Virtual Reality in Parkinson Disease
Virtual Reality in Parkinson Disease
Patients affected by Parkinson disease (PD) can benefit from rehabilitation although the
 evidences are scattered. In the last years there are increased evidences that virtual reality
 can improve functional outcome in Parkinson's disease. No evidences are known concerning the
 cardiological safety and effect on balance of Virtual Reality. The aim of this study is to
 compare a virtual reality rehabilitation program versus a conventional one in a sample of
 patients affected by mild to moderate Parkinson and to collect data on cardiological effects.
This study will be a prospective, single-blinded, randomized controlled trial aimed to
 compare two different rehabilitation programs in PD disease and to evaluate the effect of
 Virtual Reality on cardiocirculatory system.

 Patients will undergo Conventional or Virtual Reality Rehabilitation Program for 6
 consecutive weeks, 3-times in a week for a 40 minute session. Moreover, in order to acquire
 data on cardiocirculatory system during the first and the last sessions an Holter-
 electrocardiography will be used. Data will be compared with healthy subjects (matched for
 age and gender).

 The used protocols are reported below.

 Conventional (C) Rehabilitation Program The Conventional rehabilitation program will be
 performed according to the " Royal Dutch Society for Physical Therapy Guidelines for physical
 therapy in patients with Parkinson's disease". In each C rehabilitation session, patients
 will undergo 3 phases: 1) Warm-up phase: passive mobilization of main joints and muscular
 strengthen of lower limbs; 2) Active phase (both standing than seated): exercises of motor
 coordination with upper and lower limbs, balance training, start and stop exercises,
 deambulation training; 3) cool-down phase (with seated patient): manipulation exercises,
 mobilization exercises, respiratory exercises.

 Virtual Reality (VR) Rehabilitation Program Each session will consist of multiple exercises.
 These ones are described below, each exercise will be performed by the patient for 4 minutes
 followed by a 1 minute of rest.

 Exercise 1 (named Trumpet H2D1): patients placed in the center of the room and asked to
 randomly touch a moving trumpet displayed on the wall screen. When the trumpet will be
 reached by patient's arm, it will disappear giving out a sound.

 Exercise 2 (named Pink rose hemiarch left and right H1D2): patients placed in the center of
 the room and asked to touch the rose projected on the wall screen as a hemiarch, in this
 exercise the sequence of rose to touch and therefore the distance between the target and the
 patient will be decided by the physical therapist.

 Exercise 3 (named Doggy): patients placed in the center of the room and asked to lead a dog
 in the four corner of the wall screen. Patients will be free to move in the room.

 Exercise 4 (named Eggs): patients placed in the center of the room and asked to touch as fast
 as possible eggs projected in the wall screen in a random order. When the egg will be reached
 by patient's arm, it will disappear giving out a sound.

 Exercise 5 (named Mole): patients placed in the center of the room and asked to reach a mole
 that will go out from a hole. The patients will know where the mole will be and they will
 move in the room. When the mole will be reached by patient's arm, it will disappear giving
 out a sound.

 Exercise 6 (named Stay Or Move In Between): patients placed in the center of the room and wre
 asked to perform the motor task as indicated by physical therapist while maintaining balance
 between two lateral bars in order not to touch them and not make them sound.

 Exercise 7 (named Leaves): patients placed in the center of the room and asked to clean from
 wall screen as fast as possible all the leaves projected in the wall.
Inclusion Criteria:

 -  Patients affected by mild to moderate PD, according to motor examination section (Part
 III) of the Unified Parkinson's Disease Rating Scale (UPDRS III)

 -  ability to independently perform motor rehabilitation

 -  absence of cognitive impairment (MMSE >25)

 Exclusion Criteria:

 -  severe hearing loss and/or visual deficit

 -  serious comorbidity making impossible to perform rehabilitation (postural hypotension,
 heart disease, stroke, severe shoulder-hip disease)