Parkinson's Disease is a chronic neurodegenerative disorder marked by the progressive loss of dopaminergic neurons in the substantia nigra and accumulation of α-synuclein (Lewy bodies).It impacts both motor and non-motor systems, with growing global prevalence-affecting 7-10 million people, mostly men over 60 years-due to increasing life expectancy and demographic shifts.
PD shows motor symptoms like tremors and bradykinesia, along with non-motor issues like depression, REM sleep disorder, and cognitive decline. Diagnosis is often delayed due to subtle early signs like constipation or shoulder pain and atypical cases lacking classical tremors.
VR offers immersive, task-specific therapy that enhances motor learning and neuroplasticity in a safe, engaging environment. By integrating sensory feedback and real-time motion tracking, VR reduces tremors, promotes cortical reorganization (notably in the sensorimotor cortex and cerebellum), and increases rehabilitation motivation through gamified experiences.
PNF is a hands-on therapy using tactile, auditory, and proprioceptive cues to improve coordination, strength, and movement patterns. Especially useful in Parkinson's rehabilitation, PNF targets rigidity, bradykinesia, tremors, and postural instability by reinforcing neuromuscular coordination and improving movement execution in functional, diagonal planes.
Sensorimotor control is the dynamic integration of sensory input, motor planning, and execution, which becomes disrupted in PD due to impaired proprioception and feedback loops. Patients rely excessively on visual feedback, making movement effortful, highlighting the need for focused upper limb rehabilitation strategies.
Idiopathic Parkinson's Disease according to Gelb's criteria
Stage II-IV Hoehn &Yahr scale
Intact cognition status (MMSE > 24)
50-80 years of age
History of PD surgery
Phobia of virtual gaming systems
Visual anomalies
Cardiovascular problems
Parallel
Intervention 1
Other interventionParticipants in the control group received Proprioceptive Neuromuscular Facilitation (PNF) therapy three times per week for a total duration of six weeks. Each session lasted approximately 30 minutes and was conducted at a moderate intensity, corresponding to an RPE of 11-13 on the Borg scale. For kinetic tremors, the slow reversal technique was applied. For bradykinesia, the rhythmic initiation technique was used. And to enhance proprioception, tactile input was provided through manual contact, resistance, and stretch applied by the therapist at key points of the movement pattern.
artificial intelligence
DeviceParticipants in the experimental group underwent Virtual Reality (VR) training three times per week for a total of six weeks. Each session lasted approximately 30 minutes and was conducted at a moderate intensity, defined by the repetition of VR tasks five times per session. The intervention was delivered using the Oculus Meta Quest 2 head-mounted display, providing an immersive and interactive environment under the close supervision of a licensed physical therapist. The central activity involved 2 modules. Ball Shifting Module picking and placing five virtual balls within the simulated environment and transferring them from one basket to another. Cube Navigation Module, in this task, users guide a virtual cube through highlighted cells or routes using deliberate movements, requiring precise hand positioning and controlled movement paths.
Kinetic Tremors
Kinetic Tremors It is going to be measured by: Fahn-Tolosa-Marin tremor rating scale with internal consistency of Cronbach's α = 0.90. FTMTRS - Kinetic Tremor Section Rate the severity of tremor during each task using the following scale: 1. Writing: \_\_\_\_\_\_\_ 2. Drawing (Archimedes spiral): \_\_\_\_\_\_\_ 3. Pouring water: \_\_\_\_\_\_\_ 4. Drinking from a cup: \_\_\_\_\_\_\_ • Total Kinetic Tremor Score: \_\_\_\_\_\_\_/16 (0 = No tremor, 1 = Mild, intermittent, 2 = Moderate, intermittent or mild, continuous, 3 = Marked, intermittent or moderate, continuous, 4 = Severe, continuous)
Bradykinesia
It is going to be measured by: MDS-UPDRS Part III with internal consistency of Cronbach's α: 0.90-0.93. MDS-UPDRS Part III - Bradykinesia Items (3.4-3.6) Rate each movement on a scale from 0 (normal) to 4 (severe): 1. 3.4 L\&R Finger Tapping: \_\_\_\_\_\_\_ 2. 3.5 L\&R Hand Movements (open/close hands): \_\_\_\_\_\_\_ 3. 3.6 L\&R Pronation-Supination of Hands: \_\_\_\_\_\_\_ • Total Bradykinesia Score (3.4-3.6): \_\_\_\_\_\_\_/24
Proprioception
•It is going to be measured by: Fugl Meyer UE Proprioception subscale with internal consistency of Cronbach's α: at 0.94-0.98. Scoring: 0 = Only a few degrees (less than 10° in shoulder) 1. = Decreased 2. = Normal Shoulder Movement 0 1 2 Flexion (0°-180°) ☐ ☐ ☐ Abduction (0°-90°) ☐ ☐ ☐ External Rotation ☐ ☐ ☐ Internal Rotation ☐ ☐ ☐ Elbow Movement 0 1 2 Flexion ☐ ☐ ☐ Extension ☐ ☐ ☐ Forearm Movement 0 1 2 Pronation ☐ ☐ ☐ Supination ☐ ☐ ☐ Wrist Movement 0 1 2 Flexion ☐ ☐ ☐ Extension ☐ ☐ ☐ Fingers Movement 0 1 2 Flexion ☐ ☐ ☐ Extension ☐ ☐ ☐
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