# Video Games in Rehabilitation Programs for People with Parkinson's Disease: A Systematic Review
## 1 Introduction  
[PERSON]'s disease (PD) is a chronic and progressive neurodegenerative disorder that presents multisystemic involvement at both the central and peripheral nervous system levels, with a predominant impact on the motor system [1, 2]. It is characterized by the progressive loss of motor and cognitive functions and the presence of motor and non-motor symptoms. Motor symptoms include tremors at rest, bradykinesia, and rigidity or postural instability, among others [3, 4]. On the other hand, non-motor symptoms include cognitive impairment, autonomic symptoms, sleep disorders, olfactory loss, mental disorders, andothers (e.g., hypophonia, sialorrhea, fatigue, and trouble swallowing) [3; 4]. The most frequent alterations are dyskinesias and motor alterations, thus increasing the risk of falls and gait frostbites, included as motor symptoms [5]. PD is the second most common neurodegenerative disease, behind Alzheimer's disease and one of the leading causes of neurological disability [6; 7]. The prevalence of PD is increasing globally (3.81 cases per 1000), and it is estimated that more than 10 million people are living with this condition [6; 8]. In addition, its prevalence has been projected to double over the next 30 years [7]. [PERSON]'s disease occurs most frequently in individuals aged 70 to 79, with its prevalence reaching its highest levels between the ages of 85 and 89 [9]. Advancing age is the primary risk factor for PD, with men being more prone to the condition than women [7]. Currently, there is no curative treatment for PD. Pharmacological treatment focuses on mitigating the symptoms presented by people with PD, and rehabilitative treatment is mainly focused on improving the motor symptoms present, as well as the prevention of cognitive symptoms [10]. Physical rehabilitation is an essential component in the management of PD, as it can significantly improve patients' quality of life and functioning. Traditionally, these rehabilitation interventions include a multidisciplinary team, including mostly physical therapists and occupational therapists. However, these approaches often face barriers such as long-term non-adherence and limited accessibility to specialized services [10; 11; 12]. In physical therapy, the primary focus is on addressing mobility-related activity limitations, which encompass physical capacity, transfers, manual tasks, posture, balance, and gait. The overarching goal of physical therapy is to enhance (or maximize) movement quality, functional independence, and overall physical fitness while preventing (or mitigating) secondary complications and prioritizing safety [12; 13; 14]. In contrast, occupational therapy emphasizes facilitating performance and engagement in meaningful activities and roles within the home and community. These activities can be broadly categorized into self-care and functional mobility, work-related tasks, and leisure pursuits, such as shopping, dining out, or attending cultural events. Additionally, based on the caregivers' needs, the occupational therapist's role may extend to empowering caregivers to effectively support and supervise patients in their daily activities, while also promoting the caregivers' own well-being [13; 15; 16]. In recent years, virtual reality (VR) and video games have emerged as innovative and promising tools in the field of rehabilitation. VR is the technology that allows creating an interactive and controlled environment that can be adapted to the specific needs of patients, while video games can increase motivation and engagement through playful and challenging elements [12]. These technologies also involve the active participation of people in the process of recovering functionality through sensory stimuli that provide them with feedback on what they are doing [17; 18]. There are different types of VR. In immersive VR, the user is completely integrated into the virtual world (glasses or gloves) without taking into account the environment.