title: Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease.
abstract: BACKGROUND
  Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson's disease (PD). However, programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established.
  
  
  OBJECTIVE
  To examine the effects of virtual reality-based exercise on obstacle crossing performance and dynamic balance in participants with PD.
  
  
  METHODS
  Thirty-six participants with a diagnosis of PD (Hoehn and Yahr score ranging 1 to 3) were randomly assigned to one of three groups. In the exercise groups, participants received virtual reality-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks. Participants in the control group received no structured exercise program. Primary outcomes included obstacle crossing performance (crossing velocity, stride length, and vertical toe obstacle clearance) and dynamic balance (maximal excursion, movement velocity, and directional control measured by the limits-of-stability test). Secondary outcomes included sensory organization test (SOT), Parkinson's Disease Questionnaire (PDQ39), fall efficacy scale (FES-I), and timed up and go test (TUG). All outcomes were assessed at baseline, after training, and at 1-month follow-up.
  
  
  RESULTS
  The VRWii group showed greater improvement in obstacle crossing velocity, crossing stride length, dynamic balance, SOT, TUG, FES-I, and PDQ39 than the control group. VRWii training also resulted in greater improvement in movement velocity of limits-of-stability test than TE training.
  
  
  CONCLUSIONS
  VRWii training significantly improved obstacle crossing performance and dynamic balance, supporting implementation of VRWii training in participants with PD.
authors.affiliation: Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Yi
authors.initials: YY
authors.lastname: Liao
authors.affiliation: National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yea-Ru
authors.initials: YR
authors.lastname: Yang
authors.affiliation: Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Shih-Jung
authors.initials: SJ
authors.lastname: Cheng
authors.affiliation: Department of Neurology, Chang-Gung Memorial Hospital, Linkou, Taiwan Chang-Gung University College of Medicine, Linkou, Taiwan.
authors.forename: Yih-Ru
authors.initials: YR
authors.lastname: Wu
authors.affiliation: National Yang-Ming University, Taipei, Taiwan Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jong-Ling
authors.initials: JL
authors.lastname: Fuh
authors.affiliation: National Yang-Ming University, Taipei, Taiwan rywang@ym.edu.tw.
authors.forename: Ray-Yau
authors.initials: RY
authors.lastname: Wang
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D017711:Nonlinear Dynamics; D010300:Parkinson Disease / Q000150:complications*; D004856:Postural Balance / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063367:Virtual Reality Exposure Therapy / Q000379:methods*
keywords: Parkinson’s disease; balance; exercise training; obstacle crossing; virtual reality