# Video Games in Rehabilitation Programs for People with Parkinson's Disease: A Systematic Review
## 4 Discussion  
New technologies, such as VR and video games designed to promote physical activity (exergames), have the potential to be promising tools for physical training, inducing motor and cognitive improvements in different populations [38]. This systematic review aimed to evaluate the effectiveness of VR and exergames as a complement to conventional therapy in the rehabilitation of people with PD, applying a methodology for the analysis of the scientific evidence available in patients with PD undergoing rehabilitation programs, indicating the levels of evidence and degrees of recommendation. The selected studies cover various VR applications and exergame protocols, evaluating their impact on various health-related outcomes. Following the analysis of the studies selected in this review [29; 30; 31; 32; 33; 34; 35; 36; 37], improvements after the implementation of VR protocols in PD patients have been evidenced. Several authors report significant improvements in balance [30; 31; 32; 33; 34; 35; 36], gait [30; 32; 33; 34], global motor function [31; 32; 34; 35; 36], risk of falls [37], activities of daily living [30; 31; 36], quality of life [32; 37], and cognitive function [29] when using VR as an adjunct in their rehabilitation programs in people with PD. As mentioned in the results, low-cost consoles are the most commonly used methods, but they are not the only ones that can be included in rehabilitation programs for people with PD. No consensus has been found on which type of VR has the best results and which therapy it should be combined with. [PERSON] et al. [34] and [PERSON] et al. [33] used the C-Mill VR+, and [PERSON] et al. [35] used the Leap Motion Controller System(r), both of which are semi-immersive VR systems. However, [PERSON] et al. [32], [PERSON] et al. [31; 36], [PERSON] et al. [37], and [PERSON] et al. [30] all gained improvements with non-immersive VR through the Nintendo Wii. [PERSON] et al. [32] combined VR with conventional physical \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline
**Studies** & **Randomized** & **Double-Blind** & \begin{tabular}{c} **Drops and** \\ **Abandoned** \\ \end{tabular} & \
\begin{tabular}{c} **Appropriate** \\ **Randomization** \\ \end{tabular} &
\begin{tabular}{c} **Appropriate** \\ **Double Blind** \\ \end{tabular} & **Total Score** \\ \hline [PERSON] et al. [29] & YES & NO & YES & NO & NO & 2 \\ [PERSON] et al. [35] & YES & NO & YES & NO & NO & 2 \\ [PERSON] et al. [30] & YES & NO & YES & YES & NO & 3 \\ [PERSON] et al. [31] & YES & NO & YES & YES & NO & 3 \\ [PERSON] et al. [32] & YES & NO & YES & YES & NO & 3 \\ [PERSON] et al. [37] & YES & NO & YES & YES & NO & 3 \\ [PERSON] et al. [33] & YES & NO & YES & NO & NO & 2 \\ [PERSON] et al. [34] & YES & NO & YES & NO & NO & 2 \\ [PERSON] et al. [36] & YES & NO & YES & YES & NO & 3 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: [PERSON] scale. therapy, and [PERSON] et al. [31; 36] developed a protocol that combined the use of motor imagery, VR, and conventional physical therapy. [PERSON] et al. [30] combined the VR protocol with conventional occupational therapy. All of them obtained positive improvements in the intervention groups. Among all the reviewed VR protocols in patients with PD, motor symptom rehabilitation is the most frequently used. [PERSON] et al. [30] conducted a randomized pilot trial investigating the effects of balance training using the Wii Fit Balance Board on PD patients. This type of training was observed to significantly improve balance, gait, and activities of daily living compared to the control group. The results suggest that the Wii Fit may be a useful tool in the rehabilitation of PD patients. [PERSON] et al. [31] examined the combined effects of VR and motor imagery on balance, motor function, and activities of daily living of PD patients. The results indicated significant improvements in all three aspects assessed in the group using VR and motor imagery compared to the control group, suggesting that this combination could be beneficial for PD rehabilitation.