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Pompeu J.E.1, da Silva K.G.2, Freitas T.B.3, Doná F.4, Ganança F.F.5, Torriani-Pasin C.3
1University of Sao Paulo, Faculty of Medicine, Department of Physical Therapy, Speech Therapy and Occupational Therapy, Sao Paulo, Brazil, 2University of Sao Paulo, Physical Therapy, Speech Therapy and Occupational Therapy, Sao Paulo, Brazil, 3University of Sao Paulo, School of Physical Education and Sports, Sao Paulo, Brazil, 4Anhanguera University of Sao Paulo, Balance Rehabilitation and Social Inclusion Graduate Program, Sao Paulo, Brazil, 5Universidade Federal de São Paulo, Otorhinolaryngology, Sao Paulo, Brazil
Background: Parkinson´s disease (PD) is a neurodegenerative movement disorder that causes progressive deterioration of postural control and cognition that could influence the quality of life. Video games are considered as low cost virtual rehabilitation system and previous study showed that Nintendo Wii Fit can improve balance and cognition of PD patients. However, the effects of the Kinect on postural control, specifically on the Limits of Stability (LOS) and Sensory Integration has not been investigated.
Purpose: The aim of this study was to analyze the effects of Kinect Adventures games on
(1) postural control,
(2) gait,
(3) cognition and
(4) quality of life of patients with PD.
(1) postural control,
(2) gait,
(3) cognition and
(4) quality of life of patients with PD.
Methods: Eleven idiopathic PD patients were selected, in stages I to III of the Hoehn & Yahr scale, with no signs of dementia, and treated with levodopa or their synergists. All subjects performed 14 individual sessions (1 hour/session) twice a week for seven weeks. Patients were randomized between control group (CG) and experimental group (EG). CG (n=5) performed conventional physical therapy based on the European guideline for physical therapy in PD. EG (n=6) practiced four Kinect Adventures games. Both groups were assessed pre and post training and 30 days after the end of the training (follow up). Primary outcome was the area of the Limits of Stability (LOS). Secondary outcomes were:
(1) the area and velocity of the center of pressure (COP) in different sensory conditions;
(2) postural control assessed by mini BESTest (MBT);
(3) gait adaptability assessed through the Functional Gait Assessment (FGA);
(4) cognition assessed by Montreal Cognitive Assessment (MOCA) and
(5) the quality of life assessed by Parkinson´s Disease Questionnaire (PDQ-39).
It was done a descriptive analysis through the calculation of the mean difference between pre and post intervention and between post intervention with follow-up.
Results: The EG showed improvement of the LOS after training (mean difference between post and pre assessment; 95% interval of confidence) (2.2 cm2; 32.2 to 126.5) and the results lasted after 30 days (15.0 cm2; 24.0 to 94.4). CG showed improvement of the LOS after training (14.6 cm2; 20.5 to 98.5) and the results decrease after 30 days (-1.4 cm2; 27.5 to 131.9). Both intervention promoted improvement on clinical scales (MBT, FGA, MOCA and PDQ-39), but the magnitude of the results were very low.
Conclusion(s): Physical therapy based on European guideline and Virtual Rehabilitation using Kinect Adventures games promoted improvement on the LOS but their effects on gait and postural control assessed trough clinical scales did not have clinical importance.
Implications: Conventional Physical Therapy and Virtual Rehabilitation can improve postural control of patients with Parkinsons disease.
Funding acknowledgements: FAPESP, process number 2014/22348/1 and CNPQ.
Topic: Neurology: Parkinson's disease
Ethics approval: This study was approved by Ethical Committee of the Universidade Federal de São Paulo, CAAE number 08885912.1.0000.5505, Sao Paulo, Brazil.
All authors, affiliations and abstracts have been published as submitted.
