Studies have begun to explore the use of innovative technology including robotics and exergaming as a tool for rehabilitation and for enhancing motor function. Exergaming can provide a powerful tool for individualized repetitive practice of motor function, to provide feedback about performance and motivation for patients (Ref: 1). The idea is to recreate a believable artificial environment that stimulates physical responses similar to those in real environments. Exergaming systems for rehabilitation incorporate both motor training and feedback in a virtual simulation that requires advanced information processing. Exergaming allows the individual to train for long durations with multiple repetitions of movement; keys to successful "motor learning" in many of the neurological disorders (Ref: 2).
Gait training with exergaming for patients post stroke has shown to be effective in increasing gait speed and endurance. Evidence in favour of using exergaming for rehabilitation is positive but still exploratory, based on small, disparate trials.
Exergaming for training in PD
There is only a handful of short studies that utilized exergaming for the treatment of patients with Parkinson’s disease (PD). Exergaming has been used with subjects with PD as an evaluation tool for cognitive function (Ref: 3). Subjects with PD demonstrated ability to learn new paradigms of movement, but at a slower pace and with more difficulties in movement corrections, compared to control participants.
Evidence on the use of exergaming for training of balance and gait in PD is scarce. We used an exergaming system for an obstacle navigation task during gait training of twenty patients with PD (Ref: 4). Patients walked on a treadmill, while wearing a safety harness, 3 times a week for 6 weeks. Increased gait speeds were not only maintained at follow-up, but also continued to improve 4 weeks later, suggesting that the training generated a positive feedback loop that modified behaviour and overall mobility.
CuPiD see the use of exergaming as a gate to functional recovery in PD and also as a new tool for enabling patients to access training in the home setting and enable rehabilitation even when potential constraints exists.
Scenario of Use
Mrs Ellen has had PD for 4 years; she recently started suffering from instability during gait. She reports to her clinician that her first fall occurred while she was walking in the street talking to a friend and the second one when she was trying to step over a branch lying on the road. The clinician identifies she has difficulties in dual tasking and recommended a home-based training activity by means of a system based on sensors to be placed on the legs involving an exergaming simulation to enhance gait under dual tasking activities. Her training consisted of gait components such as increasing step length and step clearance while engaging in a navigational cognitive task that is based on her performance. Mrs Ellen trains for 6 weeks on a daily basis, before each training session starts she records, a self-assigned score about her motor status and her medication intake. After 6 weeks of training she goes back to her clinician for assessment.
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1 Burdea GC. Virtual rehabilitation--benefits and challenges. Methods Inf Med 2003
2 Holden MK. Virtual environments for motor rehabilitation: review. Cyberpsychol Behav 2005
3 Klinger E, Chemin I, Lebreton S, Marie RM. Virtual action planning in Parkinson's disease: a control study. Cyberpsychol Behav 2006
4 Mirelman A, Maidan I, Herman T, Deutsch JE, Giladi N, Hausdorff JM. Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? J Gerontol A Biol Sci Med Sci. 2010
Title: Testing the telerhabilitation application
Owner: IBIT Foundation