The size and behavior of virtual objects have influence on functional exercise and motivation of persons with multiple sclerosis: a randomized study.

The consequences of multiple sclerosis are problems with limb movement, coordination, and vision. Heretofore a combination of therapy and additional medications can alter the course of the disease and reduce upper extremity disability. We developed a virtual environment for pick-and-place tasks as a supportive tool to address the problem of challenging task in occupational therapy. The primary objective of the study was to investigate the influence of size and bounce on proximal and fine motor performance and intrinsic motivation. The secondary objective was to examine how the absence of challenge may decrease intrinsic motivation and heart rate. The randomized trial involved 84/107 eligible inpatients with multiple sclerosis. They were divided into 4 groups by computer randomization: Group 1 small and bouncing, Group 2 small and non-bouncing, Group 3 large and bouncing, and Group 4 large and non-bouncing virtual cubes. Each participant completed 50 sessions of up to 2 min each in approximately 14 days. Before commencement of the study the participants completed visuospatial and cognitive tests. Participants' subjective experiences were assessed daily using the intrinsic motivation inventory. Before and after the study, the box and block test and the 9-hole peg test were administered. Kinematic analysis showed significant differences between groups (average manipulation time p = 0.008, inserted cubes p = 0.004). Group 4 was the most successful (inserted cubes > 9) and the fastest (63.4 SD 25.8 s), but had low pressure/tension and heart rate. Group 1 was the slowest (88.9 SD 28.2 s) but had increased interest/enjoyment in the task under higher pressure/tension. There were substantial differences in intrinsic motivation between the 1st and last sessions within groups (Cohen's U3 < 0.3 or > 0.8). The size and behavior of virtual objects may be important for training proximal movements and fine motor skills in people with multiple sclerosis. Furthermore, the demonstrated approach proved to be effective and may reduce upper extremity disability in the long term if intrinsic motivation can be sustained longer with a challenging task.Trial registration The small scale randomized pilot trial has been registered at ClinicalTrials.gov Identifier: NCT04266444, 12/02/2020, https://clinicaltrials.gov/ct2/show/NCT04266444 .

Exergaming as Part of the Telerehabilitation Can Be Adequate to the Outpatient Training: Preliminary Findings of a Non-randomized Pilot Study in Parkinson's Disease.

Parkinson's disease is a long-term and progressive degenerative disorder of the nervous system, affecting primarily motor coordination, noticeable as a tremor in one hand. Recent studies reported on positive outcomes of intensive physiotherapy of upper extremities. We built a telerehabilitation system with virtual pick and place tasks for small scale hand movements, and designed a pilot study to find whether such exergaming as a telerehabilitation service provides comparable outcomes as an outpatient exergaming service. A non-randomized pilot trial was designed. Hospital outpatients (28/40) with Parkinson's disease were recruited. Those meeting the inclusion criteria were divided into two groups; seven outpatients were assigned to the home (H) group and 21 outpatients to the hospital (URI) group. Both groups received 10 days of exergaming over the course of 2 weeks, each daily session lasting a maximum of 1 h. Primary outcomes were clinical tests; Box and Blocks Test (BBT), Jebsen Hand Function Test (JHFT), and Unified Parkinson's Disease Rating Scale (UPDRS part III) were carried out before and after the study. Secondary outcomes were hand kinematics and exergaming results; number of successfully moved objects and task time. Statistical analysis was carried out to find significant (p < 0.05) differences and Cohen's U3 was used to determine effect sizes. The differences between the groups in gender (p = 0.781), age (p = 0.192), and duration of the disease (p = 0.195) were tested with Bartlett's test and no statistical differences were found with an F test. Both groups demonstrated statistically significant improvements in clinical test UDPRS III (p = 0.006 and p = 0.011) and the hospital group also in BBT (p = 0.002) and JHFT (p = 0.015) and with UDPRS III and JHFT even in favor of the home group (χ2 = 5.08, p = 0.024, χ2 = 7.76, p = 0.005). Nevertheless, the exergaming results show significant improvement after training (U3 > 0.86). Exergaming has already been suggested as an effective approach in the planning of rehabilitation tasks for persons with Parkinson's disease. We have prepared a pilot study demonstrating that exergaming at home with telerehabilitation support may provide comparable clinical outcomes. The study shall be followed by a randomized study with higher statistical power to provide clinical evidence. Nevertheless, carrying out even part of the rehabilitation program at home is crucial for the development of future telerehabilition clinical services. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03175107.

Can telerehabilitation games lead to functional improvement of upper extremities in individuals with Parkinson's disease?

Parkinson's disease (PD) is treated by medication, less with deep brain stimulation and physiotherapy. Different opinions on the clinical meaningfulness of the physiotherapy or recommended intensive physiotherapy were found. Our objectives were to design intensive target-based physiotherapy for upper extremities suitable for telerehabilitation services and examine the clinical meaningfulness of the exergaming at an unchanged medication plan. A telerehabilitation exergaming system using the Kinect sensor was developed; 28 patients with PD participated in the study. The system followed the participants' movements and adapted the difficulty level of the game in real time. The outcomes of the study showed that seven out of 26 participants could set up the equipment at home alone. Clinical outcomes of Box and Blocks Test (mean: 47 vs. 52, P=0.002, Cohen's d=0.40), UPDRS III (mean: 27 vs. 29, P=0.001, d=0.22), and daily activity Jebsen's test; writing a letter (mean: 24.0 vs. 20.6, P=0.003, d=0.23); and moving light objects (mean: 4.4 vs. 3.9, P=0.006, d=0.46) were statistically significant (P<0.05) and considered clinically meaningful. The Nine-Hole Peg Test showed a statistically nonsignificant improvement (mean: 28.0 vs. 26.5, P=0.089, d=0.22). The participants claimed problems with mobility but less with activities of daily living and emotional well-being (PDQ-39). The findings lead to preliminary conclusions that exergaming is feasible, but may require technical assistance, whereas clinically meaningful results could be achieved according to validated instruments and an unchanged medication plan in individuals with PD.