The feasibility and positive effects of a customised videogame rehabilitation programme for freezing of gait and falls in Parkinson's disease patients: a pilot study.
Dijana Nuic, Maria Vinti, Carine Karachi and 3 others
PMID 29636105WHAT IT FOUND
Supervised customised videogame training added to unchanged medication and deep-brain stimulation was feasible for 10 PD patients with refractory freezing and falls: all completed 18 sessions, acceptability rose, and gait and balance scores improved.
Most benefits were not maintained at 3 months.
Key findings
01All 10 patients completed the 18-session programme, and general acceptability increased significantly over time.
02Patients reported high perceived interest and competence, low perceived difficulty, and 7 of 10 rated the game amusing.
03After the 18th session, FOG-Q, GABS-B and axial scores decreased by 39%, 38% and 41%, ABC confidence increased by 35%, and 7 of 10 reported no falls; at 3 months, only axial score remained 35% lower and eight of ten patients reported recurrent falls again.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 10 patients were studied, with no control group or comparative treatment, so the contribution of the videogame cannot be separated from unchanged anti-parkinsonian treatment, deep-brain stimulation or physiotherapist supervision. The training was performed at the institute with a physiotherapist present, which the authors say may have increased acceptability and motivation; it was not tested at home. Many secondary outcomes were tested at several time points, which the authors say limits generalisation. Most clinical improvements were not maintained at 3 months: clinical scores were unchanged except axial score, and eight of ten patients reported recurrent falls again. Participants had to be able to maintain upright posture and walk independently, and dementia was excluded by a Mini Mental State Examination score below 24, so results may not apply to more impaired or cognitively impaired patients. Cognition was not assessed, although the paper notes Parkinson's disease patients classically present dysexecutive syndrome.
Declared interests
The supplied text names funders as Agence Nationale de la Recherche (FR) and World Innovation Competition; it does not report author conflicts of interest.
The easy way to misread this
Do not conclude the customised videogame alone caused the improvements. It was supervised by a physiotherapist and added to unchanged anti-parkinsonian treatment and deep-brain stimulation in 10 patients with no control group, and most clinical gains were not maintained at 3 months.