# Effectiveness of High-Intensity Therapy in Rehabilitation of Parkinson's Disease Patients
## 3 Intervention
### Robotic Therapy  
The robotic therapy intervention utilized the C-Mill VR+ system, a treadmill-based rehabilitation platform developed by Motek (a division of Hocoma AG, Volketswil, Switzerland). It combines gait training with augmented and virtual reality (VR) to improve mobility, postural control, and gait adaptability in individuals with [PERSON]'s disease. The system simulates real-life walking conditions through VR projections and provides real-time feedback, adjustable task complexity, and a bodyweight support structure with a fall safety harness. The main components of the setup are illustrated in Figure 2, including the treadmill with an embedded VR projection interface, safety harness, bodyweight support, and an external screen for therapist feedback.  
Visual cues projected onto the treadmill challenge participants to adapt their gait, step length, and weight distribution in response to dynamic stimuli. This setup is particularly beneficial for addressing freezing of gait (FOG), postural instability, and step asymmetry. Spatial-temporal gait parameters, such as step length, step width, and stance phase durations, were assessed during treadmill walking. These are visualized in Figure 3, which illustrates stance phases and step characteristics for both the left and right limbs, including dual- and single-stance durations.  
Training modules included step adjustments, targeted foot placement, and dual-tasking exercises to enhance cognitive-motor integration. Figure 4 provides a schematic overview of the entire C-Mill VR+ system setup used in this study, including the \"Butterfly\" visual element, which functions as a symmetrical stepping guide designed to improve balance and spatial coordination by encouraging patients to perform controlled weight shifting and precise foot placement during gait training.  
To evaluate more complex motor adaptation, obstacle avoidance tasks were also integrated. Figure 5 shows representative trajectories of foot placement in response to full-width obstacles, indicating correct and incorrect step patterns for both limbs. To further challenge participants, the \"Random Stepping Stones\" task was used, in which the stepping targets appeared unpredictably. Performance metrics from this task--such as  
Figure 3: Spatial-temporal gait parameters. Visualization of stance phases, step length, step width, and dual/single stance durations for the left and right limbs during treadmill walking.  
Figure 2: C-Mill VR+ setup diagram with labeled components.  
step frequency, hit/miss ratio, and obstacle avoidance success rate--are summarized in Figure 6, alongside subjective feedback on task difficulty and the use of handrails.  
Figure 4: **Schematic overview of the C-Mill VR+ system.** This system simulated real-life walking conditions, providing real-time feedback and progressive task difficulty for structured rehabilitation. Real-time Butterfly Pattern.  
Figure 5: **Obstacle avoidance trajectories.** Graphical representation of foot placement (midstance) in response to full-width obstacles, indicating correct and incorrect consecutive steps for the left and right foot.  
Throughout all sessions, physiological and biomechanical parameters--such as step variability, stride length, cadence, and center of pressure (COP) displacement--were continuously recorded. Task complexity was progressively increased by modifying obstacle frequency, step targets, and walking speed, ensuring adaptation to individual capabilities. The built-in safety system allowed for high-intensity training in a secure environment. This multimodal approach was designed to stimulate motor learning, improve postural control, and reduce FOG events in people with Parkinson's disease.