Effects of Kinesthetic Stimuli During XBOX Kinect Training on People With Parkinson's Disease
Effects of Kinesthetic Stimuli During XBOX Kinect Training on People With Parkinson's Disease
A single-blind, parallel-group, randomised trial will be conducted in Sao Paulo, Brazil.
 People with Parkinson's Disease (PD) will be recruited at "Brazil Parkinson Association"
 (BPA), a non-governmental association of PD care, and randomly allocated in two groups: the
 Movement Guidance Group (MVG) and NO-MVG Group. Both groups will perform XBOX Kinect training
 for balance and gait. However, the MVG will receive kinesthetic stimuli manually by the
 physiotherapist (PT) to improve the participant movements while the NO-MVG Group will not,
 the presence of the PT will be restrict to only guarantee the participant safety.
BACKGROUND: Despite evidences indicate the benefit of motor interventions based on video
 games in people with Parkinson's Disease (PD), practice guidelines for the therapeutic use in
 physiotherapy were still not established. Although visual and auditory stimuli provided by
 video games are pointed as one of the main advantages for their therapeutic use, the effects
 of kinesthetic stimuli offered through physical therapist manual intervention during this
 type of training in people with PD have not been investigated yet. The answer to this
 question is relevant to guide the physical therapist (PT) conduct during this kind of
 intervention.

 PURPOSE: To compare the effects of motor training using video games with and without
 kinesthetic stimuli offered by physical therapist manual guidance during intervention on the
 functionality of people with PD.

 METHODS: A blind randomized clinical trial in people with idiopathic PD, staging of 1 to 3
 according to disability scale of Hoehn and Yahr, will be performed. Participants will be
 randomized into two groups: the Movement Guidance Group (MVG) and NO-MVG Group. Both groups
 will receive 8 individual sessions, twice a week, for 4 weeks. Each session consist of 10
 minutes of warm-up and 40 minutes of XBOX Kinect training for balance and gait. In the MVG
 Group, the PT will provide kinesthetic stimuli by assisting manually the participant
 movements. In the NO-MVG Group, the involvement of the PT will be restricted to ensure
 participant safety. The two groups will be evaluated before (BT) and after (AT) training and
 after 60 days (follow-up). A blind physiotherapist will conduct the assessments. Measurements
 are categorized according to the International Functioning Classification (ICF), those
 associated with the activity level were established as primary measures: Balance Evaluation
 Systems Test (BESTest); International Falls Effectiveness Scale (FES-I); 30-second Gait Test;
 Six Minute Walk Distance (6MWD); Five Times Sit to Stand Test (FTSTS) and Unified Parkinson's
 Disease Rate Scale (UPDRS) session II. Secondary measures were the evaluation of function
 using UPDRS session III; Rapid Turns Test (RTT); Montreal Cognitive Assessment (MOCA);
 Geriatric Depression Scale (GDS-15), and participation using the Parkinson's Disease Quality
 of Life Questionnaire (PDQ-39).

 STATISTICAL ANALYSIS: An ANOVA to repeated measures will be use, having as factors: group
 (MVG Group and NO-MVG Group) and evaluations (BT, AT and FU). Followed by post hoc Tukey Test
 to the significance factors. A significance of 5% will be considered.
Inclusion Criteria:

 -  Idiopathic Parkinson's disease diagnosis according to Parkinson's Disease Society
 Brain Bank of London criteria

 -  Active treatment with levodopa

 -  Stages 1, 2, and 3 according to Hoehn and Yahr Classification

 Exclusion Criteria:

 -  Severe cognitive impairment defined as ≤ 20 in Montreal Cognitive Assessment

 -  Score greater than or equal to 6 on the geriatric depression scale

 -  Severe respiratory and / or cardiovascular conditions

 -  Visual and / or auditory deficit that cannot be corrected with glasses or a hearing
 aid;

 -  Other previously detected orthopedic or neurological diseases, other than Parkinson's
 Disease, that may interfere with the individual's performance

 -  Previous experience with Microsoft XBOX Kinect® games

 -  And being in rehabilitation in another location concomitant to this training.