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.