{"id":2966,"date":"2021-05-01T13:22:25","date_gmt":"2021-05-01T13:22:25","guid":{"rendered":"https:\/\/www.gaitbetter.com\/?p=2966"},"modified":"2025-07-30T08:31:23","modified_gmt":"2025-07-30T08:31:23","slug":"american-journal-of-physical-medicine-rehabilitation-tele-rehabilitation-with-virtual-reality","status":"publish","type":"post","link":"https:\/\/www.gaitbetter.com\/de\/american-journal-of-physical-medicine-rehabilitation-tele-rehabilitation-with-virtual-reality\/","title":{"rendered":"Tele-Rehabilitation with Virtual Reality: A Case Report on the Simultaneous, Remote Training of Two Patients with Parkinson Disease"},"content":{"rendered":"
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American Journal of Physical Medicine & Rehabilitation. 2021 May; 100:435\u2013438<\/a><\/h6>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Pablo Cornejo<\/span><\/i> Thumm, MSc, Nir Giladi, MD, Jeffrey M. Hausdorff, PhD, and Anat Mirelman, PhD<\/span><\/i><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Date: May 01, 2021<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Overview<\/b><\/h4>

Using a treadmill-virtual reality system, a novel tele-rehabilitation program for simultaneous training of two Parkinson\u2019s disease patients at home is presented. The trainer was able to adjust the rehabilitation settings remotely and provide feedback to the two patients using remote monitoring software, allowing him to see and hear them. Participants received weekly rehabilitation training sessions over the course of 1 year.<\/span><\/p>

Methods:\u00a0<\/span><\/p>

Two participants were chosen. Participant A was a 46-yr-old male patient with PD (disease duration, 17 yrs; Movement Disorder Society-Unified Parkinson\u2019s Disease Rating Scale [MDS-UPDRS] motor, 29; Hoehn and Yahr scale, 3). Participant B was a 67-yr-old female patient (disease duration, 15 yrs; MDS-UPDRS motor, 30; Hoehn and Yahr scale, 3). Before receiving tele-rehabilitation, both patients received conventional physical therapy (weekly one-on-one sessions). Both patients were on levodopa treatment, patient A received a daily dose of 815 while patient B received 1000 m. Although they were ambulatory, they had difficulty navigating outdoor environments and complex environments. A remote monitoring tool (Google Chrome remote desktop tool) and Skype were also installed to facilitate visual and auditory communication during training. This configuration allowed the trainer to monitor the participant\u2019s movement, provide feedback in real-time, and manage all parameters of the training simulation remotely and enabled the participants to converse with the trainer. A weekly training protocol was followed. Walking bouts of 5\u201315 minutes each were divided into three sessions, each with a 5\u201310-minute rest break. Training progression comprised increasing gait speed and walking duration (the motor component) by 10% each week and increasing pathway complexity every two weeks by increasing the number and size of obstacles and reducing the timing of obstacle appearances. Training settings were controlled remotely to adjust the level of challenge.<\/span><\/p>

Findings:\u00a0<\/span><\/p>

On the basis of the number of sessions attended and the self-report of the patients and therapists, feasibility and adherence to the training were assessed. Training effects on mobility were evaluated according to changes in preferred gait speed (measured on a treadmill) and walking endurance (duration of walking time) between the first and last sessions. The Activities-Specific Balance Confidence Scale assessed the patient\u2019s perceived level of balance confidence in activities of daily living (0\u2013100, where higher scores indicate better performance). The MDS-UPDRS and Hoehn and Yahr scales were assessed by a movement disorders specialist before and after the training (while on medication, at the clinic) to evaluate disease symptoms.<\/span><\/p>

Results:<\/span><\/p>

Both participants completed 12 months of weekly training, finishing 71% and 78% of all training sessions. Participants reported that training from home was easier and that the monitored trainer session increased their commitment to the training. Gait speed increased on average by 30% (participant A: from 2.8 km\/h to 3.8 km\/h; participant B: from 3 km\/h to 3.8 km\/h). The training endurance for both patients increased by 200% from walking 15 minutes in the first session to 45 minutes at the end of the year. Both participants showed improved confidence in mobility (measured by the Activities-Specific Balance Confidence Scale) with an increase of 45% and 27% for participants A and B, respectively (participant A, from 45% to 67%; participant B, from 55% to 70%). Both participants also reported that they were able to walk outdoors for longer distances without assistance. No falls were occurred during training.<\/span><\/p>

Conclusions:\u00a0<\/span><\/p>

In preliminary studies, this approach has some positive effects on mobility and confidence, is feasible, and promotes long-term compliance. The results of this study are similar to those of single-participant telerehabilitation balance training suggesting that such an approach can save therapist time. The\u00a0 study specifically included two patients with advanced Parkinson\u2019s disease in order to examine the feasibility of this approach for patients with impaired mobility who may also have difficulty travelling to the clinic. Both the trainer and participants noted the positive advantage of telerehabilitation, providing the participants access to a service without leaving their homes. This was especially important during the COVID-19 lockdown. The multi participant technique proved to be feasible, allowing a personalized treatment while also conserving therapist time. Tthe observed increase in gait speed was greater than the minimal clinically important difference (0.25 m\/sec), reflecting a meaningful motor improvement. This is further highlighted in the minimal increase in disease severity measures, for both patients, which was lower than the expected change over 1 yr in medicated patients.16 Clearly, one cannot draw conclusions from only two participants.<\/span><\/p>

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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tREAD THE PAPER<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION <\/p>","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32],"tags":[],"class_list":["post-2966","post","type-post","status-publish","format-standard","hentry","category-publications"],"_links":{"self":[{"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/posts\/2966","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/comments?post=2966"}],"version-history":[{"count":5,"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/posts\/2966\/revisions"}],"predecessor-version":[{"id":69167,"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/posts\/2966\/revisions\/69167"}],"wp:attachment":[{"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/media?parent=2966"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/categories?post=2966"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.gaitbetter.com\/de\/wp-json\/wp\/v2\/tags?post=2966"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}