Home-based step training using videogame technology in people with Parkinson’s disease: a single-blinded randomised controlled trial The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial. Nintendo Wii™ Versus Xbox Kinect™ for Assisting People With Parkinson's Disease 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 for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial Feasibility, safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study. Single and dual task gait training in people with Parkinson's Disease: A protocol for a randomised controlled trial At-home training with closed-loop augmented-reality cueing device for improving gait in patients with Parkinson disease. A Kinect-Based System for Lower Limb Rehabilitation in Parkinson’s Disease Patients: a Pilot Study Effects of dual-task training on balance and executive functions in Parkinson's disease: A pilot study Wii Fit balance board playing improves balance and gait in Parkinson disease. Training dual tasks together or apart in Parkinson's disease: Results from the DUALITY trial Evidence for motor learning in Parkinson's disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial Does auditory rhythmical cueing improve gait in people with Parkinson's disease and cognitive impairment? A feasibility study. Feasibility and effects of home-based smartphone-delivered automated feedback training for gait in people with Parkinson's disease: A pilot randomized controlled trial. V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial
Objectives : To determine whether 12-week home-based exergame step training can improve stepping performance , gait and complementary physical and neuropsychological measures associated with falls in Parkinson ’s disease . Design : A single-blinded r and omised controlled trial . Setting : Community ( experimental intervention ) , university laboratory ( outcome measures ) . Subjects : Sixty community-dwelling people with Parkinson ’s disease . Interventions : Home-based step training using videogame technology . Main measures : The primary outcomes were the choice stepping reaction time test and Functional Gait Assessment . Secondary outcomes included physical and neuropsychological measures associated with falls in Parkinson ’s disease , number of falls over six months and self-reported mobility and balance . Results : Post intervention , there were no differences between the intervention ( n = 28 ) and control ( n = 25 ) groups in the primary or secondary outcomes except for the Timed Up and Go test , where there was a significant difference in favour of the control group ( P = 0.02 ) . Intervention participants reported mobility improvement , whereas control participants reported mobility deterioration — between-group difference on an 11-point scale = 0.9 ( 95 % confidence interval : −1.8 to −0.1 , P = 0.03 ) . Interaction effects between intervention and disease severity on physical function measures were observed ( P = 0.01 to P = 0.08 ) with seemingly positive effects for the low-severity group and potentially negative effects for the high-severity group . Conclusion : Overall , home-based exergame step training was not effective in improving the outcomes assessed . However , the improved physical function in the lower disease severity intervention participants as well as the self-reported improved mobility in the intervention group suggest home-based exergame step training may have benefits for some people with Parkinson ’s disease OBJECTIVES To compare the effects of functional training , bicycle exercise , and exergaming on walking capacity of elderly with Parkinson disease ( PD ) . DESIGN A pilot r and omized , controlled , single-blinded trial . SETTING A state reference health care center for elderly , a public reference outpatient clinic for the elderly . PARTICIPANTS Elderly individuals ( ≥60 years of age ; N=62 ) with idiopathic PD ( stage 2 to 3 of modified Hoehn and Yahr staging scale ) according to the London Brain Bank . INTERVENTION The participants were r and omly assigned to three groups . Group 1 ( G1 ) participated in functional training ( n=22 ) ; group 2 ( G2 ) performed bicycle exercise ( n=20 ) , and group 3 ( G3 ) trained with Kinect Adventures ( Microsoft , Redmond , WA ) exergames ( n=20 ) . MAIN OUTCOME MEASURES The primary outcome measure was the 6-minute walk test ( 6MWT ) ; secondary outcome measures were the 10-m walk test ( 10MWT ) , sitting-rising test ( SRT ) , body mass index , Parkinson Disease Question naire-39 , World Health Organization Disability Assessment Schedule 2.0 ( WHODAS 2.0 ) , and 15-item Geriatric Depression Scale . RESULTS All groups showed significant improvements in 6MWT ( G1 P=.008 ; G2 P=.001 ; G3 P=.005 ) , SRT ( G1 P<.001 ; G2 P=.001 ; G3 P=.003 ) , and WHODAS 2.0 ( G1 P=.018 ; G2 P=.019 ; G3 P=.041 ) . Only G3 improved gait speed in 10MWT ( P=.11 ) . G1 ( P=.014 ) and G3 ( P=.004 ) improved quality of life . No difference was found between groups . CONCLUSIONS Eight weeks of exergaming can improve the walking capacity of elderly patients with PD . Exergame training had similar outcomes compared with functional training and bicycle exercise . The three physical exercise modalities presented significant improvements on walking capacity , ability to st and up and sit , and functionality of the participants This study investigated changes in motor and cognitive skills , anxiety levels , and quality of life perception among patients with Parkinson 's Disease ( PD ) following training with different commercial gaming devices — Nintendo Wii ™ and Xbox Kinect ™ . We used a quasi-experimental , simple blinded clinical trial , dividing 27 patients with PD into three equal groups of nine members : ( a ) Nintendo Wii ™ , ( b ) Xbox Kinect ™ , and ( c ) control group .  After pretests , experimental group participants spent 10 sessions playing four games of the selected gaming device , while control group participants received no intervention . Only those engaged with the Nintendo Wii ™ significantly improved their performance on single and dual task gait tests , decreased anxiety levels , and improved memory , attention , and reversibility . The control group showed no changes on any measures 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 BACKGROUND Gait and cognitive disturbances are common in Parkinson 's disease ( PD ) . These deficits exacerbate fall risk and difficulties with mobility , especially during complex or dual-task walking . Traditional gait training generally fails to fully address these complex gait activities . Virtual reality ( VR ) incorporates principles of motor learning while delivering engaging and challenging training in complex environments . We hypothesized that VR may be applied to address the multifaceted deficits associated with fall risk in PD . METHODS Twenty patients received 18 sessions ( 3 per week ) of progressive intensive treadmill training with virtual obstacles ( TT + VR ) . Outcome measures included gait under usual-walking and dual-task conditions and while negotiating physical obstacles . Cognitive function and functional performance were also assessed . RESULTS Patients were 67.1 ± 6.5 years and had a mean disease duration of 9.8 ± 5.6 years . Posttraining , gait speed significantly improved during usual walking , during dual task , and while negotiating overground obstacles . Dual-task gait variability decreased ( ie , improved ) and Trail Making Test times ( parts A and B ) improved . Gains in functional performance measures and retention effects , 1 month later , were also observed . CONCLUSIONS To our knowledge , this is the first time that TT + VR has been used for gait training in PD . The results indicate that TT + VR is viable in PD and may significantly improve physical performance , gait during complex challenging conditions , and even certain aspects of cognitive function . These findings have important implication s for underst and ing motor learning in the presence of PD and for treating fall risk in PD , aging , and others who share a heightened risk of falls 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 OBJECTIVES To assess the feasibility , safety and outcomes of playing Microsoft Kinect Adventures ™ for people with Parkinson 's disease in order to guide the design of a r and omised clinical trial . DESIGN Single-group , blinded trial . SETTING Rehabilitation Center of São Camilo University , Brazil . PARTICIPANTS Seven patients ( six males , one female ) with Parkinson 's disease ( Hoehn and Yahr Stages 2 and 3 ) . INTERVENTIONS Fourteen 60-minute sessions , three times per week , playing four games of Kinect Adventures ! MAIN OUTCOME MEASURES The feasibility and safety outcomes were patients ' game performance and adverse events , respectively . The clinical outcomes were the 6-minute walk test , Balance Evaluation System Test , Dynamic Gait Index and Parkinson 's Disease Question naire ( PDQ-39 ) . RESULTS Patients ' scores for the four games showed improvement . The mean [ st and ard deviation ( SD ) ] scores in the first and last sessions of the Space Pop game were 151 ( 36 ) and 198 ( 29 ) , respectively [ mean ( SD ) difference 47 ( 7 ) , 95 % confidence interval 15 to 79 ] . There were no adverse events . Improvements were also seen in the 6-minute walk test , Balance Evaluation System Test , Dynamic Gait Index and PDQ-39 following training . CONCLUSION Kinect-based training  was safe and feasible for people with Parkinson 's disease ( Hoehn and Yahr Stages 2 and 3 ) . Patients improved their scores for all four games . No serious adverse events occurred during training with Kinect Adventures ! , which promoted improvement in activities ( balance and gait ) , body functions ( cardiopulmonary aptitude ) and participation ( quality of life ) Background Difficulty performing more than one task at a time ( dual tasking ) is a common and disabling problem experienced by people with Parkinson disease ( PD ) . If asked to perform another task when walking , people with PD often take shorter steps or walk more slowly . Currently there is uncertainty about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance . This study will address this issue by comparing single to dual task gait training . Methods and design A prospect i ve r and omised clinical trial is being conducted . Sixty participants with idiopathic PD will be recruited , provided they score I-IV on the modified Hoehn and Yahr ( 1967 ) scale , and fulfil other inclusion criteria . Participants will be r and omly allocated to either a single or dual task gait training group . Both groups will receive 12 hours of walking training over 4 weeks . The single task group will undertake gait training with cueing strategies to increase step length . The dual task group will train to improve step length when walking and performing a variety of added tasks . Both groups will receive a tailored home program for 6 months . Blinded assessors will conduct four assessment s : two baseline assessment s , one post intervention and one at 6 months follow-up . The primary outcome measure will be step length when dual tasking over 8 m. Secondary outcome measures include : spatiotemporal gait parameters when walking under single and dual task conditions , measures of executive function , the timed up and go test , measures of community mobility , and quality of life . All analyses will be based on intention to treat principle . Discussion This trial will examine the immediate and longer term effect of dual task walking training as compared to single task training in people with idiopathic PD , at the impairment , activity , and participation levels . It has the potential to identify a new intervention that may improve and maintain walking beyond the laboratory . The results of this trial will provide guidance for clinicians in the development of walking training programs for people with PD.Trial Registration Shuffling and freezing while walking can impair function in patients with Parkinson disease ( PD ) .  Open-loop devices that provide fixed-velocity visual or auditory cues can improve gait but may be unreliable or exacerbate freezing of gait in some patients . We examined the efficacy of a closed-loop , accelerometer-driven , wearable , visual-auditory cueing device in 13 patients with PD with off-state gait impairment at baseline and after 2 weeks of twice daily ( 30 minute duration ) at-home use . We measured gait velocity , stride length , and cadence using a vali date d electronic gait- analysis system . Subjects underwent st and ard motor assessment and completed a  self-administered Freezing of Gait Question naire ( FOGQ ) ( range 0 - 24 ; lower is better ) . After training , device use enhanced walking velocity ( 61.6 ± 20.1 cm/s to 72.6 ± 26.5 cm/s , p = 0.006 ) and stride length ( 74.3 ± 16.4 cm to 84.0 ± 18.5 cm , p = 0.004 ) . Upon device removal , walking velocity ( 64.5 ± 21.4 cm/s to 75.4 ± 21.5 cm/s , p < 0.001 ) and stride length ( 79.0 ± 20.3 cm to 88.8 ± 17.7 cm , p = 0.003 ) exhibited a greater magnitude of change , suggesting immediate residual benefits . Also upon device removal , nearly 70 percent of subjects improved by at least 20 percent in either walking velocity , stride length , or both . An overall improvement in gait was measured by the FOGQ ( 14.2 ±1.9 to 12.4 ± 2.5 , p = 0.02 ) . Although issues related to compliance and response variability render a definitive interpretation of study outcome difficult , devices using closed-loop sensory feedback appear to be effective and desirable nonpharmacologic interventions to improve walking in selected individuals with PD This work brings together the emerging virtual reality techniques and the natural user interfaces to offer new possibilities in the field of rehabilitation . We have design ed a rehabilitation game based on a low cost device ( Microsoft KinectTM ) connected to a personal computer . It provides patients having Parkinson ’s Disease ( PD ) with a motivating way to perform several motor rehabilitation exercises to improve their rehabilitation . The experiment was tested on seven Parkinson ’s Disease patients and results demonstrated significant improvements in completion time score and in the 10 Meters Walk Test score . Nevertheless , additional research is needed to determine if this type of training has a long-term impact . Both the device and protocol were well accepted by subjects , being safe and easy to use . We conclude that our work provides a simple and suitable tool result ing in a more enriching rehabilitation process where motivation is highly encouraged in PD patients . Feedback coming from participants corroborate the hypothesis that the system can be applied not only in clinical rehabilitation centers but at home Abstract The aim of this study was to analyze the efficacy of cognitive – motor dual-task training compared with single-task training on balance and executive functions in individuals with Parkinson 's disease . Fifteen subjects , aged between 39 and 75 years old , were r and omly assigned to the dual-task training group ( n = 8) and single-task training group ( n = 7 ) . The training was run twice a week for 6 weeks . The single-task group received balance training and the dual-task group performed cognitive tasks simultaneously with the balance training . There were no significant differences between the two groups at baseline . After the intervention , the results for mediolateral sway with eyes closed were significantly better for the dual-task group and anteroposterior sway with eyes closed was significantly better for the single-task group . The results suggest superior outcomes for the dual-task training compared to the single-task training  for static postural control , except in anteroposterior sway with eyes closed OBJECTIVE To assess the effect of exercise training by using the Nintendo Wii Fit video game and balance board system on balance and gait in adults with Parkinson disease ( PD ) . DESIGN A prospect i ve interventional cohort study . SETTING An outpatient group exercise class . PARTICIPANTS Ten subjects with PD , Hoehn and Yahr stages 2.5 or 3 , with a mean age of 67.1 years ; 4 men , 6 women . INTERVENTIONS The subjects participated in supervised group exercise sessions 3 times per week for 8 weeks by practicing 3 different Wii balance board games ( marble tracking , skiing , and bubble rafting ) adjusted for their individualized function level . The subjects trained for 10 minutes per game , a total of 30 minutes training per session . MAIN OUTCOME MEASUREMENTS Pre- and postexercise training , a physical therapist evaluated subjects ' function by using the Berg Balance Scale , Dynamic Gait Index , and Sharpened Romberg with eyes open and closed . Postural sway was assessed at rest and with tracking tasks by using the Wii balance board . The subjects rated their confidence in balance by using the Activities-specific Balance Confidence scale and depression on the Geriatric Depression Scale . RESULTS Balance as measured by the Berg Balance Scale improved significantly , with an increase of 3.3 points ( P = .016 ) . The Dynamic Gait Index improved as well ( mean increase , 2.8 ; P = .004 ) , as did postural sway measured with the balance board ( decreased variance in stance with eyes open by 31 % ; P = .049 ) . Although the Sharpened Romberg with eyes closed increased by 6.85 points and with eyes opened by 3.3 points , improvements neared significance only for eyes closed ( P = .07 versus P = .188 ) . There were no significant changes on patient ratings for the Activities-specific Balance Confidence ( mean decrease , -1 % ; P = .922 ) or the Geriatric Depression Scale ( mean increase , 2.2 ; P = .188 ) . CONCLUSIONS An 8-week exercise training class by using the Wii Fit balance board improved selective measures of balance and gait in adults with PD . However , no significant changes were seen in mood or confidence regarding balance BACKGROUND AND OBJECTIVES Many controversies surround the usefulness of dual-task training in Parkinson 's disease ( PD ) . This study ( 1 ) compared the efficacy of two different dual-task training programs for improving dual-task gait and ( 2 ) assessed the possible fall risk of such training . METHODS Patients ( N = 121 ) with a diagnosis of PD ( aged 65.93 [ ±9.22 ] years , Hoehn and Yahr stage II-III on-medication ) were r and omized to ( 1 ) a consecutive group in which gait and cognitive tasks were trained separately  or ( 2 ) an integrated group in  which gait and cognitive tasks were trained simultaneously . Both interventions involved 6 weeks of at-home physiotherapist-led training . Two baseline tests were performed as a 6-week control period before training . Posttests were performed immediately after training and at 12-week follow-up . Dual-task gait was assessed during trained and untrained secondary tasks to assess consolidation of learning . Fall risk was determined by a weekly telephone call for 24 weeks . RESULTS No significant time by group interactions were found , suggesting that both training modes had a similar effect on dual-task gait . Immediately after training , and not after the control period , significant improvements ( P < .001 ) in dual-task gait velocity were found in all trained and untrained dual tasks . Improvements ranged between 7.75 % and 13.44 % when compared with baseline values and were retained at 12-week follow-up . No significant change in fall risk occurred in both study arms ( P = .84 ) . CONCLUSIONS Consecutive and integrated dual-task training led to similar and sustained improvements in dual-task gait velocity without increasing fall risk . These novel findings support adoption of dual-task training in clinical practice . © 2017 International Parkinson and Movement Disorder Society People with Parkinson 's disease ( PD ) have difficulty learning new motor skills . Evidence suggests external stimuli ( cues ) may enhance learning ; however , this may be specific to cued rather than non-cued performance . We aim ed to test effects of cued training on motor learning in PD . We defined motor learning as acquisition ( single task ) , automaticity ( dual task ) and retention of single- and dual-task performance ( follow-up ) . 153 subjects with PD received 3 weeks cued gait training as part of a r and omised trial ( the RESCUE trial ) . We measured changes in  cued gait performance  with three external rhythmical cues ( ERC ) ( auditory , visual and somatosensory ) during single and dual tasks after training and 6 weeks follow-up . Gait was tested without cues to compare specificity of learning ( transfer ) . Subjects were ' on ' medication and were cued at preferred step frequency during assessment . Accelerometers recorded gait and walking speed , step length and step frequency were determined from raw data . Data were analysed with SAS using linear regression models . Walking speed and step length significantly increased with all cues after training during both single- and dual-task gait and these effects were retained . Training effects were not specific to cued gait and were observed in dual-task step length , and walking speed however was more limited in single-task non-cued gait . These results support the use of ERC to enhance motor learning in PD as defined by increased acquisition , automaticity and retention . They also highlight the potential for sustained improvement in walking and complex task performance Objectives : Gait and mobility problems are difficult to treat in people with Parkinson ’s disease . The Rehabilitation in Parkinson ’s Disease : Strategies for Cueing ( RESCUE ) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity . Methods : A single-blind r and omised crossover trial was set up , including 153 patients with Parkinson ’s disease aged between 41 and 80 years and in Hoehn and Yahr stage II – IV . Subjects allocated to early intervention ( n = 76 ) received a 3-week home cueing programme using a prototype cueing device , followed by 3 weeks without training . Patients allocated to late intervention ( n = 77 ) underwent the same intervention and control period in reverse order . After the initial 6 weeks , both groups had a 6-week follow-up without training .  Posture and gait scores ( PG scores ) measured at 3 , 6 and 12 weeks by blinded testers were the primary outcome measure . Secondary outcomes included specific measures on gait , freezing and balance , functional activities , quality of life and carer strain . Results : Small but significant improvements were found after intervention of 4.2 % on the PG scores ( p = 0.005 ) . Severity of freezing was reduced by 5.5 % in freezers only ( p = 0.007 ) . Gait speed ( p = 0.005 ) , step length ( p<0.001 ) and timed balance tests ( p = 0.003 ) improved in the full cohort . Other than a greater confidence to carry out functional activities ( Falls Efficacy Scale , p = 0.04 ) , no carry-over effects were observed in functional and quality of life domains . Effects of intervention had reduced considerably at 6-week follow-up . Conclusions : Cueing training in the home has specific effects on gait , freezing and balance . The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment . Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson ’s disease Gait and balance problems result ing from Parkinson 's disease ( PD ) are more common in people with PD and dementia ( PDD ) , yet , it is unknown whether the benefits of cueing therapy for mobility generalize to them . We aim ed to determine the feasibility and effectiveness of auditory cues to improve gait in PD and cognitive impairment ( PD-CI ) . Nine participants with PD-CI walked with and without auditory cues using two different strategies : ( 1 ) Cue with temporal instruction to " step in time to the beat , " ( 2 ) Cue with spatiotemporal instruction to " take a big step in time to the beat . " Cues were delivered with a metronome at preferred stepping frequency while on medication during single and dual-task gait . Gait was assessed using GAITRite and walking speed , stride amplitude , step frequency , and variability ( CV% ) of step and double limb support time were measured . Data were analyzed in SPSS version 16 using fixed-effect linear mixed models . An adjusted , P value of 0.01 was considered significant . Participants were men , aged 74.89 ( + /-6.45 ) years with median MMSE of 22 ( range 20.5 - 25 ) and UPDRS III score of 44 ( 35.5 - 47.0 ) . Participants complied with testing and instructions . The cue that focused attention on both temporal and spatial parameters of gait significantly improved single and dual-task walking speed and stride amplitude . This study provides evidence for the potential of cueing to improve gait in PD-CI . Only individuals with mild CI were included , and the effect with increased CI and different types of dementia requires further evaluation BACKGROUND Inertial measurement units combined with a smartphone application ( CuPiD-system ) were developed to provide people with Parkinson 's disease ( PD ) real-time feedback on gait performance . This study investigated the CuPiD-system 's feasibility and effectiveness compared with conventional gait training when applied in the home environment . METHODS Forty persons with PD undertook gait training for 30 min , three times per week for six weeks . Participants were r and omly assigned to i ) CuPiD , in which a smartphone application offered positive and corrective feedback on gait , or ii ) an active control , in which personalized gait advice was provided  . Gait , balance , endurance and quality of life were assessed before and after training and at four weeks follow-up using st and ardized tests . RESULTS Both groups improved significantly on the primary outcomes ( single and dual task gait speed ) at post-test and follow-up . The CuPiD group improved significantly more on balance ( MiniBESTest ) at post-test ( from 24.8 to 26.1 , SD ∼ 5 ) and maintained quality of life ( SF-36 physical health ) at follow-up whereas the control group deteriorated ( from 50.4 to 48.3 , SD ∼ 16 ) . No other statistically significant differences were found between the two groups . The CuPiD system was well-tolerated and participants found the tool user-friendly . CONCLUSION CuPiD was feasible , well-accepted and seemed to be an effective approach to promote gait training , as participants improved equally to controls . This benefit may be ascribed to the real-time feedback , stimulating corrective actions and promoting self-efficacy to achieve optimal performance . Further optimization of the system and adequately-powered studies are warranted to corroborate these findings and determine cost-effectiveness Background Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits . Indeed , everyday walking in complex environments utilizes executive function , dual tasking , planning and scanning , all while walking forward . Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction . The proposed r and omized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk . Methods / Design Three hundred older adults with a history of falls will be recruited to participate in this study . This will include older adults ( n=100 ) , patients with mild cognitive impairment ( n=100 ) , and patients with Parkinson ’s disease ( n=100 ) . These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits . Subjects will be r and omly assigned to the intervention group ( treadmill training with virtual reality ) or to the active-control group ( treadmill training without virtual reality ) . Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks . Assessment s will take place before , after , and 1 month and 6 months after the completion of the training . A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence ( i.e. , the number of falls , multiple falls and falls rate ) . In addition , we will measure gait under usual and dual task conditions , balance , community mobility , health related quality of life , user satisfaction and cognitive function . Discussion This r and omized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality  reduces fall risk , improves mobility and enhances cognitive function in a diverse group of older adults . In addition , the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit . Trial Registration
This systematic review examined the evidence about the effects of virtual reality ( VR ) on  dual-task gait training in Parkinson 's disease ( PD ) .
Methods this study ( PROSPERO registration CRD42019114736 ) aim ed to answer the question : " Is VR beneficial for dual-task gait training in patients with PD ? "