Brian Chau is a Diplomat of Physical Medicine and Rehabilitation and Sarah Humbert is an Attending Physician, both at the US Department of Veteran Affairs Loma Linda Healthcare System. Sarah Humbert is a Diplomat of Physical Medicine and Rehabilitation, a Diplomat of Neuromuscular Medicine, and an Assistant Professor; Brian Chau is an Assistant Professor of Physical Medicine and Rehabilitation; and Aaron Shou was a Medical Student at the time the article was written and is now a Resident Physician in Physical Medicine and Rehabilitation; all at Loma Linda University School of Medicine in California .
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Background: Functional rehabilitation is important when managing Parkinson disease (PD). Virtual reality (VR) therapy is a noninvasive, potential alternative or adjunct to conventional therapies used during rehabilitation.
Observations: The authors searched for articles in Google Scholar, PubMed, Physiotherapy Evidence Database Score (PEDro), and Cochrane after setting specific requirements starting in July 2019. Methodologic quality was assessed by PEDro for randomized controlled trials. Among 89 studies identified, 28 included in this review evaluated VR therapy for use during rehabilitation for PD: 7 used immersive VR and 21 used nonimmersive VR. Among the immersive VR studies, 6 showed improvement in primary outcomes after adding VR therapy. Among the nonimmersive VR studies, 5 showed improvement with VR therapy when compared with conventional therapy, 9 showed improvement with VR and conventional therapy with no between group difference, and the remaining 7 showed improvement in primary outcomes after adding VR intervention. The quality and diversity of studies was a major limitation.
Conclusion: VR therapy is a promising rehabilitation modality for PD but more studies are needed. Additional investigations of VR therapy and PD should include direct comparisons between immersive and nonimmersive VR therapies.
Parkinson disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease.1 Age-standardized incidence rates of PD in population-based studies in Europe and the United States range from 8.6 to 19.0 per 100,000 individuals, using a strict diagnostic criterion for PD.2 The negative impact of PD on health-related quality of life imposes a heavy burden on veterans. According to the US Department of Veterans Affairs (VA) National Parkinson’s Disease Consortium, the VA has as many as 50,000 patients with PD under its care. Because of this demand, the VA has strived to revolutionize available services for veterans with PD and related movement disorders.3
The classic motor symptoms of resting tremors, bradykinesia, postural instability, and rigidity of this progressive neurodegenerative disorder is a significant cause of functional limitations that lead to increased falls and inability to perform activities of daily living that challenges the individual and caregiver. 4 Rehabilitation has been considered as an adjuvant to surgical and medical treatments for PD to maximize function and minimize complications. High-intensity multimodal exercise boot camps and therapy that focuses on intensely exercising high-amplitude movements, have been shown to improve motor performance in PD.5,6 Available evidence has shown that exercise-dependent plasticity is the main mechanism underlying the effects of physiotherapy because it increases synaptic strength and affects neurotransmission.7 Although there is no consensus on the optimal approach for rehabilitation, innovative techniques have been proposed and studied. One such approach involves virtual reality (VR), which has begun to attract attention for its potential use during rehabilitation.8
VR is a simulated experience created by computer-based technology that grants users access to a virtual environment. There are 2 categories of VR: immersive and nonimmersive. Immersive VR is the most direct experience of virtual environments and usually is implemented through a head-mounted display. These displays have monitors in front of each eye, which can provide monocular or biocular imaging with the most common display being small liquid crystal display (LCD) panels.
Nonimmersive VR typically allows a participant to view a virtual environment by using standard high-resolution monitors rather than a headset or an immersive screen room. Many systems are readily available to the general public as electronic interactive entertainment (ie, video games). Interaction with the virtual world happens through interfaces such as keyboards and controllers while viewing a television or computer monitor. These systems often are more accessible and affordable when compared with immersive VR, although this is changing rapidly.
VR therapy is a noninvasive therapeutic alternative modality for PD. This review aims to study the use of VR to treat PD from a rehabilitative standpoint. Although not the only review on the topic, this systematic review is the first to examine the differences between immersive and nonimmersive VR rehabilitation for PD. VR technology is evolving rapidly and the research behind its clinical applications is steadily growing, especially as accessibility improves. This review also is an updated summary of the current literature on the effectiveness of VR therapy during PD rehabilitation.
