Rehabilitation Program for Parkinson’s Disease Essay Paper

Literature Review

The study is a measure of the effectively of the rehabilitation program for Parkinson’s disease to improvement in balance and gait through comparison of the virtual rehabilitation and conventional rehabilitation. For the study, participants with idiopathic Parkinson’s disease shall be allocated to two different groups. The experimental group shall be given virtual reality training and the control group shall be given conventional physiotherapy. The effectivity of the two approaches shall be measured at the end of six weeks through Randomised Control Program. The study is based on the appraisal of CASP (Critical Appraisal Skills Programme (2019). The study involving the two groups , in which participants are watched for a predetermined length of time and data are prospective study . The data on the changes in the two groups with respect to their characteristics is collected and compared. (UCL Institute of Education, 2020) (casp-uk.net, 2021).

Through the analysis of published study by various scholars in the elated field, the study is evaluated to achieve a better understanding of the topic. PubMed database is explored to conduct the Literature Review for the study. Three component of clinical experience as per evidence-based practice are considered- credible research evidence, patient value and references. Physiotherapy is the standard rehabilitation process for improvement of gait and balance and the up to date knowledge and skills are essential (HSPC ,2018) (Pazzaglia, et al., 2016)

It has been found that the ‘Virtual reality balance Training’ at home is more successful in increasing balance, walking, and improving the life satisfaction in patients with Parkinson’s disease (PD) compared to the conventional home training as observed from both the groups (Albiol-Perez, et al., 2017).

(1) Virtual reality balance training can enhance balance and associated activities

(2) Virtual reality balance training may be better than conventional balance training in individuals with Parkinson’s disease who live at home.

The outcome was assessed using the Berg Balance Scale. The secondary outcomes were measured using the Dynamic Gait Index, timed Up-and-Go test, Parkinson’s disease Questionnaire, and the motor score of the Unified Parkinson’s Disease Rating Scale (Lockwich, 2022). During the training period of six weeks, the interventional group received training from a professional physical therapist, while the control group received training using a individualized ‘virtual reality balance training system’. Week 0 was for the pre-test, Week 6 was for the post-test and on Week 8 outcomes were assessed through follow-up to evaluate the results (Motomatsu, 2014)

According to Y. Chen, et. al., 2020, the two training methods successfully improved balance, walking, and overall life quality in PD patients living in the community. At the time of the pretest, the interventional and control groups were comparable. Both groups performed best posttest and during the follow-up than at pretest on the Berg Balance Scale, Dynamic Gait Index, timed Up-and-Go test and Parkinson’s disease Questionnaire after training. However, at the post-test and during the following up, no considerable changes were identified in cases of these two groups.

In another study, Esculier, et al., 2014 used a Wii Fit with a balancing board to train patients with Parkinson’s disease at home for six weeks. Rehabilitation Program for Parkinson Disease Essay Paper Their findings suggested that Wii Fit with VR training-g could help PD patients enhance their one-leg stance, dynamic balance, mobility and functional abilities. Without randomization, only eleven PD patients were recruited and nine controls without PD Maggio, et al., 2019).

Methodology

In a Randomised controlled research, Silva, et al., 2017 , compared the effects Nintendo Wii-based motor cognitive training used for seven weeks with balance exercise convention therapy in individuals with PD. The training was conducted at the Brazilian Parkinson Association (Spasojevi?, et al., 2015).

The convention training was completed with the supervision of a therapist in the control group. Static posture maintenance and dynamic weight shifting was used by the participants during each session. In the control group, therapist-led the training and gave verbal corrections to the motions of the participants.

The study is conducted through a RCT design. The study involved a Randomized Controlled Trial of Virtual Reality Rehabilitation vs. Conventional Physical Therapy for Improving Balance and Gait in Parkinson’s disease patients (Feng, et al., 2019). A single-blinded, RCT was used in this research. Twenty-eight patients with PD were randomly assigned to the interventional and control groups. To the experimental group, virtual reality training was provided, while traditional physical therapy was given to the control group. For 12 weeks, five days a week, the patients worked for 45 minutes each day. The Berg Balance Scale (BBS), the Timed Up and Go Test (TUGT), the Third Part of the Unified Parkinson’s Disease Rating Scale (UPDRS3), and the Functional Gait Assessment were used to evaluate participants pre and post rehabilitation (FGA). BBS, TUGT, and FGA scores significantly improved after treatment. (Abbruzzese, et al, 2016)

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However, there was no significant difference in the UPDRS3 scores between the control post rehabilitation data and pre rehabilitation data. Virtual reality training has been considered a superior method of training as compared to conventional physical therapy methods.

Subjects between the age of 45 to 80 years, with mild to moderate motor impairments (stages 1 – 3 on Hoehn and Yahr scale) with th e diagnosis of PD by a certified neurologist according to the United Kingdom Brain Bank Criteria, were invited to participate in the study. From the period of July to October 2011, patients with PD were referred to the center of Movement Disorders at Federal University of Bahia, Northeastern. Patients with the diagnosis of dementia, uncontrolled hypertension, cardiovascular diseases and psychiatric disorders and illnesses that prevented exercise understanding and performance were excluded from the study (Silva, et al., 2017).

In accordance to the feasibility of the study, no formal sample size is used. According to the recommendations of sample size for the RCT, at least 30 samples must be included in the study. The recruitment consists of 18 people for each group (for a total sample size of 36) assuming a 20% rate of dropout. The sample size recruited is sufficient to offer enough information on major feasibility concerns including recruitment and acceptability of the intervention (Silva, et al., 2017).

The whole sample was 69.94 (11.28) years old, with a mean (standard deviation) PD duration of 7.43 (5.62) years and a mean Hoehn and Yahr level of 2.60. (.66). Table 2 shows the demographics of the sample, separated into faller and non-faller groups. Twenty-five of the 45 individuals (54.9%) were classified as fallers, whereas the other twenty were classed as non-fallers. When these groups were compared, it was discovered that they differed considerably in terms of age, years with PD, and Hoehn and Yahr score (p.05) (Dibble & Lange, 2006)

Results

Accurate identification of people with Parkinson’s disease who are at risk of falling may help doctors prescribe therapeutic measures for fall prevention that might reduce fall risk and harm.

The study phases are depicted in Figure 1. Participants in both groups were randomly assigned to one of two interventions at a 1:1 ratio. The experiment took place over seven weeks. Two blinded, professional physical therapists assessed each participant during the “on” time. The intervention type received by each participant will be hidden from the evaluators. Individuals will be taught not to discuss any aspects of the intervention with the evaluators. Individuals will be assessed two hours after taking Levodopa. According to Lipp et al., 2020, the Levodopa action onsets within the 20 to 40 minutes and duration its effects remain for another two to four hours after medication. This is the point in time when the individual’s engine performance was improved due to levodopa’s influence.

Adherence to routine, safety, feasibility and acceptance will be the process outcomes. The rate of individuals who experienced adverse consequences of the intervention or any significant negative occurrences during the trial period will be used to assess safety.

The acceptance of the intervention will be assessed using a questionnaire prepared by the study’s researchers, in which participants will complete the questions about their motivation to participate in the intervention. (Kumar, 2018)

The study revolves round Virtual Reality-Delivered Rehabilitation Exercise Programs” versus “Conventional Exercise Programs. This paper discusses the findings of two clinical trials using flat-screen virtual reality (VR) technology for physical rehabilitation that is currently underway. In the first trial, VR-delivered exercise programme is compared to a traditional exercise programme for rehabilitation of shoulder joint range-of-motion in patients with persistent frozen shoulders (Sveistrup, et al., 2003). In the second trial, two exercise programmes for post-traumatic brain injury balance retraining, VR and conventional is compared. In various treatment situations like outpatient, inpatient and home based treatments, the VR based rehabilitation is adept to use and can be used as a replacement for conventional therapy. If this unique treatment method is shown to be beneficial, it might be used to improve treatment compliance, provide motivating and safe therapy. Provide safe and motivating therapy and even demonstrate exercise to clients in remote areas via telephonic applications of VR treatment. Because virtual reality is such a innovative technology, its therapeutic potential is only now being explored. (AMA Neurol. 2013).

To attain moderate intensity, the intensity of both group and individual exercises will be modified. Both interventions, we believe, will drive participants in distinct ways. Because traditional physical treatment will be done in groups, this group’s social side will most likely be strong, while the uniqueness of the technology and the humorous nature of video games may motivate them.

The control group’s (CG) intervention will be established by recommendations for guidelines of PD rehabilitation [8]. A qualified physical therapist will lead the sessions, which will have a maximum 20 participants and a 1:2 instructor-to-participant ratio. Through cognitive movement methods, the protocol will be constructed to enhance (1) flexibility of muscles, (2) strength of muscles, (3) increasing dynamic and static balance, (4) fitness of the body, and (5) transfer (Dorsey, et al., 2013)

Discussion

The interventional group will play four games utilizing Microsoft’s Kinect Adventure application for Xbox 360, one by one and at random. The games were chosen based on the results of prior pilot research [16].

20,000 Leaks, (2) Space Pop, (3) Reflex Ridge, and (4) River Rush are the five games that the individuals will practise. The training regimen of the game, as well as their motor and cognitive demands, is shown in Table 3. During the sessions, the certified physical therapists will supervise the game practice (Frazzitta, et al., 2009)

SPSS version 11.0 was used to analyse the data. Missing data were analysed using the intention-to-treat method. If one person dropped out, the prior testing session’s score was used for intention-to-treat analysis. Each variable’s mean and standard deviation were calculated using descriptive statistics. To determine the normality and homogeneity of variance, the Kolmogorov-Smirnov test and the Mauchly test were utilised. The greenhouse-Geisser correction was employed if the assumption of homogeneity of variance was not met. To see if there were any variations in baseline demographics and pre-intervention assessments between groups, ANOVA were employed (Yen et al., 2011).

Separate 3-way mixed-model ANOVAs (3 groups 2 tasks 3 times) were used to measure the interactions among the groups (ie, VR, CB, and control), tasks (ie, single and dual), and time effect (ie, before training, after training, and at follow-up) of variables in the SOT. The interaction of time and group for the VRT was tested using a 2-way mixed model ANOVA (3 groups 3 times). A post hoc analysis for multiple comparisons with Bonferroni adjustment was done if a significant interaction was discovered. A type I error probability (level) of less than.05/3 was chosen.

Study design for a RCT comparing the effects of virtual rehabilitation versus traditional therapy to improve posture control and gait, and cognition in Parkinson’s disease patients (Silva, et al., 2017)

Individuals with PD who live in the city of So Paulo (Brazil) will be enlisted. Individuals that match the following criteria will be chosen: 50–80 years old, idiopathic Parkinson’s disease (PD) diagnosed using the UK Brains Bank Parkinson’s Society criteria [17], without clinical fluctuation, and in stages I–III of the modified Hoehn and Yahr [18]. Levodopa and/or its synergists should be used to treat everyone. Furthermore, the PD patients were able to walk by themselves with or without the use of an assistive device, and show no signs of cognitive decline. This criteria is followed as defined by the Mini-Mental State Examination (MMSE) cutoff scores [19], adjusted for educational level (> 20 for illiterates, > 25 for those with 1 to 4 years of education, > 26 for those with more than 4 years of education) (Gil-Gómez, et al., 2013).

The Ethics Committee of the Federal University of Bahia the informed consent forms were authorized, information of the patients, protocol of the study, questionnaires and exercise methods. The Helsinki Declaration carried out every technique, and clinicaltrials.gov was used to register the study (NCT01120392). Dementia, uncontrolled hypertension, heart disease, psychological disorders and conditions that interfered with exercise comprehension and performance were all considered exclusion criteria (Pedreira, et al., 2013).

Conclusion

Balancing Clinic software (balance software for AMTI’s Access way plus balance platform, version 2.02.01) was used to collect, record, and evaluate data.

The Brazilian version of the Parkinson’s disease Questionnaire had been used to assess the quality of life (PDQ-39). Mobility, activities of daily life, emotional well-being, stigma, social support, cognition, communication and body of discomfort are among the 39 categories split into eight dimensions. Each item is given a score ranging from zero to four. The overall score goes from 0 (no problem) to 100 (worst difficulty), with lower numbers indicating a higher perception of one’s quality of life by the individual

To assess the performance game, in each session the scores of the game will be compared with the first (pretest) and last, (posttest) sessions being compared, as well as retention (30 days after).

The results of the study show that the when compared to the conventional physical treatment, twelve weeks of VR rehabilitation can improve the balance and gait of PD patients.

This study was based on the hypothesis that accurate fall risk screening in people with Parkinson’s disease can help clinicians prescribe medication to reduce fall risk and injury. To achieve this goal, the FRT, TUG, CTUG, DGI, and BBS was used to accurately distinguish between people with PD who had previously fallen and those who had not.

The calculation of the sensitivity, specificity, and likelihood ratios of the FRT, TUG, CTUG, DGI, and BBS and recalculate the cut-off scores to maximize sensitivity and minimize the negative LR, and (3) see if the FRT, TUG, CTUG, DGI. However, as predicted, the sensitivity of these tests could be increased by selecting cut-off scores that are more specific to people with Parkinson’s disease. Our findings support Behrman et al. 22’s findings for the FRT, and they go further by suggesting that previously published cut-off scores for other clinical balancing tests should be reassessed for a condition like Parkinson’s disease that affects the postural control system. Because they allow the estimation of the probability of a condition given a particular test result, likelihood ratio values are a valuable statistic for analyzing screening tests and risk levels in individual patients. The object of the study was to establish the clinical balance tests’ negative LRs in order to calculate the post-test chance of falling. Using Deeks and Altman 45’s calculations, the post-test chance of being a faller is calculated by having the pretest probability multiplied by the negative LR, which is 55% in our sample.. Multiplying 55 percent by the smallest negative LR in the sample (0.22 for the DGI with a test score of 22 points or higher) yields the value 12.

This study backs up the hypothesis that rehabilitation using modern virtual reality tools can improve neurological patients’ results by increasing motivation and participation, resulting in better treatment response. Virtual reality, in particular, can be utilized to augment the results of traditional therapies, allowing for longer training sessions and a shorter stay in the hospital. (Med. Assoc., 2019)

Despite the fact that PD is a neurodegenerative disease that progresses in stages, the findings show that PD patients maintain or even enhance their control in all postures. The key element driving these findings is that PD patients use cognitive processing to enhance control of their posture. Since the ABAR system requires patients’ constant attention, which promotes cognitive processing, this claims (Sergio Albiol-Pérez, 2017).

References

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casp-uk.net, 2021, CASP Checklists, https://casp-uk.net/casp-tools-checklists/

Chen, Y., Gao, Q., He, C. Q., & Bian, R. (2020). Effect of virtual reality on balance in individuals with Parkinson disease: a systematic review and meta-analysis of randomized controlled trials. Physical therapy, 100(6), 933-945.

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Rehabilitation Program for Parkinson Disease Essay Paper