The effects of augmented and virtual reality gait training on balance and gait in patients with Parkinson's disease

Psychological education in higher education: Opportunities and challenges in the Internet+ era

In the context of "Internet+," the rapid development and integration of information technology in China have brought new opportunities and challenges to psychological education in higher education. Compared with traditional psychological education, the high information throughput and multichannel presentation of "Internet+" have altered students’ cognitive characteristics. Consequently, traditional psychological education methods are no longer suitable for the current environment, and education methods pose new challenges for higher education. New media technologies within the "Internet+" framework have played a crucial role in psychological education. Further research is needed to explore new applications for enhancing the quality of psychological education in higher education institutions. This paper reviews the current opportunities and challenges faced by psychological education in the context of "Internet+", and explores a mechanism-driven, collaborative, and efficient educational strategy that is responsive to new conditions.

Examining virtual reality's influence on kinetic variables for obstacle crossing in Parkinson's disease

BACKGROUND

Individuals with Parkinson's disease (PD) commonly experience postural instability during walking and obstacle crossing. Previous research has explored virtual reality (VR) as a rehabilitation tool that affects gait.

RESEARCH QUESTION

How does a virtual reality environment influence the kinetic characteristics of gait during obstacle crossing in individuals with Parkinson's disease compared to real-world conditions?

METHODS

The study included 15 individuals with PD and 17 matched healthy control participants. The moment and power of lower extremity joints during walking and obstacle crossing conditions in real and VR environments were measured using three-dimensional motion analysis and force platforms.

RESULTS

The results indicate that individuals with PD demonstrated higher hip extensor moments during normal gait (NG) and obstacle crossing (OBS) tasks, accompanied by lower hip flexor moments compared to the control group. Moreover, PD individuals exhibited increased internal rotation hip joint moments during VR obstacle crossing (VR-OBS) tasks compared to NG.

CONCLUSION

Walking in a VR environment altered the kinetic status in both groups, potentially due to cautious walking to maintain stability. The greatest difference between the two groups was observed in the magnitude of joint moment in the sagittal plane, likely influenced by differences in walking speed. These findings underscore the unique joint moment patterns exhibited by PD patients during various tasks. Walking in a VR environment impacts the kinetic parameters of gait, which may have implications for designing rehabilitation programs aimed at improving gait stability in PD individuals. Clinically, these kinetic alterations highlight VR's potential as a safe modality for gait rehabilitation and fall prevention in PD.

Virtual reality and sports performance: a systematic review of randomized controlled trials exploring balance

Introduction

Our systematic literature review aimed to select randomized controlled trials (RCTs) in which virtual reality (VR) has been used in athletes or players to evaluate the effectiveness of this technology in gaining performance.

Methods

In accordance with PRISMA guidelines, a systematic literature search was conducted in the MEDLINE, Scopus and Web of Science databases using the keyword set [(Virtual reality) OR (VR)] AND [(Athletes) OR (Players)] AND [(Performance) OR (Balance)]. Peer-reviewed articles published within the last ten years in English and open access were included. The methodological quality of the articles was assessed using the Jadad scale, while the eligibility criteria were evaluated using the PICOS approach.

Results

Specifically, six RCTs were selected, one of which scored 5/5 on the Jadad scale, four scored 3/5 and one scored 2/5. Importantly, five RCTs found a positive influence of VR on performance in terms of balance, stability, sprinting, jumping, neurocognitive function, reaction time and technical skills, while only one RCT found no difference in these parameters.

Discussion

In conclusion, the results included in our systematic review showed that VR seems to have a positive effect in improving sports performance. However, the heterogeneity of the studies did not allow for a comparison of the data to clarify the relevance of VR technology in performance, suggesting the need for in-depth investigations to confirm its efficacy in sports.

Virtual reality effects on balance and mobility in people with Parkinson's disease: A systematic review with meta-analysis

BACKGROUND

Specific Virtual Reality (VR) systems designed for rehabilitation and non-specific VR systems intended for entertainment are used in Parkinson's disease (PD) rehabilitation, but their effects are unclear. The extent to which these systems integrate neurorehabilitation principles for PD rehabilitation is unknown. Previous meta-analyses exist but data are lacking on the impact of VR on mobility.

OBJECTIVES

Primary aim: to perform a systematic review with meta-analysis comparing the effects of VR and conventional therapy (CT) on balance and mobility in people with PD. Secondary aim: to perform subgroup analyses on VR type, disease severity, and treatment duration.

METHODS

Randomized controlled trials comparing VR and CT effects on balance and mobility in adults with PD were selected from Pubmed and EMBASE until September 2024. Data were synthesized qualitatively and quantitatively using a standardized mean difference (SMD) with random-effects model. Subgroup analyses (VR type, disease severity, and treatment duration) and analysis of fulfilled neurorehabilitation principles were conducted. Risk of bias was assessed (PEDro checklist and Cochrane RoB-2).

RESULTS

Twenty-eight studies (12 countries) were included: 1151 participants, mean Hoehn & Yahr stage between 1.4 and 3.4, mean (SD) treatment duration 18.8 (11.5) hours in the qualitative analysis and 23 in the quantitative analysis. Overall risk of bias was high (10 studies), some concerns (13 studies), or low (5 studies). VR was more effective than CT for balance (630 participants; 11 studies; SMD 0.42; 95% CI, 0.19-0.65; P < 0.001) and as effective as CT for mobility (591 participants; 10 studies; SMD 0.18; 95% CI, -0.03 to 0.40; P = 0.09). Balance and mobility outcomes did not differ between specific and non-specific VR. Subgroup analyses found no significant differences.

CONCLUSIONS

VR improved balance in people with PD more than CT (low-certainty evidence). VR improved mobility similarly to CT (moderate-certainty evidence). VR games should integrate neurorehabilitation principles.

Fun and games: a scoping review of enjoyment and intensity assessment in studies of game-based interventions for gait rehabilitation in neurological disorders

PURPOSE

Exergames are used to promote gait rehabilitation in patients with neurological disorders because they are believed to heighten patient enjoyment and training intensity. This scoping review evaluated whether and how studies support these claims.

METHODS

A search for studies published up until October 2023 involving virtual reality or exergames for patients with neurological disorders (stroke, Parkinson's disease, multiple sclerosis, spinal cord injury) was conducted on PubMed and Scopus, with additional articles identified through backward and forward citation searching. Studies collecting gait measurements, with at least five participants and a control group were included. Data extracted were rationale, and whether participants' enjoyment of the intervention and training intensity were assessed.

RESULTS

1060 records were identified with 58 included in this review. There were 34 articles on stroke, 11 on multiple sclerosis, and 13 on Parkinson's disease. Participant enjoyment and greater training intensity were important rationales but were only evaluated in 12 and seven of the included studies, respectively.

CONCLUSION

Results highlight that participant enjoyment and heightened training intensity are commonly cited rationales for using exergames in gait rehabilitation, but these effects are assumed and not routinely measured or analysed. Greater consistency is needed in the design and execution of exergaming studies for neurological disorders.

Emerging Applications of Augmented and Mixed Reality Technologies in Motor Rehabilitation: A Scoping Review

BACKGROUND

Augmented Reality (AR) and Mixed Reality (MR) are emerging technologies with notable potential for motor rehabilitation. Given the novelty and breadth of this field, this scoping review aims to identify how and to what extent AR and MR technologies are used in motor rehabilitation.

METHODS

We conducted a search in Scopus and PubMed (2010-2024), following PRISMA-ScR guidelines. In the analysis, we focused on four key aspects: (I) the AR/MR display technologies, (II) the sensors used to collect data to generate the augmented information, (III) the pathologies addressed, and (IV) the assessment of usability and acceptability.

RESULTS

Among 105 selected studies, 58% developed new prototypes, while 42% tested existing systems. Head-mounted displays were the most common device (56.2%), followed by monitors (34.3%) and video projectors (14.3%). The most commonly used sensors were RGB-D cameras (31.4%), sensors for localization and mapping (33.3%), normal cameras (17.1%), and electromyography sensors (14.3%). Regarding the target pathology, 34.2% of studies did not focus on a specific pathology, 26.7% were on stroke, 10.5% on limb loss, and 9.5% on Parkinson's disease. Over half (51.4%) of the studies investigated usability and acceptance.

CONCLUSIONS

AR/MR technologies hold promise for motor rehabilitation, but limited comparative studies and long-term investigations currently hinder a clear understanding of their benefits.

Better Understanding Rehabilitation of Motor Symptoms: Insights from the Use of Wearables

Movement disorders present a substantial challenge by adversely affecting daily routines and overall well-being through a diverse spectrum of motor symptoms. Traditionally, motor symptoms have been evaluated through manual observational methods and patient-reported outcomes. While those approaches are valuable, they are limited by their subjectivity. In contrast, wearable technologies (wearables) provide objective assessments while actively supporting rehabilitation through continuous tracking, real-time feedback, and personalized physical therapy-based interventions. The aim of this literature review is to examine current research on the use of wearables in the rehabilitation of motor symptoms, focusing on their features, applications, and impact on improving motor function. By exploring research protocols, metrics, and study findings, this review aims to provide a comprehensive overview of how wearables are being used to support and optimize rehabilitation outcomes. To achieve that aim, a systematic search of the literature was conducted. Findings reveal that gait disturbance and postural balance are the primary motor symptoms extensively studied with tremor and freezing of gait (FoG) also receiving attention. Wearable sensing ranges from bespoke inertial and/or electromyography to commercial units such as personal devices (ie, smartwatch). Interactive (virtual reality, VR and augmented reality, AR) and immersive technologies (headphones), along with wearable robotic systems (exoskeletons), have proven to be effective in improving motor skills. Auditory cueing (via smartwatches or headphones), aids gait training with rhythmic feedback, while visual cues (via VR and AR glasses) enhance balance exercises through real-time feedback. The development of treatment protocols that incorporate personalized cues via wearables could enhance adherence and engagement to potentially lead to long-term improvements. However, evidence on the sustained effectiveness of wearable-based interventions remains limited.

New Technological Approaches in Occupational Therapy for Pediatric Cerebral Palsy: A Systematic Review

BACKGROUND/OBJECTIVES

Pediatric cerebral palsy (CP) is a neurological disorder that affects motor skills, posture, and muscle coordination, impacting children's daily functioning and quality of life. Treatment approaches in occupational therapy aim to enhance motor function and functional independence through a variety of rehabilitative techniques. Recently, new technologies-such as virtual reality, robotics, and assistive devices-have emerged as promising tools in occupational therapy to complement traditional interventions and potentially enhance motor and sensory outcomes in children with CP. This systematic review aims to analyze the effectiveness of these innovative technological interventions in the rehabilitation of children with CP.

METHODS

A systematic review was conducted and different scales were used to assess the risk of bias and methodological quality. The degree of evidence and level of recommendation were established according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The review adhered to PRISMA guidelines, with a comprehensive literature search performed across multiple databases, including Cochrane, Web of Science, and PubMed. This systematic review has been registered in the PROSPERO database with the registration number CRD42025630162.

RESULTS

The reviewed studies indicate that technologies such as functional electrical stimulation, robotic assistance, and adaptive devices have shown improvements in mobility, motor control, posture, strength, and autonomy in children with CP. Similarly, virtual environments support the correction of facial dysfunctions and enhance social interaction through video games and social networks. While these tools hold significant potential for rehabilitation, further adjustments are needed to achieve more consistent results.

CONCLUSIONS

Emerging technologies appear to be effective tools in occupational therapy for pediatric CP, with positive impacts on motor skills and functional capabilities. Nevertheless, further studies with larger sample sizes and rigorous methodological designs are necessary to confirm these findings and establish more robust evidence on their long-term efficacy.

The Role of Virtual Reality in Postural Rehabilitation for Patients with Parkinson's Disease: A Scoping Review

Parkinson's disease is the second most common neurodegenerative disease worldwide, characterized by bradykinesia, rigidity, tremor, and postural instability. These symptoms often lead to significant postural deformities and an increased risk of falls, severely impacting the quality of life. Conventional rehabilitation methods have shown benefits, but recent advancements suggest that virtual reality (VR) could offer a promising alternative. This scoping review aims to analyze the current literature to evaluate the effectiveness of VR in the postural rehabilitation of patients with PD. A scientific literature search was performed using the following databases: PubMed, PEDro, Cochrane, and Google Scholar, focusing on randomized controlled trials (RCTs) published in English. Our selection criteria included studies that compared VR-based rehabilitation to traditional methods regarding posture-related outcomes. We identified and analyzed nine RCTs that met our inclusion criteria. The results consistently demonstrated that VR-based rehabilitation leads to greater improvements in balance and gait compared to conventional therapy. Key findings include significant enhancements in balance confidence and postural control and a reduction in fall rates. The superior efficacy of VR-based rehabilitation can be attributed to its engaging and immersive nature, which enhances patient motivation and adherence to therapy. VR allows for precise, repeatable training scenarios tailored to individual patient needs, providing a safe environment to practice and improve motor skills. In conclusion, VR-based rehabilitation represents an innovative approach with substantial potential to improve the quality of life for PD patients. However, limitations such as small sample sizes and short intervention durations in existing studies highlight the need for larger multicenter trials with longer follow-up periods to confirm these findings.

Advancements in sacroiliac joint reduction for enhancing lumbosacral pain relief and achieving balanced gait: A literature review

This article provides a comprehensive review of recent research advancements in sacroiliac joint reduction therapy for addressing lumbosacral pain and gait balance issues, delving into its application efficacy, future outlook, and existing challenges. Current literatures were searched on sacroiliac joint reduction therapy, lumbosacral pain and gait balance disorders using the databases PubMed and Cochrane. There were no restrictions when conducting the literature search with regard to publication date, study language, or study type. Research indicates notable enhancements in various gait parameters, including stride length, gait speed, and cycle uniformity, among patients undergoing sacroiliac joint reduction therapy. These improvements translate into augmented walking stability and a reduced risk of falls. Despite its clinical efficacy, this therapeutic modality encounters several challenges in practical implementation. One major hurdle is the absence of standardized international diagnostic criteria for sacroiliac joint dysfunction, hindering the widespread adoption and standardization of this treatment approach. Further clinical investigations and longitudinal data are imperative to ascertain the long-term efficacy and potential risks associated with this therapy. Future research avenues should prioritize the development of precise diagnostic tools and standardized treatment protocols to enhance the efficacy and safety of sacroiliac joint reduction therapy. Moreover, interdisciplinary collaboration is paramount, leveraging the expertise of physical therapists, rehabilitation specialists, and spine surgeons to offer comprehensive treatment solutions. Sacroiliac joint reduction therapy emerges as a compelling therapeutic option for individuals grappling with lumbosacral pain and gait instability, showcasing significant clinical potential and promising future prospects.

The impact of aerobic exercise dose based on ACSM recommendations on patients with Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

Background

To explore the effects of different dose of aerobic exercise on motor function, balance, mobility, and quality of life in Parkinson's disease patients, aiming to provide insights into determining the optimal aerobic exercise dose for treating PD.

Methods

Searching was conducted in four databases: PubMed, Embase, Web of Science, and Cochrane. The dose of aerobic exercise intervention was evaluated based on the recommendations of the American College of Sports Medicine regarding the development and maintenance of cardiorespiratory health, muscle strength, and functional mobility in patients with PD. The exercise intervention dose of the included studies were first classified into high ACSM compliance and low ACSM compliance based on meeting 4/6 of the ACSM recommendations. The reliability of the results was then validated using the criterion of meeting 5/6 of the ACSM recommendations. Comparisons of the effects of aerobic exercise dose on Motor function, Balance, Mobility, and QOL in PD patients using standardized mean difference with 95% confidence intervals.

Results

When using the 4/6 ACSM compliance criterion, 17 studies were categorized as high ACSM compliance and 12 as low ACSM compliance. The SMD ratios for high versus low ACSM compliance were: UPDRS-III (-0.79: -0.18), BBS (0.60: 0.05), TUG (-0.60: -0.60), and QOL (-1.05: -0.15). When using the 5/6 ACSM compliance criterion, 11 studies were categorized as high ACSM compliance and 19 as low ACSM compliance. The SMD ratios for high versus low ACSM compliance were: UPDRS-III (-0.95: -0.38), BBS (0.48: 0.37), TUG (-0.71: -0.55), and QOL (-0.7: 0.04).

Conclusion

This study provides preliminary support for the potential of aerobic exercise to improve certain clinical symptoms in patients with PD. Furthermore, the results indicate that compliance to higher doses of aerobic exercise, as per ACSM standards, may contribute to improvements in motor function, balance, mobility, and quality of life for patients with PD. However, due to the heterogeneity in the studies and the influence of factors that have not yet been fully explored, these conclusions should be interpreted with caution. More high-quality randomized controlled trials are needed in the future to further verify and clarify the effects of aerobic exercise.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier PROSPERO: CRD42024517548.

Group tele-rehabilitation improves quality of life among subjects with Parkinson's disease: A two arm non-parallel non-randomized clinical trial

INTRODUCTION

Tele-rehabilitation has lately emerged as a promising medium for increasing patient adherence with significant positive results. One of the most prevalent neurological diseases affecting movement is Parkinson's disease (PD), which causes a variety of motor and non-motor symptoms among patients. Consequentially, the study was designed to compare the efficacy of group tele-rehabilitation with individual tele-rehabilitation in improving quality of life (QoL) among subjects with PD.

METHOD

A two-group pretest-posttest, non-randomized clinical study recruited 68 subjects and classified them into two groups, i.e., Group A (group therapy, n = 36) and Group B (individual therapy, n = 32). Groups A and B received a supervised protocol consisting of a 40-min session on alternate days/week for twelve weeks via the WhatsApp Messenger application through group and individual therapy, respectively. The Parkinson's disease questionnaire (PDQ-39), mental and physical components of the Short Form Survey (SF-12) were used as primary outcome variables, while the Satisfaction questionnaire was used as a secondary outcome variable.

RESULT

The p-values related to within-group analyses were <0.05 except SF-12 PCS >0.05 in Group A and <0.05 in Group B. While the p-values related to between-group analyses were <0.05 except for pre-scores of SF-12 (MCS and PCS). The effect sizes for PDQ-39, SF-12 (MCS), and SF-12 (PCS) were -2.37, 3.36, and 0.66 in Group A and 1.95, 2.69, and 2.03 in Group B, respectively.

CONCLUSION

The study concluded that group tele-rehabilitation is more effective in improving QoL among subjects with PD as compared to individual tele-rehabilitation. Clinical trial Registration NoCTRI/2022/04/041818.

Comparing the effects of augmented virtual reality treadmill training versus conventional treadmill training in patients with stage II-III Parkinson's disease: the VIRTREAD-PD randomized controlled trial protocol

Background

Intensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson's Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients' performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient's satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles.

Methods

Single-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial-temporal gait parameters at T1 and T2, patients' satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α < 0.05), raised to 24 per group to compensate for potential drop-outs. Both interventions will be customized and progressive, based on the participant's performance, according to a predefined protocol.

Conclusion

This study will provide data on the possible superiority of AVR-associated TT over conventional TT in improving gait and other motor and non-motor symptoms in persons with PD and gait disturbances. Results of the exploratory analysis could add information in the field of biomarker research in PD rehabilitation.