IMPACT OF VIRTUAL REALITY TRAINING OF HAND FUNCTION IN INDIVIDUALS WITH PARKINSON’S DISEASE: A CASE STUDY

M. Ganesan¹, K. Johnson², B. Balakrishnan¹, T. Roberts³, H. David²

¹University of St Augustine, Physical Therapy, San Marcos, CA, United States, ²Hawai’i Pacific University, College of Health and Society, Doctor of Physical Therapy Program, Honolulu, Hawaii, United States, ³University of St Augustine, Occupational Therapy, San Marcos, CA, United States

Background: Individuals with Parkinson’s disease (PD) often have limited hand function due to tremors, rigidity, and bradykinesia. Although PD is a progressive neurodegenerative health condition, evidence strongly recognizes exercise as a critical ingredient to improving and maintaining health and mobility to combat symptoms. Despite early and lasting upper extremity impairments, much of the exercise research supporting individuals with PD focus on gait, balance, and lower extremity functioning. The upper extremity impairments that affect the body structure and functioning of individuals with PD can also be combated with exercise in a similar manner.

Purpose: This case study aimed to test the feasibility and efficacy of virtual training on hand functions in PD.

Methods: A 69-year male diagnosed with PD by a neurologist currently in the Hoehn and Yahr stage of 2.5 with a Mini-Mental State Examination (MMSE) score of 29/30 participated in the study. After obtaining informed consent, he has trained weekly for three 30 mins sessions for four consecutive weeks using a RAPAEL Smart Glove™ with a visual display that focuses on hand functions including, pronation, supination, radial deviation, ulnar deviation, flexion, and extension of the wrist. The virtual training also focuses on timing and coordination of movement of the hands. Outcome measures included the hand components of the motor score section of the MDS Unified Parkinson’s Disease rating scale (MDS-UPDRS), a 9-hole peg test (an average of 2 trials was used), and Quick disabilities of the arm, shoulder, and hand(DASH) questionnaire scale at baseline and at the end of four weeks of training. Training and assessment were carried out during the “ON” period of medication.

Results: The four weeks of training showed improvement in the MDS-UPRDS score from the pre-score of 15 to the post-score of 9, which is more than the minimal clinical important difference (MCID) score of 4.63 in the UPDRS motor score. The sub-score analysis revealed no change in the tremor score; only the improvement was reflected in the rigidity score and bradykinesia score. Quick DASH disability score was reduced from 38.63 to 29.54. and the time to complete the 9-hole peg test was reduced from 42.5 seconds to 27.78 seconds in the right hand and 44.5 seconds to 38.07 seconds in the left hand.

Conclusions: The case study result demonstrates the safety, feasibility, and improvement of hand function after four weeks of virtual hand function training for an individual with PD. Further studies need to confirm the finding using a larger sample size and randomized controlled study. The improvements in hand function were found in both the more involved side and the less involved side but with varying impacts.

Implications: Physical therapists and occupational therapists can consider virtual reality training as one of the methods to enhance hand function in individuals with PD. This intervention was feasible, safe, and yielded positive outcomes. Changes in hand function regarding increased strength, speed, amplitude, and decreased rigidity and bradykinesia can positively impact activity and participation restrictions in managing the progressive nature of a neurodegenerative health condition.

Funding acknowledgements: This study received partial funding from the University of St Augustine for Health Sciences (USAHS) internal research grant.

Keywords:
Parkinson's Diseases
Virtual reality training
Hand Function

Topics:
Neurology: Parkinson's disease
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: University of St Augustine

Committee: IRB, San Marcos, CA

Ethics number: PT-0927-006