclusions : This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy
Objective : The aim of this study was to evaluate the effectiveness of virtual reality interventions for improving balance and gait in people with Parkinson ’s disease .