Effects of an Innovative Telerehabilitation Intervention for People With Parkinson's Disease on Quality of Life, Motor, and Non-motor Abilities

Abstract

Parkinson's disease (PD) often leads to multifactorial motor and non-motor disabilities with resultant social restrictions. Continuity of care in this pathology, including a tailored home rehabilitation, is crucial to improve or maintain the quality of life for patients. The aim of this multicenter study was to test in a pilot sample of PD patients the efficiency and efficacy of the Human Empowerment Aging and Disability (HEAD) program. The virtual reality HEAD program was administered in two consecutive phases: (1) in clinic (ClinicHEAD, 12 45-minutes sessions, 3 sessions/week); (2) at home (HomeHEAD, 60 45-minutes sessions, 5 sessions/week). Thirty-one PD outpatients were enrolled [mean age (SD) = 66.84 (9.13)]. All patients performed ClinicHEAD, and after allocation (ratio 1:2) were assigned to the HomeHEAD or the Usual Care (UC) group. Motor, cognitive and behavioral outcome measures were assessed at enrollment (T0), at hospital discharge (T1), at 4 (T2) and 7 (T3) months after baseline. After ClinicHEAD (T1 vs. T0 comparison) a significant ( p < 0.05) improvement in functional mobility, balance, upper limb mobility, global cognitive function, memory, quality of life and psychological well-being was observed. After the HomeHEAD intervention there was an additional enhancement for upper limb mobility. At T3 follow-up, the UC group that did not continue the HEAD program at home showed a worsening with respect to the HomeHEAD group in balance and functional mobility. Furthermore, in the HomeHEAD group, a positive association was observed between adherence, mental and physical health (SF-12). A trend was also registered between adherence and positive affect. The digital health patient-tailored rehabilitation program resulted in improving motor and non-motor abilities and quality of life in clinical setting, enhancing the motor function in telerehabilitation at home, and maintaining the non-motor abilities and quality of life at follow-up. In the near future, people with PD can be supported also at home with individualized rehabilitation strategies for a better quality of life and wellbeing along with lower costs for society.

A Multidimensional Virtual Reality Neurorehabilitation Approach to Improve Functional Memory: Who Is the Ideal Candidate?

“…Overall, in line with our previous reports ( 24 ), the present work clearly showed that a relatively large number of patients benefited from the HEAD treatment in the clinical setting, with a stable condition or a significant improvement, above the MCID, in all cognitive, motor, and affective domains. It is worth noting that participants were people with chronic diseases who tend to have a stable or worsening disease course over time.…”

“…This study consists of a secondary analysis on data related to a multicenter interventional protocol of integrated rehabilitation for people with chronic neurological diseases whose efficiency and efficacy findings are described elsewhere ( 24 , 33 ). In this context, we focus on the first part of the study design in which patients underwent a 1-month rehabilitation period in and outpatient setting, consisting in 45-min sessions three times per week, for a total of 12 sessions (ClinicHEAD).…”

“…telerehabilitation). A previous study demonstrated its feasibility ( 33 ) and its efficacy in PD populations ( 24 ). However, as an integrated treatment proposed for different pathologies and grades of disabilities, a secondary investigation on the predictors of treatment success on everyday functions can provide extensive information on the population target for the HEAD rehabilitation.…”

“…The second evidence regards the adoption of VR solutions. Rehabilitation with these tools seems to be promising in terms of patient involvement and treatment efficacy ( 24 , 25 ). The utilization of these VR tools helps facilitate engagement and increase patient satisfaction during the training ( 26 – 31 ), by creating a virtual environment eliciting realistic perceptions and reactions ( 32 ).…”

The Role of Mental Imagery in Parkinson’s Disease Rehabilitation

“…Mental imagery offers PwP and therapists a wide range of delivery possibilities: individually or in a group, and physically or remotely/virtually. These options make mental imagery highly relevant for various PD communities, including remote and under-served ones, thus addressing gaps and future directions identified by the previous literature [ 121 , 122 , 123 ].…”