Effects of Immersive Virtual Reality Training Compared to Stationary Cycling on Tremor and Manual Dexterity in People with Parkinson's Disease: A Randomized Clinical Trial.
Parkinson Disease; Rest Tremor; Manual Dexterity; Virtual Reality; Bicycling
Introduction: Parkinson's disease (PD) is a chronic, progressive, and neurodegenerative disorder characterized by resting tremor and reduced manual dexterity, which adversely affect daily activities and quality of life. In response to this challenge, Active Stationary Cycling (CEA) treatment has demonstrated efficacy in mitigating tremor and enhancing upper limb (ULL) performance among individuals with PD. Concurrently, non-immersive Virtual Reality (VR) exergames have been established as secure and effective interventions for augmenting motor skills. Nonetheless, the impact of Immersive Virtual Reality (RVI) in treating PD, particularly concerning tremor and manual dexterity, remains unexplored. Objectives: This study aims to assess the comparative efficacy of training with RVI against training with CEA in addressing resting tremor and manual dexterity issues in individuals with PD. Methods: A randomized, blinded, controlled clinical trial design will be employed. The trial will involve recruiting a cohort of 36 individuals diagnosed with PD, stabilized on Levodopa treatment, categorized under stages I to III of the Hoehn & Yahr classification, aged between 50 and 85 years, exhibiting classic parkinsonian tremor type 1 according to the consensus statement from the movement disorders society, possessing normal or corrected visual and auditory acuity, and having completed a minimum of 4 years of formal education. Participants will be allocated randomly into either the RVI group (n=18) or the CEA group (n=18). The intervention protocol will span 8 consecutive weeks, encompassing two weekly sessions of 60- minute duration each. Assessment of tremor will be conducted through the Unified Parkinson’s Disease Rating Scale (UPDRS) parts II and III, in addition to the utilization of the Study My Tremor App. Evaluation of manual dexterity will be executed using the Nine Hole Peg Test and the Box and Block Test. Evaluations will transpire prior to the interventions, post-intervention, and 30 days subsequent to intervention completion. Results: Given the present reliance on medication and invasive surgical procedures for treating tremor in PD, the findings from this study hold the potential to unveil the advantages of the proposed training regimen. This insight could significantly contribute to optimizing the array of therapeutic strategies available for this population.