Effects of Virtual Reality Training in Patients With Parkinson's Disease
Condition: Parkinson's Disease
MeSH terms: Parkinson Disease
Study type: Interventional
Phase: Phase 1

Summary: 
      Background and Objective: Postural instability is common in patient with Parkinson's disease
      (PD). The purpose of this study was to investigate the effects of virtual reality (VR)
      balance training on sensory and cognitive domains of postural control.

      Setting: Balance Performance Laboratory. Participants: A total of 42 patients (Hoehn and Yahr
      stage II-III) were recruited and assigned into three groups randomly.

      Intervention: Participants in the virtual reality (VR) group and conventional balance
      training (CB) group received a 6 weeks balance training program. The control group (CG) did
      not receive any training.

      Outcome Measures: The sensory organization tests (SOT) of computerized dynamic posturography
      with single and dual tasks (i.e. with backward subtraction of number) were examined pre-,
      post-training and follow-up. The equilibrium score (ES) and sensory ratio were measured. The
      verbal reaction time (VRT) was recorded.

      Results: (1) Only VR significantly increased ES of SOT-6 (i.e., vestibular function at visual
      and somatosensory conflicting condition) post-training more than CG post-training in either
      single or dual task. (2) Only CB training significantly increased SOT-5 (i.e., vestibular
      function without visual conflict) and vestibular sensory ratio (i.e., SOT-5/SOT-1) more than
      CG post-training in either single or dual task. (3) (3) Neither VR nor CB training reduced
      VRT significantly under six sensory conditions at post-training and follow-up.

      Conclusion: Both VR training and CB training can improve sensory organization for postural
      control by enhancing utilization of vestibular information, but VR could enhance vestibular
      function with conflicting proprioceptive and visual information under single and dual tasks
      in patients with mild to moderate PD.
    

Detailed description: 
      It is common that people who are diagnosed with idiopathic Parkinson disease (PD) experience
      postural instability during daily activities.Recently, postural instability is suggested as
      the underlying mechanism of falling in patients with PD. Therefore, how to improve postural
      stability by balance training is an important issue for these patients.

      Basal ganglia have been regarded to be predominantly involved in postural control. Several
      studies suggested that the dysfunction of basal ganglia in patients with PD might play a
      major role in postural instability. Furthermore, patients with PD might have impaired
      utilization of sensory information by the basal ganglia.Computerized dynamic posturography
      (CDP) has the Sensory Organization Test (SOT), which provides an objective assessment of the
      main sensory systems (i.e., vision, proprioception and vestibular system) involved in balance
      and stability. The role of sensory information under six conditions (i.e., eyes open, eyes
      closed, sway vision, eyes open sway support, eyes closed sway support, and sway vision sway
      support) has been studied in patients with PD by the SOT of computerized CDP. Their study
      indicated that patients with PD demonstrated a significant reduction in sensory integration
      of proprioception and vision, but no significant difference in vestibular function, as
      compared to age-matched controls. One study showed that patients with PD had visual
      dependence as an adaptive strategy partly compensating for the impaired proprioception.
      However, the other study suggested that the cerebellum might be important for sensory
      integration in patients with PD.
    

Intervention name(s): balance training
Intervention type(s): Behavioral
Intervention description(s): 30 minute each time, 2 times per week for 6 weeks.
Other intervention name(s): virtual reality
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Virtual Reality; Balance; Parkinson's disease; Dual Task