# Video Games in Rehabilitation Programs for People with Parkinson's Disease: A Systematic Review
## 4 Discussion
[PERSON] et al. [33] investigated the effects of gait training using augmented reality and VR on the balance and gait of PD patients. The results showed significant improvements in balance and gait in the group that received VR training, compared to the control group, suggesting that VR may be an effective adjunct in PD gait rehabilitation. In the study by [PERSON] et al. [34], treadmill training combined with semi-immersive VR was evaluated in PD patients. Preliminary results indicated that this combination significantly improves balance and motor function compared to conventional rehabilitation, suggesting that this strategy could hold promise for rehabilitation in PD. [PERSON] et al. [36] compared the effects of VR, motor imagery, and routine physical therapy in improving motor function and balance, highlighting the potential of VR as an effective rehabilitation tool in PD. [PERSON] et al. [35] evaluated the feasibility of a therapy based on video games controlled by Leap Motion for upper limb rehabilitation in patients with PD. The results indicated that this therapy is feasible and well accepted by patients, with improvements in upper limb motor function, although further studies are needed to assess its efficacy compared to other rehabilitation approaches. [PERSON] et al. [37] conducted a randomized comparative trial evaluating the effectiveness of strategy-based training with Wii Sports in reducing the risk of falls, incidence of falls, and improving quality of life in adults with idiopathic PD. The results showed that this type of training is effective compared to traditional rehabilitation methods, significantly improving the stability and quality of life of patients. Non-motor symptoms are sometimes difficult to reflect or explain because they can be considered subjective and individualized [39]. However, the inclusion of cognitive training in rehabilitation programs for people with PD is critical to improving other aspects of daily life [40]. Some of the studies analyzed in this review included cognitive measures [29; 32]. [PERSON] et al. [29] conducted a study to analyze the role of VR in the cognitive rehabilitation of people with PD. To do this, they used a semi-immersive therapy system where the participant had to interact with various scenarios. In their results, significant improvements were found in the intervention group in the cognitive functions measured, and a greater tendency to deterioration was shown in the control group. The study by [PERSON] et al. [32] included cognitive and dual-task skills, as participants were required to perform visual scanning in various activities. However, these studies indicate the need for a more comprehensive review of the VR protocols' impact on a wider variety of cognitive functions. [PERSON] et al. [41] developed a VR system that combined dual-task and cognitive function activities, although the results obtained in the cognitive components were not evaluated. Although not all of the authors included in these reviews evaluated the cognitive abilities of people with PD, it has been observed that the training of dual-task activities and motor imagery combined with VR [29; 31; 32; 36] serves as cognitive training of executive functions, attention, and memory. Therefore, VR as a complementary tool to rehabilitation programs could be a valuable resource for enhancing or improving cognitive function in individuals with PD [42; 43]. There are few studies that measure changes in adherence to rehabilitative treatment with the implementation of VR programs. It would be a valuable outcome measure to incorporate for future research. [PERSON] et al. [39] report that adherence to treatment is enhanced in people with PD by the inclusion of entertaining and motivating content. It has been shown that through rehabilitative treatment, people with PD obtain improvements in various outcome measures, but with the addition of gamification elements, a more stimulating and adherent intervention can be created [39; 44].